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Irritable Bowel Syndrome: HELP
Articles from India
Based on 70 articles published since 2008

These are the 70 published articles about Irritable Bowel Syndrome that originated from India during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Guideline Rome Foundation Working Team Report on Post-Infection Irritable Bowel Syndrome. 2019

Barbara, Giovanni / Grover, Madhusudan / Bercik, Premysl / Corsetti, Maura / Ghoshal, Uday C / Ohman, Lena / Rajilić-Stojanović, Mirjana. ·Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: giovanni.barbara@unibo.it. · Enteric NeuroScience Program, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. · Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada. · Nottingham Digestive Diseases Biomedical Research Centre, National Institute for Health Research, Nottingham University Hospitals NHS Trust, University of Nottingham, UK. · Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. · Department of Microbiology and Immunology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. · Department of Biochemical Engineering and Biotechnology, Faculty of Technology and Metallurgy, University of Belgrade, Belgrade, Serbia. ·Gastroenterology · Pubmed #30009817.

ABSTRACT: BACKGROUND & AIMS: The existence of postinfection irritable bowel syndrome (PI-IBS) has been substantiated by epidemiology studies conducted in diverse geographic and clinical settings. However, the available evidence has not been well summarized, and there is little guidance for diagnosis and treatment of PI-IBS. The ROME Foundation has produced a working team report to summarize the available evidence on the pathophysiology of PI-IBS and provide guidance for diagnosis and treatment, based on findings reported in the literature and clinical experience. METHODS: The working team conducted an evidence-based review of publication databases for articles describing the clinical features (diagnosis), pathophysiology (intestinal sensorimotor function, microbiota, immune dysregulation, barrier dysfunction, enteroendocrine pathways, and genetics), and animal models of PI-IBS. We used a Delphi-based consensus system to create guidelines for management of PI-IBS and a developed treatment algorithm based on published findings and experiences of team members. RESULTS: PI-IBS develops in about 10% of patients with infectious enteritis. Risk factors include female sex, younger age, psychological distress during or before acute gastroenteritis, and severity of the acute episode. The pathogenesis of PI-PBS appears to involve changes in the intestinal microbiome as well as epithelial, serotonergic, and immune system factors. However, these mechanisms are incompletely understood. There are no evidence-based, effective pharmacologic strategies for treatment of PI-IBS. We provide a consensus-based treatment algorithm, based on clinical presentation and potential disease mechanisms. CONCLUSIONS: Based on a systematic review of the literature and team experience, we summarize the clinical features, pathophysiology (from animal models and human studies), and progression of PI-IBS. Based on these findings, we present an algorithm for diagnosis and treatment of PI-IBS based on team consensus. We also propose areas for future investigation.

2 Review Updated review of current pharmacological and non-pharmacological management of irritable bowel syndrome. 2018

Rawla, Prashanth / Sunkara, Tagore / Raj, Jeffrey Pradeep. ·Department of Internal Medicine, SOVAH Health, Martinsville, VA 24115, USA. Electronic address: rawlap@gmail.com. · Division of Gastroenterology and Hepatology, Mercy Medical Center, Des Moines, IA 50314, USA. · Department of Clinical Pharmacology, King Edward Memorial Hospital, Seth GS Medical College, Mumbai 400013, India. ·Life Sci · Pubmed #30290187.

ABSTRACT: Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract that is usually associated with chronic abdominal pain and altered bowel habits. The two spectra of the disease include constipation-predominant IBS and Diarrhea-predominant IBS. Earlier it was thought to be an unexplained brain-gut disorder, but of late, various underlying causes suggesting primary gut disturbance have been identified. The initial management primarily includes the non-pharmacological measures such as dietary modifications, increasing physical activity, and psychological therapy. Pharmacological management is adjunct to non-pharmacological management, and the drug is chosen based on the predominant symptom of bowel habit whether constipation or diarrhea. In this review, we aim to update the readers on the currently available management options in the treatment of IBS - both pharmacological and non-pharmacological options. Further, for the various pharmacological treatments, we summarize the clinical pharmacology, indications, contraindications, adverse effects and use in pregnancy.

3 Review Irritable bowel syndrome in Asia: Pathogenesis, natural history, epidemiology, and management. 2018

Gwee, Kok-Ann / Ghoshal, Uday Chand / Chen, Minhu. ·Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. · Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. · Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. ·J Gastroenterol Hepatol · Pubmed #28901578.

ABSTRACT: Historically, the epidemiology of gastrointestinal diseases in Asia was different from that in Western countries. Early studies suggested a low prevalence of irritable bowel syndrome (IBS) in Asia. As the diagnosis of IBS is symptom-based and as symptom perception, expression, and interpretation are influenced by sociocultural perspectives including language, the presentation of IBS is expected to vary in different communities. Furthermore, the pathogenesis is multifactorial with psychosocial (stress, illness, behavior, and diet) and biological (infection, gut microbiota, and immune activation) variables interacting, and so, the present study can anticipate that the development of IBS will vary in different environments. In recognition of this aspect of functional gastrointestinal disorders, the recently published Rome IV documents have provided greater focus on cross-cultural factors. In this review, the present study seeks to highlight Asian perspectives by identifying historical trends and recent publications from the region and comparing these with the observations from Western societies.

