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Irritable Bowel Syndrome: HELP
Articles from United Kingdom
Based on 523 articles published since 2010

These are the 523 published articles about Irritable Bowel Syndrome that originated from United Kingdom during 2010-2020.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19 · 20
276 Article How bad is bile acid diarrhoea: an online survey of patient-reported symptoms and outcomes. 2017

Bannaga, Ayman / Kelman, Lawrence / O'Connor, Michelle / Pitchford, Claire / Walters, Julian R F / Arasaradnam, Ramesh P. ·Department of Gastroenterology , University Hospital Coventry and Warwickshire , Coventry , UK. · BAM Facebook Group , Coventry , UK. · BAM Facebook Group, Coventry, UK; BAM Support UK, Coventry, UK. · Digestive Diseases Division , Imperial College London , London , UK. · Department of Gastroenterology, University Hospital Coventry and Warwickshire, Coventry, UK; University of Warwick, Coventry, UK; University of Coventry, Coventry, UK. ·BMJ Open Gastroenterol · Pubmed #28123771.

ABSTRACT: OBJECTIVES: Bile acid diarrhoea (BAD) is an underdiagnosed condition producing diarrhoea, urgency and fear of faecal incontinence. How patients experience these symptoms has not previously been studied. Bile Acid Malabsorption (BAM) Support UK was established in 2015 as a national charity with objectives including to provide details regarding how BAD affects patients, to improve earlier recognition and clinical management. DESIGN SETTING AND MAIN OUTCOME: A questionnaire was collected anonymously by BAM Support UK and the Bile Salt Malabsorption Facebook group over 4 weeks at the end of 2015. It comprised 56 questions and aimed to inform patients and clinicians about how BAD affects the respondents. RESULTS: The first 100 responses were analysed. 91% of the respondents reported a diagnosis of BAD. 58% of total respondents diagnosed following a Selenium-homocholic acid taurine scan, 69% were diagnosed by a gastroenterologist, with type 2 and 3 BAD comprising 38% and 37%, respectively, of total respondents. Symptoms had been experienced for more than 5 years before diagnosis in 44% of respondents. Following treatment, usually with bile acid sequestrants, 60% of participants reported improvement of diarrhoea and most reported their mental health has been positively impacted. Just over half of the cohort felt as though their symptoms had been dismissed during clinical consultations and 28% felt their GPs were unaware of BAD. CONCLUSIONS: BAD requires more recognition by clinicians to address the current delays in diagnosis. Treatment improves physical and mental symptoms in the majority of participants.

277 Article Derivation and validation of a diagnostic test for irritable bowel syndrome using latent class analysis. 2017

Sood, R / Gracie, D J / Gold, M J / To, N / Pinto-Sanchez, M I / Bercik, P / Moayyedi, P / Ford, A C / Law, G R. ·Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK. · Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK. · School of Medicine, University of Leeds, Leeds, UK. · Farncombe Family Digestive Health Research Institute, Gastroenterology Division, McMaster University, Health Sciences Center, Hamilton, ON, Canada. · Division of Epidemiology & Biostatistics, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. ·Aliment Pharmacol Ther · Pubmed #28105700.

ABSTRACT: BACKGROUND: The accuracy of symptom-based diagnostic criteria for irritable bowel syndrome (IBS) is modest. AIMS: To derive and validate a new test that utilises latent class analysis. METHODS: Symptom, colonoscopy, and histology data were collected from 1981 patients and 360 patients in two cohorts referred to secondary care for investigation of their gastrointestinal symptoms in Canada and the UK, respectively. Latent class analysis was used to identify naturally occurring clusters in patient-reported symptoms in the Canadian dataset, and the latent class model derived from this was then applied to the UK dataset in order to validate it. Sensitivity, specificity, and positive and negative likelihood ratios (LRs) were calculated for the latent class models. RESULTS: In the Canadian cohort, the model had a sensitivity of 44.7% (95% CI 40.0-50.0) and a specificity of 85.3% (95% CI 83.4-87.0). Positive and negative LRs were 3.03 (95% CI 2.57-3.56) and 0.65 (95% CI 0.59-0.71) respectively. A maximum positive LR of 3.93 was achieved following construction of a receiver operating characteristic curve. The performance in the UK cohort was similar, with a sensitivity and specificity of 52.5% (95% CI 42.2-62.7) and 84.3% (95% CI 79.3-88.6), respectively. Positive and negative LRs were 3.35 (95% CI 2.38-4.70) and 0.56 (95% CI 0.45-0.68), respectively, with a maximum positive LR of 4.15. CONCLUSIONS: A diagnostic test for IBS, utilising patient-reported symptoms incorporated into a latent class model, performs as accurately as symptom-based criteria. It has potential for improvement via addition of clinical markers, such as coeliac serology and faecal calprotectin.

278 Article 'Holiday sickness'-reported exploratory outcome of over 500 United Kingdom holidaymakers with travellers' diarrhoea. 2017

Sheen, Prof Aali J / Zahid, M Saad B / Fagbemi, Andrew / Fullwood, Catherine / Whitehead, Kathryn. ·Department of Surgery, Central Manchester NHS Foundation Trust, Oxford Road, Manchester, UK aali.sheen@cmft.nhs.uk. · Department of Microbiology Research, School of Healthcare Sciences, Manchester Metropolitan University, Manchester, UK. · Department of Surgery, Central Manchester NHS Foundation Trust, Oxford Road, Manchester, UK. · Department of Paediatric Gastroenterology, Central Manchester NHS Foundation Trust, Oxford Road, Manchester, UK. · Centre for Biostatistics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK. · Research & Innovation, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK. ·J Travel Med · Pubmed #28077608.

