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Irritable Bowel Syndrome: HELP
Articles from Dartmouth Medical School
Based on 34 articles published since 2010
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These are the 34 published articles about Irritable Bowel Syndrome that originated from Dartmouth Medical School during 2010-2020.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial Safety of Eluxadoline in Patients With IBS-D Without a Gallbladder. 2017

Cash, Brooks D / Lacy, Brian E / Schoenfeld, Philip S / Dove, Leonard S / Covington, Paul S. ·University of South Alabama, Mobile, Alabama, USA. · Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA. · University of Michigan School of Medicine, Ann Arbor, Michigan, USA. · Allergan plc, Parsippany, New Jersey, USA. · Furiex Pharmaceuticals, Allergan plc, Parsippany, New Jersey, USA. ·Am J Gastroenterol · Pubmed #28978951.

ABSTRACT: -- No abstract --

2 Editorial From the Editors: Brief Synopsis. 2017

Brown, E Sherwood / Green, Alan I. ·a Department of Psychiatry , The University of Texas Southwestern Medical Center , Dallas , Texas , USA. · b Department of Psychiatry , Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA. ·J Dual Diagn · Pubmed #28521661.

ABSTRACT: -- No abstract --

3 Editorial Does Yoga Help Patients With Irritable Bowel Syndrome? 2016

Patel, Nihal / Lacy, Brian. ·Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. ·Clin Gastroenterol Hepatol · Pubmed #27552854.

ABSTRACT: -- No abstract --

4 Review Mechanism of action and therapeutic benefit of rifaximin in patients with irritable bowel syndrome: a narrative review. 2020

Chey, William D / Shah, Eric D / DuPont, Herbert L. ·Department of Nutrition Sciences, Division of Gastroenterology, Michigan Medicine, 3912 Taubman Center, SPC 5362, Ann Arbor, MI 48109-5362, USA. · Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. · Division of Epidemiology, Human Genetics and Environmental Sciences and Center for Infectious Diseases, University of Texas School of Public Health, Houston, TX, USA. ·Therap Adv Gastroenterol · Pubmed #32047534.

ABSTRACT: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder with a multifactorial pathophysiology. The gut microbiota differs between patients with IBS and healthy individuals. After a bout of acute gastroenteritis, postinfection IBS may result in up to approximately 10% of those affected. Small intestinal bacterial overgrowth (SIBO) is more common in patients with IBS than in healthy individuals, and eradication of SIBO with systemic antibiotics has decreased symptoms of IBS in some patients with IBS and SIBO. The nonsystemic (i.e. low oral bioavailability) antibiotic rifaximin is indicated in the United States and Canada for the treatment of adults with IBS with diarrhea (IBS-D). The efficacy and safety of 2-week single and repeat courses of rifaximin have been demonstrated in randomized, placebo-controlled studies of adults with IBS. Rifaximin is widely thought to exert its beneficial clinical effects in IBS-D through manipulation of the gut microbiota. However, current studies indicate that rifaximin induces only modest effects on the gut microbiota of patients with IBS-D, suggesting that the efficacy of rifaximin may involve other mechanisms. Indeed, preclinical data reveal a potential role for rifaximin in the modulation of inflammatory cytokines and intestinal permeability, but these two findings have not yet been examined in the context of clinical studies. The mechanism of action of rifaximin in IBS is likely multifactorial, and further study is needed.

5 Review Rome Criteria and a Diagnostic Approach to Irritable Bowel Syndrome. 2017

Lacy, Brian E / Patel, Nihal K. ·Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA. brian.e.lacy@hitchcock.org. · Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA. nihal.k.patel@hitchcock.org. ·J Clin Med · Pubmed #29072609.