4 Review Epidemiological and clinical perspectives on irritable bowel syndrome in India, Bangladesh and Malaysia: A review. 2017

Rahman, M Masudur / Mahadeva, Sanjiv / Ghoshal, Uday C. ·Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka 1000, Bangladesh. · Division of Gastroenterology, Department of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia. · Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India. udayghoshal@gmail.com. ·World J Gastroenterol · Pubmed #29085223.

ABSTRACT: Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder, common in clinic and in the community. It has a significant impact on both society and patients' quality of life. The epidemiology, clinical presentation, and management of IBS may vary in different geographical regions due to differences in diet, gastrointestinal infection, socio-cultural and psycho-social factors, religious and illness beliefs, symptom perception and reporting. Although previous reviews and consensus reports on IBS in Asia have been published, Asia is quite diverse socio-demographically. In this context, India, Bangladesh and Malaysia share some similarities, including: (1) large proportion of the population living in rural areas; (2) rapid development and associated lifestyle changes in urban areas; and (3) dietary, cultural and religious practices. The present review explores the clinical and epidemiological data on IBS from these three major nations in South and South-East Asia. In-depth review of the literature revealed important differences between IBS in the East, as revealed by studies from these three countries, and the West; these include a predominantly rural profile, differences in bowel habit and symptom profile, raising concern with regards to diagnostic criteria and subtyping of IBS, higher dietary fiber consumption, frequent lactose malabsorption, parasitosis, and possible overlap between post-infectious IBS and tropical sprue. Moreover, the current perception on difference in prevalence of the disorder in these countries, as compared to the West, might be related to variation in survey methods.

5 Review Chronic constipation in Rome IV era: The Indian perspective. 2017

Ghoshal, Uday C. ·Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India. udayghoshal@gmail.com. ·Indian J Gastroenterol · Pubmed #28643273.

ABSTRACT: Chronic constipation (CC) is a common problem in the community and in gastroenterology practice all over the world including India. After release of Rome IV guidelines in April 2016, there is increasing interest among gastroenterologists and physicians in India to look into special issues on CC in the Indian perspective. There are important differences in the bowel habit, definition, epidemiology, and pathophysiology including dietary factors and management of CC in India as compared to the West. As severity and frequency of abdominal pain, a symptom essential to diagnose constipation-predominant irritable bowel syndrome (IBS-C) rather than functional constipation (FC), is less common among Indian patients, FC is commoner than IBS-C in India. The pathophysiological mechanisms of CC may include slow colon transit, fecal evacuation disorder (FED), or a combination of these; though CC in a third to half of patients presenting to tertiary care facilities may result from these pathophysiological mechanisms, most patients presenting to primary care may have lifestyle and dietary issues. The current Rome IV algorithm dictates to explore the underlying physiological factors in the pathogenesis of functional gastrointestinal disorders including CC, which may translate to its personalized management. However, the availability of the methods to explore pathophysiological factors and manage CC caused by FED non-pharmacologically (using biofeedback) in India is limited. Though several pharmacological agents are available in India to manage CC, there are several unmet needs in its treatment. This review explores CC in India in relation to these issues, some of which are unique in the Indian perspective.

6 Review Post-infectious IBS, tropical sprue and small intestinal bacterial overgrowth: the missing link. 2017

Ghoshal, Uday C / Gwee, Kok-Ann. ·Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India. · Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 6A Napier Road, Singapore, 258500. ·Nat Rev Gastroenterol Hepatol · Pubmed #28513629.

ABSTRACT: Evidence is emerging that IBS, a hitherto enigmatic disorder thought to be predominantly related to psychological factors, has a microorganic basis in a subset of patients with the disease. Post-infectious IBS (PI-IBS), commonly of the diarrhoea-predominant subtype (defined as new development of IBS following acute infectious diarrhoea), is one such condition known to occur in up to 10-30% individuals after acute gastroenteritis. However, following acute infectious gastroenteritis, patients can also develop post-infectious malabsorption syndrome (PI-MAS), popularly known as tropical sprue. As no study on PI-IBS has rigorously excluded tropical sprue by appropriate investigations, including small intestinal biopsy, the frequency of tropical sprue among patients with PI-IBS is not known. Small intestinal bacterial overgrowth (SIBO) has been suggested to be associated with IBS in general, and in particular diarrhoea-predominant IBS, including PI-IBS. SIBO is also known to be associated with tropical sprue. As both IBS, particularly the subset probably associated with SIBO, and tropical sprue improve with antibiotic treatment, we provide evidence and an explanatory model to support a link among these disorders.

7 Review Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy. 2017

Ghoshal, Uday C / Shukla, Ratnakar / Ghoshal, Ujjala. ·Department of Gastroenterology and Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. ·Gut Liver · Pubmed #28274108.

