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Irritable Bowel Syndrome: HELP
Articles from Germany
Based on 171 articles published since 2008

These are the 171 published articles about Irritable Bowel Syndrome that originated from Germany during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7
1 Guideline [Irritable bowel syndrome: German consensus guidelines on definition, pathophysiology and management]. 2011

Layer, P / Andresen, V / Pehl, C / Allescher, H / Bischoff, S C / Classen, M / Enck, P / Frieling, T / Haag, S / Holtmann, G / Karaus, M / Kathemann, S / Keller, J / Kuhlbusch-Zicklam, R / Kruis, W / Langhorst, J / Matthes, H / Mönnikes, H / Müller-Lissner, S / Musial, F / Otto, B / Rosenberger, C / Schemann, M / van der Voort, I / Dathe, K / Preiss, J C / Anonymous5280685 / Anonymous5290685. ·Für die Konsensusgruppe Reizdarmsyndrom; Konsensuskonferenz 18./ 19.9.2009. layer@ik-h.de ·Z Gastroenterol · Pubmed #21287438.

ABSTRACT: -- No abstract --

2 Editorial Editorial: irritable bowel syndrome-in addition to having properly-trained dietitians, is it time to add a yoga teacher to our multidisciplinary team? Authors' reply. 2018

Schumann, D / Cramer, H. ·Department of Internal and Integrative Medicine, Faculty of Medicine, Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany. ·Aliment Pharmacol Ther · Pubmed #29314131.

ABSTRACT: -- No abstract --

3 Editorial [Complementary therapies in the guidelines for the treatment of irritable bowel syndrome]. 2015

Lauche, Romy / Cramer, Holger / Klose, Petra / Dobos, Gustav / Langhorst, Jost. ·Klinik für Naturheilkunde und Integrative Medizin, Kliniken Essen-Mitte, Medizinische Fakultät, Universität Duisburg-Essen, Essen, Deutschland. ·Forsch Komplementmed · Pubmed #25824397.

ABSTRACT: -- No abstract --

4 Editorial Imaging the leaky gut. 2014

Wallace, Michael B / Vazquez-Roque, Maria / Bojarski, Christian / Schulzke, Jörg-Dieter. ·Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida. Electronic address: Wallace.Michael@mayo.edu. · Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida. · Department of Gastroenterology, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany. · Institute of Clinical Physiology, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany. ·Gastroenterology · Pubmed #25265577.

ABSTRACT: -- No abstract --

5 Review Low fermentable, oligo-, di-, mono-saccharides and polyol diet in the treatment of irritable bowel syndrome: A systematic review and meta-analysis. 2018

Schumann, Dania / Klose, Petra / Lauche, Romy / Dobos, Gustav / Langhorst, Jost / Cramer, Holger. ·Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany. Electronic address: d.schumann@kliniken-essen-mitte.de. · Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany. · Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany; Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney, Australia. ·Nutrition · Pubmed #29129233.

ABSTRACT: OBJECTIVES: The aim of this review was to systematically assess and meta-analyze the effects of a low fermentable, oligo-, di-, mono-saccharides and polyol (FODMAP) diet (LFD) on the severity of symptoms, quality of life, and safety in patients with irritable bowel syndrome (IBS). METHODS: The MEDLINE/PubMed, Scopus, and Cochrane Library databases were screened through January 19, 2016. Randomized controlled trials (RCTs) that compared LFD to other diets were included if they assessed symptoms of IBS or abdominal pain in patients with IBS. Safety, quality of life, anxiety, depression, and effect on gut microbiota were defined as secondary outcomes. Standardized mean difference (SMD) and 95% confidence interval (CI) were calculated. RESULTS: Nine RCTs with a total of 596 subjects were included. Three RCTs compared LFD with a habitual diet, two RCTs provided all meals and compared LFD with a western diet, one RCT each compared LFD with a diet high in FODMAPs or a sham diet, and two RCTs compared with other diet recommendations for IBS. A meta-analysis revealed significant group differences for LFD compared with other diets with regard to gastrointestinal symptoms (SMD = -0.62; 95% CI = -0.93 to -0.31; P = 0.0001), abdominal pain (SMD = -0.50; 95% CI = -0.77 to -0.22; P = 0.008), and health-related quality of life (SMD = 0.36; 95% CI = 0.10-0.62; P = 0.007). Three studies reported a significant reduction in luminal bifidobacteria after LFD. Adverse events were assessed in three RCTs only and no intervention-related adverse events were reported. CONCLUSIONS: This meta-analysis found evidence of the short-term efficacy and safety of LFD in patients with IBS. However, only a preliminary recommendation for LFD can be made until long-term effects are investigated.

6 Review Mechanism of Action of STW 5 in Functional Dyspepsia and IBS: The Origin of Multi-Target. 2017

Allescher, Hans-Dieter / Abdel-Aziz, Heba. ·Center for Esophageal and Gastrointestinal Motility Disorders, Center for Internal Medicine, Gastroenterology, Hepatology and Metabolism, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany. · Medical and Clinical Affairs Phytomedicines, Steigerwald Arzneimittelwerk GmbH, Bayer Consumer Health, Darmstadt, Germany. ·Dig Dis · Pubmed #29421789.

