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Irritable Bowel Syndrome: HELP
Articles by David Surendran Sanders
Based on 27 articles published since 2008
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Between 2008 and 2019, D. Sanders wrote the following 27 articles about Irritable Bowel Syndrome.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial Editorial: Noncoeliac gluten sensitivity--a disease of the mind or gut? 2014

Aziz, I / Hadjivassiliou, M / Sanders, D S. ·Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK. imran.aziz@sth.nhs.uk. ·Aliment Pharmacol Ther · Pubmed #24903428.

ABSTRACT: -- No abstract --

2 Review Gluten-Free Diet and Its 'Cousins' in Irritable Bowel Syndrome. 2018

Rej, Anupam / Sanders, David Surendran. ·Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield S10 2JF, UK. anupam.rej@sth.nhs.uk. · Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield S10 2JF, UK. david.sanders@sth.nhs.uk. · Academic Unit of Gastroenterology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, S10 2RX, UK. david.sanders@sth.nhs.uk. ·Nutrients · Pubmed #30423854.

ABSTRACT: Functional disorders are common, with irritable bowel syndrome (IBS) being the commonest and most extensively evaluated functional bowel disorder. It is therefore paramount that effective therapies are available to treat this common condition. Diet appears to play a pivotal role in symptom generation in IBS, with a recent interest in the role of dietary therapies in IBS. Over the last decade, there has been a substantial increase in awareness of the gluten-free diet (GFD), with a recent focus of the role of a GFD in IBS. There appears to be emerging evidence for the use of a GFD in IBS, with studies demonstrating the induction of symptoms following gluten in patients with IBS. However, there are questions with regards to which components of wheat lead to symptom generation, as well as the effect of a GFD on nutritional status, gut microbiota and long-term outcomes. Further studies are required, although the design of dietary studies remain challenging. The implementation of a GFD should be performed by a dietitian with a specialist interest in IBS, which could be achieved via the delivery of group sessions.

3 Review The Overlapping Area of Non-Celiac Gluten Sensitivity (NCGS) and Wheat-Sensitive Irritable Bowel Syndrome (IBS): An Update. 2017

Catassi, Carlo / Alaedini, Armin / Bojarski, Christian / Bonaz, Bruno / Bouma, Gerd / Carroccio, Antonio / Castillejo, Gemma / De Magistris, Laura / Dieterich, Walburga / Di Liberto, Diana / Elli, Luca / Fasano, Alessio / Hadjivassiliou, Marios / Kurien, Matthew / Lionetti, Elena / Mulder, Chris J / Rostami, Kamran / Sapone, Anna / Scherf, Katharina / Schuppan, Detlef / Trott, Nick / Volta, Umberto / Zevallos, Victor / Zopf, Yurdagül / Sanders, David S. ·Department of Pediatrics, Marche Polytechnic University, 60121 Ancona, Italy. c.catassi@univpm.it. · Department of Medicine, Columbia University Medical Center, New York, NY 10027, USA. aa819@cumc.columbia.edu. · Medical Department, Division of Gastroenterology, Infectiology and Rheumatology, Charité, Campus Benjamin Franklin, 12203 Berlin, Germany. christian.bojarski@charite.de. · Department of Gastroenterology and Liver Diseases, CHU, 38043 Grenoble, France. bbonaz@chu-grenoble.fr. · Celiac Center Amsterdam, Department of Gastroenterology, VU University Medical Center, 1117 Amsterdam, The Netherlands. g.bouma@vumc.nl. · Department of Internal Medicine, "Giovanni Paolo II" Hospital, Sciacca (AG) and University of Palermo, 92019 Sciacca, Italy. acarroccio@hotmail.com. · Paediatric Gastroenterology Unit, Sant Joan de Reus University Hospital. IISPV, 43003 Tarragona, Spain. gcv@tinet.cat. · Department of Internal and Experimental Medicine Magrassi-Lanzara, University of Campania Luigi Vanvitelli, 80131 Naples, Italy. laura.demagistris@unicampania.it. · Medical Clinic 1, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany. walburga.dieterich@uk-erlangen.de. · Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), University of Palermo, 90133 Palermo, Italy. diana.diliberto@unipa.it. · Center for the Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy. lucelli@yahoo.com. · Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA 02114, USA. AFASANO@mgh.harvard.edu. · Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK. Marios.Hadjivassiliou@sth.nhs.uk. · Academic Unit of Gastroenterology, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK. matthew.kurien@sth.nhs.uk. · Department of Pediatrics, Marche Polytechnic University, 60121 Ancona, Italy. mariaelenalionetti@gmail.com. · Celiac Center Amsterdam, Department of Gastroenterology, VU University Medical Center, 1117 Amsterdam, The Netherlands. cjmulder@vumc.nl. · Gastroenterology Unit, Milton Keynes University Hospital, Milton Keynes MK6 5LD, UK. krostami@hotmail.com. · Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA 02114, USA. annasapone@yahoo.it. · German Research Centre for Food Chemistry, Leibniz Institute, Lise-Meitner-Straße 34, D-85354 Freising, Germany. Katharina.Scherf@lrz.tu-muenchen.de. · Institute of Translational Immunology, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany. detlef.schuppan@unimedizin-mainz.de. · Academic Unit of Gastroenterology, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK. nick.trott@sth.nhs.uk. · Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy. umberto.volta@aosp.bo.it. · Institute of Translational Immunology, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany. zevallos@uni-mainz.de. · Medical Clinic 1, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany. Yurdaguel.Zopf@uk-erlangen.de. · Academic Unit of Gastroenterology, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK. david.sanders@sth.nhs.uk. ·Nutrients · Pubmed #29160841.