ABSTRACT: AIMS: To ascertain any predictors of potential food poisoning pathogens and development of post-infective irritable bowel syndrome (IBS) in UK travellers. An analysis was undertaken on prospectively collected data on 527 patients reporting symptoms of suspected food poisoning between June 2012 and June 2015. MAIN OUTCOME MEASURES: Positive stool sample indicative of food poisoning pathogens and diagnosis of post-infective IBS. RESULTS: Data on 527 patients were examined. The large majority of patients did not provide a stool sample on return from holiday (n = 430, 81.6%) as few visited a Doctor locally or in the UK. Only 18 patients (18.6%, 95% confidence interval [CI] 11.4-27.7) who provided a stool sample were positive for microbiological food poisoning pathogens. Univariate analysis indicated a significant relationship between a positive stool sample and whether the individual sought any medical assistance at the resort (odds ratio [OR] 0.24, 95% CI 0.08-0.70) and whether they took any treatment (including self-medicated), (OR 0.21, 95% CI 0.06-0.67). Of the 527 patients only 30 (5.7%, 95% CI 3.9-8.1) experienced post-infective IBS. Univariate regression indicated a significant relationship between experiencing Per Rectal (PR) bleeding and a diagnosis of post-infective IBS (OR 3.64, 95% CI 1.00-10.49). Univariate regression also indicated an increase in the risk of developing post-infective IBS with increasing duration of symptoms (OR 1.04, 95% CI 1.02-1.05). No significant relationship was found between a positive stool sample and developing post-infective IBS (P = 0.307). CONCLUSIONS: Very few patients provide a stool sample after experiencing holiday sickness abroad. Of those that do, only a small proportion have a positive stool sample indicative of a food poisoning microorganism. Around 6% of individuals were diagnosed with post-infective IBS. Those individuals with PR bleeding and symptoms persisting for longer durations were significantly more at risk of developing post-infective IBS, whilst medical aid and treatment abroad was found to reduce the odds of a positive stool sample.

279 Article Distinct Abnormalities of Small Bowel and Regional Colonic Volumes in Subtypes of Irritable Bowel Syndrome Revealed by MRI. 2017

Lam, Ching / Chaddock, Gemma / Marciani Laurea, Luca / Costigan, Carolyn / Cox, Eleanor / Hoad, Caroline / Pritchard, Susan / Gowland, Penny / Spiller, Robin. ·NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK. · Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK. ·Am J Gastroenterol · Pubmed #27958282.

ABSTRACT: OBJECTIVES: Non-invasive biomarkers which identify different mechanisms of disease in subgroups of irritable bowel syndrome (IBS) could be valuable. Our aim was to seek useful magnetic resonance imaging (MRI) parameters that could distinguish each IBS subtypes. METHODS: 34 healthy volunteers (HV), 30 IBS with diarrhea (IBS-D), 16 IBS with constipation (IBS-C), and 11 IBS with mixed bowel habit (IBS-M) underwent whole-gut transit and small and large bowel volumes assessment with MRI scans from t=0 to t=360 min. Since the bowel frequency for IBS-M were similar to IBS-D, IBS-M and IBS-D were grouped together and labeled as IBS non-constipation group (IBS-nonC). RESULTS: Median (interquartile range): fasting small bowel water content in IBS-nonC was 21 (10-42), significantly less than HV at 44 ml (15-70), P<0.01 as was the postprandial area under the curve (AUC) P<0.01. The fasting transverse colon volumes in IBS-C were significantly larger at 253 (200-329) compared with HV, IBS-nonC whose values were 165 (117-255) and 198 (106-270) ml, respectively, P=0.02. Whole-gut transit time for IBS-C was prolonged at 69 (51-111), compared with HV at 34 (4-63) and IBS-D at 34 (17-78) h, P=0.03. Bloating score (VAS 0-10 cm) correlated with transverse colon volume at t=405 min, Spearman r=0.21, P=0.04. CONCLUSIONS: The constricted small bowel in IBS-nonC and the dilated transverse colon in IBS-C point to significant differences in underlying mechanisms of disease.

280 Article The role of alexithymia and gastrointestinal-specific anxiety as predictors of treatment outcome in irritable bowel syndrome. 2017

Porcelli, Piero / De Carne, Massimo / Leandro, Gioacchino. ·Psychosomatic Unit, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Castellana Grotte, Italy. Electronic address: piero.porcelli@irccsdebellis.it. · Department of Gastroenterology 2, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Castellana Grotte, Italy. Electronic address: massimo.decarne@irccsdebellis.it. · Department of Gastroenterology 1, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Castellana Grotte, Italy; Department of Liver and Digestive Health, University College of London, UK. Electronic address: gioacchino.leandro@irccsdebellis.it. ·Compr Psychiatry · Pubmed #27940317.

ABSTRACT: In a previous investigation irritable bowel syndrome (IBS) was associated more to alexithymia than gastrointestinal-specific anxiety (GSA). In this study their independent contribution in predicting treatment outcome was longitudinally investigated. Consecutive 150 IBS patients were evaluated for IBS symptoms, alexithymia, GSA, and psychological distress with validated scales after as-usual treatment for 6-12months. The primary treatment outcome was improvement measured with the IBS-Severity Scoring System that showed 111 patients who improved and 39 who did not improve. Improvement was associated to both alexithymia (d=1.27) and GSA (d=4.63) but only alexithymia showed overtime stability by hierarchical regression, controlled for co-variables. A series of logistic and linear regressions showed that baseline alexithymia, but not GSA, independently predicted both post-treatment improvement status (Cox & Snell R

281 Article Economic burden of inadequate symptom control among US commercially insured patients with irritable bowel syndrome with diarrhea. 2017

Buono, Jessica L / Mathur, Kush / Averitt, Amelia J / Andrae, David A. ·a Allergan plc , Jersey City , NJ , USA. · b Axtria Inc. , Berkeley Heights , NJ , USA. ·J Med Econ · Pubmed #27919177.

ABSTRACT: AIMS: To assess healthcare resource use and costs among irritable bowel syndrome (IBS) with diarrhea (IBS-D) patients with and without evidence of inadequate symptom control on current prescription therapies and estimate incremental all-cause costs associated with inadequate symptom control. METHODS: IBS-D patients aged ≥18 years with ≥1 medical claim for IBS (ICD-9-CM 564.1x) and either ≥2 claims for diarrhea (ICD-9-CM 787.91, 564.5x), ≥1 claim for diarrhea plus ≥1 claim for abdominal pain (ICD-9-CM 789.0x), or ≥1 claim for diarrhea plus ≥1 pharmacy claim for a symptom-related prescription within 1 year of an IBS diagnosis were identified from the Truven Health MarketScan database. Inadequate symptom control, resource use, and costs were assessed up to 1 year following the index date. Inadequate symptom control included any of the following: (1) switch or (2) addition of new symptom-related therapy; (3) IBS-D-related inpatient or emergency room (ER) admission; (4) IBS-D-related medical procedure; (5) diagnosis of condition indicating treatment failure; or (6) use of a more aggressive prescription. Generalized linear models assessed incremental costs of inadequate symptom control. RESULTS: Of 20,624 IBS-D patients (mean age = 48.5 years; 77.8% female), 66.4% had evidence of inadequate symptom control. Compared to those without inadequate symptom control, patients with evidence of inadequate symptom control had significantly more hospitalizations (12.0% vs 6.0%), ER visits (37.1% vs 22.6%), use of outpatient services (73.0% vs 60.7%), physician office visits (mean 11.0 vs 8.1), and prescription fills (mean 40.0 vs 26.7) annually (all p < .01). Incremental costs associated with inadequate symptom control were $3,065 (2013 US dollars), and were driven by medical service costs ($2,391; 78%). LIMITATIONS: Study included US commercially insured patients only and inferred IBS-D status and inadequate symptom control from claims. CONCLUSIONS: Inadequate symptom control associated with available IBS-D therapies represents a significant economic burden for both payers and IBS-D patients.