ABSTRACT: Functional gastrointestinal disorders (FGIDs) account for at least 40% of all referrals to gastroenterologists. Of the 33 recognized adult FGIDs, irritable bowel syndrome (IBS) is the most prevalent, with a worldwide prevalence estimated at 12%. IBS is an important health care concern as it greatly affects patients' quality of life and imposes a significant economic burden to the health care system. Cardinal symptoms of IBS include abdominal pain and altered bowel habits. The absence of abdominal pain makes the diagnosis of IBS untenable. The diagnosis of IBS can be made by performing a careful review of the patient's symptoms, taking a thoughtful history (e.g., diet, medication, medical, surgical, and psychological history), evaluating the patient for the presence of warning signs (e.g., "red flags" of anemia, hematochezia, unintentional weight loss, or a family history of colorectal cancer or inflammatory bowel disease), performing a guided physical examination, and using the Rome IV criteria. The Rome criteria were developed by a panel of international experts in the field of functional gastrointestinal disorders. Although initially developed to guide researchers, these criteria have undergone several revisions with the intent of making them clinically useful and relevant. This monograph provides a brief overview on the development of the Rome criteria, discusses the utility of the Rome IV criteria, and reviews how the criteria can be applied clinically to diagnose IBS. In addition, a diagnostic strategy for the cost-effective diagnosis of IBS will be reviewed.

6 Review Irritable Bowel Syndrome. 2017

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

ABSTRACT: -- No abstract --

7 Review Hot Topics in Primary Care: Role of the Microbiome in Disease: Implications for Treatment of Irritable Bowel Syndrome. 2017

Lacy, Brian E. ·Professor of Medicine, Chief, Section of Gastroenterology & Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. ·J Fam Pract · Pubmed #28375407.

ABSTRACT: Dietary and some other treatments for IBS are supported by a growing body of evidence, much of which comes from programs such as the Human Microbiome Project and Human Gut Microbiome Initiative, which were intended to identify and characterize microorganisms found in association with both healthy and diseased humans. These programs used state-of-the-art technology to characterize the human microbiome from multiple body sites. This evidence indicates that the gut microbiome plays an important role in IBS and some other gastrointestinal (GI) disorders.

8 Review Diarrhea-predominant irritable bowel syndrome: Diagnosis, etiology, and new treatment considerations. 2016

Lacy, Brian E / Moreau, Julie C. ·Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. ·J Am Assoc Nurse Pract · Pubmed #27436200.

ABSTRACT: PURPOSE: To provide an overview of irritable bowel syndrome (IBS), specifically the efficacy and tolerability of treatment options for diarrhea-predominant IBS (IBS-D). DATA SOURCES: Research articles available via PubMed were reviewed. CONCLUSIONS: IBS is a chronic multifactorial disorder that has a negative impact on patient-related quality of life. Genetic factors, psychosociologic factors, alterations in the gut microbiota, and changes in immune, motor, and sensory responses to various stimuli all may be involved in the development of IBS. While pharmacologic therapies for IBS-D have historically been limited (e.g., alosetron), newer therapies (eluxadoline and rifaximin), both approved in the United States in 2015, may be considered for appropriate patients for the management of IBS-D. IMPLICATIONS FOR PRACTICE: Nurse practitioners play an important role in the diagnosis, care, and management of patients with IBS-D. The goals of therapy should be to reach a correct diagnosis before initiating therapy, provide reassurance to the patient, educate the patient on potential treatment options, improve IBS-D symptoms, minimize risk of harm with treatment, and maximize patient-related quality of life. The authors present a treatment algorithm to guide nurse practitioners on the management of patients with IBS-D.

9 Review Dietary Interventions and Irritable Bowel Syndrome: A Review of the Evidence. 2016

Shah, Shawn L / Lacy, Brian E. ·Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA. Shawn.L.Shah@Hitchcock.org. · Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA. ·Curr Gastroenterol Rep · Pubmed #27372289.

