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Irritable Bowel Syndrome: HELP
Articles by David Surendran Sanders
Based on 33 articles published since 2010
(Why 33 articles?)
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Between 2010 and 2020, D. Sanders wrote the following 33 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 The role of diet in irritable bowel syndrome: implications for dietary advice. 2019

Rej, A / Aziz, I / Tornblom, H / Sanders, D S / Simrén, M. ·Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK. · Department of Infection, Immunity and Cardiovascular Disease, Academic Unit of Gastroenterology, University of Sheffield, Sheffield, UK. · Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. · Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, NC, USA. ·J Intern Med · Pubmed #31468640.

ABSTRACT: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder that affects approximately 10% of the population. Diet triggers symptoms in the vast majority of individuals with IBS. In view of this, there has been a focus on the role of diet in IBS. The diets currently being headlined for IBS include (i) traditional dietary advice, (ii) the low fermentable oligo-, di-, mono- saccharides and polyols (FODMAPs) diet and (iii) the gluten-free diet (GFD). Although traditional dietary advice is considered as the first-line dietary therapy, its evidence base is variable, with a few randomized controlled trials (RCTs) exploring the efficacy of this approach, other than for fibre. There are now a growing number of RCTs demonstrating the efficacy of the low FODMAP diet in the short-term, with some emerging data on the long-term 'adapted' low FODMAP diet. There are also several RCTs showing the benefits of a GFD in IBS; however, this concept is hampered with uncertainty as to the mechanism of action. Nevertheless, all of these dietary therapies are viable options for individuals with IBS, with the dietitian and patient engagement at the forefront of achieving success. However, future pragmatic studies are needed to clarify the comparative efficacy and convenience of implementing these various diets into routine life. Moreover, it is imperative to better delineate the concern that restrictive diets - such as the low FODMAP and GFD - may promote nutritional inadequacies, disordered eating behaviours, and lead to detrimental alterations to the gut microbiota.

3 Review Breaking bread! 2019

Rej, Anupam / Aziz, Imran / Sanders, David Surendran. ·Academic Unit of Gastroenterology,Royal Hallamshire Hospital, Sheffield Teaching Hospitals,Sheffield,UK. ·Proc Nutr Soc · Pubmed #30322423.

ABSTRACT: Humankind has existed for 2·5 million years but only in the past 10 000 years have we been exposed to wheat. Therefore, it could be considered that wheat (gluten) is a novel introduction to humankind's diet! Prior to 1939, the rationing system had already been devised. This led to an imperative to try to increase agricultural production. Thus, it was agreed in 1941 that there was a need to establish a Nutrition Society. The very roots of the Society were geared towards necessarily increasing the production of wheat. This goal was achieved and by the end of the 20th century, global wheat output had expanded by 5-fold. Perhaps, as a result, the epidemiology of coeliac disease (CD) or gluten sensitive enteropathy has changed. CD now affects 1 % or more of all adults. Despite this, delays in diagnosis are common, for every adult patient diagnosed approximately three-four cases are undetected. This review explores humankind's relationship with gluten, wheat chemistry, the rising prevalence of modern CD and the new entity of non-coeliac gluten or wheat sensitivity. The nutritional interventions of a low fermentable oligo-, di- and mono-saccharides and polyols diet and gluten-free diet (GFD) for irritable bowel syndrome and the evidence to support this approach (including our own published work) are also reviewed. There appears to be a rising interest in the GFD as a 'lifestyler', 'free from' or 'clean eater' choice, causing concern. Restrictive diets may lead to potential nutritional implications, with long-term effects requiring further exploration.

4 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.