282 Article Acute colitis chronically alters immune infiltration mechanisms and sensory neuro-immune interactions. 2017

Campaniello, Melissa A / Mavrangelos, Chris / Eade, Samuel / Harrington, Andrea M / Blackshaw, L Ashley / Brierley, Stuart M / Smid, Scott D / Hughes, Patrick A. ·Centre for Nutrition and Gastrointestinal Diseases, University of Adelaide and South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia. · Centre for Nutrition and Gastrointestinal Diseases, University of Adelaide and South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Department of Pharmacology, University of Adelaide, Adelaide, Australia. · Centre for Neuroscience and Trauma, Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, UK. · Department of Pharmacology, University of Adelaide, Adelaide, Australia. · Centre for Nutrition and Gastrointestinal Diseases, University of Adelaide and South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia. Electronic address: patrick.hughes@adelaide.edu.au. ·Brain Behav Immun · Pubmed #27864046.

ABSTRACT: OBJECTIVE: Little is understood regarding how disease progression alters immune and sensory nerve function in colitis. We investigated how acute colitis chronically alters immune recruitment and the impact this has on re-activated colitis. To understand the impact of disease progress on sensory systems we investigated the mechanisms underlying altered colonic neuro-immune interactions after acute colitis. DESIGN: Inflammation was compared in mouse models of health, acute tri-nitrobenzene sulphonic acid (TNBS) colitis, Remission and Reactivated colitis. Cytokine concentrations were compared by ELISA in-situ and in explanted colon tissue. Colonic infiltration by CD11b/F4-80 macrophage, CD4 T RESULTS: Colonic damage, MPO activity, macrophage infiltration, IL-1β and IL-6 concentrations were lower in Reactivated compared to Acute colitis. T CONCLUSIONS: Acute colitis persistently alters immune responses and afferent nerve signalling pathways to successive episodes of colitis. These findings highlight the complexity of viscero-sensory neuro-immune interactions in painful remitting and relapsing diseases.

283 Article Irritable bowel syndrome and active inflammatory bowel disease diagnosed by faecal gas analysis. 2017

Aggio, R B M / White, P / Jayasena, H / de Lacy Costello, B / Ratcliffe, N M / Probert, C S J. ·Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK. · Department of Engineering, Design and Mathematics, University of the West of England, Bristol, UK. · Department of Clinical Medicine, Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka. · Institute of Biosensor Technology, University of the West of England, Bristol, UK. ·Aliment Pharmacol Ther · Pubmed #27862117.

ABSTRACT: BACKGROUND: Inflammatory bowel disease and irritable bowel syndrome may present in a similar manner. Measuring faecal calprotectin concentration is often recommended to rule out inflammatory bowel disease, however, there are no tests to positively diagnose irritable bowel syndrome and invasive tests are still used to rule out other pathologies. AIM: To investigate a platform technology for diagnosing inflammatory bowel disease and irritable bowel syndrome based on faecal gas. METHODS: The platform technology is composed of a gas chromatography column coupled to a metal oxide gas sensor (OdoReader) and a computer algorithm. The OdoReader separates the volatile compounds from faecal gas and the computer algorithm identifies resistance patterns associated with specific medical conditions and builds classification models. This platform was applied to faecal samples from 152 patients: 33 patients with active inflammatory bowel disease; 50 patients with inactive inflammatory bowel disease; 28 patients with irritable bowel syndrome and 41 healthy donors (Control). RESULTS: The platform classified samples with accuracies from 75% to 100% using rigorous validation schemes: namely leave-one-out cross-validation, 10-fold cross-validation, double cross-validation and their Monte Carlo variations. The most clinically important findings, after double cross-validation, were the accuracy of active Crohn's disease vs. irritable bowel syndrome (87%; CI 84-89%) and irritable bowel syndrome vs. controls (78%; CI 76-80%). These schemes provide an estimate of out-of-sample predictive accuracy for similar populations. CONCLUSIONS: This is the first description of an investigation for the positive diagnosis of irritable bowel syndrome, and for diagnosing inflammatory bowel disease.

284 Article Colon Hypersensitivity to Distension, Rather Than Excessive Gas Production, Produces Carbohydrate-Related Symptoms in Individuals With Irritable Bowel Syndrome. 2017

Major, Giles / Pritchard, Sue / Murray, Kathryn / Alappadan, Jan Paul / Hoad, Caroline L / Marciani, Luca / Gowland, Penny / Spiller, Robin. ·Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, United Kingdom. · Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom. · Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, United Kingdom. Electronic address: robin.spiller@nottingham.ac.uk. ·Gastroenterology · Pubmed #27746233.

ABSTRACT: BACKGROUND & AIMS: Poorly digested, fermentable carbohydrates may induce symptoms of irritable bowel syndrome (IBS) via unclear mechanisms. We performed a randomized trial with magnetic resonance imaging (MRI) analysis to investigate correlations between symptoms and changes in small- and large-bowel contents after oral challenge. METHODS: We performed a 3-period, cross-over study of 29 adult patients with IBS (based on Rome III criteria, with symptoms of abdominal pain or discomfort for at least 2 days/wk) and reported bloating. In parallel, we performed the same study of 29 healthy individuals (controls). Studies were performed in the United Kingdom from January 2013 through February 2015. On 3 separate occasions (at least 7 days apart), subjects were given a 500-mL drink containing 40 g of carbohydrate (glucose in the first period, fructose in the second, and inulin in the third, in a random order). Levels of breath hydrogen were measured and intestinal content was assessed by MRI before and at various time points after consumption of each drink. Symptoms were determined based on subjects' responses to the Hospital Anxiety and Depression Scale questionnaire and the Patient Health Questionnaire-15. The primary end point was whether participants had a clinically important symptom response during the 300 minutes after consumption of the drink. RESULTS: More patients with IBS reached the predefined symptom threshold after intake of inulin (13 of 29) or fructose (11 of 29) than glucose (6 of 29). Symptoms peaked sooner after intake of fructose than inulin. Fructose increased small-bowel water content in both patients and controls whereas inulin increased colonic volume and gas in both. Fructose and inulin increased breath hydrogen levels in both groups, compared with glucose; fructose produced an earlier increase than inulin. Controls had lower symptom scores during the period after drink consumption than patients with IBS, despite similar MRI parameters and breath hydrogen responses. In patients who reached the symptom threshold after inulin intake, peak symptom intensity correlated with peak colonic gas (r = 0.57; P < .05). Changes in MRI features and peak breath hydrogen levels were similar in patients who did and did not reach the symptom threshold. CONCLUSIONS: Patients with IBS and healthy individuals without IBS (controls) have similar physiological responses after intake of fructose or inulin; patients reported symptoms more frequently after inulin than controls. In patients with a response to inulin, symptoms related to levels of intraluminal gas, but peak gas levels did not differ significantly between responders, nonresponders, or controls. This indicates that colonic hypersensitivity to distension, rather than excessive gas production, produces carbohydrate-related symptoms in patients with IBS. Clinicaltrials.gov no: NCT01776853.