ABSTRACT: BACKGROUND: STW 5 is a complex herbal combination preparation composed of 9 different herbal extracts. As an herbal medicinal product, this preparation is indicated for treating functional dyspepsia (FD) and irritable bowel syndrome (IBS). Its efficacy and practical applicability was demonstrated in several clinical studies. SUMMARY: Each herbal constituent of STW 5 has distinct effects on the gastrointestinal tract, and each shows activity through different mechanisms of action: among others, the single extracts have effects on nerves, smooth muscles, epithelial, and inflammatory cells. For example, they have relaxing or tonicizing effects on gastrointestinal muscles, and they counteract inflammation through different physiological systems, contributing to the clinical efficacy through modulation of multiple therapeutic targets. Key Messages: STW 5 is a role model for the concept of multi-targeting in therapy. Especially in complex syndromes such as FD and IBS, simultaneous multi-targeting of different functional causes seems to be a more promising approach than the classical paradigm of one disease - one receptor - one effect.

7 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.

8 Review Evaluating the Multitarget Effects of Combinations through Multistep Clustering of Pharmacological Data: the Example of the Commercial Preparation Iberogast. 2017

Abdel-Aziz, Heba / Kelber, Olaf / Lorkowski, Gerhard / Storr, Martin. ·Phytomedicines Supply and Development Center, Steigerwald Arzneimittelwerk GmbH, Bayer Consumer Health, Darmstadt, Germany. · GL Pharma Consulting Research & Development, Gauting, Germany. · Center of Endoscopy, Starnberg and Medical Clinic II, Ludwig-Maximilians University, Munich, Germany. ·Planta Med · Pubmed #28859216.

ABSTRACT: Herbal combination preparations are widely used in traditional herbal medicine and are even established as modern evidence-based herbal medicinal products. The rationale behind such combinations is often questioned and assessing the contribution of each of the combination partners to overall activity is challenging. STW 5 (Iberogast) is such a combination with confirmed clinical efficacy in functional gastrointestinal disorders. It consists of nine plant extracts responsible for its multitarget function in these multifactorial diseases with their heterogeneous and overlapping pathomechanisms. This makes the combination an ideal candidate for the use of the newly described method of stepwise cluster analysis, a standardized procedure to transfer heterogeneous pharmacological data, from different models, into effect size categories. This allows for a stepwise cluster formation starting from the level of single tests up to the level of different pathomechanisms involved in the development of a certain disease, in this case functional dyspepsia subtypes and irritable bowel syndrome. In the current article, an overview on the pharmacological data on STW 5 and its single components is provided. The data are further analyzed using stepwise cluster formation, resulting in a summary of the different modes of action of STW 5 along with an evaluation of the contribution of the single constituents to the overall multitarget effects of the herbal combination preparation.

9 Review Modulation of gastrointestinal motility beyond metoclopramide and domperidone : Pharmacological and clinical evidence for phytotherapy in functional gastrointestinal disorders. 2017

Madisch, Ahmed / Vinson, Bettina R / Abdel-Aziz, Heba / Kelber, Olaf / Nieber, Karen / Kraft, Karin / Storr, Martin. ·Gastroenterologie, Interventionelle Endoskopie, Diabetologie, KRH Klinikum Siloah, Hannover, Germany. · Medical and Clinical Affairs Phytomedicines, Innovation and Development, Phytomedicines Supply and Development Center, Bayer Consumer Health, Steigerwald Arzneimittelwerk GmbH, Darmstadt, Germany. · Scientific Strategy Phytomedicines, Innovation and Development, Phytomedicines Supply and Development Center, Bayer Consumer Health, Steigerwald Arzneimittelwerk GmbH, Darmstadt, Germany. · Institut für Pharmazie, Universität Leipzig, Leipzig, Germany. · Lehrstuhl für Naturheilkunde, Zentrum für Innere Medizin, Universitätsmedizin Rostock, Rostock, Germany. · Zentrum für Endoskopie, Oßwaldstraße 1, 82319, Starnberg, Germany. gidoc@gmx.com. ·Wien Med Wochenschr · Pubmed #28424994.

ABSTRACT: The prokinetic cisapride, an important therapeutic option in functional gastrointestinal (GI) disorders, was withdrawn from the market 15 years ago due to rare severe side effects. Likewise in 2014, the use of metoclopramide (MCP) and domperidone in functional GI disorders (FGID) was restricted, consequently leaving a therapeutic gap in clinical practice. A systematic review revealed that the herbal medicinal product (HMP) STW 5 presents a therapeutic option equivalent to MCP and cisapride. STW 5 is the only HMP for which efficacy has been shown in randomized controlled clinical trials (RCTs) in functional dyspepsia and irritable bowel syndrome, based on its multitarget effect on numerous etiological factors. Due to an outstanding favorable safety profile, STW 5 allows an effective and safe use in FGID without a limitation of the duration of the treatment.