ABSTRACT: Gluten-related disorders have recently been reclassified with an emerging scientific literature supporting the concept of non-celiac gluten sensitivity (NCGS). New research has specifically addressed prevalence, immune mechanisms, the recognition of non-immunoglobulin E (non-IgE) wheat allergy and overlap of NCGS with irritable bowel syndrome (IBS)-type symptoms. This review article will provide clinicians with an update that directly impacts on the management of a subgroup of their IBS patients whose symptoms are triggered by wheat ingestion.

4 Review From coeliac disease to noncoeliac gluten sensitivity; should everyone be gluten free? 2016

Aziz, Imran / Dwivedi, Krit / Sanders, David S. ·Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK. ·Curr Opin Gastroenterol · Pubmed #26808363.

ABSTRACT: PURPOSE OF REVIEW: Gluten-free diets (GFDs) have seen a disproportional rise in use and popularity relative to the prevalence of established gluten-related disorders such as coeliac disease or immunoglobulin E wheat allergy. This entity has been termed noncoeliac gluten sensitivity (NCGS). This review aims to provide a current perspective on the emerging evidence for and against NCGS, along with the associated need for a GFD. RECENT FINDINGS: NCGS and the benefits of a GFD are reported amongst patients with irritable bowel syndrome, inflammatory bowel disease, and nonintestinal disorders such as neuropsychiatric diseases and fibromyalgia. However, no reliable biomarkers currently exist to diagnose NCGS and hence confirmatory testing can only be performed using double-blind placebo-controlled gluten-based challenges. Unfortunately, such tests are not available in routine clinical practice. Furthermore, recent novel studies have highlighted the role of other gluten-based components in contributing to the symptoms of self-reported NCGS. These include fermentable oligo, di, mono-saccharides and polyols, amylase trypsin inhibitors, and wheat germ agglutinins. Therefore, NCGS is now seen as a spectrum encompassing several biological responses and terms such as 'noncoeliac wheat sensitivity' have been suggested as a wider label to define the condition. SUMMARY: Despite the rising use of a GFD further studies are required to clearly establish the extent and exclusivity of gluten in NCGS.

5 Review The spectrum of noncoeliac gluten sensitivity. 2015

Aziz, Imran / Hadjivassiliou, Marios / Sanders, David S. ·Department of Gastroenterology, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK. · Department of Neurosciences, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK. ·Nat Rev Gastroenterol Hepatol · Pubmed #26122473.

ABSTRACT: The past 5 years have seen an increase in the use of a gluten-free diet outside a diagnosis of coeliac disease or IgE-mediated wheat allergy. This trend has led to the identification of a new clinical entity termed noncoeliac gluten sensitivity (NCGS). In this Review, we discuss the evidence for NCGS as demonstrated by the results of double-blind, placebo-controlled dietary rechallenge studies. Furthermore, the characteristic phenotype of individuals with NCGS is described as well as the symptom manifestations commonly reported after gluten exposure, which include intestinal symptoms consistent with IBS, and extraintestinal symptoms such as neurological dysfunction, psychological disturbances, fibromyalgia and skin rash. Moreover, emerging evidence suggests that NCGS can be associated with organic gastrointestinal pathologies, such as IBD, in which its presence might be a reflection of severe or stricturing disease. However, NCGS is not without its controversies and uncertainties, in particular pertaining to whether it is gluten or nongluten components of the grain evoking symptoms; evidence suggests that fermentable carbohydrates, amylase trypsin inhibitors and wheat-germ agglutinin can also be responsible culprits. Finally, we discuss the novel techniques that might help diagnose NCGS in the future.

6 Review Systematic review: noncoeliac gluten sensitivity. 2015

Molina-Infante, J / Santolaria, S / Sanders, D S / Fernández-Bañares, F. ·Department of Gastroenterology, Hospital San Pedro de Alcantara, Caceres, Spain. ·Aliment Pharmacol Ther · Pubmed #25753138.

ABSTRACT: BACKGROUND: Noncoeliac gluten sensitivity (NCGS) is a controversial emerging disorder. Despite reported symptoms related to the ingestion of gluten, NCGS remains a diagnosis based on the exclusion of coeliac disease, given the absence of reliable biomarkers. AIM: To evaluate the prevalence, diagnostic exclusion of coeliac disease and the efficacy of a gluten-free diet (GFD) for NCGS patients. METHODS: A PubMed search was performed up to December 2014. According to consensus diagnostic criteria, NCGS was defined as self-reported gluten intolerance, negative coeliac serology and absence of villous atrophy. Studies evaluating the impact of a GFD on patients with irritable bowel syndrome (IBS) were also included. RESULTS: Prevalence rates of NCGS (0.5-13%) differed widely. Seventeen studies, including 1561 patients (26 children), met the inclusion criteria for NCGS. HLA haplotypes could not be linked to histology [normal or lymphocytic enteritis (LE)] in 1123 NCGS patients. HLADQ2/DQ8 haplotypes were present in 44% of NCGS patients. After advanced diagnostic techniques in 189 NCGS patients combining LE and HLADQ2/DQ8 haplotypes, 39 (20%) were reclassified as coeliac disease. There was a higher than expected family history of coeliac disease and autoimmune disorders in NCGS patients. A GFD resulted in variable results for variable, but significantly improved stool frequency in HLADQ2 positive diarrhoea-predominant IBS patients. CONCLUSIONS: Prevalence rates for NCGS are extremely variable. A subset of NCGS patients might belong in the so-called 'coeliac-lite' disease. The benefit of a GFD for NCGS patients is currently controversial. HLADQ2 positive diarrhoea-type IBS patients might gain symptom improvement from a GFD.

