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Irritable Bowel Syndrome: HELP
Articles by Dr. Nicholas Talley
Based on 82 articles published since 2008
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Between 2008 and 2019, N. J. Talley wrote the following 82 articles about Irritable Bowel Syndrome.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Editorial Irritable bowel syndrome, dyspepsia and other chronic disorders of gastrointestinal function. 2016

Talley, Nicholas J / Holtmann, Gerald. ·Global Research, University of Newcastle, Newcastle, NSW Nicholas.Talley@newcastle.edu.au. · University of Queensland, Brisbane, QLD. ·Med J Aust · Pubmed #27681970.

ABSTRACT: -- No abstract --

2 Editorial Editorial: differentiating chronic idiopathic constipation from constipation-predominant irritable bowel syndrome--possible and important?--Authors' reply. 2015

Talley, N J / Koloski, N A / Jones, M P. ·Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia. nicholas.talley@newcastle.edu.au. · Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia. · Department of Psychology, Macquarie University, North Ryde, NSW, Australia. ·Aliment Pharmacol Ther · Pubmed #25968151.

ABSTRACT: -- No abstract --

3 Editorial Editorial: the overlap of atopy and functional gastrointestinal disorders in primary care--authors' reply. 2014

Jones, M P / Walker, M M / Ford, A C / Talley, N J. ·Psychology Department, Macquarie University, North Ryde, NSW, USA. mike.jones@mq.edu.au. ·Aliment Pharmacol Ther · Pubmed #25303378.

ABSTRACT: -- No abstract --

4 Editorial Bugs, stool, and the irritable bowel syndrome: too much is as bad as too little? 2011

Talley, Nicholas J / Fodor, Anthony A. · ·Gastroenterology · Pubmed #21945058.

ABSTRACT: -- No abstract --

5 Editorial Pathogenesis of irritable bowel syndrome are genes a SERT-ainty? 2009

Talley, Nicholas J. · ·J Clin Gastroenterol · Pubmed #19727006.

ABSTRACT: -- No abstract --

6 Review What's in a name? 'Non-coeliac gluten or wheat sensitivity': controversies and mechanisms related to wheat and gluten causing gastrointestinal symptoms or disease. 2018

Potter, Michael D E / Walker, Marjorie M / Keely, Simon / Talley, Nicholas J. ·Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, New Lambton Heights, New South Wales, Australia. · Department of Gastroenterology, John Hunter Hospital, Newcastle, New South Wales, Australia. ·Gut · Pubmed #30061187.

ABSTRACT: -- No abstract --

7 Review Irritable bowel syndrome and functional dyspepsia: what can epidemiology tell us about etiology? 2018

Talley, Nicholas J / Holtmann, Gerald. ·a University of Newcastle, Faculty of Health and Medicine , Newcastle , Australia. · b Australian GI Research Alliance (AGIRA) , Newcastle , Australia. · c Department of Gastroenterology , University of Queensland , Brisbane , Australia. ·Expert Rev Gastroenterol Hepatol · Pubmed #29774764.

ABSTRACT: -- No abstract --

8 Review Irritable Bowel Syndrome. 2017

Ford, Alexander C / Lacy, Brian E / Talley, Nicholas J. ·From the Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, and the Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom (A.C.F.) · the Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (B.E.L.) · the Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia (N.J.T.) · the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (N.J.T.) · and Karolinska Institute, Stockholm (N.J.T.). ·N Engl J Med · Pubmed #28657875.

ABSTRACT: -- No abstract --

9 Review Pathophysiology of irritable bowel syndrome. 2016

Holtmann, Gerald J / Ford, Alexander C / Talley, Nicholas J. ·Department of Gastroenterology and Hepatology, Princess Alexandra Hospital Brisbane, and Translational Research Institute, University of Queensland, Brisbane, QLD, Australia. · Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK. · Faculty of Health and Medicine, University of Newcastle, NSW, Australia; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. Electronic address: nicholas.talley@newcastle.edu.au. ·Lancet Gastroenterol Hepatol · Pubmed #28404070.