10 Review A fresh look at IBS-opportunities for systems medicine approaches. 2017

Albusoda, A / Barki, N / Herregods, T / Kamphuis, J B J / Karunaratne, T B / Lazarou, M / Lee, I / Mazurak, N / Perna, E / Polster, A / Pribic, T / Uhlig, F / Wang, H / Enck, P. ·Queen Mary and Westfield College University of London, London, UK. · Technische Universität München, Munich, Germany. · Academisch Medisch Centrum bij de Universiteit, Amsterdam, The Netherlands. · Institut National de la Recherche Agronomique, Toulouse, France. · Alma Mater Studiorum Università di Bologna, Bologna, Italy. · Eberhard Karls Universität Tübingen, Tübingen, Germany. · Symbio Pharm GmbH, Herborn, Germany. · Katholieke Universiteit Leuven, Leuven, Belgium. · Göteborgs Universitet, Gothenburg, Sweden. · Fundacio Hospital Universitari Vall d'Hebron, Institut de Recerca, Barcelona, Spain. · University of Sheffield, Sheffield, UK. ·Neurogastroenterol Motil · Pubmed #27997070.

ABSTRACT: NeuroGUT is a EU-funded initial training network (ITN) of 14 research projects in neurogastroenterology that have employed an equal number of early-stage researchers. Neurogut trainees have-among other activities-attended an international conference on irritable bowel syndrome (IBS) in Bologna in 2016 and were asked to critically review and evaluate the current knowledge on IBS for their respective research activities, and to state what they were missing. Most appreciated were the topics brain imaging of gut activity, the role of the gut microbiota, the pharmacology of gut functions, the IBS-IBD interrelation, the new Rome IV criteria, the role of gas, and the placebo response in functional disorders. Missed were more detailed coverage of high-resolution manometry, functional brain imaging, advanced "systems medicine" approaches and bioinformatics technology, better sub-classification of IBS patients, and the development of disease biomarkers, extended at the molecular (genetic/epigenetic, proteonomic) level. They summarize that despite excellent specialized research, there is a gap open that should be filled with systems medicine. For this, it would be necessary that medical research learns even more from the data sciences and other basic disciplines, for example, information technology and system biology, and also welcomes a change in paradigm that enhances open sharing of data, information, and resources.

11 Review Consensus report: faecal microbiota transfer - clinical applications and procedures. 2017

König, J / Siebenhaar, A / Högenauer, C / Arkkila, P / Nieuwdorp, M / Norén, T / Ponsioen, C Y / Rosien, U / Rossen, N G / Satokari, R / Stallmach, A / de Vos, W / Keller, J / Brummer, R J. ·Örebro, Sweden. · Hamburg, Germany. · Graz, Austria. · Helsinki, Finland. · Amsterdam, The Netherlands. · Gothenburg, Sweden. · Jena, Germany. · Wageningen, The Netherlands. ·Aliment Pharmacol Ther · Pubmed #27891639.

ABSTRACT: BACKGROUND: Faecal microbiota transplantation or transfer (FMT) aims at replacing or reinforcing the gut microbiota of a patient with the microbiota from a healthy donor. Not many controlled or randomised studies have been published evaluating the use of FMT for other diseases than Clostridium difficile infection, making it difficult for clinicians to decide on a suitable indication. AIM: To provide an expert consensus on current clinical indications, applications and methodological aspects of FMT. METHODS: Well-acknowledged experts from various countries in Europe have contributed to this article. After literature review, consensus has been achieved by repetitive circulation of the statements and the full manuscript among all authors with intermittent adaptation to comments (using a modified Delphi process). Levels of evidence and agreement were rated according to the GRADE system. Consensus was defined a priori as agreement by at least 75% of the authors. RESULTS: Key recommendations include the use of FMT in recurrent C. difficile infection characterised by at least two previous standard treatments without persistent cure, as well as its consideration in severe and severe-complicated C. difficile infection as an alternative to total colectomy in case of early failure of antimicrobial therapy. FMT in inflammatory bowel diseases (IBD), irritable bowel syndrome (IBS) and metabolic syndrome should only be performed in research settings. CONCLUSIONS: Faecal microbiota transplantation or transfer is a promising treatment for a variety of diseases in which the intestinal microbiota is disturbed. For indications other than C. difficile infection, more evidence is needed before more concrete recommendations can be made.

12 Review Mucosal pathobiology and molecular signature of epithelial barrier dysfunction in the small intestine in irritable bowel syndrome. 2017

González-Castro, Ana M / Martínez, Cristina / Salvo-Romero, Eloísa / Fortea, Marina / Pardo-Camacho, Cristina / Pérez-Berezo, Teresa / Alonso-Cotoner, Carmen / Santos, Javier / Vicario, María. ·Laboratory of Neuro-Immuno-Gastroenterology, Digestive Diseases Research Unit, Vall d'Hebron Institut de Recerca, Department of Gastroenterology, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. · Department of Human Molecular Genetics, Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany. · Inserm, U1043, Toulouse, France. · Centre de Physiopathologie de Toulouse Purpan (CPTP), Université de Toulouse, Université Paul Sabatier, Toulouse, France. · Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain. ·J Gastroenterol Hepatol · Pubmed #27087165.