7 Review Constipation-predominant irritable bowel syndrome: a review of current and emerging drug therapies. 2014

Jadallah, Khaled A / Kullab, Susan M / Sanders, David S. ·Khaled A Jadallah, Susan M Kullab, Department of Internal Medicine, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan. ·World J Gastroenterol · Pubmed #25083062.

ABSTRACT: Irritable bowel syndrome (IBS) is a highly prevalent medical condition that adversely affects patient quality of life and constitutes a significant economic burden on healthcare resources. A large proportion of patients suffer from the constipation subtype of IBS (IBS-C), most commonly afflicting older individuals and those with a lower socioeconomic status. Conventional pharmacologic and nonpharmacologic treatment options have limited efficacies and/or significant adverse events, which lead to increased long-term health care expenditures. Failure to effectively treat IBS-C patients over the past decades has largely been due to a poor understanding of disease pathophysiology, lack of a global view of the patient, and an inappropriate selection of patients and treatment endpoints in clinical trials. In recent years, however, more effective and safer drugs have been developed for the treatment of IBS-C. The advancement in the area of pharmacologic treatment is based on new knowledge of the pathophysiologic basis of IBS-C and the development of drugs with increased selectivity within pharmacologic classes with recognized efficacies. This narrative review covers the spectrum of available drugs and their mechanisms of action, as well as the efficacy and safety profiles of each as determined in relevant clinical trials that have investigated treatment options for IBS-C and chronic constipation. A brief summary of laxative-based treatment options is presented, followed by up-to-date assessments for three classes of drugs: prokinetics, prosecretory agents, and bile acid modulators.

8 Review Non-Celiac Gluten sensitivity: the new frontier of gluten related disorders. 2013

Catassi, Carlo / Bai, Julio C / Bonaz, Bruno / Bouma, Gerd / Calabrò, Antonio / Carroccio, Antonio / Castillejo, Gemma / Ciacci, Carolina / Cristofori, Fernanda / Dolinsek, Jernej / Francavilla, Ruggiero / Elli, Luca / Green, Peter / Holtmeier, Wolfgang / Koehler, Peter / Koletzko, Sibylle / Meinhold, Christof / Sanders, David / Schumann, Michael / Schuppan, Detlef / Ullrich, Reiner / Vécsei, Andreas / Volta, Umberto / Zevallos, Victor / Sapone, Anna / Fasano, Alessio. ·Department of Pediatrics, Università Politecnica delle Marche, Ancona 60121, Italy. afasano@partners.org. ·Nutrients · Pubmed #24077239.

ABSTRACT: Non Celiac Gluten sensitivity (NCGS) was originally described in the 1980s and recently a "re-discovered" disorder characterized by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing food, in subjects that are not affected with either celiac disease (CD) or wheat allergy (WA). Although NCGS frequency is still unclear, epidemiological data have been generated that can help establishing the magnitude of the problem. Clinical studies further defined the identity of NCGS and its implications in human disease. An overlap between the irritable bowel syndrome (IBS) and NCGS has been detected, requiring even more stringent diagnostic criteria. Several studies suggested a relationship between NCGS and neuropsychiatric disorders, particularly autism and schizophrenia. The first case reports of NCGS in children have been described. Lack of biomarkers is still a major limitation of clinical studies, making it difficult to differentiate NCGS from other gluten related disorders. Recent studies raised the possibility that, beside gluten, wheat amylase-trypsin inhibitors and low-fermentable, poorly-absorbed, short-chain carbohydrates can contribute to symptoms (at least those related to IBS) experienced by NCGS patients. In this paper we report the major advances and current trends on NCGS.

9 Review Prevalence of irritable bowel syndrome-type symptoms in patients with celiac disease: a meta-analysis. 2013

Sainsbury, Anita / Sanders, David S / Ford, Alexander C. ·Leeds Gastroenterology Institute, St James's University Hospital, Leeds, United Kingdom. anitabansal@yahoo.com ·Clin Gastroenterol Hepatol · Pubmed #23246645.

ABSTRACT: BACKGROUND & AIMS: Patients with celiac disease (CD) often report symptoms compatible with irritable bowel syndrome (IBS). However, the prevalence of these symptoms in patients with CD and their relation to adherence to a gluten-free diet (GFD) have not been assessed systematically. METHODS: We searched MEDLINE, EMBASE, and EMBASE Classic (through July 2012) to identify cross-sectional surveys or case-control studies reporting prevalence of IBS-type symptoms in adult patients (≥ 16 years old) with established CD. The number of individuals with symptoms meeting criteria for IBS was extracted for each study, according to case or control status and adherence to a GFD. Pooled prevalence and odds ratios (ORs), with 95% confidence intervals (CIs), were calculated. We analyzed data from 7 studies with 3383 participants. RESULTS: The pooled prevalence of IBS-type symptoms in all patients with CD was 38.0% (95% CI, 27.0%-50.0%). The pooled OR for IBS-type symptoms was higher in patients with CD than in controls (5.60; 95% CI, 3.23-9.70). In patients who were nonadherent with a GFD, the pooled OR for IBS-type symptoms, compared with those who were strictly adherent, was 2.69 (95% CI, 0.75-9.56). There was also a trend toward a higher OR for IBS-type symptoms among patients who did not adhere to the GFD, compared with controls (12.42; 95% CI, 6.84-11.75), compared with that observed for adherent CD patients vs controls (4.28; 95% CI, 1.56-11.75). CONCLUSIONS: IBS-type symptoms occur frequently in patients with CD and are more common than among controls. Adherence to a GFD might be associated with a reduction in symptoms.