ABSTRACT: The pathogenesis of irritable bowel syndrome (IBS), once thought to be largely psychogenic in origin, is now understood to be multifactorial. One of the reasons for this paradigm shift is the realization that gut dysbiosis, including small intestinal bacterial overgrowth (SIBO), causes IBS symptoms. Between 4% and 78% of patients with IBS and 1% and 40% of controls have SIBO; such wide variations in prevalence might result from population differences, IBS diagnostic criteria, and, most importantly, methods to diagnose SIBO. Although quantitative jejunal aspirate culture is considered the gold standard for the diagnosis of SIBO, noninvasive hydrogen breath tests have been popular. Although the glucose hydrogen breath test is highly specific, its sensitivity is low; in contrast, the early-peak criteria in the lactulose hydrogen breath test are highly nonspecific. Female gender, older age, diarrhea-predominant IBS, bloating and flatulence, proton pump inhibitor and narcotic intake, and low hemoglobin are associated with SIBO among IBS patients. Several therapeutic trials targeting gut microbes using antibiotics and probiotics have further demonstrated that not all symptoms in patients with IBS originate in the brain but rather in the gut, providing support for the micro-organic basis of IBS. A recent proof-of-concept study showing the high frequency of symptom improvement in patients with IBS with SIBO further supports this hypothesis.

8 Review Cross-cultural and psychological issues in irritable bowel syndrome. 2017

Sahoo, Swapnajeet / Padhy, Susanta Kumar. ·Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India. ·J Gastroenterol Hepatol · Pubmed #28244198.

ABSTRACT: Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders encountered by gastroenterologists worldwide. Of all the etiological factors that had been postulated to explain the pathophysiology of IBS, cultural and psychological factors are unique and difficult to understand. Culture plays an important role in coloring the presentation of IBS, and many a times, it has a significant role in several treatment aspects too. Psychological aspects like personality profiles, family relationships, societal myths, and abuse in any form are equally important in the management perspectives of IBS. In this brief review, we had tried to specifically focus on these aspects in IBS and have explained the evidences in favor of these factors. Knowledge about various cross-cultural aspects and psychological factors in patients with IBS is essential for taking an appropriate history and for undertaking a holistic approach for the management of the same. A collaborative team effort by psychiatrists and gastroenterologists could help in reducing the burden of this difficult to treat functional bowel disorder.

9 Review Interleukin-10: A Compelling Therapeutic Target in Patients With Irritable Bowel Syndrome. 2017

Kumar, Sunil / Shukla, Ratnakar / Ranjan, Prabhat / Kumar, Awanish. ·Faculty of Biotechnology, Institute of Bioscience and Technology, Shri Ramswaroop Memorial University, Barabanki, India. Electronic address: sunil.bio@srmu.ac.in. · Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. · Department of Biotechnology, National Institute of Technology, Raipur, India. Electronic address: awanik.bt@nitrr.ac.in. ·Clin Ther · Pubmed #28237672.

ABSTRACT: PURPOSE: Pro- and antiinflammatory cytokines are important modulators of the immune response and play a major role in conditions of intestinal inflammation, such as irritable bowel syndrome (IBS). Cytokine production is regulated genetically, and imbalances in cytokine secretion may affect disease susceptibility and clinical outcomes of various conditions. There is a rapidly growing body of evidence to support an etiologic role for gastrointestinal infection and the associated immune activation in the development of postinfectious IBS. Other factors such as psychological stress, anxiety, and depression may likely be involved in the altered profiles of pro- and antiinflammatory cytokines that lead to chronic IBS. METHODS: We searched the literature using PubMed, MEDLINE, and Google Scholar with related key terms and prepared this review article on that basis. FINDINGS: Interleukin (IL)-10 is a regulatory cytokine that inhibits both antigen presentation and the release of proinflammatory cytokines. Therefore, it is proposed as a potent antiinflammatory biological therapy for IBS. IMPLICATIONS: Recently, a strong interest in the therapeutic potential of IL-10 for IBS has developed. The diverse roles of IL-10 in IBS are reviewed here. We conducted an in-depth review on IL-10 and IBS to address this question. Future studies of IL-10 may provide new insights into IBS therapy.

10 Review Role of cannabis in digestive disorders. 2017

Goyal, Hemant / Singla, Umesh / Gupta, Urvashi / May, Elizabeth. ·aDepartment of Internal Medicine, Mercer University School of Medicine, Macon bDepartment of Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA cLU-3, Pitampura, New Delhi, India. ·Eur J Gastroenterol Hepatol · Pubmed #27792038.