ABSTRACT: Irritable bowel syndrome (IBS) is one of the most prevalent gastrointestinal disorders in developed countries. Its etiology remains unknown; however, a common finding, regardless of IBS subtype, is the presence of altered intestinal barrier. In fact, signaling and location of cell-to-cell adhesion proteins, in connection with increased immune activity, seem abnormal in the intestinal epithelium of IBS patients. Despite that most research is performed on distal segments of the intestine, altered permeability has been reported in both, the small and the large bowel of all IBS subtypes. The small intestine carries out digestion and nutrient absorption and is also the site where the majority of immune responses to luminal antigens takes place. In fact, the upper intestine is more exposed to environmental antigens than the colon and is also a site of symptom generation. Recent studies have revealed small intestinal structural alterations of the epithelial barrier and mucosal immune activation in association with intestinal dysfunction, suggesting the commitment of the intestine as a whole in the pathogenesis of IBS. This review summarizes the most recent findings on mucosal barrier alterations and its relationship to symptoms arising from the small intestine in IBS, including epithelial structural abnormalities, mucosal immune activation, and microbial dysbiosis, further supporting the hypothesis of an organic origin of IBS.

13 Review Phenotyping of subjects for large scale studies on patients with IBS. 2016

Boeckxstaens, G E / Drug, V / Dumitrascu, D / Farmer, A D / Hammer, J / Hausken, T / Niesler, B / Pohl, D / Pojskic, L / Polster, A / Simren, M / Goebel-Stengel, M / Van Oudenhove, L / Vassallo, M / Wensaas, K-A / Aziz, Q / Houghton, L A / Anonymous3490872. ·Translational Research Center for Gastrointestinal Disorders, KULeuven & Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium. · Gastroenterology Department, University Hospital "St Spiridon", Gr. T.Popa University of Medicine and Pharmacy, Iasi, Romania. · 2nd Medical Dept., Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. · Wingate Institute of Neurogastroenterology, Barts and The London School of Medicine and Dentistry, London, UK. · Department of Gastroenterology, University Hospitals of North Midlands, Stoke on Trent, UK. · Medizinische Universität Wien, Universitätsklinik für Innere Medizin 3, Vienna, Austria. · Department of Medicine, Unit of Gastroenterology, Haukeland University Hospital, Bergen, Norway. · Department of Human Molecular Genetics, University of Heidelberg, Heidelberg, Germany. · Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland. · Institute for Genetic Engineering and Biotechnology, University of Sarajevo, Sarajevo, Bosnia and Herzegovina. · 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 at Chapel Hill, Chapel Hill, NC, USA. · Department of Internal Medicine, Martin-Luther-Krankenhaus, Berlin, Germany. · Department of Medicine, Mater Dei Hospital, Tal-Qroqq, Malta. · Uni Research Health, Research Unit for General Practice, Bergen, Norway. · Leeds Institute of Biomedical and Clinical Sciences, University of Leeds and Leeds Gastroenterology Institute, Leeds Teaching Hospitals Trust, Leeds, UK. · Centre for Gastrointestinal Sciences, University of Manchester, Manchester, UK. · Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA. ·Neurogastroenterol Motil · Pubmed #27319981.

ABSTRACT: BACKGROUND: Irritable bowel syndrome (IBS) is a complex condition with multiple factors contributing to its aetiology and pathophysiology. Aetiologically these include genetics, life-time events and environment, and physiologically, changes in motility, central processing, visceral sensitivity, immunity, epithelial permeability and gastrointestinal microflora. Such complexity means there is currently no specific reliable biomarker for IBS, and thus IBS continues to be diagnosed and classified according to symptom based criteria, the Rome Criteria. Carefully phenotyping and characterisation of a 'large' pool of IBS patients across Europe and even the world however, might help identify sub-populations with accuracy and consistency. This will not only aid future research but improve tailoring of treatment and health care of IBS patients. PURPOSE: The aim of this position paper is to discuss the requirements necessary to standardize the process of selecting and phenotyping IBS patients and how to organise the collection and storage of patient information/samples in such a large multi-centre pan European/global study. We include information on general demographics, gastrointestinal symptom assessment, psychological factors, quality of life, physiological evaluation, genetic/epigenetic and microbiota analysis, biopsy/blood sampling, together with discussion on the organisational, ethical and language issues associated with implementing such a study. The proposed approach and documents selected to be used in such a study was the result of a thoughtful and thorough four-year dialogue amongst experts associated with the European COST action BM1106 GENIEUR (www.GENIEUR.eu).

14 Review Manipulation of the Microbiota Using Probiotics. 2016

Grimm, Verena / Riedel, Christian U. ·Institute of Microbiology and Biotechnology, University of Ulm, Albert-Einstein-Allee 11, 89069, Ulm, Germany. verena.grimm@uni-ulm.de. · Institute of Microbiology and Biotechnology, University of Ulm, Albert-Einstein-Allee 11, 89069, Ulm, Germany. ·Adv Exp Med Biol · Pubmed #27161354.

ABSTRACT: A number of diseases are associated with alterations in the composition of the microbiota of various niches of the human body. Although, in most cases, it is unclear if these alterations are the cause or the consequence of disease, they provide a rationale for therapeutic or prophylactic manipulation of a dysbiotic microbiota. Approaches to manipulate the microbiome include administration of either live bacteria, which are underrepresented in the diseased individual, substances that aim at increasing the populations of these bacteria, or a combination of the two. This chapter summarizes the available data in therapeutic manipulation of a various diseased states including irritable bowel syndrome, inflammatory bowel disease, necrotizing enterocolitis, atopic and allergic diseases, and antibiotic-associated and infectious diarrhoea.