ABSTRACT: Irritable bowel syndrome (IBS) is the best studied of the functional gastrointestinal disorders. It is a highly prevalent disorder characterized by symptoms of abdominal pain, bloating, and disordered bowel habits, which may include constipation, diarrhea, or both. IBS has a significant negative impact on patients, both financially and with regard to their quality-of-life. At present, there is no cure for IBS, and while there are a number of pharmacological therapies available to treat IBS symptoms, they are not uniformly effective. For this reason, many patients and providers are turning to dietary interventions in an attempt to ameliorate IBS symptoms. At first glance, this approach appears reasonable as dietary interventions are generally safe and side effects, including potential adverse reactions with medications, are rare. However, although dietary interventions for IBS are frequently recommended, there is a paucity of data to support their use. The goals of this article are to answer key questions about diets currently recommended for the treatment of IBS, using the best available data from the literature.

10 Review Diagnosis and treatment of diarrhea-predominant irritable bowel syndrome. 2016

Lacy, Brian E. ·Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. ·Int J Gen Med · Pubmed #26929659.

ABSTRACT: Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders worldwide. The economic impact of IBS on the health care system is substantial, as is the personal impact on patients. Patients with diarrhea-predominant IBS (IBS-D) comprise a substantial proportion of the overall IBS population. Primary care providers are often the first point of contact for patients with IBS-D and can accurately diagnose IBS after a careful history and examination without extensive diagnostic tests. Several pharmacologic treatments (eg, loperamide, alosetron, and antidepressants) and non-pharmacologic treatments (eg, dietary modification and probiotics) are available for IBS-D, but restrictions on use (eg, alosetron) or the lack of controlled trial data showing reductions in both global and individual IBS-D symptoms (eg, bloating, pain and stool frequency) emphasize the need for alternative treatment options. Two newer medications (eluxadoline and rifaximin) were approved in May 2015 for the treatment of IBS-D, and represent new treatment options for this common gastrointestinal condition.

11 Review Emerging treatments in neurogastroenterology: eluxadoline - a new therapeutic option for diarrhea-predominant IBS. 2016

Lacy, B E. ·Division of Gastroenterology & Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. ·Neurogastroenterol Motil · Pubmed #26690872.

ABSTRACT: BACKGROUND: Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder worldwide. The global prevalence of IBS is estimated to be as high as 15%. For many patients, IBS is a chronic disorder which can significantly reduce quality of life. Just as important as the effects on any one individual, IBS also places a significant impact on the population as a whole with its negative effects on the health care system. Irritable bowel syndrome is categorized into one of three main categories: IBS with diarrhea, IBS with constipation, and IBS with mixed bowel habits. Patients with diarrhea-predominant IBS (IBS-D) comprise a substantial proportion of the overall IBS population. A number of therapeutic options exist to treat the symptoms of abdominal pain, bloating, diarrhea, and fecal urgency, including non-pharmacologic therapies such as dietary changes and probiotics, or pharmacologic therapies such as loperamide and alosetron. However, many patients have persistent symptoms despite these therapies. This unmet need led to the development of eluxadoline, a mu-opioid receptor agonist/delta-opioid receptor antagonist/kappa-receptor agonist. Approved by the FDA in May 2015, this medication shows promise in the treatment of diarrhea-predominant IBS for both men and women. PURPOSE: This monograph will briefly review the impact of IBS, discuss current treatments for IBS-D, and then focus on the pharmacology, clinical efficacy and safety of eluxadoline. Potential mechanisms related to rare events of acute pancreatitis or elevated liver tests will be discussed.

12 Review Rifaximin and eluxadoline - newly approved treatments for diarrhea-predominant irritable bowel syndrome: what is their role in clinical practice alongside alosetron? 2016

Cash, Brooks D / Lacy, Brian E / Rao, Tharaknath / Earnest, David L. ·a Gastroenterology Division , University of South Alabama , Mobile , AL , USA. · b Division of Gastroenterology & Hepatology , Dartmouth-Hitchcock Medical Center , Lebanon , NH , USA. · c Clinical Development & Medical Affairs , Prometheus Laboratories Inc ., San Diego , CA , USA. ·Expert Opin Pharmacother · Pubmed #26559529.