5 Review Clinical application of dietary therapies in irritable bowel syndrome. 2018

Rej, Anupam / Avery, Amanda / Ford, Alexander Charles / Holdoway, Anne / Kurien, Matthew / McKenzie, Yvonne / Thompson, Julie / Trott, Nick / Whelan, Kevin / Williams, Marianne / Sanders, David Surendran. ·Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, United Kingdom.anupam.rej@sth.nhs.uk. · Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Nottingham, United Kingdom. · Leeds Institute of Biomedical and Clinical Sciences, Leeds University, Leeds, United Kingdom. · Registered dietitian, Bath, Somerset, United Kingdom. · Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust;Academic Unit of Gastroenterology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom. · Nuffield Health, The Manor Hospital, Oxford, United Kingdom. · Calm Gut Clinic, Todmorden, United Kingdom. · Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, United Kingdom. · Department of Nutritional Sciences, King's College London, London, United Kingdom. · Specialist Gastroenterology Community Dietetic Service, Somerset Partnership NHS Foundation Trust, Bridgwater, United Kingdom. ·J Gastrointestin Liver Dis · Pubmed #30240475.

ABSTRACT: BACKGROUND AND AIMS: Diet appears to play a pivotal role in symptom generation in Irritable Bowel Syndrome (IBS). First line dietary therapy for IBS has focused on advice concerning healthy eating and lifestyle management. Research recently has focused on the role of a diet low in fermentable oligo-, di-, and mono-saccharides and polyols (FODMAPs), gluten free (GFD) and wheat free (WFD) diets for the relief of symptoms in IBS. METHODS: A round table discussion with gastroenterologists and dietitians with a specialist interest in dietary therapies in IBS was held in Sheffield, United Kingdom in May 2017. Existing literature was reviewed. PubMed and EMBASE were searched with the MeSH terms irritable bowel syndrome/diet/diet therapy/gluten/low FODMAP in different combinations to identify relevant articles. A consensus on the application of these dietary therapies into day-to-day practice was developed. RESULTS: Fourteen randomized trials in IBS evaluating the low FODMAP diet (n studies = 9), GFD (n = 4) and WFD (n = 1) were included in this review. The total number of patients recruited from randomized trials reviewed was: n=580 low FODMAP diet (female, n=430), n=203 GFD (female, n=139), n=276 WFD (female, n=215). There was no significant difference in the gender of patients recruited for both the low FODMAP and GFD randomized studies (p=0.12). The response rate in the literature to a low FODMAP diet ranged between 50-76%, and to GFD ranged between 34-71%. Percentage of IBS patients identified as wheat sensitive was reported as 30% in the literature. CONCLUSION: There are no head-to-head trials to date utilizing the low FODMAP diet, GFD and WFD for dietary treatment of IBS and still a number of concerns for diets, including nutritional inadequacy and alteration of the gut microbiota. The consensus suggests that there is evidence for the use of the low FODMAP diet, GFD and WFD as dietary therapies for IBS; the decision-making process for using each individual therapy should be directed by a detailed history by the dietitian, involving the patient in the process.

6 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.

7 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.

8 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.

9 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.

10 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.

11 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.

12 Review Non-celiac gluten sensitivity: clinical relevance and recommendations for future research. 2013

Mooney, P D / Aziz, I / Sanders, D S. ·Regional GI and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK. ·Neurogastroenterol Motil · Pubmed #23937528.

ABSTRACT: BACKGROUND: There has been increasing interest in the entity of Non-Celiac Gluten Sensitivity (NCGS) in recent years; however, it still remains a controversial topic and its pathogenesis is not well understood. Celiac Disease, in contrast, is a well-studied condition that has become increasingly recognized as a prevalent condition arising from a heightened immunological response to gluten. Wheat allergy is an IgE-mediated condition capable of causing a variety of gastrointestinal symptoms. However, the number of patients who have neither celiac disease nor wheat allergy, but appear to derive benefit from a gluten-free diet, is also increasing substantially. The use of the term NCGS as a way of describing this condition has become increasingly prevalent in recent years. PURPOSE: In this review, we will focus on gastrointestinal manifestations of NCGS and discuss the evidence for the condition and its putative pathogenesis. We will discuss areas of controversy and areas for potential future research.

13 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.

14 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.

15 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.