15 Review Irritable bowel syndrome. 2016

Enck, Paul / Aziz, Qasim / Barbara, Giovanni / Farmer, Adam D / Fukudo, Shin / Mayer, Emeran A / Niesler, Beate / Quigley, Eamonn M M / Rajilić-Stojanović, Mirjana / Schemann, Michael / Schwille-Kiuntke, Juliane / Simren, Magnus / Zipfel, Stephan / Spiller, Robin C. ·Department of Internal Medicine VI (Psychosomatic Medicine and Psychotherapy), University Hospital Tübingen, Tübingen, Germany. · Wingate Institute of Neurogastroenterology, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK. · Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, Bologna, Italy. · Department of Behavioural Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. · Oppenheimer Center for Neurobiology of Stress, Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. · Department of Human Molecular Genetics, University of Heidelberg, Heidelberg, Germany. · Lynda K and David M Underwood Center for Digestive Disorders, Division of Gastroenterology and Hepatology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, Texas, USA. · Department of Biochemical Engineering and Biotechnology, Faculty of Technology and Metallurgy, University of Belgrade, Belgrade, Serbia. · Department of Human Biology, Technical University Munich, Freising-Weihenstephan, Germany. · Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. · NIHR Nottingham Digestive Diseases Biomedical Research Unit, University of Nottingham, Nottingham, UK. ·Nat Rev Dis Primers · Pubmed #27159638.

ABSTRACT: Irritable bowel syndrome (IBS) is a functional gastrointestinal disease with a high population prevalence. The disorder can be debilitating in some patients, whereas others may have mild or moderate symptoms. The most important single risk factors are female sex, younger age and preceding gastrointestinal infections. Clinical symptoms of IBS include abdominal pain or discomfort, stool irregularities and bloating, as well as other somatic, visceral and psychiatric comorbidities. Currently, the diagnosis of IBS is based on symptoms and the exclusion of other organic diseases, and therapy includes drug treatment of the predominant symptoms, nutrition and psychotherapy. Although the underlying pathogenesis is far from understood, aetiological factors include increased epithelial hyperpermeability, dysbiosis, inflammation, visceral hypersensitivity, epigenetics and genetics, and altered brain-gut interactions. IBS considerably affects quality of life and imposes a profound burden on patients, physicians and the health-care system. The past decade has seen remarkable progress in our understanding of functional bowel disorders such as IBS that will be summarized in this Primer.

16 Review Effect of Yoga in the Therapy of Irritable Bowel Syndrome: A Systematic Review. 2016

Schumann, Dania / Anheyer, Dennis / Lauche, Romy / Dobos, Gustav / Langhorst, Jost / Cramer, Holger. ·Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany. Electronic address: d.schumann@kliniken-essen-mitte.de. · Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany. · Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany; Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Sydney, Australia. ·Clin Gastroenterol Hepatol · Pubmed #27112106.

ABSTRACT: BACKGROUND & AIMS: This review aims to systematically survey the effects of yoga on symptoms of irritable bowel syndrome (IBS), pain, quality of life, mood, stress, and safety in patients with IBS. METHODS: MEDLINE/Pubmed, Scopus, the Cochrane Library, CAM-QUEST, CAMbase, and IndMED were screened through November 2015. Randomized controlled trials comparing yoga with usual care, nonpharmacologic, or pharmacologic interventions were analyzed for patients with IBS. Primary outcomes included gastrointestinal symptoms, quality of life, and pain. Anxiety, mood, and safety were defined as secondary outcomes. Risk of bias was assessed according to the Cochrane Collaboration recommendations. RESULTS: Six randomized controlled trials with a total of 273 patients were included in the qualitative analysis. There was evidence for a beneficial effect of a yogic intervention over conventional treatment in IBS, with significantly decreased bowel symptoms, IBS severity, and anxiety. Furthermore, there were significant improvements in quality of life, global improvement, and physical functioning after yoga compared with no treatment. Two randomized controlled trials reported safety data stating that no adverse events occurred. Overall, risk of bias of the included studies was unclear. CONCLUSIONS: The findings of this systematic review suggest that yoga might be a feasible and safe adjunctive treatment for people with IBS. Nevertheless, no recommendation can be made regarding yoga as a routine intervention for patients with IBS because of major flaws in study methods. More research is needed with respect to a high-quality study design and consensus in clinical outcome measurements in IBS. ClinicalTrials.gov number, NCT02721836.

17 Review Gene-environment interactions and the enteric nervous system: Neural plasticity and Hirschsprung disease prevention. 2016

Heuckeroth, Robert O / Schäfer, Karl-Herbert. ·Department of Pediatrics, The Children's Hospital of Philadelphia Research Institute, USA; The Perelman School of Medicine at the University of Pennsylvania, Abramson Research Center, 3615 Civic Center Boulevard, Philadelphia, PA 19104, USA. Electronic address: heuckerothr@email.chop.edu. · ENS Group, University of Applied Sciences Kaiserslautern/Zweibrücken, Germany; University of Heidelberg, Paediatric Surgery Mannheim, Germany. ·Dev Biol · Pubmed #26997034.