ABSTRACT: INTRODUCTION: Diarrhea-predominant irritable bowel syndrome (IBS-D) is a common functional gastrointestinal condition in which patients experience abdominal pain, diarrhea, bloating, cramps, flatulence, fecal urgency, and incontinence. AREAS COVERED: We review two recently approved therapies that focus on treating underlying pathogenic mechanisms of IBS-D: (1) the non-absorbable antibiotic rifaximin, and (2) the opioid receptor agonist/antagonist eluxadoline. We compare the safety and efficacy data emerging from rifaximin and eluxadoline registration trials with safety and efficacy data from the alosetron clinical development program. EXPERT OPINION: The rifaximin and eluxadoline clinical development programs for IBS-D have demonstrated significant improvement in IBS-D endpoints compared to placebo. Direct comparison of primary endpoint results from the alosetron, rifaximin, and eluxadoline pivotal trials is not possible; however, general estimates of efficacy can be made, and these demonstrate similar and significantly greater responses to 'adequate relief' and a composite endpoint of abdominal pain/stool form for each agent compared to placebo. With the recent approval in the United States of rifaximin and eluxadoline for IBS-D, how should clinicians employ these agents? We suggest that they be utilized sequentially, taking into consideration patient symptoms and severity, prior medical history, mode of action, cost, availability, managed care coverage, and adverse event profiles.

13 Review The Science, Evidence, and Practice of Dietary Interventions in Irritable Bowel Syndrome. 2015

Lacy, Brian E. ·Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Electronic address: brian.e.lacy@hitchcock.org. ·Clin Gastroenterol Hepatol · Pubmed #25769411.

ABSTRACT: Irritable bowel syndrome (IBS) is a highly prevalent disorder that is characterized by symptoms of abdominal pain, bloating, constipation, and/or diarrhea. The diagnosis can be made using Rome III criteria or published guidelines after taking a thoughtful history, excluding warning signs, and performing a careful physical examination. Limited testing (ie, complete blood count and C-reactive protein level) may be useful in appropriate patients. A number of pharmacologic options are available, although many patients fail to respond to pharmacologic therapy. Although several IBS diets frequently are recommended, data supporting their use are limited. This article provides a rationale as to why specific diets might improve IBS symptoms and evaluates published trials.

14 Review Clinical pearls for irritable bowel syndrome: management of the diarrhea-predominant subtype. 2014

Lacy, Brian E / OʼShana, Tracia. ·Brian E. Lacy, PhD, MD, is Associate Professor of Medicine, Dartmouth Medical School, Hanover, and Director, GI Motility Laboratory, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Tracia O'Shana, APRN, is Instructor in Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. ·Gastroenterol Nurs · Pubmed #25461461.

ABSTRACT: Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder that is characterized by the presence of abdominal pain or discomfort and is subtyped by the predominant stool symptoms of constipation, diarrhea, or mixed constipation and diarrhea. The diagnosis of IBS was once considered to be one of exclusion, but data now show that exhaustive tests provide very limited diagnostic yield. Instead, the symptom-based Rome criteria can be used to make a confident determination of IBS. For patients diagnosed with IBS, pharmacological decisions are based on the underlying disturbances such as abdominal pain, bowel symptoms, and urgency; how the condition affects quality of life; and symptom severity. Traditionally, treatment of IBS has focused on one or two individual symptoms rather than syndrome relief; however, emerging evidence on newer targeted treatment options is drawing clinical attention. Targeted treatment will require ongoing evaluation of disease severity, as current data show that severe IBS is more common than previously thought and severity influences treatment choices. This article reviews the disease state of IBS, answers questions about the condition, and discusses the evidence supporting current management options.

15 Review American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. 2014

Ford, Alexander C / Moayyedi, Paul / Lacy, Brian E / Lembo, Anthony J / Saito, Yuri A / Schiller, Lawrence R / Soffer, Edy E / Spiegel, Brennan M R / Quigley, Eamonn M M / Anonymous3830802. ·1] Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK [2] First author on the monograph, but is not a member of the Task Force. · 1] Farncombe Family Digestive Health Research Institute, Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada [2] Conducted systematic reviews with the support of A.C. Ford, and carried out the technical analyses of the data independent of the Task Force. · Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA. · Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. · Mayo Clinic, Rochester, Minnesota, USA. · Baylor University Medical Center, Digestive Health Associates of Texas, Dallas, Texas, USA. · Division of Gastroenterology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA. · UCLA School of Medicine, UCLA/VA Center for Outcomes Research and Education (CORE), Los Angeles, California, USA. · Division of Gastroenterology and Hepatology, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas, USA. ·Am J Gastroenterol · Pubmed #25091148.