285 Article Negative Effects on Psychological Health and Quality of Life of Genuine Irritable Bowel Syndrome-type Symptoms in Patients With Inflammatory Bowel Disease. 2017

Gracie, David J / Williams, Christopher J M / Sood, Ruchit / Mumtaz, Saqib / Bholah, M Hassan / Hamlin, P John / Ford, Alexander C. ·Leeds Gastroenterology Institute, St James's University Hospital, Leeds, United Kingdom; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom. Electronic address: djgracie1982@doctors.org.uk. · Leeds Gastroenterology Institute, St James's University Hospital, Leeds, United Kingdom. · Leeds Gastroenterology Institute, St James's University Hospital, Leeds, United Kingdom; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom. ·Clin Gastroenterol Hepatol · Pubmed #27189912.

ABSTRACT: BACKGROUND & AIMS: Symptoms compatible with irritable bowel syndrome (IBS) are common in patients with inflammatory bowel disease (IBD), but it is unclear whether this relates to occult IBD activity. We attempted to resolve this issue in a secondary care population by using a cross-sectional study design. METHODS: We analyzed Rome III IBS symptoms, disease activity indices, and psychological, somatization, and quality of life data from 378 consecutive, unselected adult patients with IBD seen in clinics at St James's University Hospital in Leeds, United Kingdom from November 2012 through June 2015. Participants provided a stool sample for fecal calprotectin (FC) analysis; levels ≥250 μg/g were used to define mucosal inflammation. By using symptom data and FC levels we identified 4 distinct groups of patients: those with true IBS-type symptoms (IBS-type symptoms with FC levels <250 μg/g, regardless of disease activity indices), quiescent IBD (no IBS-type symptoms with FC levels <250 μg/g, regardless of disease activity indices), occult inflammation (normal disease activity indices and FC levels ≥250 μg/g, regardless of IBS symptom status), or active IBD (abnormal disease activity indices with FC levels ≥250 μg/g, regardless of IBS symptom status). We compared characteristics between these groups. RESULTS: Fifty-seven of 206 patients with Crohn's disease (27.7%) and 34 of 172 patients with ulcerative colitis (19.8%) had true IBS-type symptoms. Levels of psychological comorbidity and somatization were significantly higher among patients with true IBS-type symptoms than patients with quiescent IBD or occult inflammation. Quality of life levels were also significantly reduced compared with patients with quiescent disease or occult inflammation and were similar to those of patients with active IBD. By using FC levels ≥100 μg/g to define mucosal inflammation, we found a similar effect of IBS-type symptoms on psychological health and quality of life. CONCLUSIONS: In a cross-sectional study, we identified a distinct group of patients with IBD and genuine IBS-type symptoms in the absence of mucosal inflammation. These symptoms had negative effects on psychological well-being and quality of life to the same degree as active IBD. New management strategies are required for this patient group.

286 Article Relations between symptom severity, illness perceptions, visceral sensitivity, coping strategies and well-being in irritable bowel syndrome guided by the common sense model of illness. 2017

Knowles, Simon R / Austin, David W / Sivanesan, Suresh / Tye-Din, Jason / Leung, Chris / Wilson, Jarrad / Castle, David / Kamm, Michael A / Macrae, Finlay / Hebbard, Geoff. ·a Faculty Health, Arts, and Design, Department of Psychology , Swinburne University of Technology , Melbourne , Australia. · b Department of Medicine , The University of Melbourne , Melbourne , Australia. · c Department of Psychiatry , St Vincent's Hospital , Melbourne , Australia. · d Department of Gastroenterology and Hepatology , Royal Melbourne Hospital , Melbourne , Australia. · e Department of Psychology , Deakin University , Melbourne , Australia. · f Walter and Eliza Hall Institute , Melbourne , Australia. · g The Austin Hospital , Melbourne , Australia. · h Royal Hobart Hospital , Tasmania , Australia. · i Department of Gastroenterology and Medicine , St Vincent's Hospital , Melbourne , Australia. · j Division of Immunology , Imperial College , London , UK. ·Psychol Health Med · Pubmed #27045996.

ABSTRACT: Irritable Bowel Syndrome (IBS) is a common condition affecting around 10-20% of the population and associated with poorer psychological well-being and quality of life. The aim of the current study was to explore the efficacy of the Common Sense Model (CSM) using Structural Equation Modelling (SEM) in an IBS cohort. One hundred and thirty-one IBS patients (29 males, 102 females, mean age 38 years) participating in the IBSclinic.org.au pre-intervention assessment were included. Measures included IBS severity (Irritable Bowel Syndrome Severity Scoring System), coping patterns (Carver Brief COPE), visceral sensitivity (Visceral Sensitivity Index), illness perceptions (Brief Illness Perceptions Questionnaire), psychological distress (Depression, Anxiety and Stress Scale), and quality of life (IBS Quality of Life scale; IBS-QoL). Using SEM, a final model with an excellent fit was identified (χ

287 Article Acupuncture for irritable bowel syndrome: 2-year follow-up of a randomised controlled trial. 2017

MacPherson, Hugh / Tilbrook, Helen / Agbedjro, Deborah / Buckley, Hannah / Hewitt, Catherine / Frost, Chris. ·Department of Health Sciences, University of York, York, UK. · Department of Biostatistics, Kings College London, London, UK. · Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK. ·Acupunct Med · Pubmed #26980547.

