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Irritable Bowel Syndrome: HELP
Articles from United Kingdom
Based on 434 articles published since 2008

These are the 434 published articles about Irritable Bowel Syndrome that originated from United Kingdom during 2008-2019.
+ Citations + Abstracts
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276 Article Characteristics of functional bowel disorder patients: a cross-sectional survey using the Rome III criteria. 2014

Ford, A C / Bercik, P / Morgan, D G / Bolino, C / Pintos-Sanchez, M I / Moayyedi, P. ·Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK. ·Aliment Pharmacol Ther · Pubmed #24308816.

ABSTRACT: BACKGROUND: There is some evidence that, despite attempts to classify them separately, functional bowel disorders are not distinct entities and that such divisions are artificial. AIM: To examine this issue in a large cohort of secondary care patients. METHODS: Consecutive, unselected adults with gastrointestinal (GI) symptoms attending out-patient clinics at two hospitals in Hamilton, Ontario were recruited. Demographic data, symptoms and presence of anxiety, depression or somatisation were collected prospectively. We used validated questionnaires, including the Rome III questionnaire, with patients categorised as having irritable bowel syndrome (IBS), functional diarrhoea or chronic idiopathic constipation (CIC). We compared data between these disorders, and measured degree of overlap between them by suspending their mutual exclusivity. RESULTS: Of 3656 patients providing complete lower GI symptom data, 1551 (42.4%) met criteria for a functional bowel disorder. Diarrhoea-predominant IBS (IBS-D) patients were younger, and more were female, met criteria for anxiety, and reported somatisation-type behaviour, compared with functional diarrhoea. Only loose, mushy or watery stools were more common in functional diarrhoea. When mutual exclusivity was suspended, overlap occurred in 27.6%. Constipation-predominant IBS (IBS-C) patients were younger, and more were female, had never married, reported anxiety type symptoms and exhibited somatisation-type behaviour. One in five CIC patients reported abdominal pain or discomfort. All constipation symptoms were more common in IBS-C. When the mutual exclusivity was suspended, overlap occurred in 18.1%. CONCLUSIONS: There were significant differences in demographics between individuals with functional bowel disorders. Despite this, the Rome III classification system falls short of describing unique entities.

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

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

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

278 Article Fasting and postprandial volumes of the undisturbed colon: normal values and changes in diarrhea-predominant irritable bowel syndrome measured using serial MRI. 2014

Pritchard, S E / Marciani, L / Garsed, K C / Hoad, C L / Thongborisute, W / Roberts, E / Gowland, P A / Spiller, R C. ·Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK. ·Neurogastroenterol Motil · Pubmed #24131490.

ABSTRACT: BACKGROUND: Previous assessments of colon morphology have relied on tests which were either invasive or used ionizing radiation. We aimed to measure regional volumes of the undisturbed colon in healthy volunteers (HV) and patients with diarrhea-predominant irritable bowel syndrome (IBS-D). METHODS: 3D regional (ascending, transverse, and descending) colon volumes were measured in fasting abdominal magnetic resonance (MR) images of 75 HVs and 25 IBS-D patients. Thirty-five of the HV and all 25 IBS-D subjects were fed a standard meal and postprandial MRI data obtained over 225 min. KEY RESULTS: Colonic regions were identified and 3D maps from cecum to sigmoid flexure were defined. Fasted regional volumes showed wide variation in both HVs being (mean ± SD) ascending colon (AC) 203 ± 75 mL, transverse (TC) 198 ± 79 mL, and descending (DC) 160 ± 86 mL with no difference from IBS-D subjects (AC 205 ± 69 mL, TC 232 ± 100 mL, and DC 151 ± 71 mL, respectively). The AC volume expanded by 10% after feeding (p = 0.007) in the 35 HV possibly due to increased ileo-colonic inflow. A later rise in AC volume occurred from t = 90 to t = 240 min as the meal residue entered the cecum. In contrast, IBS-D subjects showed a much reduced postprandial response of the AC (p < 0.0001) and a greater increase in TC volume after 90 min (p = 0.0244) compared to HV. CONCLUSIONS & INFERENCES: We have defined a normal range of the regional volumes of the undisturbed colon in fasted and fed states. The AC in IBS-D appeared less able to accommodate postprandial inflow which may account for faster colonic transit.

279 Article Genetic variants in CDC42 and NXPH1 as susceptibility factors for constipation and diarrhoea predominant irritable bowel syndrome. 2014

Wouters, Mira M / Lambrechts, Diether / Knapp, Michael / Cleynen, Isabelle / Whorwell, Peter / Agréus, Lars / Dlugosz, Aldona / Schmidt, Peter Thelin / Halfvarson, Jonas / Simrén, Magnus / Ohlsson, Bodil / Karling, Pontus / Van Wanrooy, Sander / Mondelaers, Stéphanie / Vermeire, Severine / Lindberg, Greger / Spiller, Robin / Dukes, George / D'Amato, Mauro / Boeckxstaens, Guy. ·Translational Research Center for Gastrointestinal Disorders, Leuven University, Leuven, Belgium. · Vesalius Research Center, VIB, Leuven University, Leuven, Belgium Laboratory for Translational Genetics, Department of Oncology, Leuven University, Leuven, Belgium. · Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany. · Department of Medicine, University of Manchester, Manchester, UK. · Centre for Family Medicine, Karolinska Institutet, Stockholm, Sweden. · Department of Medicine, Karolinska Institutet, Stockholm, Sweden. · Department of Internal Medicine, Örebro University Hospital, Örebro, Sweden. · Department of Internal Medicine, Gothenburg University, Gothenburg, Sweden. · Department of Clinical Sciences, Skånes University Hospital, Malmoe, Sweden. · Department of Medicine, Umeå University, Umeå, Sweden. · Queen's Medical Centre, Nottingham, UK. · Academic DPU, GlaxoSmithKline, Research Triangle Par, North Carolina, USA. · Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden. ·Gut · Pubmed #24041540.