ABSTRACT: -- No abstract --

16 Review The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis. 2014

Moayyedi, Paul / Quigley, Eamonn M M / Lacy, Brian E / Lembo, Anthony J / Saito, Yuri A / Schiller, Lawrence R / Soffer, Edy E / Spiegel, Brennan M R / Ford, Alexander C. ·Health Sciences Center, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada. · Division of Gastroenterology and Hepatology, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA. · Dartmouth-Hitchcock Medical Center, Division of Gastroenterology and Hepatology, One Medical Center Drive, Lebanon, New Hampshire, USA. · The Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. · Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA. · Digestive Health Associates of Texas, Baylor University Medical Center, Dallas, Texas, USA. · Division of Gastroenterology at Cedars-Sinai, University of Southern California, Los Angeles, California, USA. · Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA. · 1] Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK [2] Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK. ·Am J Gastroenterol · Pubmed #25070054.

ABSTRACT: OBJECTIVES: Fiber has been used for many years to treat irritable bowel syndrome (IBS). This approach had fallen out of favor until a recent resurgence, which was based on new randomized controlled trial (RCT) data that suggested it might be effective. We have previously conducted a systematic review of fiber in IBS, but new RCT data for fiber therapy necessitate a new analysis; thus, we have conducted a systematic review of this intervention. METHODS: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched up to December 2013. Trials recruiting adults with IBS, which compared fiber supplements with placebo, control therapy, or "usual management", were eligible. Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy as well as number needed to treat (NNT) with a 95% confidence interval (CI). RESULTS: We identified 14 RCTs involving 906 patients that had evaluated fiber in IBS. There was a significant benefit of fiber in IBS (RR=0.86; 95% CI 0.80-0.94 with an NNT=10; 95% CI=6-33). There was no significant heterogeneity between results (I(2)=0%, Cochran Q=13.85 (d.f.=14), P=0.46). The benefit was only seen in RCTs on soluble fiber (RR=0.83; 95% CI 0.73-0.94 with an NNT=7; 95% CI 4-25) with no effect seen with bran (RR=0.90; 95% CI 0.79-1.03). CONCLUSIONS: Soluble fiber is effective in treating IBS. Bran did not appear to be of benefit, although we did not uncover any evidence of harm from this intervention, as others have speculated from uncontrolled data.

17 Review Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. 2014

Ford, Alexander C / Quigley, Eamonn M M / Lacy, Brian E / Lembo, Anthony J / Saito, Yuri A / Schiller, Lawrence R / Soffer, Edy E / Spiegel, Brennan M R / Moayyedi, Paul. ·1] Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK [2] Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK. · Division of Gastroenterology and Hepatology, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA. · Dartmouth-Hitchcock Medical Center, Gastroenterology, One Medical Center Drive, Lebanon, New Hampshire, USA. · The Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. · Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA. · Digestive Health Associates of Texas, Baylor University Medical Center, Dallas, Texas, USA. · Division of Gastroenterology at Cedars-Sinai, University of Southern California, Los Angeles, California, USA. · Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA. · Gastroenterology Division, McMaster University, Health Sciences Center, Hamilton, Ontario, Canada. ·Am J Gastroenterol · Pubmed #25070051.