ABSTRACT: Traditionally, irritable bowel syndrome has been considered to be a disorder with no known underlying structural or biochemical explanation, but this concept is likely to be outdated. In this Review we challenge the widely accepted view that irritable bowel syndrome is an unexplained brain-gut disorder. There is epidemiological evidence that, in a major subset of patients, gastrointestinal symptoms arise first and only later do incident mood disorders occur. Additionally, possible mechanisms for gut-brain dysfunction have been identified, suggesting primary gut disturbances might be the underlying cause in a subgroup. Underlying mechanisms that could lead to irritable bowel syndrome include genetic factors (most notably an identified mutation of SCN5A); post-infectious changes, chronic infections and disturbances in the intestinal microbiota; low-grade mucosal inflammation, immune activation, and altered intestinal permeability; disordered bile salt metabolism (in 10-20% of cases with diarrhoea); abnormalities in serotonin metabolism; and alterations in brain function, which could be primary or secondary factors. Identical irritable bowel syndrome symptoms are probably due to different disease processes; grouping patients with this disorder into either diarrhoea-predominant or constipation-predominant subtypes promotes heterogeneity. An approach based on the underlying pathophysiology could help to develop therapies that target causes and ultimately provide a cure for patients with irritable bowel syndrome.

10 Review Immune dysregulation in the functional gastrointestinal disorders. 2015

Keely, Simon / Walker, Marjorie M / Marks, Ellen / Talley, Nicholas J. ·School of Biomedical Sciences & Pharmacy, University of Newcastle & Vaccine and Asthma (VIVA) Program, Hunter Medical Research Institute, Callaghan, NSW, Australia. · School of Medicine & Public Health, University of Newcastle, Callaghan, NSW, Australia. ·Eur J Clin Invest · Pubmed #26444549.

ABSTRACT: Gastrointestinal conditions may be broadly classified into two: organic and functional disease, with functional disorders accounting for the majority of patients with chronic gastrointestinal symptoms. Functional gastrointestinal disorders (FGIDs) present with no obvious pathology or well-accepted biochemical mechanism and, as such, treatment strategies are limited and focus on symptoms rather than cure. Irritable bowel syndrome and functional dyspepsia are the most widely recognised FGIDs, and there is a growing body of evidence to suggest an underlying inflammatory phenotype in subsets with these conditions. Here, we discuss the current knowledge of immune involvement in FGIDs and the commonalities between the different manifestations of FGIDs and propose a new hypothesis, potentially defining an underlying immunopathological basis of these conditions.

11 Review Therapeutic strategies for functional dyspepsia and irritable bowel syndrome based on pathophysiology. 2015

Talley, Nicholas J / Holtmann, Gerald / Walker, Marjorie M. ·Global Research, University of Newcastle, HMRI Building, Room 3419, Kookaburra Circuit, New Lambton, NSW, 2305, Australia, nicholas.talley@newcastle.edu.au. ·J Gastroenterol · Pubmed #25917563.

ABSTRACT: Functional gastrointestinal disorders (FGIDs) are common and distressing. They are so named because a defined pathophysiology in terms of structural or biochemical pathways is lacking. Traditionally FGIDs have been conceptualized as brain-gut disorders, with subgroups of patients demonstrating visceral hypersensitivity and motility abnormalities as well as psychological distress. However, it is becoming apparent that there are certain structural or biochemical gut alterations among subsets with the common FGIDs, most notably functional dyspepsia (FD) and irritable bowel syndrome (IBS). For example, a sodium channel mutation has been identified in IBS that may account for 2 % of cases, and subtle intestinal inflammation has been observed in both IBS and FD. Other research has implicated early life events and stress, autoimmune disorders and atopy and infections, the gut microbiome and disordered mucosal immune activation in patients with IBS or FD. Understanding the origin of symptoms in FGIDs will allow therapy to be targeted at the pathophysiological changes, not at merely alleviating symptoms, and holds hope for eventual cure in some cases. For example, there are promising developments in manipulating the microbiome through diet, prebiotics and antibiotics in IBS, and testing and treating patients for Helicobacter pylori infection remains a mainstay of therapy in patients with dyspepsia and this infection. Locally acting drugs such as linaclotide have been an advance in treating the symptoms of constipation-predominant IBS, but do not alter the natural history of the disease. A role for a holistic approach to patients with FGIDs is warranted, as brain-to-gut and gut-to-brain pathways appear to be activated.