16 Article Increased fasting small-bowel water content in untreated coeliac disease and scleroderma as assessed by magnetic resonance imaging. 2019

Lam, Ching / Sanders, David S / Lanyon, Peter / Garsed, Klara / Foley, Stephen / Pritchard, Susan / Marciani, Luca / Hoad, Caroline L / Costigan, Carolyn / Gowland, Penny / Spiller, Robin. ·Nottingham Digestive Diseases Centre, University of Nottingham and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK. · Sheffield Teaching Hospitals NHS Foundation Trust and University of Sheffield, Sheffield, UK. · Nottingham University Hospitals Trust, Nottingham, UK. · Derby Teaching Hospitals NHS Foundation Trust, Derby, UK. · Sherwood Forest Hospitals NHS Foundation Trust, Mansfield, UK. · Sir Peter Mansfield Magnetic Resonance Centre, University of Nottingham, UK. ·United European Gastroenterol J · Pubmed #31839961.

ABSTRACT: Background and aims: The regular overnight migrating motor complex (MMC) ensures that the normal fasting small-bowel water content (SBWC) is minimised. We have applied our recently validated non-invasive magnetic resonance technique to assess SBWC in newly diagnosed coeliac disease (CD), scleroderma (SCD) and irritable bowel syndrome (IBS), conditions possibly associated with small intestinal bacterial overgrowth (SIBO). Methods: A total of 20 CD and 15 SCD patients with gastrointestinal symptoms were compared to 20 healthy volunteers (HV) and 26 IBS with diarrhoea (IBS-D) patients, as previously reported. All underwent a fasting magnetic resonance imaging (MRI) scan on a 1.5 T Philips Achieva MRI scanner to assess fasting SBWC and colonic volumes. Stool and symptom diaries were completed for one week. Results: Compared to HV, all patients had significantly increased stool frequency and Bristol stool form score. SBWC was significantly increased in CD (median 109 mL; interquartile range (IQR) 53-224 mL) compared to HV (median 53 mL; IQR 31-98 mL; Conclusion: Fasting SBWC as assessed by MRI is significantly increased in newly diagnosed CD and SCD but decreased in IBS-D. Future studies should test whether increased resting fluid predisposes to SIBO.

17 Article Treatment of irritable bowel syndrome with diarrhoea using titrated ondansetron (TRITON): study protocol for a randomised controlled trial. 2019

Gunn, David / Fried, Ron / Lalani, Rabia / Farrin, Amanda / Holloway, Ivana / Morris, Tom / Olivier, Catherine / Kearns, Rachael / Corsetti, Maura / Scott, Mark / Farmer, Adam / Emmanuel, Anton / Whorwell, Peter / Yiannakou, Yan / Sanders, David / Mclaughlin, John / Kapur, Kapil / Eugenicos, Maria / Akbar, Ayesha / Trudgill, Nigel / Houghton, Lesley / Dinning, Phil G / Ford, Alexander C / Aziz, Qasim / Spiller, Robin. ·NIHR Nottingham Digestive Diseases Biomedical Research Centre, University of Nottingham, Nottingham, UK. · Nottingham Digestive Diseases Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK. · Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. · Wingate Institute of Neurogastroenterology, Queen Mary University of London, London, UK. · Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK. · Royal Stoke Hospital, University Hospitals of North Midlands NHS Trust, Stoke, UK. · University College London Hospital, University College London Hospitals NHS Foundation Trust, London, UK. · Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK. · County Durham and Darlington Foundation Trust, University Hospital of North Durham, Durham, UK. · Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. · Salford Royal NHS Foundation Trust, Salford Royal University Hospital, Manchester, UK. · Barnsley Hospital, Barnsley Hospital NHS Foundation Trust, Barnsley, UK. · Western General Hospital Edinburgh, NHS Lothian, Edinburgh, UK. · London North West Healthcare NHS Trust, St Mark's Hospital, London, UK. · Sandwell General Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK. · St James's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK. · Discipline of Surgery and Gastroenterology, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia. · NIHR Nottingham Digestive Diseases Biomedical Research Centre, University of Nottingham, Nottingham, UK. robin.spiller@nottingham.ac.uk. · Nottingham Digestive Diseases Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK. robin.spiller@nottingham.ac.uk. ·Trials · Pubmed #31429811.