ABSTRACT: OBJECTIVE: The complex genetic aetiology underlying irritable bowel syndrome (IBS) needs to be assessed in large-scale genetic studies. Two independent IBS cohorts were genotyped to assess whether genetic variability in immune, neuronal and barrier integrity genes is associated with IBS. DESIGN: 384 single nucleotide polymorphisms (SNPs) covering 270 genes were genotyped in an exploratory cohort (935 IBS patients, 639 controls). 33 SNPs with Puncorrected<0.05 were validated in an independent set of 497 patients and 887 controls. Genotype distributions of single SNPs were assessed using an additive genetic model in IBS and clinical subtypes, IBS-C and IBS-D, both in individual and combined cohorts. Trait anxiety (N=614 patients, 533 controls), lifetime depression (N=654 patients, 533 controls) and mRNA expression in rectal biopsies (N=22 patients, 29 controls) were correlated with SNP genotypes. RESULTS: Two SNPs associated independently in the exploratory and validation cohort: rs17837965-CDC42 with IBS-C (ORexploratory=1.59 (1.05 to 1.76); ORvalidation=1.76 (1.03 to 3.01)) and rs2349775-NXPH1 with IBS-D (ORexploratory=1.28 (1.06 to 1.56); ORvalidation=1.42 (1.08 to 1.88)). When combining both cohorts, the association of rs2349775 withstood post hoc correction for multiple testing in the IBS-D subgroup. Additionally, three SNPs in immune-related genes (rs1464510-LPP, rs1881457-IL13, rs2104286-IL2RA), one SNP in a neuronal gene (rs2349775-NXPH1) and two SNPs in epithelial genes (rs245051-SLC26A2, rs17837965-CDC42) were weakly associated with total-IBS (Puncorrected<0.05). At the functional level, rs1881457 increased IL13 mRNA levels, whereas anxiety and depression scores did not correlate with rs2349775-NXPH1. CONCLUSIONS: Rs2349775 (NXPH1) and rs17837965 (CDC42) were associated with IBS-D and IBS-C, respectively, in two independent cohorts. Further studies are warranted to validate our findings and to determine the mechanisms underlying IBS pathophysiology.

280 Article Cognitive performance in irritable bowel syndrome: evidence of a stress-related impairment in visuospatial memory. 2014

Kennedy, P J / Clarke, G / O'Neill, A / Groeger, J A / Quigley, E M M / Shanahan, F / Cryan, J F / Dinan, T G. ·Alimentary Pharmabiotic Centre, University College Cork, Ireland. · Department of Psychology, University of Hull, UK. ·Psychol Med · Pubmed #23985155.

ABSTRACT: BACKGROUND: Central nervous system (CNS) dysfunction is a prominent feature of the functional gastrointestinal (GI) disorder, irritable bowel syndrome (IBS). However, the neurobiological and cognitive consequences of key pathophysiological features of IBS, such as stress-induced changes in hypothalamic-pituitary-adrenal (HPA)-axis functioning, is unknown. Our aim was to determine whether IBS is associated with cognitive impairment, independently of psychiatric co-morbidity, and whether cognitive performance is related to HPA-axis function. METHOD: A cross-sectional sample of 39 patients with IBS, a disease control group of 18 patients with Crohn's disease (CD) in clinical remission and 40 healthy age- and IQ-matched control participants were assessed using the Paired Associates Learning (PAL), Intra-Extra Dimensional Set Shift (IED) and Spatial Working Memory (SWM) tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) and a computerized Stroop test. HPA-axis function was determined by measuring the cortisol awakening response (CAR). RESULTS: IBS patients exhibited a subtle visuospatial memory deficit at the PAL six- pattern stage (p = 0.03), which remained after psychiatric co-morbidity was controlled for (p = 0.04). Morning cortisol levels were lower in IBS (p = 0.04) and significantly associated with visuospatial memory performance within IBS only (p = 0.02). CONCLUSIONS: For the first time, altered cognitive function on a hippocampal-mediated test of visuospatial memory, which was related to cortisol levels and independent of psychiatric co-morbidity, has been identified in IBS. Visuospatial memory impairment may be a common, but currently neglected, component of IBS. Further elucidation of the nature of this impairment may lead to a greater understanding of the underlying pathophysiology of IBS, and may provide novel therapeutic approaches.

281 Article Characterisation of faecal protease activity in irritable bowel syndrome with diarrhoea: origin and effect of gut transit. 2014

Tooth, David / Garsed, Klara / Singh, Gulzar / Marciani, Luca / Lam, Ching / Fordham, Imogen / Fields, Annie / Banwait, Rawinder / Lingaya, Melanie / Layfield, Robert / Hastings, Maggie / Whorwell, Peter / Spiller, Robin. ·School of Biomedical Sciences, University of Nottingham, , Nottingham, Nottinghamshire, UK. ·Gut · Pubmed #23911555.