12 Review Current and emerging pharmacotherapeutic options for irritable bowel syndrome. 2014

Barboza, Jose L / Talley, Nicholas J / Moshiree, Baharak. ·University of South Florida College of Pharmacy, 12901 Bruce B. Downs Blvd. MDC30, Tampa, FL, 33612, USA. jbarboza@health.usf.edu. · University of Newcastle, Callaghan, NSW, 2308, Australia. · Mayo Clinic, Jacksonville, FL, USA. · Division of Gastroenterology, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA. ·Drugs · Pubmed #25260888.

ABSTRACT: Treatment of irritable bowel syndrome (IBS) is challenging for both primary care physicians and gastroenterologists because of the heterogeneity of the patient population and the multifactorial pathophysiologies responsible for the symptoms in IBS. This review focuses on the current and emerging pharmacological treatments for IBS. Many of the current medications used to treat this disorder have distinct properties such as efficacy for different symptoms, safety profiles, contraindications, costs, dosing regimens, treatment duration and long-term data. All of these factors, in addition to patient preference and cognitive, food and environmental triggers, must be considered prior to any medication selection. This review will focus on randomized controlled trials with a general uniformity in study design, a rigorous patient selection and appropriate treatment durations. We will also discuss other exciting emerging treatments for IBS such as the µ-opioid receptor (agonists and antagonists), selective κ-opioid receptor agonists, anti-inflammatory drugs, serotonergic agents, bile acid modulators and intestinal bile acid transporters, which may prove promising in treating our patients.

13 Review Irritable bowel syndrome. 2012

Ford, Alexander C / Talley, Nicholas J. ·Leeds Gastroenterology Institute, St James's University Hospital, UK. alexf12399@yahoo.com ·BMJ · Pubmed #22951548.

ABSTRACT: -- No abstract --

14 Review Mucosal inflammation as a potential etiological factor in irritable bowel syndrome: a systematic review. 2011

Ford, Alexander C / Talley, Nicholas J. ·Leeds Gastroenterology Institute, D Floor, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK. alexf12399@yahoo.com ·J Gastroenterol · Pubmed #21331765.

ABSTRACT: BACKGROUND: The causes of irritable bowel syndrome (IBS) remain obscure. Some investigators have proposed chronic low-grade mucosal inflammation as a potential etiological factor. We performed a systematic review to examine this issue in detail. METHODS: MEDLINE, EMBASE, and EMBASE classic were searched up to December 2010 to identify studies of case-control design applying tests for low-grade inflammation to either full-thickness intestinal or endoscopic mucosal biopsies from patients with IBS. Controls were required to be healthy individuals, or asymptomatic patients undergoing investigation for reasons other than the reporting of upper or lower gastrointestinal symptoms. Individual study results were summarized descriptively. RESULTS: The literature search identified 1388 citations, of which 16 studies were eligible for inclusion. Individual study results were diverse, partly as a consequence of the different surrogate markers for inflammatory mechanisms studied. Mast cells, T lymphocytes, B lymphocytes, and mucosal cytokine production all appeared altered among cases with IBS in individual studies, while no study demonstrated a significant difference in numbers of plasma cells, neutrophils, or eosinophils. Some studies suggested a relationship between mast cell abnormalities and symptom severity and frequency, as well as co-existent fatigue and depression. Studies were limited by the lack of comparability of controls, and the fact that most were conducted in highly selected groups of patients with IBS. CONCLUSIONS: Low-grade mucosal inflammation, particularly mast cell activation, may be a contributory factor in the pathogenesis of IBS. Mast cell stabilizers warrant further assessment as a potential therapy in the condition.