ABSTRACT: Intestinal function is primarily controlled by an intrinsic nervous system of the bowel called the enteric nervous system (ENS). The cells of the ENS are neural crest derivatives that migrate into and through the bowel during early stages of organogenesis before differentiating into a wide variety of neurons and glia. Although genetic factors critically underlie ENS development, it is now clear that many non-genetic factors may influence the number of enteric neurons, types of enteric neurons, and ratio of neurons to glia. These non-genetic influences include dietary nutrients and medicines that may impact ENS structure and function before or after birth. This review summarizes current data about gene-environment interactions that affect ENS development and suggests that these factors may contribute to human intestinal motility disorders like Hirschsprung disease or irritable bowel syndrome.

18 Review [Efficacy, tolerability, and safety of cannabinoids in gastroenterology: A systematic review]. 2016

Volz, M S / Siegmund, B / Häuser, W. ·Medizinische Klinik mit Schwerpunkten Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland. · Innere Medizin I, Klinikum Saarbrücken gGmbH, Winterberg 1, 66119, Saarbrücken, Deutschland. whaeuser@klinikum-saarbruecken.de. · Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Technische Universität München, München, Deutschland. whaeuser@klinikum-saarbruecken.de. ·Schmerz · Pubmed #26809974.

ABSTRACT: BACKGROUND: The medical use of cannabis is discussed in gastroenterology for inflammatory bowel diseases (IBD), irritable bowel syndrome (IBS), and chronic pancreatitis. MATERIALS AND METHODS: A systematic literature search until March 2015 was performed in the databases Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, www.cannabis-med.org , and clinicaltrials.gov. Randomized controlled trials (RCT) investigating herbal cannabis and/or pharmaceutical cannabinoids in IBD, IBS, or chronic pancreatitis with a study duration of ≥ 4 weeks and a sample size of at least n = 10 per study arm were identified. Clinical outcomes comprised efficacy (pain, nausea, appetite/weight, diarrhea, health-related quality of life, and remission rates for IBD), tolerability (drop-out rate due to side effects), and safety (severe side effects). Methodology quality of RCTs was evaluated with the Cochrane Risk of Bias Tool. RESULTS: Only one RCT treating 21 patients with Crohn's disease and herbal cannabis was identified. The study revealed no significant differences of remission rate because of low statistical power. However, there was a clear tendency for less abdominal pain and improved appetite with medical cannabis. The methodological risk of the study was high. Furthermore, results of two RCTs investigating synthetic cannabis in IBD and chronic pancreatitis, respectively, have not yet been released. No RCT for IBS was found. Several case reports described cannabis-induced acute pancreatitis. CONCLUSIONS: Cannabis may be useful for symptom relief in Crohn's disease such as pain, nausea, and loss of appetite. However, studies with high methodological quality, sufficient sample size, and study duration are mandatory to determine potential therapeutic effects and risks of cannabis in gastroenterology. Currently, use of tetrahydrocannabinol to alleviate symptoms such as pain and appetite loss in Crohn's disease should only be considered in individual patients after failure of established medical therapies and only after careful risk-benefit assessment.

19 Review Lessons learned--resolving the enigma of genetic factors in IBS. 2016

Gazouli, Maria / Wouters, Mira M / Kapur-Pojskić, Lejla / Bengtson, May-Bente / Friedman, Eitan / Nikčević, Gordana / Demetriou, Christiana A / Mulak, Agata / Santos, Javier / Niesler, Beate. ·Department of Basic Sciences, Laboratory of Biology, School of Medicine, University of Athens, Michalakopoulou 176, 11527 Athens, Greece. · Translational Research Center for Gastrointestinal Disorders (TARGID), University Hospital Leuven, Herestraat 49, Leuven 3000, Belgium. · Institute for Genetic Engineering and Biotechnology, University of Sarajevo, Kemalbegova 10, 71.000 Sarajevo, Bosnia and Herzegovina. · Vestfold Hospital Trust, Tønsberg, Department of Internal Medicine, Division of Gastroenterology, P.O. Box 2168, 3103 Tønsberg, Norway. · The Suzanne Levy Gertner Oncogenetics Unit, Chaim Sheba Medical Centre, 52621 Tel-Hashomer, Israel. · Laboratory for Molecular Biomedicine, Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Vojvode Stepe 444a, 23 11010 Belgrade, Serbia. · Department of Electron Microscopy / Molecular Pathology, The Cyprus Institute of Neurology and Genetics, P.O. Box 23462, 1683 Nicosia, Cyprus. · Department of Gastroenterology and Hepatology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland. · Neuro-immuno-gastroenterology Lab, Digestive Diseases Research Unit, Vall d'Hebron Institut de Recerca. Department of Gastroenterology, Hospital Universitari Vall d'Hebron &Facultat de Medicina, Universitat Autònoma de Barcelona and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain. · Institute of Human Genetics, Department of Human Molecular Genetics, University of Heidelberg, Im Neuenheimer Feld 366, 69120 Heidelberg, Germany. ·Nat Rev Gastroenterol Hepatol · Pubmed #26726033.