ABSTRACT: OBJECTIVES: Faecal serine proteases (FSPs) may play a role in irritable bowel syndrome with diarrhoea (IBS-D), but their origin is unclear. We aimed to structurally characterise them and define the impact of colonic cleansing and transit time. DESIGN: Faecal samples were obtained from 30 healthy volunteers (HV) and 79 patients with IBS-D participating in a trial of ondansetron versus placebo. Colonic transit was measured using radio-opaque markers. Samples were also obtained from 24 HV before and after colonic cleansing with the osmotic laxative MoviPrep. FSPs were purified from faecal extracts using benzamidine-Sepharose affinity chromatography. SDS-PAGE profiled components were identified using trypsinolysis and tandem mass spectrometry. Functional protease activity in faecal extracts was measured using a colorimetric assay based on the proteolysis of azo-casein. RESULTS: Protein analysis identified the most abundant FSPs as being of human origin and probably derived from pancreatic juice. Functional assays showed increased faecal protease (FP) and amylase in patients with IBS-D compared with HV. Those with higher amylase had significantly higher FP and greater anxiety. FP activity correlated negatively with whole gut transit in patients with IBS-D (Spearman r=-0.32, p=0.005) and HV (r=-0.55, p=0.014). Colon cleansing caused a significant rise in FP activity in HV from a baseline of median (IQR) 253 (140-426) to 1031 (435-2296), levels similar to those seen in patients with IBS-D. FSP activity correlated positively with days/week with urgency. CONCLUSIONS: The most abundant FSPs are of human origin. Rapid transit through the colon and/or decreased (possibly bacterial) proteolytic degradation increases their faecal concentration and could contribute to visceral hypersensitivity in patients with IBS-D. CLINICALTRIALSGOV: NCT00745004.

282 Article Clinical update: recurrent abdominal pain in children. 2013

Paul, Siba Prosad / Candy, David C A. ·Bristol Royal Hospital for Children, Bristol. · Royal Alexandra Children's Hospital, Brighton. ·Community Pract · Pubmed #24369571.

ABSTRACT: Recurrent abdominal pain (RAP) is common in children and most cases have a non-organic cause. Diagnosis is made by excluding other serious causes, and early referral and intervention help ensure a better outcome. RAP can cause significant anxiety in parents and carers, who can become overwhelmed by fear of serious disease and feel helpless by being unable to relieve their child's pain. Parents and children (especially adolescents) need explanation that there is nothing seriously wrong with their 'tummy' and provide reassurance and support. Although there is limited evidence, pharmacological therapies are used in severe cases. The main crux of therapy is non-pharmacological and includes symptom control through lifestyle changes, dietary interventions and behavioural therapies with an aim to return to normal activity.

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

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

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

284 Article Using read codes to identify patients with irritable bowel syndrome in general practice: a database study. 2013

Harkness, Elaine F / Grant, Laura / O'Brien, Sarah J / Chew-Graham, Carolyn A / Thompson, David G. ·Institute of Inflammation and Repair, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK. Elaine.F.Harkness@manchester.ac.uk. ·BMC Fam Pract · Pubmed #24295337.

ABSTRACT: BACKGROUND: Estimates of the prevalence of irritable bowel syndrome (IBS) vary widely, and a large proportion of patients report having consulted their general practitioner (GP). In patients with new onset gastrointestinal symptoms in primary care it might be possible to predict those at risk of persistent symptoms. However, one of the difficulties is identifying patients within primary care. GPs use a variety of Read Codes to describe patients presenting with IBS. Furthermore, in a qualitative study, exploring GPs' attitudes and approaches to defining patients with IBS, GPs appeared reluctant to add the IBS Read Code to the patient record until more serious conditions were ruled out. Consequently, symptom codes such as 'abdominal pain', 'diarrhoea' or 'constipation' are used. The aim of the current study was to investigate the prevalence of recorded consultations for IBS and to explore the symptom profile of patients with IBS using data from the Salford Integrated Record (SIR). METHODS: This was a database study using the SIR, a local patient sharing record system integrating primary, community and secondary care information. Records were obtained for a cohort of patients with gastrointestinal disorders from January 2002 to December 2011. Prevalence rates, symptom recording, medication prescribing and referral patterns were compared for three patient groups (IBS, abdominal pain (AP) and Inflammatory Bowel Disease (IBD)). RESULTS: The prevalence of IBS (age standardised rate: 616 per year per 100,000 population) was much lower than expected compared with that reported in the literature. The majority of patients (69%) had no gastrointestinal symptoms recorded in the year prior to their IBS. However a proportion of these (22%) were likely to have been prescribed NICE guideline recommended medications for IBS in that year. The findings for AP and IBD were similar. CONCLUSIONS: Using Read Codes to identify patients with IBS may lead to a large underestimate of the community prevalence. The IBS diagnostic Read Code was rarely applied in practice. There are similarities with many other medically unexplained symptoms which are typically difficult to diagnose in clinical practice.

285 Article Exploring patients' views of a cognitive behavioral therapy-based website for the self-management of irritable bowel syndrome symptoms. 2013

Tonkin-Crine, Sarah / Bishop, Felicity L / Ellis, Matthew / Moss-Morris, Rona / Everitt, Hazel. ·Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom. sktc1o07@soton.ac.uk ·J Med Internet Res · Pubmed #24001787.