15 Review IBS in 2010: advances in pathophysiology, diagnosis and treatment. 2011

Ford, Alexander C / Talley, Nicholas J. ·Leeds Gastroenterology Institute, Leeds General Infirmary, Great George Street, Leeds, UK. alexf12399@yahoo.com ·Nat Rev Gastroenterol Hepatol · Pubmed #21293507.

ABSTRACT: IBS is a chronic, fluctuating disorder that continues to be the subject of considerable research. 2010 saw some key advances across all aspects of IBS, including further advances in our understanding of the pathophysiology, diagnosis and treatment of this condition.

16 Review An update on irritable bowel syndrome: from diagnosis to emerging therapies. 2011

Chang, Joseph Y / Talley, Nicholas J. ·Enteric NeuroScience Program, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. ·Curr Opin Gastroenterol · Pubmed #21099429.

ABSTRACT: PURPOSE OF REVIEW: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder characterized by abdominal discomfort or pain that is accompanied by a disturbance in defecation. Although the exact etiopathogenesis is not completely understood, recent advances in the understanding of the biochemical, physiologic, and biopsychosocial mechanisms of IBS have resulted in exciting new insights as well as therapies. This article will review the recent developments in pathogenesis, diagnosis, and treatment. RECENT FINDINGS: IBS may be the product of various pathogenic mechanisms which include IBS as a serotonergic disorder; the role of genetics; IBS as an inflammatory state and the potential role of mast cells; IBS as a result of bacterial overgrowth and altered gastrointestinal microbiome; and abnormal pain processing and pain memory. Emerging therapies have developed targeting these mechanisms. SUMMARY: IBS remains a symptom-based diagnosis that can usually be made comfortably based on clinical history without testing in the absence of alarm features. Novel and emerging therapies that are based upon the evolving understanding of the pathophysiology of IBS hold significant promise and for the first time there are potential therapies that may alter the natural history of this disorder.

17 Review Current and emerging therapies in irritable bowel syndrome: from pathophysiology to treatment. 2010

Chang, Joseph Y / Talley, Nicholas J. ·Enteric NeuroScience Program, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street SW Rochester, MN 55905, USA. ·Trends Pharmacol Sci · Pubmed #20554042.

ABSTRACT: Irritable bowel syndrome is a common functional gastrointestinal disorder with characteristic symptoms of abdominal pain/discomfort with a concurrent disturbance in defecation. It accounts for a significant healthcare burden, and symptoms may be debilitating for some patients. Traditional symptom-based therapies have been found to be ineffective in the treatment of the entire syndrome complex, and do not modify the natural history of the disorder. Although the exact etiopathogenesis of IBS is incompletely understood, recent advances in the elucidation of the pathophysiology and molecular mechanisms of IBS have resulted in the development of novel therapies, as well as potential future therapeutic targets. This article reviews current and emerging therapies in IBS based upon: IBS as a serotonergic disorder; stimulating intestinal chloride channels; modulation of visceral hypersensitivity; altering low-grade intestinal inflammation; and modulation of the gut microbiota.

18 Review Errors in the conduct of systematic reviews of pharmacological interventions for irritable bowel syndrome. 2010

Ford, Alexander C / Guyatt, Gordon H / Talley, Nicholas J / Moayyedi, Paul. ·Gastroenterology Division, Health Sciences Center, McMaster University, Hamilton, Ontario, Canada. alexf12399@yahoo.com ·Am J Gastroenterol · Pubmed #19920807.