ABSTRACT: BACKGROUND: Irritable bowel syndrome with diarrhoea (IBS-D) affects up to 4% of the general population. Symptoms include frequent, loose, or watery stools with associated urgency, resulting in marked reduction of quality of life and loss of work productivity. Ondansetron, a 5HT METHODS: This trial is a phase III, parallel group, randomised, double-blind, multi-centre, placebo-controlled trial, with embedded mechanistic studies. Participants (n = 400) meeting Rome IV criteria for IBS-D will be recruited from outpatient and primary care clinics and by social media to receive either ondansetron (dose titrated up to 24 mg daily) or placebo for 12 weeks. Throughout the trial, participants will record their worst abdominal pain, worst urgency, stool frequency, and stool consistency on a daily basis. The primary endpoint is the proportion of "responders" in each group, using Food and Drug Administration (FDA) recommendations. Secondary endpoints include pain intensity, stool consistency, frequency, and urgency. Mood and quality of life will also be assessed. Mechanistic assessments will include whole gut transit, faecal tryptase and faecal bile acid concentrations at baseline and between weeks 8 and 11. A subgroup of participants will also undergo assessment of sensitivity (n = 80) using the barostat, and/or high-resolution colonic manometry (n = 40) to assess motor patterns in the left colon and the impact of ondansetron. DISCUSSION: The TRITON trial aims to assess the effect of ondansetron across multiple centres. By defining ondansetron's mechanisms of action we hope to better identify patients with IBS-D who are likely to respond. TRIAL REGISTRATION: ISRCTN, ISRCTN17508514 , Registered on 2 October 2017.

18 Article UK clinical experience up to 52 weeks with linaclotide for irritable bowel syndrome with constipation. 2018

Yiannakou, Yan / Agrawal, Anu / Allen, Patrick B / Arebi, Naila / Brown, Steven R / Eugenicos, Maria P / Farmer, Adam D / McLain-Smith, Su / McLaughlin, John / Sanders, David S / Lawrance, Dominic / Emmanuel, Anton. ·University Hospital of North Durham, County Durham and Darlington NHS Foundation Trust, North Road, Durham DH1 5TW, UK. · Doncaster Royal Infirmary, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, UK. · The Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, UK. · St Mark's Hospital, London North West University Healthcare NHS Trust and Imperial College, London, UK. · Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. · Western General Hospital, NHS Lothian, Edinburgh, UK. · University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK and Institute of Applied Clinical Sciences, University of Keele, Keele, UK. · pH Associates Ltd, Marlow, UK. · The University of Manchester, Manchester, UK, Salford Royal NHS Foundation Trust, Salford, UK and Manchester Academic Health Sciences Centre, Manchester, UK. · Allergan plc, Marlow, UK. · University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK. ·Therap Adv Gastroenterol · Pubmed #30302125.

ABSTRACT: Background: Linaclotide, a guanylate cyclase C agonist, has been shown in clinical trials to improve symptoms of irritable bowel syndrome with constipation (IBS-C). Here we report data from a real-world study of linaclotide in the UK. Methods: This 1-year, multicentre, prospective, observational study in the UK enrolled patients aged 18 years and over initiating linaclotide for IBS-C. The primary assessment was change from baseline in IBS Symptom Severity Scale (IBS-SSS) score at 12 weeks, assessed in patients with paired baseline and 12-week data. Change from baseline in IBS-SSS score at 52 weeks was a secondary assessment. Adverse events were recorded. Results: In total, 202 patients were enrolled: 185 (91.6%) were female, median age was 44.9 years (range 18.1-77.2) and 84 (41.6%) reported baseline laxative use. Mean (standard deviation) baseline IBS-SSS score was 339 (92), with most patients ( Conclusion: Linaclotide significantly improved IBS-SSS score at 12 and 52 weeks. These results provide insights into outcomes with linaclotide treatment over 1 year in patients with IBS-C in real-world clinical practice.