ABSTRACT: BACKGROUND: Cognitive behavioral therapy (CBT) has been shown to have positive effects on the management of irritable bowel syndrome (IBS) symptoms. A factorial pilot randomized placebo-controlled trial (called MIBS) tested the potential effectiveness of a self-management CBT-based website alongside two medications: methylcellulose and mebeverine, and a placebo. The results showed no significant differences in quality of life or symptom severity measures, but enablement and participant's global assessment of relief was higher in the website groups. OBJECTIVE: To conduct a qualitative study nested within this trial, in order to explore patients' views and experiences of using the CBT-based website to facilitate self-management of IBS. METHODS: Semistructured interviews were carried out with patients who had used the website with one session of nurse support (n=16) or the website alone (n=15) while participating in the MIBS trial. An inductive thematic analysis was conducted. RESULTS: We identified three types of engagement with the CBT-based website. One group of participants, mostly in the website-only condition, had limited or no engagement with the website. One group engaged with the content and advice on practical lifestyle changes. The final group of participants engaged with the content and advice on psychological aspects related to IBS. Similarities and differences between these three groups are explored. CONCLUSIONS: Teaching self-management techniques through a Web intervention was received positively by most of the participants. Concepts linked to cognitive aspects of CBT appeared to be harder for participants to engage with. Participants who received nurse support rated the cognitive aspects more positively, suggesting that some therapy support alongside the website should be considered. However, the Web format was preferred by some who favored anonymity as well as those who appreciated the accessibility and ease of use of this type of management. Suggestions on how to encourage engagement with Web interventions are discussed.

286 Article Validation of the Rome III criteria for the diagnosis of irritable bowel syndrome in secondary care. 2013

Ford, Alexander C / Bercik, Premysl / Morgan, David G / Bolino, Carolina / Pintos-Sanchez, Maria Ines / Moayyedi, Paul. ·Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK. Electronic address: alexf12399@yahoo.com. ·Gastroenterology · Pubmed #23994201.

ABSTRACT: BACKGROUND & AIMS: There are few validation studies of existing diagnostic criteria for irritable bowel syndrome (IBS). We conducted a validation study of the Rome and Manning criteria in secondary care. METHODS: We collected complete symptom, colonoscopy, and histology data from 1848 consecutive adult patients with gastrointestinal symptoms at 2 hospitals in Hamilton, Ontario; the subjects then underwent colonoscopy. Assessors were blinded to symptom status. Individuals with normal colonoscopy and histopathology results, and no evidence of celiac disease, were classified as having no organic gastrointestinal disease. The reference standard used to define the presence of true IBS was lower abdominal pain or discomfort in association with a change in bowel habit and no organic gastrointestinal disease. Sensitivity, specificity, and positive and negative likelihood ratios, with 95% confidence intervals, were calculated for each diagnostic criteria. RESULTS: In identifying patients with IBS, sensitivities of the criteria ranged from 61.9% (Manning) to 95.8% (Rome I), and specificities from 70.6% (Rome I) to 81.8% (Manning). Positive likelihood ratios ranged from 3.19 (Rome II) to 3.39 (Manning), and negative likelihood ratios from 0.06 (Rome I) to 0.47 (Manning). The level of agreement between diagnostic criteria was greatest for Rome I and Rome II (κ = 0.95), and lowest for Manning and Rome III (κ = 0.59). CONCLUSIONS: Existing diagnostic criteria perform modestly in distinguishing IBS from organic disease. There appears to be little difference in terms of accuracy. More accurate ways of diagnosing IBS, avoiding the need for investigation, are required.

287 Article An observational study of cognitive function in patients with irritable bowel syndrome and inflammatory bowel disease. 2013

Berrill, J W / Gallacher, J / Hood, K / Green, J T / Matthews, S B / Campbell, A K / Smith, A. ·Department of Gastroenterology, University Hospital Llandough, Cardiff, UK. ·Neurogastroenterol Motil · Pubmed #23981191.

ABSTRACT: BACKGROUND: Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are associated with several risk factors for developing cognitive impairment. These include altered cytokine levels, concurrent mood disorders, and the presence of chronic pain. This observational study aimed to explore the cognitive profile of patients with these conditions. METHODS: Participants completed the Cardiff Cognitive Battery, a series of computerized neuropsychological performance tests that examine a range of cognitive function including psychomotor speed, memory, and intelligence. A progressive analysis of covariance model was used with demographic details, anxiety and depression scores entered as covariates. Fecal calprotectin levels were measured in IBD patients to determine disease activity. KEY RESULTS: In total 231 participants were recruited (150 IBD patients, 40 IBS patients, and 41 healthy controls). IBD patients had significantly lower scores on fluid (p = 0.01) and crystalline intelligence tests (p = 0.028) compared to healthy volunteers, however, this reflected differences in concurrent mood disorder and level of education. When these factors were added as covariates, there was no significant difference between the groups. Duration and activity of disease did not affect cognitive function in IBD patients. Severity of symptoms had no impact on cognition in patients with IBS. CONCLUSIONS & INFERENCES: The results of this observational study do not support the hypothesis that IBS or IBD have an intrinsic disease process that is associated with cognitive dysfunction. It is possible that concurrent mood disorders, in particular depression, may affect the cognitive performance of patients with IBD in specific tasks.