ABSTRACT: OBJECTIVES: Systematic reviews and meta-analyses are integral to evidence-based clinical decision making. Although flawed systematic reviews could compromise optimal decision making, their accuracy has received limited investigation. We assessed conduct of systematic reviews of pharmaceutical interventions for irritable bowel syndrome (IBS). METHODS: We searched MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews (up to June 2008) to identify and replicate all published systematic reviews and meta-analyses that examined pharmacological interventions for IBS. We identified trials appropriately and inappropriately included according to the investigators' own eligibility criteria and eligible trials the investigators failed to include, and assessed the accuracy of dichotomous data extraction from all truly eligible trials. We conducted meta-analyses of accurate data from all truly eligible trials, and examined the differences between these accurate estimates and those reported by the authors. RESULTS: The search strategy identified 120 citations, and 13 appeared to be relevant. Five systematic reviews did not extract dichotomous data, leaving eight eligible for inclusion. In five of the eight meta-analyses 13-29% of included trials were ineligible according to investigators' criteria, constituting 8-26% of included patients. Six of the meta-analyses missed 17 separate published eligible trials; 3-11% of eligible patients were, as a result, not included. All eight meta-analyses contained errors in dichotomous data extraction, in 29-100% of truly eligible trials, leading to errors in 15 of 16 reported pooled treatment effects. There was a > or =10% relative difference in treatment effects between the reported and recalculated summary statistic in five (31%) cases, and a change in the statistical significance of the recalculated summary statistic in a further four (25%) cases. CONCLUSIONS: We found many errors in both application of eligibility criteria and dichotomous data extraction in the eight meta-analyses studied. Independent verification of systematic reviews and meta-analyses may be required for full confidence in their results.

19 Review The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. 2010

Moayyedi, P / Ford, A C / Talley, N J / Cremonini, F / Foxx-Orenstein, A E / Brandt, L J / Quigley, E M M. ·Department of Medicine, Division of Gastroenterology, McMaster University Medical Centre, 1200 Main Street West, HSC 4W8E, Hamilton, ON L8N 3Z5, Canada. moayyep@mcmaster.ca ·Gut · Pubmed #19091823.

ABSTRACT: INTRODUCTION: Probiotics may benefit irritable bowel syndrome (IBS) symptoms, but randomised controlled trials (RCTs) have been conflicting; therefore a systematic review was conducted. METHODS: MEDLINE (1966 to May 2008), EMBASE (1988 to May 2008) and the Cochrane Controlled Trials Register (2008) electronic databases were searched, as were abstracts from DDW (Digestive Diseases Week) and UEGW (United European Gastroenterology Week), and authors were contacted for extra information. Only parallel group RCTs with at least 1 week of treatment comparing probiotics with placebo or no treatment in adults with IBS according to any acceptable definition were included. Studies had to provide improvement in abdominal pain or global IBS symptoms as an outcome. Eligibility assessment and data extraction were performed by two independent researchers. Data were synthesised using relative risk (RR) of symptoms not improving for dichotomous data and standardised mean difference (SMD) for continuous data using random effects models. RESULTS: 19 RCTs (18 papers) in 1650 patients with IBS were identified. Trial quality was generally good, with nine reporting adequate methods of randomisation and six a method of concealment of allocation. There were 10 RCTs involving 918 patients providing outcomes as a dichotomous variable. Probiotics were statistically significantly better than placebo (RR of IBS not improving=0.71; 95% CI 0.57 to 0.88) with a number needed to treat (NNT)=4 (95% CI 3 to 12.5). There was significant heterogeneity (chi(2)=28.3, p=0.001, I(2)=68%) and possible funnel plot asymmetry. Fifteen trials assessing 1351 patients reported on improvement in IBS score as a continuous outcome (SMD=-0.34; 95% CI -0.60 to -0.07). There was statistically significant heterogeneity (chi(2)=67.04, p<0.001, I(2)=79%), but this was explained by one outlying trial. CONCLUSION: Probiotics appear to be efficacious in IBS, but the magnitude of benefit and the most effective species and strain are uncertain.

20 Review Small intestinal bacterial overgrowth in irritable bowel syndrome: systematic review and meta-analysis. 2009

Ford, Alexander C / Spiegel, Brennan M R / Talley, Nicholas J / Moayyedi, Paul. ·Gastroenterology Division, McMaster University, Health Sciences Centre, Hamilton, Ontario, Canada. alexf12399@yahoo.com ·Clin Gastroenterol Hepatol · Pubmed #19602448.