ABSTRACT: BACKGROUND: A recent randomised controlled trial (RCT) of acupuncture as a treatment for irritable bowel syndrome (IBS) demonstrated sustained benefits over a period of 12 months post-randomisation. AIM: To extend the trial follow-up to evaluate the effects of acupuncture at 24 months post-randomisation. METHODS: Patients in primary care with ongoing IBS were recruited to a two-arm pragmatic RCT of acupuncture for IBS. Participants were randomised to the offer of up to 10 weekly sessions of acupuncture plus usual care (n=116 patients) or to continue with usual care alone (n=117). The primary outcome was the self-reported IBS symptom severity score (IBS SSS) measured at 24 months post-randomisation. Analysis was by intention-to-treat using an unstructured multivariate linear model incorporating all repeated measures. RESULTS: The overall response rate was 61%. The adjusted difference in mean IBS SSS at 24 months was -18.28 (95% CI -40.95 to 4.40) in favour of the acupuncture arm. Differences at earlier time points estimated from the multivariate model were: -27.27 (-47.69 to -6.86) at 3 months; -23.69 (-45.17 to -2.21) at 6 months; -24.09 (-45.59 to -2.59) at 9 months; and -23.06 (-44.52 to -1.59) at 12 months. CONCLUSIONS: There were no statistically significant differences between the acupuncture and usual care groups in IBS SSS at 24 months post-randomisation, and the point estimate for the mean difference was approximately 80% of the size of the statistically significant results seen at 6, 9 and 12 months. TRIAL REGISTRATION NUMBER: ISRCTN08827905.

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

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

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

289 Article In Vitro Recording of Mesenteric Afferent Nerve Activity in Mouse Jejunal and Colonic Segments. 2016

Nullens, Sara / Deiteren, Annemie / Jiang, Wen / Keating, Christopher / Ceuleers, Hannah / Francque, Sven / Grundy, David / De Man, Joris G / De Winter, Benedicte Y. ·Laboratory of Experimental Medicine and Pediatrics, Division of Gastroenterology, University of Antwerp. · Visceral Pain Group, Discipline of Medicine, University of Adelaide. · Department of Biomedical Sciences, University of Sheffield. · Department of Pharmacy, Pharmacology and Postgraduate Medicine, University of Hertfordshire. · Department of Gastroenterology and Hepatology, Antwerp University Hospital. · Laboratory of Experimental Medicine and Pediatrics, Division of Gastroenterology, University of Antwerp; benedicte.dewinter@uantwerpen.be. ·J Vis Exp · Pubmed #27805592.

ABSTRACT: Afferent nerves not only convey information concerning normal physiology, but also signal disturbed homeostasis and pathophysiological processes of the different organ systems from the periphery towards the central nervous system. As such, the increased activity or 'sensitization' of mesenteric afferent nerves has been allocated an important role in the pathophysiology of visceral hypersensitivity and abdominal pain syndromes. Mesenteric afferent nerve activity can be measured in vitro in an isolated intestinal segment that is mounted in a purpose-built organ bath and from which the splanchnic nerve is isolated, allowing researchers to directly assess nerve activity adjacent to the gastrointestinal segment. Activity can be recorded at baseline in standardized conditions, during distension of the segment or following the addition of pharmacological compounds delivered intraluminally or serosally. This technique allows the researcher to easily study the effect of drugs targeting the peripheral nervous system in control specimens; besides, it provides crucial information on how neuronal activity is altered during disease. It should be noted however that measuring afferent neuronal firing activity only constitutes one relay station in the complex neuronal signaling cascade, and researchers should bear in mind not to overlook neuronal activity at other levels (e.g., dorsal root ganglia, spinal cord or central nervous system) in order to fully elucidate the complex neuronal physiology in health and disease. Commonly used applications include the study of neuronal activity in response to the administration of lipopolysaccharide, and the study of afferent nerve activity in animal models of irritable bowel syndrome. In a more translational approach, the isolated mouse intestinal segment can be exposed to colonic supernatants from IBS patients. Furthermore, a modification of this technique has been recently shown to be applicable in human colonic specimens.

290 Article Managing irritable bowel syndrome in children. 2016

Adams, Helen Louise / Basude, Dharamveer / Kyle, Alison / Sandmann, Sarah / Paul, Siba Prosad. ·University of Bristol, Bristol, England. · Bristol Royal Hospital for Children, Bristol, England. · Yeovil District Hospital, Yeovil, England. · Torbay Hospital, Torquay, Devon, England. ·Nurs Stand · Pubmed #27762987.

ABSTRACT: Irritable bowel syndrome (IBS) is the most common cause of non-organic recurrent abdominal pain in children. IBS is a clinical diagnosis, which is based on the Rome IV criteria for functional gastrointestinal disorders in children, as well as the patient's history. The diagnosis of IBS is established following the exclusion of organic causes of recurrent abdominal pain. Staggered investigations should be avoided because they might increase the child's and family's anxiety in the absence of an organic diagnosis. In most cases, providing a positive diagnosis of IBS and explaining the current understanding of the functional pathophysiology of the condition and management strategies gives reassurance to the child and their family. Management is based on dietary, pharmacological and biopsychosocial interventions. IBS can be a debilitating condition, with effects on activities of daily living, education and social interactions. Nurses working in various clinical settings will encounter children with IBS and have an important role in the management of children with this condition.

291 Article Using best practice to create a pathway to improve management of irritable bowel syndrome: aiming for timely diagnosis, effective treatment and equitable care. 2016

Williams, Marianne / Barclay, Yvonne / Benneyworth, Rosie / Gore, Steve / Hamilton, Zoe / Matull, Rudi / Phillips, Iain / Seamark, Leah / Staveley, Kate / Thole, Steve / Greig, Emma. ·Department of Community Dietitian , Somerset Partnership NHS Trust , Bridgwater , UK. · Somerset Clinical Commissioning Group , Taunton , UK. · Yeovil District NHS Foundation Trust , Yeovil , UK. · Taunton and Somerset NHS Foundation Trust , Taunton, Somerset , UK. · Somerset Clinical Commissioning Group , Wincanton , UK. · NHS Somerset , Yeovil , UK. ·Frontline Gastroenterol · Pubmed #27761233.