ABSTRACT: OBJECTIVES: Irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC) are functional bowel disorders. Evidence suggests that disturbance in the gastrointestinal microbiota may be implicated in both conditions. We performed a systematic review and meta-analysis to examine the efficacy of prebiotics, probiotics, and synbiotics in IBS and CIC. METHODS: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (up to December 2013). Randomized controlled trials (RCTs) recruiting adults with IBS or CIC, which compared prebiotics, probiotics, or synbiotics with placebo or no therapy, were eligible. Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% confidence interval (CI). Continuous data were pooled using a standardized or weighted mean difference with a 95% CI. RESULTS: The search strategy identified 3,216 citations. Forty-three RCTs were eligible for inclusion. The RR of IBS symptoms persisting with probiotics vs. placebo was 0.79 (95% CI 0.70-0.89). Probiotics had beneficial effects on global IBS, abdominal pain, bloating, and flatulence scores. Data for prebiotics and synbiotics in IBS were sparse. Probiotics appeared to have beneficial effects in CIC (mean increase in number of stools per week=1.49; 95% CI=1.02-1.96), but there were only two RCTs. Synbiotics also appeared beneficial (RR of failure to respond to therapy=0.78; 95% CI 0.67-0.92). Again, trials for prebiotics were few in number, and no definite conclusions could be drawn. CONCLUSIONS: Probiotics are effective treatments for IBS, although which individual species and strains are the most beneficial remains unclear. Further evidence is required before the role of prebiotics or synbiotics in IBS is known. The efficacy of all three therapies in CIC is also uncertain.

18 Review Effect of antidepressants and psychological therapies, including hypnotherapy, in irritable bowel syndrome: systematic review and meta-analysis. 2014

Ford, Alexander C / Quigley, Eamonn M M / Lacy, Brian E / Lembo, Anthony J / Saito, Yuri A / Schiller, Lawrence R / Soffer, Edy E / Spiegel, Brennan M R / Moayyedi, Paul. ·1] Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK [2] Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK. · Division of Gastroenterology and Hepatology, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA. · Dartmouth-Hitchcock Medical Center, Gastroenterology, Lebanon, New Hampshire, USA. · The Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. · Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA. · Digestive Health Associates of Texas, Baylor University Medical Center, Dallas, Texas, USA. · Division of Gastroenterology at Cedars-Sinai, University of Southern California, Los Angeles, Califoria, USA. · Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA. · Division of Gastroenterology, McMaster University, Health Sciences Center, Hamilton, Ontario, Canada. ·Am J Gastroenterol · Pubmed #24935275.

ABSTRACT: OBJECTIVES: Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder. Evidence relating to the treatment of this condition with antidepressants and psychological therapies continues to accumulate. METHODS: We performed an updated systematic review and meta-analysis of randomized controlled trials (RCTs). MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (up to December 2013). Trials recruiting adults with IBS, which compared antidepressants with placebo, or psychological therapies with control therapy or "usual management," were eligible. Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% confidence interval (CI). RESULTS: The search strategy identified 3,788 citations. Forty-eight RCTs were eligible for inclusion: thirty-one compared psychological therapies with control therapy or "usual management," sixteen compared antidepressants with placebo, and one compared both psychological therapy and antidepressants with placebo. Ten of the trials of psychological therapies, and four of the RCTs of antidepressants, had been published since our previous meta-analysis. The RR of IBS symptom not improving with antidepressants vs. placebo was 0.67 (95% CI=0.58-0.77), with similar treatment effects for both tricyclic antidepressants and selective serotonin reuptake inhibitors. The RR of symptoms not improving with psychological therapies was 0.68 (95% CI=0.61-0.76). Cognitive behavioral therapy, hypnotherapy, multicomponent psychological therapy, and dynamic psychotherapy were all beneficial. CONCLUSIONS: Antidepressants and some psychological therapies are effective treatments for IBS. Despite the considerable number of studies published in the intervening 5 years since we last examined this issue, the overall summary estimates of treatment effect have remained remarkably stable.

19 Review Linaclotide in the management of gastrointestinal tract disorders. 2012

Lacy, B E / Levenick, J M / Crowell, M D. ·Dartmouth-Hitchcock Medical Center-Gastroenterology, Lebanon, New Hampshire 03756, USA. brian.lacy@hitchcock.org ·Drugs Today (Barc) · Pubmed #22462039.