288 Article Changes in illness-related cognitions rather than distress mediate improvements in irritable bowel syndrome (IBS) symptoms and disability following a brief cognitive behavioural therapy intervention. 2013

Chilcot, Joseph / Moss-Morris, Rona. ·Health Psychology Section, Psychology Department, Institute of Psychiatry, King's College London, UK. Electronic address: joseph.chilcot@kcl.ac.uk. ·Behav Res Ther · Pubmed #23948131.

ABSTRACT: OBJECTIVE: A previous randomised controlled trial demonstrated that a cognitive behavioural therapy (CBT) self-management intervention significantly improved irritable bowel syndrome (IBS) symptoms and disability compared to treatment as usual (TAU). The current study analysed additional data to establish whether; 1) cognitive, behavioural and emotional factors hypothesized to perpetuate IBS symptoms and disability changed following CBT and, 2) ascertain if changes in these factors over the intervention period mediated treatment effects 6-months later. METHOD: IBS patients (CBT = 31, TAU = 33) completed measures pre-and-post intervention including: Brief Illness Perception Questionnaire, Hospital Anxiety & Depression Scale and Cognitive and Behavioural Responses to Symptoms Questionnaire. Path models were evaluated to determine whether changes in cognitive and behavioural factors over the treatment period mediated treatment effects. RESULTS: Compared to TAU, CBT patients showed significant positive changes on several cognitive variables but not anxiety and depression following intervention. Positive change in illness perceptions following intervention mediated the treatment effect on improved IBS symptom severity and social adjustment six months later. Changes in damaging beliefs mediated the effect on social adjustment. CONCLUSIONS: Change in cognition rather than mood mediated treatment related improvements. Changing negative perceptions of IBS appears to be a particularly important treatment mechanism.

289 Article Nurse-led hypnotherapy: an innovative approach to Irritable Bowel Syndrome. 2013

Bremner, Helen. ·178 Attingham Drive, Dudley DY1 3HY, UK. helen.bremner@hotmail.com ·Complement Ther Clin Pract · Pubmed #23890461.

ABSTRACT: INTRODUCTION: Irritable Bowel Syndrome (IBS) is a common, chronic functional illness, which can greatly reduce patients' quality of life, and consumes healthcare resources. Standard treatments include dietary changes and medication, though these are often ineffective. RESEARCH: Clinical studies of hypnotherapy demonstrate improvement in symptoms and quality of life in over 80% of subjects with intractable IBS. Our experience of a nurse-led hypnotherapy service for IBS in a community setting provides evidence of comparable efficacy for symptom control, improved quality of life, reduced dependence on medication and improved general health measures. We address the challenges of setting up and maintaining the service in a changing healthcare environment. CONCLUSION: This model of care could act as a template for providers of gastroenterology and functional disease services wishing to provide IBS care.

290 Article Diagnostic accuracy and clinical application of faecal calprotectin in adult patients presenting with gastrointestinal symptoms in primary care. 2013

Pavlidis, Polychronis / Chedgy, Fergus Jq / Tibble, Jeremy A. ·Brighton and Sussex University Hospitals, Digestive Diseases Centre, Brighton, UK. ·Scand J Gastroenterol · Pubmed #23883068.

ABSTRACT: OBJECTIVE: Assessment of faecal calprotectin (fCal) test performance in primary care within an irritable bowel syndrome (IBS) diagnostic pathway. METHODS: Study based on consecutively collected fCal data from 962 patients, aged 18-45, presenting to their general practitioner (GP) with persistent gastrointestinal symptoms. RESULTS: Six hundred and eighty six (71%) patients had a negative (<50 μg/g) and 276 (29%) had a positive fCal. 28% (77/276) of the patients testing positive and 3% (17/686) of those testing negative had an organic diagnosis. At 50 μg/g the sensitivity of the test for organic disease was 82%, (95% confidence interval [CI] 73-89) and the specificity was 77% (95% CI 74-80), with negative predictive value (NPV) and positive predictive value (PPV) of 98% and 28%, respectively. A cut-off increase to 150 μg/g reduces the NPV by 1% whilst increasing the PPV to 71%. This would reduce colonoscopy and flexible sigmoidoscopy bookings by 10% at the cost of four missed cases of inflammatory bowel disease. CONCLUSIONS: This study provides the first evidence on the use of fCal testing in primary care. The low prevalence of organic disease in this setting has a significant impact on test performance. This suggests a need for change in cut-off value, to improve PPV whilst accepting a reduction in test sensitivity, if it is to be used as part of the pathway for management of patients with suspected IBS.

291 Article Rome III functional constipation and irritable bowel syndrome with constipation are similar disorders within a spectrum of sensitization, regulated by serotonin. 2013

Shekhar, Chander / Monaghan, Phillip J / Morris, Julie / Issa, Basma / Whorwell, Peter J / Keevil, Brian / Houghton, Lesley A. ·Neurogastroenterology Unit, University of Manchester, Manchester, UK. ·Gastroenterology · Pubmed #23872499.