19 Article Prevalence and Characterization of Self-Reported Gluten Sensitivity in The Netherlands. 2016

van Gils, Tom / Nijeboer, Petula / IJssennagger, Catharina E / Sanders, David S / Mulder, Chris J J / Bouma, Gerd. ·Celiac Center Amsterdam, Department Gastroenterology and Hepatology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. t.vangils@vumc.nl. · Celiac Center Amsterdam, Department Gastroenterology and Hepatology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. p.nijeboer@vumc.nl. · Celiac Center Amsterdam, Department Gastroenterology and Hepatology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. c.ijssennagger@vumc.nl. · Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK. David.Sanders@sth.nhs.uk. · Celiac Center Amsterdam, Department Gastroenterology and Hepatology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. cjmulder@vumc.nl. · Celiac Center Amsterdam, Department Gastroenterology and Hepatology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. g.bouma@vumc.nl. ·Nutrients · Pubmed #27834802.

ABSTRACT: BACKGROUND: A growing number of individuals reports symptoms related to the ingestion of gluten-containing food in the absence of celiac disease. Yet the actual prevalence is not well established. METHODS: Between April 2015 and March 2016, unselected adults visiting marketplaces, dental practices and a university in The Netherlands were asked to complete a modified validated questionnaire for self-reported gluten sensitivity (srGS). RESULTS: Among the 785 adults enquired, two had celiac disease. Forty-nine (6.2%) reported symptoms related to the ingestion of gluten-containing food. These individuals were younger, predominantly female and lived more frequently in urban regions compared with the other respondents. Symptoms reported included bloating (74%), abdominal discomfort (49%) and flatulence (47%). A total of 23 (47%) srGS individuals reported having had tried a gluten-free or gluten-restricted diet. Abdominal discomfort related to fermentable oligosaccharide, disaccharide, monosaccharide and polyol (FODMAP)-containing food was more often reported in srGS individuals compared with the other respondents (73.5% vs. 21.7%, CONCLUSION: Self-reported GS is common in The Netherlands, especially in younger individuals, females and urban regions, although the prevalence was lower than in a comparable recent UK study. It cannot be excluded that FODMAPs are in part responsible for these symptoms.