ABSTRACT: BACKGROUND: Irritable bowel syndrome (IBS) costs the National Health Service almost £12 million per annum. Despite national guidelines advising primary care management, these have failed to stem secondary care referrals of patients with likely IBS for unnecessary and costly assessment and investigation without necessarily achieving resolution of their symptoms. METHODS: In 2011, an integrated team from primary and secondary care developed a business case using baseline data to create a Somerset-wide IBS pathway using Clinical Commissioning Group funding. This provided face-to-face general practitioners (GP) education, developed a diagnostic pathway and funded faecal calprotectin (FC) testing to exclude inflammatory pathology for patients aged 16-45 years with likely IBS and no alarm symptoms. For those with FC≤50 μg/g, we provided a management algorithm and community-based dietetic treatment. Audit results measured usage and outcomes from FC testing, changes in patterns and costs of new patients reviewed in gastroenterology outpatients and dietetic IBS treatment outcomes. RESULTS: The proportion of new patient slots used reduced from 14.3% to 8.7% over 10 months while overall costs reduced by 25% for patients with no alarm symptoms and likely IBS aged 16-45 years. FC results confirmed research findings with no inflammatory pathology, if FC≤50 μg/g over 2 years. 63% of patients had satisfactory control of their IBS after specialist dietetic input with 74% reporting improved quality of life. CONCLUSIONS: The combination of GP education, providing diagnosis and management pathways, using FC to exclude inflammatory pathology and providing an effective treatment for patients with likely IBS appeared successful in our pilot. This proved cost-effective, reduced secondary care involvement and improved patient care.

292 Article Faecal biomarker patterns in patients with symptoms of irritable bowel syndrome. 2016

Emmanuel, Anton / Landis, Darryl / Peucker, Mark / Hungin, A Pali S. ·GI Physiology Unit , University College Hospital , London , UK. · Medical Affairs, Genova Diagnostics, Inc. , Asheville, North Carolina , USA. · Care-Safe, LLC , Waltham, Massachusetts , USA. · School of Medicine, Pharmacy and Health, Wolfson Research Institute, Queen's Campus, Durham University , Stockton on Tees , UK. ·Frontline Gastroenterol · Pubmed #27761231.

ABSTRACT: OBJECTIVE: To determine rates of faecal biomarker results capable of suggesting potentially treatable causes of irritable bowel syndrome (IBS) symptomatology in a population of patients with symptoms of IBS who meet Rome III criteria for that condition. DESIGN: Descriptive, retrospective study in which faecal biomarker results (dichotomised into 'normal' and 'abnormal' values) were related to data from patient-completed questionnaire data identifying demographics, Rome III criteria for IBS and IBS phenotype (IBS-D, IBS-C, IBS-M and IBS-U). SETTING: Commercial reference laboratory. PATIENTS: Individuals whose physicians ordered faecal biomarker testing for evaluation of chronic abdominal symptoms consistent with IBS. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Rates of occurrence of abnormal results on any of seven faecal biomarkers suggesting a treatable cause for IBS symptoms. RESULTS: Abdominal symptoms meeting Rome III criteria for IBS were present in 3553 records (the population), which were subjected to further analysis. Abnormal biomarker results (the outcomes) occurred in 94% of cases; 73% and 65% of records indicated growth of a bacterial potential pathogen and low growth of beneficial organisms, respectively. Abnormal results for all other faecal biomarkers occurred with frequencies from 5% to 13%. Frequency of abnormal results for elastase, calprotectin, eosinophil protein X, and beneficial organisms rose significantly with age, and differed significantly across IBS phenotypes. CONCLUSIONS: A large proportion of patients manifesting symptoms meeting Rome III IBS diagnostic criteria have faecal biomarker results indicating potential underlying, treatable causes of their symptoms. Faecal biomarker testing is an appropriate means of identifying potentially treatable causes of IBS symptoms.

293 Article Dietary guidelines for irritable bowel syndrome are important for gastroenterologists, dietitians and people with irritable bowel syndrome. 2016

Chey, William D / Whelan, Kevin. ·University of Michigan Health System, Division of Gastroenterology, Michigan, USA. · King's College London, Diabetes and Nutritional Sciences Division, London, UK. kevin.whelan@kcl.ac.uk. ·J Hum Nutr Diet · Pubmed #27599641.

ABSTRACT: -- No abstract --

294 Article Validity and reliability of the Bristol Stool Form Scale in healthy adults and patients with diarrhoea-predominant irritable bowel syndrome. 2016

Blake, M R / Raker, J M / Whelan, K. ·Diabetes and Nutritional Sciences Division, Faculty of Life Sciences and Medicine, King's College London, London, UK. · Department of Nutrition and Dietetics, Monash University, Melbourne, Vic., Australia. ·Aliment Pharmacol Ther · Pubmed #27492648.

ABSTRACT: BACKGROUND: The Bristol Stool Form Scale (BSFS) is a 7-point scale used extensively in clinical practice and research for stool form measurement, which has undergone limited validity and reliability testing. AIM: To determine the validity and reliability of the BSFS in measuring stool form in healthy adults and patients with diarrhoea-predominant irritable bowel syndrome (IBS-D). METHODS: One hundred and sixty-nine healthy volunteers provided a stool sample and used the BSFS to classify stool form, which was compared with measured stool water content and with values from 19 patients with IBS-D. Eighty-six volunteers used the BSFS to classify 26 stool models to determine accuracy and reliability. RESULTS: Volunteers' classifications of stool type correlated with stool water (Spearman's rho = 0.491, P < 0.001), which increased in hard (Types 1-2), normal (Types 3-5) and loose stools (Types 6-7) (P < 0.001). The BSFS detected differences in stool form between healthy volunteers (mean 3.7, s.d. 1.5) and IBS-D patients (mean 5.0, s.d. 1.2) (P < 0.001). Overall, 977/1204 (81%) stool models were correctly classified (substantial accuracy, κ = 0.78), although <80% of Types 2, 3, 5 and 6 were classified correctly. On 852/1118 (76%) occasions, volunteers classified covert duplicate models to the same stool type (substantial reliability, κ = 0.72), but with only moderate reliability for Types 2 (63%, κ = 0.57) and 3 (62%, κ = 0.55). CONCLUSIONS: The BSFS demonstrated substantial validity and reliability, although difficulties arose around clinical decision points (Types 2, 3, 5, 6) that warrant investigation in larger clinical populations. Potential for improving validity and reliability through modifications to the BSFS or training in its use should be explored.

295 Article Enhancing Diagnostic Performance of Symptom-Based Criteria for Irritable Bowel Syndrome by Additional History and Limited Diagnostic Evaluation. 2016

Sood, Ruchit / Camilleri, Michael / Gracie, David J / Gold, Matthew J / To, Natalie / Law, Graham R / Ford, Alexander C. ·Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK. · Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK. · Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), Mayo Clinic, Rochester, Minnesota, USA. · School of Medicine, University of Leeds, Leeds, UK. · Division of Epidemiology and Biostatistics, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. ·Am J Gastroenterol · Pubmed #27481310.