ABSTRACT: BACKGROUND & AIMS: Patients with irritable bowel syndrome with constipation (IBS-C) and patients with functional constipation (FC) have similar symptoms, and these disorders overlap in their diagnostic features. Little is known about their overlap in physiology or the involvement of serotonin signaling. We investigated relationships between platelet-depleted plasma concentrations of serotonin, gastrointestinal symptoms, and motor-sensory function in patients with FC or IBS-C compared with healthy volunteers (controls). METHODS: We measured platelet-depleted plasma concentrations of serotonin in fasting and fed individuals with IBS-C (n = 23; 19-50 years old), FC (n = 11; 25-46 years old), and controls (n = 23; 20-49 years old) recruited in Manchester, UK. We also quantified abdominal and bowel-related symptoms, rectal sensitivity, oro-cecal transit, and colonic (whole intestine) transit. RESULTS: Patients with IBS-C or FC had similar baseline symptoms, bowel habits, oro-cecal and colonic transit, and fasting concentrations of serotonin and response to meal ingestion. Only patients with IBS-C had increased symptoms after ingestion of a meal (P < .001)-these patients tended to have lower sensory thresholds than patients with FC. Defecation frequency in the combined group of patients with IBS-C or FC correlated inversely with serotonin concentration (r = -0.4; P = .03). Serotonin concentration also correlated with pain threshold (r = 0.4; P = .02) and stool threshold (r = 0.5; P = .06), which correlated inversely with defecation frequency (r = -0.3; P = .10). CONCLUSIONS: FC and IBS-C, based on Rome III criteria, are not distinct disorders, symptomatically or physiologically. Instead, they appear to lie in a spectrum of visceral sensitivity modulated by serotonin signaling. Symptom response to meal ingestion should be considered in patient classification.

292 Article Analysis of volatile organic compounds of bacterial origin in chronic gastrointestinal diseases. 2013

Walton, Christopher / Fowler, Dawn P / Turner, Claire / Jia, Wenjing / Whitehead, Rebekah N / Griffiths, Lesley / Dawson, Claire / Waring, Rosemary H / Ramsden, David B / Cole, Jeffrey A / Cauchi, Michael / Bessant, Conrad / Hunter, John O. ·Cranfield Health, Cranfield University, Bedfordshire, United Kingdom. c.walton@cranfield.ac.uk ·Inflamm Bowel Dis · Pubmed #23867873.

ABSTRACT: BACKGROUND: The aim of this study was to determine whether volatile organic compounds (VOCs) present in the headspace of feces could be used to diagnose or distinguish between chronic diseases of the gastrointestinal tract and apparently healthy volunteers. METHODS: A total of 87 people were recruited, divided between 4 categories: healthy volunteers (n = 19), Crohn's disease (n = 22), ulcerative colitis (n = 20), and irritable bowel syndrome (n = 26). They each supplied fecal samples before, and except for the healthy volunteers, after treatment. Fecal samples were incubated in a sample bag with added purified air at 40°C and headspace samples were taken and concentrated on thermal sorption tubes. Gas chromatography-mass spectrometry then desorbed and analyzed these. The concentrations of a selection of high-abundance compounds were determined and assessed for differences in concentration between the groups. RESULTS: Crohn's disease samples showed significant elevations in the concentrations of ester and alcohol derivates of short-chain fatty acids and indole compared with the other groups; indole and phenol were elevated in ulcerative colitis and irritable bowel syndrome but not at a statistically significant level. After treatment, the levels of many of the VOCs were significantly reduced and were more similar to those concentrations in healthy controls. CONCLUSIONS: The abundance of a number of VOCs in feces differs markedly between Crohn's disease and other gastrointestinal conditions. Following treatment, the VOC profile is altered to more closely resemble that of healthy volunteers.

293 Article Randomized clinical trial: macrogol/PEG 3350 plus electrolytes for treatment of patients with constipation associated with irritable bowel syndrome. 2013

Chapman, R W / Stanghellini, V / Geraint, M / Halphen, M. ·Department of Gastroenterology, John Radcliffe Hospital, Oxford, UK. ·Am J Gastroenterol · Pubmed #23835436.

ABSTRACT: OBJECTIVES: Polyethylene glycol (PEG) 3350 plus electrolytes (PEG 3350+E) is an established treatment for constipation and has been proposed as a treatment option for constipation associated with irritable bowel syndrome (IBS-C). This study aimed to compare the efficacy and safety of PEG 3350+E vs. placebo in adult patients with IBS-C. METHODS: Following a 14-day run-in period without study medication, patients with confirmed IBS-C were randomized to receive PEG 3350+E (N=68) or placebo (N=71) for 28 days. The primary endpoint was the mean number of spontaneous bowel movements (SBMs) per day in the last treatment week. RESULTS: In both groups, mean weekly number of SBMs (±s.d.) increased from run-in. The difference between the groups in week 4 (PEG 3350+E, 4.40±2.581; placebo, 3.11±1.937) was statistically significant (95% confidence interval: 1.17, 1.95; P<0.0001). Although mean severity score for abdominal discomfort/pain was significantly reduced compared with run-in with PEG 3350+E, there was no difference vs. placebo. Spontaneous complete bowel movements, responder rates, stool consistency, and severity of straining also showed superior improvement in the PEG 3350+E group over placebo in week 4. The most common drug related treatment-emergent adverse events were abdominal pain (PEG 3350+E, 4.5%; placebo, 0%) and diarrhoea (PEG 3350+E, 4.5%; placebo, 4.3%). CONCLUSIONS: In IBS-C, PEG 3350+E was superior to placebo for relief of constipation, and although a statistically significant improvement in abdominal discomfort/pain was observed compared with baseline, there was no associated improvement compared with placebo. PEG 3350+E is a well-established and effective treatment that should be considered suitable for use in IBS-C.