20 Article Diagnosis of Non-Celiac Gluten Sensitivity (NCGS): The Salerno Experts' Criteria. 2015

Catassi, Carlo / Elli, Luca / Bonaz, Bruno / Bouma, Gerd / Carroccio, Antonio / Castillejo, Gemma / Cellier, Christophe / Cristofori, Fernanda / de Magistris, Laura / Dolinsek, Jernej / Dieterich, Walburga / Francavilla, Ruggiero / Hadjivassiliou, Marios / Holtmeier, Wolfgang / Körner, Ute / Leffler, Dan A / Lundin, Knut E A / Mazzarella, Giuseppe / Mulder, Chris J / Pellegrini, Nicoletta / Rostami, Kamran / Sanders, David / Skodje, Gry Irene / Schuppan, Detlef / Ullrich, Reiner / Volta, Umberto / Williams, Marianne / Zevallos, Victor F / Zopf, Yurdagül / Fasano, Alessio. ·Department of Pediatrics, Università Politecnica delle Marche, 60123 Ancona, Italy. c.catassi@univpm.it. · Centre for the Prevention and Diagnosis of Celiac Disease/Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan 20122, Italy. lucelli@yahoo.com. · Clinique Universitaire d'Hépato-Gastroenterologie, CHU de Grenoble, 38043 Grenoble Cedex 09, France. BBonaz@chu-grenoble.fr. · Department of Gastroenterology, VU University Medical Center, Amsterdam, the Netherlands. g.bouma@vumc.nl. · Department of Internal Medicine, "Giovanni Paolo II" Hospital, Sciacca (AG) and University of Palermo, Sciacca 92019, Italy. acarroccio@hotmail.com. · Paediatric Gastroenterology Unit, Hospital Sant Joan de Reus, 43201 Reus, Spain. gcastillejo@grupsagessa.com. · Service d'Hépato-gastro-entérologie et Endoscopie Digestive, Hôpital Européen Georges Pompidou, 75015 Paris, France. christophe.cellier@egp.aphp.fr. · Interdisciplinary Department of Medicine, University of Bari, Bari 70124, Italy. fernandacristofori@gmail.com. · Department of Internal and Experimental Medicine Magrassi-Lanzara, Second University of Naples, 80131 Naples, Italy. laura.demagistris@unina2.it. · Gastroenterology Unit, Department of Pediatrics, University Medical Centre Maribor, Maribor 2000, Slovenia. jernej.dolinsek@ukc-mb.si. · Medical Clinic 1, University of Erlangen, 91054 Erlangen, Germany. walburga.dieterich@uk-erlangen.de. · Interdisciplinary Department of Medicine, University of Bari, Bari 70124, Italy. rfrancavilla@gmail.com. · Academic Department of Neurosciences and University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK. lucelli@yahoo.com. · Division of Gastroenterology and Internal Medicine, Hospital Porz am Rhein, Köln 51149, Germany. BBonaz@chu-grenoble.fr. · Practice of Nutrition Therapy Allergology and Gastroenterology, Köln 50935, Germany. ute.koerner@t-online.de. · Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. acarroccio@hotmail.com. · Seksjon for Gastromedisin, Avdeling for Transplantasjonsmedisin, OUS Rikshospitalet Senter for Immunregulering, Oslo University, 0424 Oslo, Norway. knut.lundin@medisin.uio.no. · Institute of Food Sciences-CNR, Lab. Immuno-Morphology, 83100 Avellino, Italy. christophe.cellier@egp.aphp.fr. · Department of Gastroenterology, VU University Medical Center, Amsterdam, the Netherlands. cjmulder@vumc.nl. · Department of Food Science, University of Parma, IT-43124 Parma, Italy. nicoletta.pellegrini@unipr.it. · Department of Gastroenterology, Alexandra Hospital, Redditch B98 7UB, UK. laura.demagistris@unina2.it. · Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital and University of Sheffield Medical School, Sheffield S10 2JF, UK. david.sanders@sth.nhs.uk. · Division of Clinical Nutrition, Oslo University Hospital, 0424 Oslo, Norway,. g.i.skodje@medisin.uio.no. · University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany. detlef.schuppan@unimedizin-mainz.de. · Charité-Universitätsmedizin Berlin, Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, 12203 Berlin, Germany. reiner.ullrich@charite.de. · Department of Medical and Surgical Sciences University of Bologna, St. Orsola-Malpighi Hospital via Massarenti 9, 40138 Bologna, Italy. umberto.volta@aosp.bo.it. · Somerset Partnership NHS Foundation Trust, Bridgwater TA6 4RN, UK. marianne@wisediet.co.uk. · University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany. zevallos@uni-mainz.de. · Medical Clinic 1, University of Erlangen, 91054 Erlangen, Germany. yurdaguel.zopf@uk-erlangen.de. · Pediatric Gastroenterology and Nutrition, Mass General Hospital for Children, Boston, MA 02114, USA. afasano@mgh.harvard.edu. ·Nutrients · Pubmed #26096570.

ABSTRACT: Non-Celiac Gluten Sensitivity (NCGS) is a syndrome characterized by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing food, in subjects that are not affected by either celiac disease or wheat allergy. Given the lack of a NCGS biomarker, there is the need for standardizing the procedure leading to the diagnosis confirmation. In this paper we report experts' recommendations on how the diagnostic protocol should be performed for the confirmation of NCGS. A full diagnostic procedure should assess the clinical response to the gluten-free diet (GFD) and measure the effect of a gluten challenge after a period of treatment with the GFD. The clinical evaluation is performed using a self-administered instrument incorporating a modified version of the Gastrointestinal Symptom Rating Scale. The patient identifies one to three main symptoms that are quantitatively assessed using a Numerical Rating Scale with a score ranging from 1 to 10. The double-blind placebo-controlled gluten challenge (8 g/day) includes a one-week challenge followed by a one-week washout of strict GFD and by the crossover to the second one-week challenge. The vehicle should contain cooked, homogeneously distributed gluten. At least a variation of 30% of one to three main symptoms between the gluten and the placebo challenge should be detected to discriminate a positive from a negative result. The guidelines provided in this paper will help the clinician to reach a firm and positive diagnosis of NCGS and facilitate the comparisons of different studies, if adopted internationally.

21 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.

22 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.

23 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.

24 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.

25 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.

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