ABSTRACT: Cannabis sativa, a subspecies of the Cannabis plant, contains aromatic hydrocarbon compounds called cannabinoids. [INCREMENT]-Tetrahydrocannabinol is the most abundant cannabinoid and is the main psychotropic constituent. Cannabinoids activate two types of G-protein-coupled cannabinoid receptors: cannabinoid type 1 receptor and cannabinoid type 2 receptor. There has been ongoing interest and development in research to explore the therapeutic potential of cannabis. [INCREMENT]-Tetrahydrocannabinol exerts biological functions on the gastrointestinal (GI) tract. Cannabis has been used for the treatment of GI disorders such as abdominal pain and diarrhea. The endocannabinoid system (i.e. endogenous circulating cannabinoids) performs protective activities in the GI tract and presents a promising therapeutic target against various GI conditions such as inflammatory bowel disease (especially Crohn's disease), irritable bowel syndrome, and secretion and motility-related disorders. The present review sheds light on the role of cannabis in the gut, liver, and pancreas and also on other GI symptoms, such as nausea and vomiting, cannabinoid hyperemesis syndrome, anorexia, weight loss, and chronic abdominal pain. Although the current literature supports the use of marijuana for the treatment of digestive disorders, the clinical efficacy of cannabis and its constituents for various GI disorders remains unclear.

11 Review The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies: a Rome Foundation working team literature review. 2017

Sperber, Ami D / Dumitrascu, Dan / Fukudo, Shin / Gerson, Charles / Ghoshal, Uday C / Gwee, Kok Ann / Hungin, A Pali S / Kang, Jin-Yong / Minhu, Chen / Schmulson, Max / Bolotin, Arkady / Friger, Michael / Freud, Tamar / Whitehead, William. ·Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. · 2nd Medical Department of Internal Medicine, University of Medicine and Pharmacy, Cluj-Napoca, Romania. · Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Seiryo Aoba, Japan. · Division of Gastroenterology, Mt. Sinai School of Medicine, Mind-Body Digestive Center, New York, New York, USA. · Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI), Lucknow, India. · Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. · Durham University School of Medicine, Pharmacy and Health, Wolfson Research Institute, Stockton-on-Tees, UK. · Department of Gastroenterology, St. George's Hospital, London, UK. · Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. · Laboratory of Liver, Pancreas and Motility (HIPAM), Unit of Research in Experimental Medicine, Faculty of Medicine, Universidad Nacional Autonoma de Mexico (UNAM), Hospital General de México, Mexico City, Mexico. · Center for Functional GI & Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. ·Gut · Pubmed #26818616.

ABSTRACT: OBJECTIVES: The global prevalence of IBS is difficult to ascertain, particularly in light of the heterogeneity of published epidemiological studies. The aim was to conduct a literature review, by experts from around the world, of community-based studies on IBS prevalence. DESIGN: Searches were conducted using predetermined search terms and eligibility criteria, including papers in all languages. Pooled prevalence rates were calculated by combining separate population survey prevalence estimates to generate an overall combined meta-prevalence estimate. The heterogeneity of studies was assessed. RESULTS: 1451 papers were returned and 83, including 288 103 participants in 41 countries, met inclusion criteria. The mean prevalence among individual countries ranged from 1.1% in France and Iran to 35.5% in Mexico. There was significant variance in pooled regional prevalence rates ranging from 17.5% (95% CI 16.9% to 18.2%) in Latin America, 9.6% (9.5% to 9.8%) in Asia, 7.1% (8.0% to 8.3%) in North America/Europe/Australia/New Zealand, to 5.8% (5.6% to 6.0%) in the Middle East and Africa. There was a significant degree of heterogeneity with the percentage of residual variation due to heterogeneity at 99.9%. CONCLUSIONS: The main finding is the extent of methodological variance in the studies reviewed and the degree of heterogeneity among them. Based on this, we concluded that publication of a single pooled global prevalence rate, which is easily calculated, would not be appropriate or contributory. Furthermore, we believe that future studies should focus on regional and cross-cultural differences that are more likely to shed light on pathophysiology.

12 Review Can Probiotics Cure Inflammatory Bowel Diseases? 2016

Korada, Siva Kumar / Yarla, Nagendra Sastry / Bishayee, Anupam / Aliev, Gjumrakch / Aruna Lakshmi, K / Arunasree, M K / Dananajaya, B L / Mishra, Vijendra. ·National Institute of Food Technology Entrepreneurship and Management (NIFTEM), Sonepat, Haryana, India. vijendramishra.niftem@gmail.com. ·Curr Pharm Des · Pubmed #26648465.

ABSTRACT: Gastrointestinal (GI) disorders, especially microbial dysbiosis play role in several GI ailments such as irritable bowel syndrome, colorectal cancer, inflammatory bowel diseases, and antibiotic-associated diarrhoea. Role of inflammatory bowel disease (IBD) is multifactorial as it involves loss of maintaining intestinal epithelial barrier integrity, increased release of pro-inflammatory molecules, and microbial dysbiosis in gut microflora. Some specific pathogens also play a key role in the IBD development. The origin and causation are still in unfathomable condition and the exact root cause is unknown. Recently probiotic studies have been gaining importance because of their positive responses in their IBD experimental results. According to joint Food and Agricultural Organisation/World Health Organisation working group, probiotics are defined as live microorganisms which when administered in adequate amount confer health benefit on the host. These live beneficial microorganisms are considered helpful in improving gut colonization and perseverance thereby improves prophylactic effect. In the direction of IBD research, a number of studies are needed to standardize its methodology and its applicability on human usage. The particular review presents an overview of gut microflora and its impact on host health, types of IBD and existing therapies to treat this disorder, mechanism of several probiotic actions, role of probiotics in IBD prevention with their supporting evidences.