294 Article Management of refractory irritable bowel syndrome and comorbid mental ill-health: challenges, reflections and patient's perspective of life on the body-mind divide. 2013

Udo, Itoro / Gash, Amanda. ·Department of Liaison Psychiatry, Roseberry Park Hospital, Tees Esk Wear Valleys NHS Foundation Trust, Middlesbrough, UK. dr_itoro@yahoo.com ·BMJ Case Rep · Pubmed #23814199.

ABSTRACT: This complex case illustrates how blurred the divide between body and mind can be. In a patient with refractory irritable bowel symptoms, the emergence of new social problems exacerbate both psychiatric (anxiety and depression) and physical symptoms. Treatment of the physical symptomatology consisted of acute hospital treatments initially and subsequent primary care consultations. Psychiatric treatment consists of psychopharmacological (venlafaxine and mirtazapine) and psychotherapeutic approaches (cognitive behavioural therapy initially, and clinical hypnosis). The objectives of psychiatric treatment were to stabilise symptoms, reduce hospital admissions and foster self-management. The gains of management are presented. Social difficulties encountered over the period of treatment were legal processes to gain custody of son, bereavement, financial difficulties occasioned by stoppage of welfare benefits and legal processes involved in welfare appeal. Importantly, the patient's perceptive of treatment and care is presented. Detrimental effects that current welfare reforms in the UK may have on health are highlighted.

295 Article Commentary: demystifying IBS mind-based therapies. 2013

Paine, P. ·Department of Gastroenterology, Salford Royal Foundation Trust, Salford, Manchester, UK. peter.paine@srft.nhs.uk ·Aliment Pharmacol Ther · Pubmed #23808417.

ABSTRACT: -- No abstract --

296 Article GP perspectives of irritable bowel syndrome--an accepted illness, but management deviates from guidelines: a qualitative study. 2013

Harkness, Elaine F / Harrington, Val / Hinder, Sue / O'Brien, Sarah J / Thompson, David G / Beech, Paula / Chew-Graham, Carolyn A. ·Institute of Inflammation and Repair, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PL, England. Elaine.F.Harkness@manchester.ac.uk ·BMC Fam Pract · Pubmed #23805998.

ABSTRACT: BACKGROUND: The estimated prevalence of irritable bowel syndrome (IBS) is 10%. Up to one third of patients develop chronic symptoms, which impact on everyday functioning and psychological wellbeing. Guidelines suggest an increased role for primary care in the management of patients with IBS, and referral for psychological interventions. Literature reports dissatisfaction and frustration experienced by both patients with IBS and healthcare professionals. The aim of this study was to explore the perspectives of general practitioners (GPs) in relation to the diagnosis and management of IBS and their views on the potential use of a risk assessment tool to aid management decisions for patients with IBS in primary care. METHODS: This was a qualitative study using face-to-face semi-structured interviews with GPs in North West England. Interviews were fully transcribed and data analyzed using constant comparison across interviews. Tensions between GP accounts and the NICE guideline for the management of IBS were highlighted. RESULTS: GPs described IBS as a diagnosis of exclusion and the process as tentative and iterative, with delay in adding a Read code to the patient record until they were confident of the diagnosis. Whilst GPs accepted there was a link between IBS and psychological symptoms they suggested that the majority of patients could be managed within primary care without referral for psychological interventions, in conflict with the NICE guideline. They did not feel that a risk assessment tool for patients with IBS would be helpful. CONCLUSIONS: This study highlights the tensions between evidence recognizing the need to identify patients whose symptoms may become chronic and offer pro-active care, including referral for psychological therapies, and the perspectives of GPs managing patients in every-day clinical practice. The reluctance of GPs to refer patients for evidence-based psychological treatments may have implications for commissioning services and patient care.

297 Article An excess of prior irritable bowel syndrome diagnoses or treatments in Celiac disease: evidence of diagnostic delay. 2013

Card, Timothy R / Siffledeen, Jesse / West, Joe / Fleming, Kate M. ·Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building Phase 2, Nottingham City Hospital, Nottingham, UK. tim.card@nottingham.ac.uk ·Scand J Gastroenterol · Pubmed #23697749.

ABSTRACT: OBJECTIVE: It is recognized that celiac disease can present with symptoms characteristic of irritable bowel syndrome (IBS) and that a substantial proportion of patients referred to gastroenterologists with these symptoms may have celiac disease. The authors set out to discover how commonly those suffering with celiac disease are misdiagnosed as suffering from IBS and whether such misdiagnosis delays the correct diagnosis. MATERIALS AND METHODS: A case control study using computerized records from the General Practice Research Database was conducted. The authors compared the proportion of patients with celiac disease who had a diagnosis of or had undergone treatment for IBS over a variety of time periods before the diagnosis of celiac disease with the proportion of a matched group without celiac disease who were similarly diagnosed or treated. RESULTS: It was found that 16% of celiac patients had such a prior diagnosis compared to 4.9% of controls (a threefold increased risk of prior IBS; OR = 3.8, 95% CI: 3.6-4.2), and that if one looked at typical treatment for IBS rather than diagnostic codes, 28% of celiac patients appeared to have been treated compared to 9% of controls. Many of the diagnoses of IBS occurred within the last year before diagnosis of celiac disease, but there was a clear excess of IBS even 10 years earlier. CONCLUSIONS: In contemporary UK practice, it is likely that at least some patients with celiac disease spend many years being treated as having IBS. Following guidelines to test serologically for celiac disease will minimize this problem.