ABSTRACT: BACKGROUND & AIMS: Small intestinal bacterial overgrowth (SIBO) has been proposed as an etiologic factor in irritable bowel syndrome (IBS), but evidence is conflicting. We conducted a systematic review and meta-analysis of the prevalence of SIBO in IBS. METHODS: MEDLINE and EMBASE were searched up to November 2008. Case series and case-control studies applying diagnostic tests for SIBO in unselected adults meeting diagnostic criteria for IBS were eligible. Prevalence of a positive test for SIBO was extracted and pooled for all studies, and compared between cases and controls using an odds ratio and 95% confidence interval (CI). RESULTS: Twelve studies were identified containing 1921 subjects meeting criteria for IBS. Pooled prevalence of a positive lactulose or glucose hydrogen breath test was 54% (95% CI, 32%-76%) and 31% (95% CI, 14%-50%), respectively, with statistically significant heterogeneity between study results. Prevalence of a positive jejunal aspirate and culture was 4% (95% CI, 2%-9%). The pooled odds ratio for any positive test for SIBO in cases compared with healthy asymptomatic controls was 3.45 (95% CI, 0.9-12.7) or 4.7 (95% CI, 1.7-12.95), depending on the criteria used to define a positive test, with statistically significant heterogeneity for both. CONCLUSIONS: Prevalence of SIBO in individuals meeting diagnostic criteria for IBS was highest with breath testing. The prevalence in cases with IBS compared with controls varied according to criteria used to define a positive test. The role of testing for SIBO in individuals with suspected IBS remains unclear.

21 Review An evidence-based position statement on the management of irritable bowel syndrome. 2009

Anonymous2020631 / Brandt, Lawrence J / Chey, William D / Foxx-Orenstein, Amy E / Schiller, Lawrence R / Schoenfeld, Philip S / Spiegel, Brennan M / Talley, Nicholas J / Quigley, Eamonn M M. ·Department of Medicine, Montefiore Medical Center, Albert Einstein School of Medicine. ·Am J Gastroenterol · Pubmed #19521341.

ABSTRACT: -- No abstract --

22 Review Green light from the FDA for new drug development in irritable bowel syndrome and functional dyspepsia. 2009

Talley, Nicholas J. ·Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA. ·Am J Gastroenterol · Pubmed #19491845.

ABSTRACT: -- No abstract --

23 Review Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis. 2009

Ford, Alexander C / Chey, William D / Talley, Nicholas J / Malhotra, Ashish / Spiegel, Brennan M R / Moayyedi, Paul. ·MB MRCP, Gastroenterology Division, McMaster University, Health Sciences Centre, 1200 Main St W, Hamilton, ON L8N 3Z5, Canada. alexf12399@yahoo.com ·Arch Intern Med · Pubmed #19364994.

ABSTRACT: BACKGROUND: Individuals with irritable bowel syndrome (IBS) report abdominal pain, bloating, and diarrhea, symptoms similar to those in celiac disease. Studies suggest that the prevalence of celiac disease is increased in individuals with IBS; however, evidence is conflicting, and current guidelines do not always recommend screening for celiac disease in these individuals. METHODS: We conducted a systematic review and meta-analysis to estimate prevalence of celiac disease in unselected adults who met diagnostic criteria for IBS. MEDLINE (1950 to May 31, 2008) and EMBASE (1980 to May 31, 2008) were searched. Case series and case-control studies that used serologic tests for celiac disease were eligible for inclusion. Prevalence of positive serologic indications of celiac disease and biopsy-proved celiac disease were extracted and pooled for all studies and were compared between cases and controls using an odds ratio and 95% confidence interval. RESULTS: Fourteen studies were identified comprising 4204 individuals, of whom 2278 (54%) met diagnostic criteria for IBS. Pooled prevalence of positive IgA-class antigliadin antibodies, either positive endomysial antibodies or tissue transglutaminase, and biopsy-proved celiac disease were 4.0% (95% confidence interval, 1.7-7.2), 1.63% (0.7-3.0), and 4.1% (1.9-7.0), respectively. Pooled odds ratios (95% confidence intervals) for positive IgA-class antigliadin antibodies, either positive endomysial antibodies or tissue transglutaminase, and biopsy-proved celiac disease in cases meeting diagnostic criteria for IBS compared with controls without IBS were 3.40 (1.62-7.13), 2.94 (1.36-6.35), and 4.34 (1.78-10.6). CONCLUSION: Prevalence of biopsy-proved celiac disease in cases meeting diagnostic criteria for IBS was more than 4-fold that in controls without IBS.