ABSTRACT: IBS is the most prevalent functional gastrointestinal disorder and phenotypically characterized by chronic abdominal discomfort, pain and altered defecation patterns. The pathophysiology of IBS is multifactorial, albeit with a substantial genetic component. To date, studies using various methodologies, ranging from family and twin studies to candidate gene approaches and genome-wide association studies, have identified several genetic variants in the context of IBS. Yet, despite enlarged sample sizes, increased statistical power and meta-analyses in the past 7 years, positive associations are still scarce and/or have not been reproduced. In addition, epigenetic and pharmacogenetic approaches remain in their infancy. A major hurdle is the lack of large homogenized case-control cohorts recruited according to standardized and harmonized criteria. The COST Action BM1106 GENIEUR (GENes in Irritable Bowel Syndrome Research Network EURope) has been established to address these obstacles. In this Review, the (epi)genetic working group of GENIEUR reports on the current state-of-the-art in the field, highlights fundamental flaws and pitfalls in current IBS (epi)genetic research and provides a vision on how to address and improve (epi)genetic approaches in this complex disorder in the future.

20 Review [Non-celiac disease non-wheat allergy wheat sensitivity]. 2015

Zopf, Yurdagül / Dieterich, Walburga. ·Medizinische Klinik 1, Friedrich-Alexander-Universität Erlangen-Nürnberg. ·Dtsch Med Wochenschr · Pubmed #26536646.

ABSTRACT: Non-celiac non-wheat allergy wheat sensitivity is regarded as discrete glutensensitivity diagnosed after the exclusion of celiac disease and wheat allergy. Due to the absence of reliable biomarkers no exact prevalence rates are known and estimations range between 0,5-6 %. Soon after ingestion of wheat, patients complain of intestinal symptoms mainly bloating, abdominal pain, diarrhea or nausea which improve fast under glutenfree diet. Often extraintestinal manifestation as tiredness, muscle or joint pain, headache and depression are reported. Actually, there are no serological markers and no intestinal mucosal damage was found in patients. The underlying mechanism of the disease is completely unknown and beside of gluten other wheat proteins as well as amylase-trypsin-inhibitor or short chain sugars are discussed as triggers. In addition, the involvement of the intestinal microbiome in pathology of glutensensitivity must be considered.

21 Review Systematic review: instruments to assess abdominal pain in irritable bowel syndrome. 2015

Mujagic, Z / Keszthelyi, D / Aziz, Q / Reinisch, W / Quetglas, E G / De Leonardis, F / Segerdahl, M / Masclee, A A M. ·Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands. · Centre for Digestive Diseases, Blizard Institute of Cell & Molecular Science, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK. · Department Internal Medicine III, Medical University of Vienna, Vienna, Austria. · McMaster University, Hamilton, ON, Canada. · Medical Intelligence, Early Clinical Development, Grünenthal GmBH, Aachen, Germany. · Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden. ·Aliment Pharmacol Ther · Pubmed #26290286.

ABSTRACT: BACKGROUND: Consensus on standard methods to assess chronic abdominal pain in patients with irritable bowel syndrome (IBS) is currently lacking. AIM: To systematically review the literature with respect to instruments of measurement of chronic abdominal pain in IBS patients. METHODS: Systematic literature search was performed in PubMed/Medline databases for studies using pain measurement instruments in patients with IBS. RESULTS: One hundred and ten publications were reviewed. A multitude of different instruments is currently used to assess chronic abdominal pain in IBS patients. The single-item methods, e.g. the validated 10-point numeric rating scale (NRS), and questionnaires assessing gastrointestinal symptoms severity, focus mostly on the assessment of only the intensity of abdominal pain. Of these questionnaires, the validated IBS-Symptom Severity Scale includes the broadest measurement of pain-related aspects. General pain questionnaires and electronic momentary symptom assessment tools have been used to study abdominal pain in IBS patients, but have not yet been validated for this purpose. The evidence for the use of provocation tests, e.g. the rectal barostat with balloon distention, for measurement of abdominal pain in IBS is weak, due to the poor correlation between visceral pain thresholds assessed by provocation tests and abdominal pain as assessed by retrospective questionnaires. CONCLUSIONS: The multitude of different instruments to measure chronic abdominal pain in IBS makes it difficult to compare endpoints of published studies. There is need for validated instruments to assess chronic abdominal pain in IBS patients, that overcome the limitations of the currently available methods.

22 Review [Differentiated therapy of irritable bowel syndrome in adults]. 2015

Kubisch, Constanze H / Gross, Manfred M. ·Internistische Klinik Dr. Müller, Am Isarkanal 36, D-81479, München, Deutschland, Constanze.Kubisch@muellerklinik.de. ·MMW Fortschr Med · Pubmed #26206037.

ABSTRACT: -- No abstract --

23 Review Placebo effects and their determinants in gastrointestinal disorders. 2015

Elsenbruch, Sigrid / Enck, Paul. ·Institute of Medical Psychology &Behavioural Immunobiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany. · Department of Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen University, Frondsbergstrasse 23, 72076 Tübingen, Germany. ·Nat Rev Gastroenterol Hepatol · Pubmed #26194942.