10 Review The irritable bowel syndrome-celiac disease connection. 2012

Aziz, Imran / Sanders, David S. ·Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK. imran.aziz@sth.nhs.uk ·Gastrointest Endosc Clin N Am · Pubmed #23083983.

ABSTRACT: Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder that has a significant impact on quality of life and health care resources. Celiac disease (CD), a gluten-sensitive enteropathy, can be mistaken for IBS. This article discusses the connection between IBS and CD and the new concept of nonceliac gluten sensitivity (NCGS). NCGS may occur in the presence of a normal or near-normal small bowel biopsy. Some patients with IBS without CD may derive symptomatic benefit from a gluten-free diet. Future research could facilitate a significant impact on the quality of life in this potential subgroup of patients.

11 Clinical Trial Efficacy of a Gluten-Free Diet in Subjects With Irritable Bowel Syndrome-Diarrhea Unaware of Their HLA-DQ2/8 Genotype. 2016

Aziz, Imran / Trott, Nick / Briggs, Rebecca / North, John R / Hadjivassiliou, Marios / Sanders, David S. ·Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom. Electronic address: imran.aziz@sth.nhs.uk. · Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom. ·Clin Gastroenterol Hepatol · Pubmed #26748221.

ABSTRACT: BACKGROUND & AIMS: A gluten-containing diet alters bowel barrier function in patients with irritable bowel syndrome with diarrhea (IBS-D), particularly those who are positive for HLA allele DQ2/8. We studied the effects of a gluten-free diet (GFD) in patients with IBS-D who have not previously considered the effects of gluten in their diet and were unaware of their HLA-DQ2/8 genotype. METHODS: We performed a prospective study of 41 patients with IBS-D (20 HLA-DQ2/8-positive and 21 HLA-DQ2/8-negative) at the Royal Hallamshire Hospital in Sheffield, United Kingdom, from September 2012 through July 2015. All subjects were placed on a 6-week GFD following evaluation by a dietician. Subjects completed validated questionnaires at baseline and Week 6 of the GFD. The primary endpoint was mean change in IBS Symptom Severity Score; a 50-point reduction was considered to indicate a clinical response. Secondary endpoints were changes in hospital anxiety and depression score, fatigue impact score, and Short Form-36 results. Clinical responders who chose to continue a GFD after the study period were evaluated on average 18 months later to assess diet durability, symptom scores, and anthropometric and biochemical status. RESULTS: A 6-week GFD reduced IBS Symptom Severity Score by ≥50 points in 29 patients overall (71%). The mean total IBS Symptom Severity Score decreased from 286 before the diet to 131 points after 6 weeks on the diet (P < .001); the reduction was similar in each HLA-DQ group. However, HLA-DQ2/8-negative subjects had a greater reduction in abdominal distention (P = .04). Both groups had marked mean improvements in hospital anxiety and depression scores, fatigue impact score, and Short Form-36 results, although HLA-DQ2/8-positive subjects had a greater reduction in depression score and increase in vitality score than HLA-DQ2/8-negative subjects (P = .02 and P = .03, respectively). Twenty-one of the 29 subjects with a clinical response (72%) planned to continue the GFD long term; 18 months after the study they were still on a GFD, with maintained symptom reductions, and demonstrated similar anthropometric and biochemical features compared with baseline. CONCLUSIONS: A dietitian-led GFD provided sustained benefit to patients with IBS-D. The symptoms that improved differed in magnitude according to HLA-DQ status. Clinical trials.gov no: NCT02528929.

12 Article High Prevalence of Idiopathic Bile Acid Diarrhea Among Patients With Diarrhea-Predominant Irritable Bowel Syndrome Based on Rome III Criteria. 2015

Aziz, Imran / Mumtaz, Saqib / Bholah, Hassan / Chowdhury, Fahmid U / Sanders, David S / Ford, Alexander C. ·Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom. · Leeds Gastroenterology Institute, St James's University Hospital, Leeds, United Kingdom. · Nuclear Medicine Department, St James's University Hospital, Leeds, United Kingdom. · Leeds Gastroenterology Institute, St James's University Hospital, Leeds, United Kingdom; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom. Electronic address: alexf12399@yahoo.com. ·Clin Gastroenterol Hepatol · Pubmed #25769413.

ABSTRACT: BACKGROUND & AIMS: Some studies have found that patients with idiopathic bile acid diarrhea (BAD) present with symptoms of diarrhea-predominant irritable bowel syndrome (D-IBS). However, these studies either were retrospective, did not define D-IBS according to current criteria, or included patients with chronic functional diarrhea. We performed a prospective study of the prevalence of idiopathic BAD in consecutive patients fulfilling the Rome III criteria for D-IBS. METHODS: We analyzed data from 118 consecutive adult patients who fulfilled the Rome III criteria for D-IBS (mean age, 41.7 y; 72.9% female), seen at 2 gastroenterology clinics in the United Kingdom. We excluded patients with risk factors for BAD (previous history of cholecystectomy, terminal ileal Crohn's disease, terminal ileal resection or right hemicolectomy, pelvic or abdominal radiotherapy, celiac disease, or microscopic colitis). Participants completed questionnaires at baseline (on demographics, hospital anxiety, somatization, and depression, as well as the patient health questionnaire-12 and the Short Form-36), and then received the (75)selenium homocholic acid taurine retention test. Retention of (75)selenium homocholic acid taurine 7 days after administration was used to identify patients with idiopathic BAD (mild BAD, 10%-14.9%; moderate BAD, 5.1%-9.9%; and severe BAD, ≤5%). RESULTS: Twenty-eight patients were found to have BAD (23.7% of total), with similar percentages at each study site (25.3% and 20%; P = .54). Eight patients had mild BAD (28.6%), 8 patients had moderate BAD (28.6%), and 12 patients had severe BAD (42.8%). There was no statistical difference in age, sex, depression, patient health questionnaire-12 responses, or SF-36 scores between individuals with vs without BAD. However, patients with BAD had a higher mean body mass index than patients without BAD (31.6 vs 26.4; P = .003). Physical activity (based on the Short Form-36) was significantly lower in subjects with moderate (43.8) or severe BAD (41.7), compared with patients with mild BAD (87.5) (P = .046). CONCLUSIONS: Almost 25% of patients presenting with D-IBS have idiopathic BAD; most cases are moderate to severe. Guidelines should advocate testing to exclude BAD before patients are diagnosed with D-IBS.