13 Review The Overlap between Irritable Bowel Syndrome and Non-Celiac Gluten Sensitivity: A Clinical Dilemma. 2015

Makharia, Archita / Catassi, Carlo / Makharia, Govind K. ·Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. govindmakharia@gmail.com. · Department of Pediatrics, Università Politecnica delle Marche, 60123 Ancona, Italy. c.catassi@univpm.it. ·Nutrients · Pubmed #26690475.

ABSTRACT: The spectrum of gluten-related disorders has widened in recent times and includes celiac disease, non-celiac gluten sensitivity, and wheat allergy. The complex of symptoms associated with these diseases, such as diarrhea, constipation or abdominal pain may overlap for the gluten related diseases, and furthermore they can be similar to those caused by various other intestinal diseases, such as irritable bowel syndrome (IBS). The mechanisms underlying symptom generation are diverse for all these diseases. Some patients with celiac disease may remain asymptomatic or have only mild gastrointestinal symptoms and thus may qualify for the diagnosis of IBS in the general clinical practice. Similarly, the overlap of symptoms between IBS and non-celiac gluten sensitivity (NCGS) often creates a dilemma for clinicians. While the treatment of NCGS is exclusion of gluten from the diet, some, but not all, of the patients with IBS also improve on a gluten-free diet. Both IBS and NCGS are common in the general population and both can coexist with each other independently without necessarily sharing a common pathophysiological basis. Although the pathogenesis of NCGS is not well understood, it is likely to be heterogeneous with possible contributing factors such as low-grade intestinal inflammation, increased intestinal barrier function and changes in the intestinal microbiota. Innate immunity may also play a pivotal role. One possible inducer of innate immune response has recently been reported to be amylase-trypsin inhibitor, a protein present in wheat endosperm and the source of flour, along with the gluten proteins.

14 Review Breath tests and irritable bowel syndrome. 2014

Rana, Satya Vati / Malik, Aastha. ·Satya Vati Rana, Aastha Malik, Department of Super Specialty Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India. ·World J Gastroenterol · Pubmed #24976698.

ABSTRACT: Breath tests are non-invasive tests and can detect H₂ and CH₄ gases which are produced by bacterial fermentation of unabsorbed intestinal carbohydrate and are excreted in the breath. These tests are used in the diagnosis of carbohydrate malabsorption, small intestinal bacterial overgrowth, and for measuring the orocecal transit time. Malabsorption of carbohydrates is a key trigger of irritable bowel syndrome (IBS)-type symptoms such as diarrhea and/or constipation, bloating, excess flatulence, headaches and lack of energy. Abdominal bloating is a common nonspecific symptom which can negatively impact quality of life. It may reflect dietary imbalance, such as excess fiber intake, or may be a manifestation of IBS. However, bloating may also represent small intestinal bacterial overgrowth. Patients with persistent symptoms of abdominal bloating and distension despite dietary interventions should be referred for H₂ breath testing to determine the presence or absence of bacterial overgrowth. If bacterial overgrowth is identified, patients are typically treated with antibiotics. Evaluation of IBS generally includes testing of other disorders that cause similar symptoms. Carbohydrate malabsorption (lactose, fructose, sorbitol) can cause abdominal fullness, bloating, nausea, abdominal pain, flatulence, and diarrhea, which are similar to the symptoms of IBS. However, it is unclear if these digestive disorders contribute to or cause the symptoms of IBS. Research studies show that a proper diagnosis and effective dietary intervention significantly reduces the severity and frequency of gastrointestinal symptoms in IBS. Thus, diagnosis of malabsorption of these carbohydrates in IBS using a breath test is very important to guide the clinician in the proper treatment of IBS patients.

15 Review Irritable bowel syndrome: pathogenesis, diagnosis, treatment, and evidence-based medicine. 2014

Saha, Lekha. ·Lekha Saha, Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India. ·World J Gastroenterol · Pubmed #24944467.

ABSTRACT: Irritable bowel syndrome (IBS) is a chronic and debilitating functional gastrointestinal disorder that affects 9%-23% of the population across the world. The percentage of patients seeking health care related to IBS approaches 12% in primary care practices and is by far the largest subgroup seen in gastroenterology clinics. It has been well documented that these patients exhibit a poorer quality of life and utilize the health care system to a greater degree than patients without this diagnosis. The pathophysiology of IBS is not clear. Many theories have been put forward, but the exact cause of IBS is still uncertain. According to the updated ROME III criteria, IBS is a clinical diagnosis and presents as one of the three predominant subtypes: (1) IBS with constipation (IBS-C); (2) IBS with diarrhea (IBS-D); and (3) mixed IBS (IBS-M); former ROME definitions refer to IBS-M as alternating IBS (IBS-A). Across the IBS subtypes, the presentation of symptoms may vary among patients and change over time. Patients report the most distressing symptoms to be abdominal pain, straining, myalgias, urgency, bloating and feelings of serious illness. The complexity and diversity of IBS presentation makes treatment difficult. Although there are reviews and guidelines for treating IBS, they focus on the efficacy of medications for IBS symptoms using high-priority endpoints, leaving those of lower priority largely unreported. Therefore, the aim of this review is to provide a comprehensive evidence-based review of the diagnosis, pathogenesis and treatment to guide clinicians diagnosing and treating their patients.