ABSTRACT: OBJECTIVES: Symptom-based criteria to diagnose irritable bowel syndrome (IBS) positively perform only modestly. Our aim was to assess whether including other items from the clinical history and limited diagnostic evaluation improves their performance. METHODS: We collected complete symptom, colonoscopy, and histology data from 318 consecutive, unselected adult patients with lower gastrointestinal (GI) symptoms in secondary care. All participants underwent colonoscopy, with relevant organic findings recorded. The reference standard used to define the presence of true IBS was patient-reported lower abdominal pain or discomfort associated with a change in bowel habit, in the absence of organic GI disease. Sensitivity, specificity, and positive and negative likelihood ratios (LRs), with 95% confidence intervals, were calculated for Rome III criteria, as well as for modifications, incorporating nocturnal stools, results of simple blood tests (hemoglobin and C-reactive protein (CRP)), measures of somatization, and/or affective disorders (hospital anxiety or depression scale (HADS) score). RESULTS: The sensitivity and specificity of the Rome III criteria for identifying IBS was 69.6%, and 82.0%, respectively, with positive and negative LRs of 3.87 and 0.37, respectively. Clinically useful enhancements in positive LRs were provided by combining Rome III criteria with: (a) high level of somatization (7.27); (b) normal hemoglobin and CRP with HADS score of ≥8 (5.04); (c) normal hemoglobin and CRP with a high level of somatization (7.56); or (d) no nocturnal passage of stool with a high level of somatization (17.3). Specificity was ≥95% with each of these modifications. CONCLUSIONS: Incorporating nocturnal stools, somatization, and affective disorders from the clinical history, and hemoglobin and CRP measurements, enhances the positive LR and specificity of symptom-based Rome III criteria for IBS.

296 Article Randomized double blind placebo-controlled trial of Saccharomyces cerevisiae CNCM I-3856 in irritable bowel syndrome: improvement in abdominal pain and bloating in those with predominant constipation. 2016

Spiller, Robin / Pélerin, Fanny / Cayzeele Decherf, Amélie / Maudet, Corinne / Housez, Béatrice / Cazaubiel, Murielle / Jüsten, Peter. ·Nottingham Digestive Diseases Biomedical Research Unit, Nottingham Digestive Diseases Centre, Nottingham, United Kingdom. · Lesaffre Human Care, Lesaffre Group, Marcq en Baroeul, France. · Biofortis-Mérieux NutriSciences, Saint-Herblain, France. ·United European Gastroenterol J · Pubmed #27403301.

ABSTRACT: BACKGROUND: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder characterized by recurrent abdominal pain and/or discomfort. Probiotics have been reported to benefit IBS symptoms but the level of benefit remains quite unclear. OBJECTIVE: This study was designed to assess the benefit of Saccharomyces cerevisiae I-3856 on IBS symptoms. METHODS: A randomized, double blind, placebo-controlled trial has been performed in 379 subjects with diagnosed IBS. Subjects were randomly supplemented with the probiotics (1000 mg) or placebo for 12 weeks. Questionnaires (gastrointestinal symptoms, stools, wellbeing, and quality of life) were completed. Primary endpoint was percentage of responders defined as having a 50% decrease in the weekly average "intestinal pain/discomfort score" for at least 4 out of the last 8 weeks of the study. RESULTS: There was no overall benefit of S. cerevisiae I-3856 on IBS symptoms and wellbeing in the study population. Moreover, S. cerevisiae I-3856 was not statistically significant predictor of the responder status of the subjects (p > 0.05). Planned subgroup analyses showed significant effect in the IBS-C subjects: improvement of gastrointestinal symptoms was significantly higher in active group, compared to placebo, on abdominal pain/discomfort and bloating throughout the study and at the end of the supplementation. CONCLUSIONS: In this study, S. cerevisiae I-3856 at the dose of 1000 mg per day does not improve intestinal pain and discomfort in general IBS patients. However, it seems to have an effect in the subgroup with constipation which needs further studies to confirm (NCT01613456 in ClinicalTrials.gov registry).

297 Article Psychometric assessment of the IBS-D Daily Symptom Diary and Symptom Event Log. 2016

Rosa, Kathleen / Delgado-Herrera, Leticia / Zeiher, Bernie / Banderas, Benjamin / Arbuckle, Rob / Spears, Glen / Hudgens, Stacie. ·Psychometrician, Leland, NC, USA. · Astellas Pharma Global Development, Inc., 1 Astellas Way, Northbrook, IL, 60062, USA. Leticia.Delgado-Herrera@astellas.com. · Astellas Pharma Global Development, Inc., 1 Astellas Way, Northbrook, IL, 60062, USA. · Adelphi Values, Boston, MA, USA. · Adelphi Values, Bollington, UK. · AbbVie, North Chicago, IL, USA. · Clinical Outcomes Solutions, Tucson, AZ, USA. ·Qual Life Res · Pubmed #27342236.

ABSTRACT: PURPOSE: Diarrhea-predominant irritable bowel syndrome (IBS-D) can considerably impact patients' lives. Patient-reported symptoms are crucial in understanding the diagnosis and progression of IBS-D. This study psychometrically evaluates the newly developed IBS-D Daily Symptom Diary and Symptom Event Log (hereafter, "Event Log") according to US regulatory recommendations. METHODS: A US-based observational field study was conducted to understand cross-sectional psychometric properties of the IBS-D Daily Symptom Diary and Event Log. Analyses included item descriptive statistics, item-to-item correlations, reliability, and construct validity. RESULTS: The IBS-D Daily Symptom Diary and Event Log had no items with excessive missing data. With the exception of two items ("frequency of gas" and "accidents"), moderate to high inter-item correlations were observed among all items of the IBS-D Daily Symptom Diary and Event Log (day 1 range 0.67-0.90). Item scores demonstrated reliability, with the exception of the "frequency of gas" and "accidents" items of the Diary and "incomplete evacuation" item of the Event Log. The pattern of correlations of the IBS-D Daily Symptom Diary and Event Log item scores with generic and disease-specific measures was as expected, moderate for similar constructs and low for dissimilar constructs, supporting construct validity. Known-groups methods showed statistically significant differences and monotonic trends in each of the IBS-D Daily Symptom Diary item scores among groups defined by patients' IBS-D severity ratings ("none"/"mild," "moderate," or "severe"/"very severe"), supporting construct validity. CONCLUSIONS: Initial psychometric results support the reliability and validity of the items of the IBS-D Daily Symptom Diary and Event Log.