ABSTRACT: Placebo effects in clinical trials have sparked an interest in the placebo phenomenon, both in randomized controlled trials (RCTs) and in experimental gastroenterology. RCTs have demonstrated similar short-term and long-term placebo response rates in gastrointestinal compared to other medical diagnoses. Most mediators and moderators of placebo effects in gastrointestinal diseases are also of similar type and size to other medical diagnoses and not specific for gastrointestinal diagnoses. Other characteristics such as an increase in the placebo response over time and the placebo-enhancing effects of unbalanced randomization were not seen, at least in IBS. Experimental placebo and nocebo studies underscore the 'power' of expectancies and conditioning processes in shaping gastrointestinal symptoms not only at the level of self-reports, but also within the brain and along the brain-gut axis. Brain imaging studies have redressed earlier criticism that placebo effects might merely reflect a response bias. These findings raise hope that sophisticated trials and experiments designed to boost positive expectations and minimize negative expectations could pave the way for a practical and ethically sound use of placebo knowledge in daily practice. Rather than focusing on a 'personalized' choice of drugs based on biomarkers or genes, it might be the doctor-patient communication that needs to be tailored.

24 Review Guided self-help interventions for irritable bowel syndrome: a systematic review and meta-analysis. 2015

Liegl, Gregor / Plessen, Constantin Y / Leitner, Anton / Boeckle, Markus / Pieh, Christoph. ·aDepartment of Psychotherapy and Biopsychosocial Health, Danube University, Krems, Austria bMedical Clinic, Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Berlin cDepartment of Psychosomatic Medicine, University Hospital Regensburg, Regensburg, Germany. ·Eur J Gastroenterol Hepatol · Pubmed #26164395.

ABSTRACT: OBJECTIVE: Although irritable bowel syndrome (IBS) is highly prevalent and is accompanied by high costs for respective healthcare systems, the data on treatment effectiveness are limited. Current treatment methods have limitations in terms of side effects and availability. Guided self-help (GSH) might be an easily accessible and cost-effective treatment alternative. This study is the first systematic review and meta-analysis of GSH interventions for IBS. METHODS: Using electronic databases (MEDLINE, SCOPUS, PsycINFO, and Web of Science), we performed a systematic search for randomized-controlled trials. Using a random-effect model, we calculated the pooled standardized mean differences (SMDs) of GSH on IBS symptom severity (primary outcome) and quality of life (secondary outcome). We additionally examined the moderating effects of online-based interventions and face-to-face therapist contact by applying mixed models. RESULTS: A systematic literature search identified 10 eligible randomized-controlled trials, including 886 participants. Compared with the control conditions, the effect size was medium for the decrease in IBS symptom severity (SMD=0.72; 95% confidence interval: 0.34-1.08) and large for the increase in patients' quality of life (SMD=0.84; 95% confidence interval: 0.46-1.22). Neither treatment format nor face-to-face contact was a predictor of therapy outcomes in between-group analyses. In contrast, within-group analyses led to the conclusion that online-based interventions are more effective than other self-help formats. CONCLUSION: GSH is an effective alternative for the treatment of IBS. As GSH methods are easy to implement, it seems sensible to integrate GSH into clinical practice. LIMITATIONS: With respect to the high study heterogeneity, the number of studies included was relatively small.

25 Review Systematic review with meta-analysis: post-infectious irritable bowel syndrome after travellers' diarrhoea. 2015

Schwille-Kiuntke, J / Mazurak, N / Enck, P. ·Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany. ·Aliment Pharmacol Ther · Pubmed #25871571.

ABSTRACT: BACKGROUND: Gastrointestinal infection is known as a risk factor for the development of the irritable bowel syndrome (post-infectious irritable bowel syndrome, PI-IBS). The incidence of PI-IBS ranges between 3% and over 30% of people after infectious gastroenteritis. AIM: To perform a meta-analysis pools and report data concerning the relative risk (RR) of PI-IBS after TD. METHODS: Database search using Medline through PubMed, Scopus, EBM Reviews (Cochrane Database of Systematic Reviews) and PsycINFO was performed to identify relevant studies. Those that met the inclusion criteria were pooled. A random effects model (Mantel-Haenszel) was performed. RESULTS: Six eligible studies were found. In three of six studies, the authors reported a statistically significant association of TD and PI-IBS. The pooled RR was 3.35 (95% CI: 2.22-5.05) with a significant overall effect (P < 0.00001). Overall PI-IBS incidence was 5.4% in TD subjects and 1.4% in healthy subjects. There was no significant heterogeneity within the pooled studies (I(2)  = 5%). Self-reported TD alone resulted in an over 1.5-fold RR for PI-IBS compared to laboratory-confirmed TD [RR 3.90 (95% CI: 2.35-6.49) vs. RR 2.42 (95% CI: 1.22-4.78)]. CONCLUSIONS: There is a strong association between travellers' diarrhoea and post-infectious irritable bowel syndrome. Self-reports of exposure seem to result in a higher post-infectious irritable bowel syndrome occurrence than laboratory-confirmed cases of travellers' diarrhoea, but further studies are needed to confirm this finding. Finally, potential influences of the selection of an appropriate study population on post-infectious irritable bowel syndrome epidemiology are discussed.