16 Review Tropical sprue in 2014: the new face of an old disease. 2014

Ghoshal, Uday C / Srivastava, Deepakshi / Verma, Abhai / Ghoshal, Ujjala. ·Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226014, India, udayghoshal@gmail.com. ·Curr Gastroenterol Rep · Pubmed #24781741.

ABSTRACT: Tropical sprue (TS), once known to be a common cause of malabsorption syndrome (MAS) in India and other tropical countries, is believed to be uncommon currently in spite of contrary evidence. Several recent studies from India showed TS to be the commonest cause of sporadic MAS in Indian adults. TS is diagnosed in patients presenting with suggestive clinical presentation, which cannot be explained by another cause of MAS and investigations revealing malabsorption of two unrelated substances, abnormal small-intestinal mucosal histology, which responds to treatment with antibiotics such as tetracycline and folic acid. There is substantial overlap between TS and postinfectious irritable bowel syndrome. There have been several advances in epidemiology, pathogenesis, and diagnosis of TS, hitherto an enigmatic condition.

17 Review Irritable bowel syndrome and small intestinal bacterial overgrowth: meaningful association or unnecessary hype. 2014

Ghoshal, Uday C / Srivastava, Deepakshi. ·Uday C Ghoshal, Deepakshi Srivastava, Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226104, India. ·World J Gastroenterol · Pubmed #24627585.

ABSTRACT: Irritable bowel syndrome (IBS) is a common condition characterized by abdominal pain or discomfort, bloating, and altered stool form and passage. Small intestinal bacterial overgrowth (SIBO) is a condition in which there is overgrowth of bacteria in small bowel in excess of 10⁵ colony forming units per milliliter on culture of the upper gut aspirate. Frequency of SIBO varied from 4%-78% among patients with IBS and from 1%-40% among controls. Higher frequency in some studies might be due to fallacious criteria [post-lactulose breath-hydrogen rise 20 PPM above basal within 90 min (early-peak)]. Glucose hydrogen breath test (GHBT) has a low sensitivity to diagnose SIBO. Hence, studies based on GHBT might have under-estimated frequency of SIBO. Therefore, it is important to analyze these studies carefully to evaluate whether the reported association between IBS and SIBO is over or under-projected. This review evaluates studies on association between SIBO and IBS, discordance between different studies, their strength and weakness including methodological issues and evidence on therapeutic manipulation of gut flora on symptoms of IBS.

18 Review Post-infectious irritable bowel syndrome: the past, the present and the future. 2011

Ghoshal, Uday C / Ranjan, Prabhat. ·Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. udayghoshal@gmail.com ·J Gastroenterol Hepatol · Pubmed #21443719.

ABSTRACT: BACKGROUND: Irritable bowel syndrome (IBS), once thought to be a psychosomatic disease, is being considered to be more organic. Post-infectious IBS (PI-IBS), defined as acute onset IBS (by Rome criteria) after gastrointestinal infection in an individual without prior IBS with two or more of the followings: fever, vomiting, diarrhea, a positive stool culture. The recent and old literature of PI-IBS will be reviewed. Future directions for research will be presented. METHODS: Literature on PI-IBS was reviewed by electronic search and cross references of these papers. RESULTS: Interest in studies on PI-IBS, which was described five to six decades ago, re-surfaced recently. 3.6 to 32% patients with acute gastroenteritis develop PI-IBS during 3-12 month follow-up. PI-IBS is commonly diarrhea predominant. Factors implicated in development include nature of pathogens, duration and severity of diarrhea, younger age, female gender and psychological co-morbidities like anxiety and depression. The pathogenesis of PI-IBS is largely related to continuing gut inflammation due to inability of the host to contain the inflammatory reaction, altered gut microbiota, increased intestinal permeability, muscle hyper-contractility and visceral hypersensitivity. There could be an overlap between PI-IBS and post-infectious malabsorption syndrome (PI-MAS), popularly known as tropical sprue. CONCLUSIONS: Development of IBS in a subset of patients with acute gastroenteritis is uncontested. This is expected to open a paradigm shift in understanding the pathogenesis of IBS. Future studies should address the issue of overlap of PI-IBS and PI-MAS. Exploring the molecular mechanisms of pathogenesis of PI-IBS may help to design preventive and therapeutic strategies.

19 Review Bugs and irritable bowel syndrome: The good, the bad and the ugly. 2010

Ghoshal, Uday C / Park, Hyojin / Gwee, Kok-Ann. ·Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. udayghoshal@gmail.com ·J Gastroenterol Hepatol · Pubmed #20074148.