13 Article A study evaluating the bidirectional relationship between inflammatory bowel disease and self-reported non-celiac gluten sensitivity. 2015

Aziz, Imran / Branchi, Federica / Pearson, Katherine / Priest, Josephine / Sanders, David S. ·*Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom; and †Gastroenterology and Endoscopy Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplant, Università degli Studi di Milano, Milan, Italy. ·Inflamm Bowel Dis · Pubmed #25719528.

ABSTRACT: BACKGROUND: Non-celiac gluten sensitivity and the associated use of a gluten-free diet (GFD) are perceived to belong to the spectrum of irritable bowel syndrome (IBS). However, recent reports suggest substantial use of a GFD in inflammatory bowel disease (IBD). We assessed the bidirectional relationship between IBD and self-reported non-celiac gluten sensitivity (SR-NCGS). METHODS: A cross-sectional questionnaire screened for SR-NCGS and the use of a GFD in 4 groups: ulcerative colitis (n = 75), Crohn's disease (n = 70), IBS (n = 59), and dyspeptic controls (n = 109). We also assessed diagnostic outcomes for IBD in 200 patients presenting with SR-NCGS. RESULTS: The prevalence of SR-NCGS was 42.4% (n = 25/59) for IBS, followed by 27.6% (n = 40/145) for IBD, and least among dyspeptic controls at 17.4% (n = 19/109); P = 0.015. The current use of a GFD was 11.9% (n = 7/59) for IBS, 6.2% (n = 9/145) for IBD, and 0.9% (1/109) for dyspeptic controls; P = 0.02. No differences were established between ulcerative colitis and Crohn's disease. However, Crohn's disease patients with SR-NCGS were significantly more likely to have stricturing disease (40.9% versus 18.9%, P = 0.046), and higher mean Crohn's Disease Activity Index score (228.1 versus 133.3, P = 0.002), than those without SR-NCGS. Analysis of 200 cases presenting with SR-NCGS suggested that 98.5% (n = 197) could be dietary-related IBS. However, 1.5% (n = 3) were found to have IBD; such patients had associated alarm symptoms, and/or abnormal blood parameters, prompting colonic investigations. CONCLUSIONS: SR-NCGS is not only exclusive to IBS but also associated with IBD, where its presence may be reflecting severe or stricturing disease. Randomized studies are required to further delineate the nature of this relationship and clarify whether a GFD is a valuable dietetic intervention in selected IBD patients.

14 Article Prevalence, investigational pathways and diagnostic outcomes in differing irritable bowel syndrome subtypes. 2014

Lin, Simone / Mooney, Peter D / Kurien, Matthew / Aziz, Imran / Leeds, John S / Sanders, David S. ·Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK. ·Eur J Gastroenterol Hepatol · Pubmed #25076066.

ABSTRACT: BACKGROUND: There has been increasing interest in subclassifying irritable bowel syndrome (IBS) to make a positive diagnosis. AIM: The aim of this study was to assess the population prevalence of differing subtypes, investigational pathways and diagnostic outcomes. MATERIALS AND METHODS: Data were prospectively collected from three groups between 2005 and 2012. Group 1 [n=1002, 55% female, mean age 39 years (range 16-93 years)] comprised healthy volunteers who were interviewed using the Rome III diagnostic questionnaire. In secondary care, group 2 [n=64, 80% female, mean age 44 years (range 23-79 years)] comprised patients with constipation-predominant IBS (IBS-C) and group 3 [n=333, 66% female, mean age 51 years (range 23-92 years)] comprised patients with diarrhoea-predominant IBS (IBS-D). In groups 2 and 3, demographic data and diagnostic yield of investigations were evaluated as per normal clinical practice. RESULTS: IBS prevalence in group 1 was 6% (60/1002). IBS-C patients were significantly older than those with IBS-D (mean age 45 vs. 30 years, P=0.027). In groups 2 and 3, patients with IBS-C underwent a total of 56 additional investigations (mean 0.88 per patient), which was significantly lower than the number of investigations undertaken in the IBS-D group of 734 (mean 2.2 per patient, P<0.001). Further investigations in group 3 (IBS-D) identified an alternative diagnosis in 22%, whereas in group 2 (IBS-C) this was 0% (P<0.0001). CONCLUSION: This is the first study to evaluate the population prevalence of different IBS subtypes within a UK population. Although further investigations in IBS-D patients have led to alternative diagnoses, none were identified in the IBS-C population. The merits of investigating IBS-C patients should be questioned.

15 Article A UK study assessing the population prevalence of self-reported gluten sensitivity and referral characteristics to secondary care. 2014

Aziz, Imran / Lewis, Nina R / Hadjivassiliou, Marios / Winfield, Stefanie N / Rugg, Nathan / Kelsall, Alan / Newrick, Laurence / Sanders, David S. ·Departments of aGastroenterology bNeurology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK. ·Eur J Gastroenterol Hepatol · Pubmed #24216570.