298 Article Symptoms of irritable bowel syndrome in patients with inflammatory bowel disease: examining the role of sub-clinical inflammation and the impact on clinical assessment of disease activity. 2013

Berrill, J W / Green, J T / Hood, K / Campbell, A K. ·Department of Gastroenterology, University Hospital Llandough, Cardiff, Wales, UK. jamesberrill1@doctors.org.uk ·Aliment Pharmacol Ther · Pubmed #23668698.

ABSTRACT: BACKGROUND: Symptoms compatible with irritable bowel syndrome (IBS) are frequently present in patients with inflammatory bowel disease (IBD); however, the cause of this phenomenon is unclear. AIM: To determine the different contributions of 'true IBS' and sub-clinical inflammation in producing IBS-type symptoms in IBD patients, and to ascertain the impact these symptoms have on the clinical assessment of IBD activity. METHODS: In this cross-sectional study, 169 IBD patients completed questionnaires to assess disease activity, presence of IBS-type symptoms, and levels of anxiety and depression. Stool samples were collected for analysis of faecal calprotectin (FC). RESULTS: IBS-type symptoms were significantly more common in female patients (OR = 4.64, 1.55-13.88) and were associated with higher levels of anxiety (OR = 1.11, 1.01-1.21). There was no statistical difference between the FC levels of patients in clinical remission with IBS-type symptoms compared with those without (median values = 111 μg/g vs. 45.5 μg/g respectively, P = 0.171). The prevalence of IBS-type symptoms in patients with a normal FC level was 31%. CONCLUSIONS: A substantial number of IBD patients with normal faecal calprotectin level experience IBS-type symptoms. These patients exhibit similar features to people diagnosed with IBS in the general community, suggesting that the conditions are not mutually exclusive and may coexist in a considerable number of IBD patients. A systematic diagnostic approach is required to assess IBD patients with IBS-type symptoms as sub-clinical inflammation may play a role in a proportion of cases.

299 Article Irritable bowel syndrome in the UK military after deployment to Iraq: what are the risk factors? 2013

Goodwin, Laura / Bourke, Julius H / Forbes, Harriet / Hotopf, Matthew / Hull, Lisa / Jones, Norman / Rona, Roberto J / Wessely, Simon / Fear, Nicola T. ·King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, SE5 9RJ, UK, laura.goodwin@kcl.ac.uk. ·Soc Psychiatry Psychiatr Epidemiol · Pubmed #23636672.

ABSTRACT: PURPOSE: Diarrhoea and vomiting (D & V) was common in military personnel during deployment to the initial phases of the Iraq war. D & V is an established risk factor for irritable bowel syndrome (IBS). This study examined the prevalence of IBS in a military sample with a history of deployment to Iraq and the association between D & V and common mental disorder (CMD) with IBS. METHODS: The study used data from a two-phase cohort study of military/personnel. The sample was restricted to individuals who had been deployed to Iraq before phase 1 of the study and who had completed the self-report D & V question. A measure of probable IBS was derived at both phases of the study based on self-reported symptoms in the previous month. CMD was assessed by the General Health Questionnaire (GHQ-12). RESULTS: Fifty-nine percent of the sample reported a D & V event and 6.6 % met the criteria for probable IBS at phase 1. Reporting D & V, thinking one might be killed on deployment, poor physical health and CMD were associated with probable IBS at phase 1. CMD at phase 1 was strongly associated with chronic symptoms of IBS. CONCLUSIONS: There was a high prevalence of D & V during deployment to the early stages of the Iraq war, yet the prevalence of probable IBS on return from deployment was relatively low. D & V was strongly associated with IBS after deployment, and CMD was a risk factor for chronic symptoms of IBS.

300 Article Randomised controlled trial of brief intervention with biofeedback and hypnotherapy in patients with refractory irritable bowel syndrome. 2013

Dobbin, A / Dobbin, J / Ross, S C / Graham, C / Ford, M J. ·School of Clinical Sciences and Community Health, University of Edinburgh, Edinburgh, UK. alastair@foundationforpositivementalhealth.com ·J R Coll Physicians Edinb · Pubmed #23516685.

ABSTRACT: Irritable bowel syndrome (IBS) is a common disorder associated with profoundly impaired quality of life and emotional distress. The management of refractory IBS symptoms remains challenging and non-pharmacological therapeutic approaches have been shown to be effective. We compared brief interventions with biofeedback and hypnotherapy in women referred by their GP with refractory IBS symptoms. Patients were randomised to one of two treatment groups, biofeedback or hypnotherapy, delivered as three one-hour sessions over 12 weeks. Symptom assessments were undertaken using validated, self-administered questionnaires. Two of the 128 consecutive IBS patients suitable for the study declined to consider nonpharmacological therapy and 29 patients did not attend beyond the first session. Of the 97 patients randomised into the study, 21 failed to attend the therapy session; 15 of 76 patients who attended for therapy dropped out before week 12 post-therapy. The mean (SD) change in IBS symptom severity score 12 weeks post-treatment in the biofeedback group was -116.8 (99.3) and in the hypnotherapy group -58.0 (101.1), a statistically significant difference between groups (difference=-58.8, 95% confidence interval [CI] for difference [-111.6, -6.1], p=0.029). In 61 patients with refractory IBS, biofeedback and hypnotherapy were equally effective at improving IBS symptom severity scores, total non-gastrointestinal symptom scores and anxiety and depression ratings during 24 weeks follow-up. Biofeedback may prove to be the more cost-effective option as it requires less expertise.

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