298 Article Multicentre prospective survey of SeHCAT provision and practice in the UK. 2016

Summers, Jennifer A / Peacock, Janet / Coker, Bolaji / McMillan, Viktoria / Ofuya, Mercy / Lewis, Cornelius / Keevil, Stephen / Logan, Robert / McLaughlin, John / Reid, Fiona. ·Division of Health and Social Care Research, King's College London, London, UK; NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, Guy's Hospital, London, UK. · King's Technology Evaluation Centre, King's College London, London, UK; Department of Medical Engineering and Physics, King's College Hospital NHS Foundation Trust, London, UK. · King's Technology Evaluation Centre, King's College London, London, UK; Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK. · Department of Gastroenterology , King's College Hospital NHS Foundation Trust , London , UK. · Faculty of Medical and Human Sciences, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK; Research Committee, British Society of Gastroenterology, London, UK. ·BMJ Open Gastroenterol · Pubmed #27252882.

ABSTRACT: OBJECTIVE: A clinical diagnosis of bile acid malabsorption (BAM) can be confirmed using SeHCAT (tauroselcholic ((75)selenium) acid), a radiolabelled synthetic bile acid. However, while BAM can be the cause of chronic diarrhoea, it is often overlooked as a potential diagnosis. Therefore, we investigated the use of SeHCAT for diagnosis of BAM in UK hospitals. DESIGN: A multicentre survey was conducted capturing centre and patient-level information detailing patient care-pathways, clinical history, SeHCAT results, treatment with bile acid sequestrants (BAS), and follow-up in clinics. Eligible data from 38 centres and 1036 patients were entered into a validated management system. RESULTS: SeHCAT protocol varied between centres, with no standardised patient positioning, and differing referral systems. Surveyed patients had a mean age of 50 years and predominantly women (65%). The mean SeHCAT retention score for all patients was 19% (95% CI 17.8% to 20.3%). However, this differed with suspected BAM type: type 1: 9% (95% CI 6.3% to 11.4%), type 2: 21% (95% CI 19.2% to 23.0%) and type 3: 22% (95% CI 19.6% to 24.2%). Centre-defined 'abnormal' and 'borderline' results represented over 50% of the survey population. BAS treatment was prescribed to only 73% of patients with abnormal results. CONCLUSIONS: The study identified a lack of consistent cut-off/threshold values, with differing centre criteria for defining an 'abnormal' SeHCAT result. BAS prescription was not related in a simple way to the SeHCAT result, nor to the centre-defined result, highlighting a lack of clear patient care-pathways. There is a clear need for a future diagnostic accuracy study and a better understanding of optimal management pathways.

299 Article Validation and modification of a diagnostic scoring system to predict microscopic colitis. 2016

Kane, John S / Sood, Ruchit / Law, Graham R / Gracie, David J / To, Natalie / Gold, Matthew J / Ford, Alexander C. ·a Leeds Gastroenterology Institute, St. James's University Hospital , Leeds , UK ; · b Leeds Institute of Biomedical and Clinical Sciences, University of Leeds , Leeds , UK ; · c Division of Biostatistics , Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK ; · d School of Medicine, University of Leeds , Leeds , UK. ·Scand J Gastroenterol · Pubmed #27243102.

ABSTRACT: OBJECTIVE: Many patients with diarrhoea undergo colonoscopy. If this is macroscopically normal, random biopsies are obtained to rule out microscopic colitis (MC), but most patients have functional disease. Accurate predictors of MC could avoid the need to take biopsies in a substantial proportion of patients, saving money for the health service. We validated a previously described diagnostic scoring system for MC, and incorporated further variables to assess whether this improved performance. MATERIAL AND METHODS: Consecutive adults with loose stools undergoing colonoscopy in Leeds, UK were included. Demographic and symptom data were collected prospectively. The diagnostic scoring system described previously was applied. In addition, the incorporation of further variables, including drugs associated with MC, number of stools, nocturnal passage of stools, and duration of loose stools, into the scoring system was assessed. Sensitivities, specificities, and positive and negative predictive values were calculated. RESULTS: Among 242 patients (mean age 51.0 years, 163 (67.4%) female), 26 (10.7%) of whom had MC, a cut off of ≥4 on the original scoring system had a sensitivity of 92.3% and specificity of 35.2%. Nocturnal passage of stools and duration of loose stools <6 months were significant predictors of MC. Incorporating these variables in a new scoring system with a cut off of ≥6 identified MC with 95.7% sensitivity and 46.0% specificity. CONCLUSIONS: Incorporating nocturnal passage of stools and duration of loose stools into the scoring system may improve ability to predict MC, and avoid random colonic biopsies in a greater proportion of patients with loose stools.

300 Article Rome IV Diagnostic Questionnaires and Tables for Investigators and Clinicians. 2016

Palsson, Olafur S / Whitehead, William E / van Tilburg, Miranda A L / Chang, Lin / Chey, William / Crowell, Michael D / Keefer, Laurie / Lembo, Anthony J / Parkman, Henry P / Rao, Satish Sc / Sperber, Ami / Spiegel, Brennan / Tack, Jan / Vanner, Stephen / Walker, Lynn S / Whorwell, Peter / Yang, Yunsheng. ·Bioinformatics Building Room 4111, Campus Box 7080, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7080. · Bioinformatics Building Room 4112, Campus Box 7080, University of North Carolina at Chapel Hill, Chapel Hill, NC. · Bioinformatics Building Room 4008 Campus Box 7080 University of North Carolina at Chapel Hill Chapel Hill, NC 27599-7080. · Center for Neurobiology of Stress, David Geffen School of Medicine, UCLA Los Angeles,California. · Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan. · Mayo Clinic, Scottsdale, Arizona. · Feinberg School of Medicine, Northwestern University, Chicago, Illinois. · Harvard Medical School, Boston, Massachusetts. · Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania. · Director, Digestive Health Center, Medical College of GeorgiaGeorgia Regents University, Augusta, Georgia. · Kibbutz Farod, House 86, D.N. Bikat Bet Hakerem, 2010000, Israel. · Mt. Sinai Medical Center, Los Angeles, California. · K. U. Leuven, Center for GI Research, Herestraat 49, Leuven 3000, Belgium. · Division of Gastroenterology, Kingston General Hospital, Ontario, Canada. · Department of Pediatrics, Adolescent Division, Vanderbilt University Medical Center, 2146 Belcourt Ave, Nashville TN 37212. · University Hospital of South Manchester, United Kingdom. · Chinese PLA General Hospital Beijing, China. ·Gastroenterology · Pubmed #27144634.

ABSTRACT: The Rome IV Diagnostic Questionnaires were developed to screen for functional gastrointestinal disorders (FGIDs), serve as inclusion criteria in clinical trials, and support epidemiological surveys. Separate questionnaires were developed for adults, children/adolescents, and infants/toddlers. For the adult questionnaire, we first surveyed 1,162 adults without gastrointestinal disorders, and recommended the 90

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