ABSTRACT: BACKGROUND: Reports suggest that gluten sensitivity (GS) exists in the absence of coeliac disease (CD). This clinical entity has been termed noncoeliac gluten sensitivity (NCGS). OBJECTIVES: To determine the population prevalence of self-reported GS and referral characteristics to secondary care. PATIENTS AND METHODS: A UK population-based questionnaire screened for GS and related symptoms. Diagnostic outcomes were also analyzed in patients referred to secondary care with GS. CD diagnosis entailed a positive coeliac serology (endomysial and/or tissue transglutaminase antibodies) plus Marsh 1-3 on duodenal biopsies. NCGS diagnosis was based on exclusion of CD. Clinical comparisons were made between NCGS and CD. RESULTS: A total of 1002 adults in the population (female 55%, mean age 39 years). The self-reported prevalence for GS was 13% (female 79%, mean age 39.5 years, P<0.0001), with 3.7% consuming a gluten-free diet and 0.8% known to have a doctor diagnosis of CD. Individuals with GS had an increased prevalence of fulfilling the Rome III criteria for irritable bowel syndrome, in comparison with those without GS (20 vs. 3.89%, odds ratio 6.23, P<0.0001).In secondary care 200 GS patients (female 84%, mean age 39.6 years) were investigated, in whom 7% were found to have CD and 93% to have NCGS. All CD patients were human leucocyte antigen DQ2 or DQ8 positive compared with 53% of NCGS cases (P=0.0003). Nutritional deficiencies (P≤0.003), autoimmune disorders (23.1 vs. 9.7%, P=0.0001) and a lower mean BMI (23.7 vs. 25.8, P=0.001) were significantly associated with CD compared with NCGS. CONCLUSION: GS is commonly self-reported with symptoms suggesting an association with irritable bowel syndrome. The majority of patients have NCGS, an entity which demonstrates clinical and immunologic difference to CD.

16 Article Factors influencing the type, timing and severity of symptomatic responses to dietary gluten in patients with biopsy-proven coeliac disease. 2013

Barratt, Stephen M / Leeds, John S / Sanders, David S. ·Shefield Teaching Hospitals NHS Foundation Trust, Shefield,UK; Email:david.sanders@sth.nhs.uk. ·J Gastrointestin Liver Dis · Pubmed #24369320.

ABSTRACT: BACKGROUND & AIM: There is a paucity of data reflecting the symptomatic responses to dietary gluten (SRDG) in patients with Coeliac Disease (CD). We aimed to determine the type, timing and severity of SRDG with reference to a range of disease-related factors. METHODS: Postal survey of 224 biopsy-proven patients including gluten-free diet (GFD) adherence, symptom checklist, ROME II criteria and The Hospital Anxiety & Depression Scale. Case-note review was also conducted. RESULTS: 26% of respondents were male. Full GFD adherence: n=159 (70%). Irritable bowel syndrome (IBS): n=50 (22%). Anxiety: n=30 (13%); Depression: n=33 (14%); Anxiety & Depression: n=72 (32%). Pruritus, fatigue and bloating were a more common SRDG in the partial/none GFD adherent group (p=ns). Co-existing IBS was associated with a greater prevalence of nausea and fatigue in response to gluten (p=<0.05). Fully GFD adherent patients are more likely to have SRDG <1hr than partial/none adherent (OR 4.8; p=0.004), as are a third of patients with co-existing IBS (OR 1.5; p=0.027) and those patients at risk of both anxiety and depression (OR 1.9; p=0.04). Inadvertent exposure to dietary gluten in the fully GFD adherent group is more likely to result in a severe SRDG in comparison to symptoms arising prior to consistent GFD adherence (OR 2.3; p=0.01). IBS sufferers are also more likely to rate their SRDG as severe in nature (OR 1.4; p=0.038). CONCLUSION: Patients with consistent GFD adherence experience a SRDG faster and more severe in comparison to prior gluten exposure possibly demonstrating an adept immunological response. Anxiety and depression also enhance the speed of symptom onset and co-existing visceral hypersensitivity is a risk factor for severe reactions to dietary gluten.

17 Article Prodromal irritable bowel syndrome may be responsible for delays in diagnosis in patients presenting with unrecognized Crohn's disease and celiac disease, but not ulcerative colitis. 2011

Barratt, S M / Leeds, J S / Robinson, K / Lobo, A J / McAlindon, M E / Sanders, D S. ·The Gastroenterology & Liver Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK. mdd06sb@sheffield.ac.uk ·Dig Dis Sci · Pubmed #21695401.

ABSTRACT: INTRODUCTION: We aimed to determine the prevalence and duration of prodromal periods in patients with celiac disease and inflammatory bowel disease (Crohn's disease and ulcerative colitis). Furthermore, we explored to what extent vague abdominal symptoms consistent with both disorders were attributed to irritable bowel syndrome (IBS) and if the presence of prodromal IBS (P-IBS) had an impact on prodrome duration. METHODS: In the study, 683 biopsy-proven patients (celiac n = 225, ulcerative colitis n = 228, Crohn's disease n = 230) completed a postal survey including an assessment of prodromal periods and IBS symptoms during both the prodrome and at present (achieved by completion of the ROME II criteria). Results were compared to age/sex-matched controls (n = 348). RESULTS: Crohn's disease patients had the highest prevalence of prodromes (94%) in comparison to ulcerative colitis (48%) and celiac disease (44%). However, Crohn's disease patients have the lowest prevalence of P-IBS (29%) in comparison to ulcerative colitis (38%) and celiac disease (67%). Prodrome duration in patients with P-IBS Crohn's disease was 4 years in comparison to 2 years without (p = 0.018). Prodrome duration in P-IBS celiac disease was 10 years in comparison to 7 years without (p = 0.046). Prodrome duration in patients with ulcerative colitis was not affected by P-IBS (p ≥ 0.05). Age and sex were not confounding factors. CONCLUSIONS: This is the first study to make direct comparisons of prodrome periods between celiac disease and IBD. Prodrome duration in celiac disease is significantly longer and more often characterized by P-IBS than IBD. In celiac disease and CD, P-IBS increases prodrome duration. This may represent a failure to understand the overlap between IBS and celiac disease/IBD.