ABSTRACT: Recently, there has been strong interest in the therapeutic potential of probiotics for irritable bowel syndrome (IBS). At the same time, there is a rapidly growing body of evidence to support an etiological role for gastrointestinal infection and the associated immune activation in the development of post-infectious IBS. In a more controversial area, small intestinal bacterial overgrowth has been associated with a subset of patients with IBS; the issue of whether it is appropriate to treat a subset of IBS patients with antibiotics and probiotics is currently a matter for debate. Thus, it appears that the gastrointestinal microbial flora may exert beneficial effects for symptoms of IBS under some circumstances, while in other situations gut microbes could give rise to symptoms of IBS. How do we make sense of the apparently diverse roles that 'bugs' may play in IBS? To address this question, we have conducted an in-depth review, attempting where possible to draw lessons from Asian studies.

20 Review Pathogenesis and management of irritable bowel syndrome. 2009

Mathew, Praveen / Bhatia, Shobna J. ·Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Parel, Mumbai, India. ·Trop Gastroenterol · Pubmed #19624083.

ABSTRACT: The exact cause of irritable bowel syndrome (IBS) is not known. Multiple factors, like genetic, gut motility, visceral hypersensitivity, psychosocial factors and immune-mediated factors, are thought to contribute to the symptom complex of IBS. Till date an 'IBS gene' has not been defined, and there is a need for further studies. The concept that IBS as a diagnosis of exclusion is not acceptable any more. The treatment of IBS is targeted at the management of constipation, diarrhoea and abdominal pain and includes pharmacotherapy with tegaserod, alosetron and lubiprostone. Cognitive behavioral therapy is very beneficial.

21 Review Recent research in stress, coping and women's health. 2009

Rao, Kiran. ·Department of Mental Health and Social Psychology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Karnataka, India. kiranrao.nimhans@gmail.com ·Curr Opin Psychiatry · Pubmed #19553874.

ABSTRACT: PURPOSE OF REVIEW: To highlight recent publications in the area of stress and coping, with specific reference to women's physical health status. RECENT FINDINGS: The transactional model of stress and coping continues to be the mainstay of research in this area. Several longitudinal studies have demonstrated that stress appraisal and resultant coping responses affect health outcome and health-related quality of life in women. In addition to problem-focused coping, women often use distraction methods, seeking social support and faith or religious coping. Psychological interventions in chronic medical conditions need to move beyond education and incorporate more cognitive behavioral components, at the same time addressing women's specific needs. SUMMARY: Coping behaviors in response to the negative threat appraisal of a chronic or severe medical illness serve to reduce psychological distress. However, it is still not clear how they impact at the physiological level. In addition, coping responses, which enhance positive effects and promote health-related quality of life, merit greater attention from researchers. There is a need for more gender comparative research to improve health outcomes in men and women.

22 Review Role of serotonin in gastrointestinal motility and irritable bowel syndrome. 2009

Sikander, Arbab / Rana, Satya Vati / Prasad, Kaushal Kishor. ·Department of Super specialty of Gastroenterology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh-160012, India. ·Clin Chim Acta · Pubmed #19361459.

ABSTRACT: Serotonin (5-HT) is an important signaling molecule in the gut targeting enterocytes, smooth muscles and enteric neurons. Most of the body serotonin is present in enterochromaffin cells. Serotonin activates both intrinsic and extrinsic primary afferent neurons to, respectively initiate peristaltic and secretory reflexes and to transmit information to the central nervous system. Serotonin is inactivated by the serotonin reuptake transporter (SERT) in the enterocytes or neurons. Exogenous serotonin application evokes so many responses that it is difficult to determine which is physiologically relevant. This effect is largely due to the presence of multiple receptor subtypes, which appear to be present on several classes of myenteric neurons, on smooth muscle cells, and on epithelial cells. Irritable bowel syndrome (IBS) is a complex disorder that is associated with altered gastrointestinal motility, secretion and sensation. Altered serotonin signaling may lead to both intestinal and extra intestinal systems in IBS. In this review, the literature related to role of serotonin signaling in pathophysiology of IBS has been searched and summarized. Therapeutic agents targeting altered serotonin signaling may provide new effective treatment for patients with IBS. Tegaserod, 5-HT(4) partial agonist is used in constipation predominant IBS while alosetron, a 5-HT(3) antagonist used in IBS with diarrhea. Other compounds such as tricyclic antidepressants and serotonin selective reuptake inhibitors have been used in some patients with IBS.

23 Clinical Trial Effect of capsule 'UB03' containing potential probiotic strains for the treatment of patients with irritable bowel syndrome. 2011

Sudha, M Ratna / Sawant, P. ·Centre for Research & Development, Unique Biotech Limited, SP Biotech Park, Phase-II, Plot-2, Shameerpet, Hyderabad 500078, AP, India. sudha.ratna@gmail.com ·Benef Microbes · Pubmed #21986362.