24 Review Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis. 2009

Ford, A C / Talley, N J / Schoenfeld, P S / Quigley, E M M / Moayyedi, P. ·Gastroenterology Division, McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada. alexf12399@yahoo.com ·Gut · Pubmed #19001059.

ABSTRACT: OBJECTIVE: Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder. Evidence for treatment of the condition with antidepressants and psychological therapies is conflicting. DESIGN: Systematic review and meta-analysis of randomised controlled trials (RCTs). MEDLINE, EMBASE and the Cochrane Controlled Trials Register were searched (up to May 2008). SETTING: RCTs based in primary, secondary and tertiary care. PATIENTS: Adults with IBS. INTERVENTIONS: Antidepressants versus placebo, and psychological therapies versus control therapy or "usual management". MAIN OUTCOME MEASURES: Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% confidence interval (CI). The number needed to treat (NNT) was calculated from the reciprocal of the risk difference. RESULTS: The search strategy identified 571 citations. Thirty-two RCTs were eligible for inclusion: 19 compared psychological therapies with control therapy or "usual management", 12 compared antidepressants with placebo, and one compared both psychological therapy and antidepressants with placebo. Study quality was generally good for antidepressant but poor for psychological therapy trials. The RR of IBS symptoms persisting with antidepressants versus placebo was 0.66 (95% CI, 0.57 to 0.78), with similar treatment effects for both tricyclic antidepressants and selective serotonin reuptake inhibitors. The RR of symptoms persisting with psychological therapies was 0.67 (95% CI, 0.57 to 0.79). The NNT was 4 for both interventions. CONCLUSIONS: Antidepressants are effective in the treatment of IBS. There is less high-quality evidence for routine use of psychological therapies in IBS, but available data suggest these may be of comparable efficacy.

25 Review Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. 2008

Ford, Alexander C / Talley, Nicholas J / Spiegel, Brennan M R / Foxx-Orenstein, Amy E / Schiller, Lawrence / Quigley, Eamonn M M / Moayyedi, Paul. ·Gastroenterology Division, McMaster University, Health Sciences Centre, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada. alexf12399@yahoo.com ·BMJ · Pubmed #19008265.

ABSTRACT: OBJECTIVE: To determine the effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome. DESIGN: Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES: Medline, Embase, and the Cochrane controlled trials register up to April 2008. Review methods Randomised controlled trials comparing fibre, antispasmodics, and peppermint oil with placebo or no treatment in adults with irritable bowel syndrome were eligible for inclusion. The minimum duration of therapy considered was one week, and studies had to report either a global assessment of cure or improvement in symptoms, or cure of or improvement in abdominal pain, after treatment. A random effects model was used to pool data on symptoms, and the effect of therapy compared with placebo or no treatment was reported as the relative risk (95% confidence interval) of symptoms persisting. RESULTS: 12 studies compared fibre with placebo or no treatment in 591 patients (relative risk of persistent symptoms 0.87, 95% confidence interval 0.76 to 1.00). This effect was limited to ispaghula (0.78, 0.63 to 0.96). Twenty two trials compared antispasmodics with placebo in 1778 patients (0.68, 0.57 to 0.81). Various antispasmodics were studied, but otilonium (four trials, 435 patients, relative risk of persistent symptoms 0.55, 0.31 to 0.97) and hyoscine (three trials, 426 patients, 0.63, 0.51 to 0.78) showed consistent evidence of efficacy. Four trials compared peppermint oil with placebo in 392 patients (0.43, 0.32 to 0.59). CONCLUSION: Fibre, antispasmodics, and peppermint oil were all more effective than placebo in the treatment of irritable bowel syndrome.

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