18 Article Bile acid malabsorption: an under-investigated differential diagnosis in patients presenting with diarrhea predominant irritable bowel syndrome type symptoms. 2011

Kurien, Matthew / Evans, Kate E / Leeds, John S / Hopper, Andy D / Harris, Andrew / Sanders, David S. ·Gastroenterology & Liver Unit, Royal Hallamshire Hospital, Sheffield, UK. mattkurien@hotmail.com ·Scand J Gastroenterol · Pubmed #21492055.

ABSTRACT: OBJECTIVE: Bile acid malabsorption (BAM) has been reported as a possible cause of diarrhea predominant irritable bowel syndrome (D-IBS) type symptoms. We aimed to determine how commonly patients with D-IBS type symptoms had a diagnosis of BAM as demonstrated by a positive SeHCAT (75 Selenium-homocholic acid taurine) test (retention <10% at seven days). MATERIALS AND METHODS: A retrospective analysis was undertaken of patient's records for all patients who underwent a SeHCAT test between 2001 and 2009 in a tertiary hospital (Group A). Concurrently, a cohort of patients with Rome II D-IBS type symptoms was examined to determine the potential utility of SeHCAT test (Group B). RESULTS: In Group A 39.2% (n = 107/273) of patients had a positive SeHCAT result. The median time from first hospital visit to SeHCAT result was 30 weeks. Predictive factors for BAM: terminal ileal Crohn's disease (p < 0.01), terminal ileal resection (p < 0.01), and previous cholecystectomy (p < 0.01). 33.6% of patients who had a positive SeHCAT also had Rome II D-IBS. In Group B the D-IBS control cohort only 1.9% of patients had undergone a SeHCAT scan (p < 0.001 compared to Group A). CONCLUSION: BAM is common and should be considered earlier when investigating unselected patients with D-IBS type symptoms.

19 Article Reflux and irritable bowel syndrome are negative predictors of quality of life in coeliac disease and inflammatory bowel disease. 2011

Barratt, Stephen M / Leeds, John S / Robinson, Kerry / Shah, Premal J / Lobo, Alan J / McAlindon, Mark E / Sanders, David S. ·The Gastroenterology and Liver Unit, The Royal Hallamshire Hospital, Sheffield, UK. mdd06sb@sheffield.ac.uk ·Eur J Gastroenterol Hepatol · Pubmed #21178777.

ABSTRACT: BACKGROUND AND AIM: An increased prevalence of reflux and irritable bowel syndrome (IBS) symptoms is associated with coeliac disease and inflammatory bowel disease (IBD). We aimed to determine the prevalence of reflux and IBS symptoms in a cohort of patients with coeliac disease and IBD and their relationship with quality of life (QoL) and psychological distress. METHODS: Histologically proven coeliac disease (n=225), ulcerative colitis (UC) (n=228), Crohn's disease (CD) (n=230) patients and age/sex-matched controls (n=348) completed the Short-Form 36 (SF-36)-Item Health Survey, Hospital Anxiety and Depression Scale (HADS), reflux screen and Rome II criteria. RESULTS: UC patients report higher SF-36 (QoL) scores than coeliac disease; CD fairing worse overall (P≤0.0001). Reflux prevalence: coeliac disease 66%; UC 62%; CD 72%; controls 50%. Patients report reflux of a greater severity: coeliac disease odds ratio=6.8, 95% confidence interval=3.6-12.7, P≤0.001; IBD odds ratio=2.2, 95% confidence interval=1.6-3.2, P≤0.0001. Stepwise reductions in SF-36 scores in association with increasing reflux severity were found (P≤0.0001). IBS prevalence: coeliac disease 22%; UC 16%; CD 24%; controls 6%. Concomitant IBS was associated with reduced SF-36 scores in patients (P≤0.0001). CONCLUSION: Reflux and IBS are more prevalent in coeliac disease and IBD in comparison with age-matched and sex-matched controls. These additional symptoms are associated with reduced QoL and increasing likelihood of anxiety and depression. QoL may be improved if coeliac disease and IBD patients were assessed for reflux and IBS.

20 Article Faecal lactoferrin--a novel test to differentiate between the irritable and inflamed bowel? 2010

Sidhu, R / Wilson, P / Wright, A / Yau, C W H / D'Cruz, F A / Foye, L / Morley, S / Lobo, A J / McAlindon, M E / Sanders, D S. ·Gastroenterology & Liver Unit, Royal Hallamshire Hospital, Glossop Road, Sheffield S102JF, United Kingdom. reena_sidhu@yahoo.com ·Aliment Pharmacol Ther · Pubmed #20331581.

ABSTRACT: BACKGROUND: Distinguishing between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) can be challenging. AIMS: To investigate the utility of faecal lactoferrin as a marker of inflammation in patients with IBD, IBS and controls. METHODS: Disease activity in IBD patients was assessed using the modified Harvey-Bradshaw Activity Index. Stool samples were analysed using an ELISA assay. RESULTS: We recruited 137 patients with IBS, 126 with ulcerative colitis (UC) and 104 with Crohn's disease (CD), and 98 healthy volunteers. The median +/- IQ lactoferrin concentration (microg/g faecal weight) was 0 +/- 1.4 for IBS patients, 6.6 +/- 42 for UC patients, 4 +/- 12.7 for CD patients and 0.5 +/- 2 for healthy controls. Lactoferrin levels were significantly higher in IBD patients compared with IBS/healthy controls (P < 0.001). The median lactoferrin concentrations were significantly higher in active UC & CD patients compared with inactive patients (P < 0.001 and P = 0.002 respectively). The sensitivity, specificity, positive and negative predictive values of lactoferrin in distinguishing active IBD from IBS/healthy controls were 67% and 96%, 87% and 86.8% respectively. CONCLUSIONS: Lactoferrin is useful to differentiate between IBD and IBS, and can be used as an adjunct to blood parameters to determine IBD patients who have ongoing inflammation.