ABSTRACT: The objective of this research was to study the efficacy and safety of capsule 'UB03' to treat patients with Irritable Bowel Syndrome (IBS). Thirty patients with Rome II IBS were assigned to receive capsule 'UB03' (10 billion lyophilised bacteria and yeast/capsule produced by Unique Biotech Limited, India) twice daily for 90 days. Assessment of IBS was carried out according with Rome II criteria and their severity for 90 days of treatment with an interval of 30 days. Complete haemogram, serum glutamic pyruvic transaminase, serum creatinine were performed as a part of safety evaluation at the time of inclusion and after 90 days of treatment. There was significant improvement in frequency of defecation (23%), consistency of stool, abdominal discomfort, bloating and flatulence. However, there was no significant change in abdominal pain and mucus in stool. This trial demonstrates that the consumption of capsule 'UB03' containing potential probiotic strains is found to be effective and safe for the treatment of patients with IBS.

24 Clinical Trial Lactose hydrogen breath test versus lactose tolerance test in the tropics: does positive lactose tolerance test reflect more severe lactose malabsorption? 2009

Ghoshal, Uday C / Kumar, Sunil / Chourasia, Dipti / Misra, Asha. ·Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. udayghoshal@gmail.com ·Trop Gastroenterol · Pubmed #19760990.

ABSTRACT: BACKGROUND: We compared the lactose hydrogen breath (lactose HBT) and lactose tolerance tests (LTT) in their ability to diagnose lactose malabsorption (LM). METHODS: Fasting and post-lactose (50 g) breath hydrogen and blood sugar were tested in patients with irritable bowel syndrome (IBS). Persistent rise in breath hydrogen by 20 ppm and failure of blood sugar to rise by >20 mg/dL above basal level, were considered positive lactose HBT and LTT, respectively. Symptoms of diarrhoea, bloating, abdominal pain and flatulence were noted. RESULTS: Of 203 patients, 11 demonstrated high basal breath hydrogen and hence, 192 (age 37+/-14 years, 134 male) were included in the study. 125 (65%) and 137 (71%) were lactose HBT and LTT positive, respectively. 102/125 lactose HBT positive patients were LTT positive and 35/67 lactose HBT negative patients were LTT positive. 62/192 (32%) developed symptoms following lactose ingestion, which tended to be more in the LTT positive (49/137, 36% vs. 13/55, 24% p=0.07) but not in the lactose HBT positive patients (44/125, 35% vs. 18/67, 27% p=0.2). Peak breath hydrogen was higher (38+/-37 vs. 66+/-43; p<0.01) in LTT positive than negative patients. Peak level of breath hydrogen inversely correlated (58+/-43 vs. 10+/-23; p<0.001) with change in blood glucose following lactose ingestion. CONCLUSIONS: Positive LTT is associated with a higher breath hydrogen score than negative LTT. There was a trend towards more frequent symptom development following lactose load in LTT positive but not in lactose HBT positive patients. LTT is an easy and efficient test for diagnosis of LM.

25 Article Effect of video-assisted patient education on compliance with therapy, quality of life, psychomorbidity, and cost of illness in irritable bowel syndrome. 2019

Kamat, Nagesh / Rajan Mallayasamy, Surulivel / Sharma, Psvn / Kamath, Asha / Pai, Ganesh. ·a Department of Gastroenterology and Hepatology , Kasturba Medical College, Manipal Academy of Higher Education (MAHE) , Manipal , India. · b Department of Pharmacotherapy , UNTS College of Pharmacy, University of North Texas Health Science Center , Fort Worth , TX , USA. · c Department of Pharmacy Practice , Manipal College of Pharmaceutical Sciences , Manipal , India. · d Department of Psychiatry , Kasturba Medical College , Manipal , India. · e Department of Community Medicine , Kasturba Medical College , Manipal , India. ·Postgrad Med · Pubmed #30445893.

ABSTRACT: OBJECTIVE: Patient education is important in irritable bowel syndrome (IBS), but its effects on outcomes have not been studied extensively. METHODS: Patients were enrolled and prospectively divided into an interventional and usual care group. Both received standard of care, but the former additionally received video-assisted patient education. Self-administered questionnaires IBS-quality of life (QOL), Beck Anxiety-Depression Inventory II (BAI, BDI), and Hospital Anxiety and Depression Scale (HADS) were administered at baseline, 3 months, and 6 months. Compliance was defined as drug intake of >80% of the prescribed dose. COI included prospective, prevalence-based, societal perspective. RESULTS: Of the 107 patients included, 84 [78.5%; male = 66 (78.57%); median age = 44 (range 20-77 years)] completed the follow up. While the median (inter-quartile range; IQR) QOL scores decreased significantly in both the groups (p < 0.001 for either group), the final scores were significantly better in the interventional group [49 (44-52.5) versus 80 (76-103), respectively; p < 0.005]. There was a significant improvement in the BDI; p < 0.001]. However, the rest did not achieve statistical significance. At 6 months, total median (IQR) semi-annual cost per patient was INR 14,639 (8253-17,909) [US $240 (135-294]. CONCLUSION: Video-assisted patient education should be a part of the treatment of IBS since it improves the QOL and depression scores.