21 Article Some patients with irritable bowel syndrome may have exocrine pancreatic insufficiency. 2010

Leeds, John S / Hopper, Andrew D / Sidhu, Reena / Simmonette, Alison / Azadbakht, Narges / Hoggard, Nigel / Morley, Stephen / Sanders, David S. ·Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom. jsleeds@hotmail.com ·Clin Gastroenterol Hepatol · Pubmed #19835990.

ABSTRACT: BACKGROUND & AIMS: Patients with irritable bowel syndrome (IBS) might have other underlying pathologies. Pancreatic disease can be elusive-especially in the early stages, and some symptoms overlap with those of IBS. We evaluated the prevalence of exocrine pancreatic insufficiency in diarrhea-predominant IBS (D-IBS) and assessed the effects of pancreatic enzyme supplementation. METHODS: The study included patients who met the Rome II criteria for D-IBS, patients with chronic diarrhea, and subjects without diarrhea (controls). Subjects' baseline weight, stool frequency, stool consistency (using the Bristol score), and fecal elastase-1 (Fel-1) levels were determined. Patients were assessed using British Society of Gastroenterology IBS guidelines. Patients with Fel-1 levels less than 100 microg/g stool (indicating pancreatic exocrine insufficiency; group 1) were compared with age- and sex-matched patients with D-IBS and normal levels of Fel-1 (group 2), given pancreatic enzyme therapy, and reassessed at 12 weeks. RESULTS: Fel-1 levels were less than 100 microg/g in stool from 19 of 314 patients with D-IBS (6.1%; 95% confidence interval [CI], 3.7%-9.3%), none of the 105 patients with chronic diarrhea (95% CI, 0.0%-3.5%), and none of 95 controls (95% CI, 0.0-3.8%) (P < .001). After enzyme supplementation, improvements in stool frequency (P < .001), stool consistency (P < .001), and abdominal pain (P = .003) were observed in patients in group 1, but not in group 2. CONCLUSIONS: Pancreatic exocrine insufficiency was detected in 6.1% of patients who fulfilled the Rome II criteria for D-IBS. In these patients, pancreatic enzyme therapy might reduce diarrhea and abdominal pain. Pancreatic exocrine insufficiency should be considered in patients with D-IBS.

22 Article The role of serum chromogranin A in diarrhoea predominant irritable bowel syndrome. 2009

Sidhu, Reena / McAlindon, Mark E / Leeds, John S / Skilling, Jessica / Sanders, David S. ·Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom. reena_sidhu@yahoo.com ·J Gastrointestin Liver Dis · Pubmed #19337629.

ABSTRACT: BACKGROUND & AIMS: Elevated serum chromogranin A (CgA) levels have been reported co-incidentally in a small group of irritable bowel syndrome (IBS) patients (n=19). Our aim was to ascertain the prevalence of elevated CgA in diarrhoea predominant Rome II IBS (D-IBS) patients and investigate if this could be a marker for octreotide therapy. METHODS: Patients with Rome II D-IBS were recruited prospectively and investigated as per British Society Guidelines including serial CgA levels (u/l). Patients with refractory symptoms and elevated CgA were considered for further investigation + or - octreotide therapy. RESULTS: 219 patients were recruited (68% females, mean age 45 years). 81% (n=177) of IBS patients had normal CgA levels (0-20u/l). Whilst 12.3% (n=27) had values between 20-60u/l, 6.8% (n=15) had CgA levels >60u/l; 96% (26/27) with initial CgA level of 20-60u/l had repeated CgA levels which normalised. One patient (3.7%) had a gastric adenocarcinoma. In the 15 patients with elevated CgA levels >60u/l, 8 normalised on repeated testing. In the other 7, there were no cases of carcinoid, n=1 gastric leiomyoma, n=1 rectal tumour and 4 patients had persistently elevated CgA levels but with improvement of symptoms. In one patient, octreotide was commenced which resulted in normalisation of CgA and symptoms. CONCLUSION: CgA levels appear to be transiently elevated in D-IBS. Future work assessing CgA in patients with refractory D-IBS may potentially identify individuals who will benefit from octreotide therapy.

23 Minor Screening for bile acid diarrhoea in suspected irritable bowel syndrome. 2015

Aziz, Imran / Kurien, Matthew / Sanders, David S / Ford, Alexander C. ·Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK. · Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK. ·Gut · Pubmed #24870624.

ABSTRACT: -- No abstract --

24 Minor Subtle mucosal changes at capsule endoscopy in diarrhoea predominant Irritable Bowel Syndrome. 2012

Kalla, Rahul / McAlindon, Mark E / Sanders, David S / Sidhu, Reena. · ·Med Hypotheses · Pubmed #22766519.

ABSTRACT: -- No abstract --

25 Minor Is gluten sensitivity a "No Man's Land" or a "Fertile Crescent" for research? 2010

Ball, Alex J / Hadjivassiliou, Marios / Sanders, David S. · ·Am J Gastroenterol · Pubmed #20054311.

ABSTRACT: -- No abstract --

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