ABSTRACT: Chronic constipation is a highly prevalent, heterogeneous disorder that significantly affects patients' lives. Nearly 15% of the U.S. population meets diagnostic criteria for chronic constipation (1). Chronic constipation reduces patients' quality of life and imposes a significant economic burden to the healthcare system (2, 3). A number of therapeutic options are currently available to treat symptoms of chronic constipation, although they are not universally successful (4, 5). Irritable bowel syndrome (IBS) is another common functional gastrointestinal disorder, with a prevalence rate estimated at up to 12% in the U.S. (6). Similar to chronic constipation, IBS imposes a significant impact on both the healthcare system and the individual patient (7-12). Currently, only one medication (lubiprostone) is approved by the U.S. Food and Drug Administration for the treatment of IBS with constipation (IBS-C), and is approved only for women (13). Although effective in many patients, it is not universally effective for the treatment of constipation symptoms in all patients with IBS-C. Other treatment options are therefore needed for those patients with chronic constipation and IBS-C who fail currently available therapies. This article will present information on the pharmacology and pharmacokinetics of linaclotide, a new agent designed to treat symptoms of both chronic constipation and IBS-C. Preclinical data, clinical studies and safety data will also be reviewed.

20 Clinical Trial Eluxadoline Efficacy in IBS-D Patients Who Report Prior Loperamide Use. 2017

Lacy, Brian E / Chey, William D / Cash, Brooks D / Lembo, Anthony J / Dove, Leonard S / Covington, Paul S. ·Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA. · Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA. · Division of Gastroenterology and Hepatology, University of South Alabama, Mobile, Alabama, USA. · Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. · Furiex Pharmaceuticals, an affiliate of Allergan plc, Parsippany, New Jersey, USA. ·Am J Gastroenterol · Pubmed #28417992.

ABSTRACT: OBJECTIVES: Irritable bowel syndrome with diarrhea (IBS-D) is often managed with over-the-counter therapies such as loperamide, though with limited success. This analysis evaluated the efficacy of eluxadoline in patients previously treated with loperamide in two phase 3 studies. METHODS: Adults with IBS-D (Rome III criteria) were enrolled and randomized to placebo or eluxadoline (75 or 100 mg) twice daily for 26 (IBS-3002) or 52 (IBS-3001) weeks. Patients reported loperamide use over the previous year and recorded their rescue loperamide use during the studies. The primary efficacy end point was the proportion of patients with a composite response of simultaneous improvement in abdominal pain and reduction in diarrhea. RESULTS: A total of 2,428 patients were enrolled; 36.0% reported prior loperamide use, of whom 61.8% reported prior inadequate IBS-D symptom control with loperamide. Among patients with prior loperamide use, a greater proportion treated with eluxadoline (75 and 100 mg) were composite responders vs. those treated with placebo with inadequate prior symptom control, over weeks 1-12 (26.3% (P=0.001) and 27.0% (P<0.001) vs. 12.7%, respectively); similar results were observed over weeks 1-26. When daily rescue loperamide use was imputed as a nonresponse day, the composite responder rate was still higher in patients receiving eluxadoline (75 and 100 mg) vs. placebo over weeks 1-12 (P<0.001) and weeks 1-26 (P<0.001). Adverse events included nausea and abdominal pain. CONCLUSIONS: Eluxadoline effectively and safely treats IBS-D symptoms of abdominal pain and diarrhea in patients who self-report either adequate or inadequate control of their symptoms with prior loperamide treatment, with comparable efficacy and safety irrespective of the use of loperamide as a rescue medication during eluxadoline treatment.

21 Clinical Trial Safety of Eluxadoline in Patients with Irritable Bowel Syndrome with Diarrhea. 2017

Cash, Brooks D / Lacy, Brian E / Schoenfeld, Philip S / Dove, Leonard S / Covington, Paul S. ·Department of Medicine, University of South Alabama, Mobile, Alabama, USA. · Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA. · University of Michigan School of Medicine, Ann Arbor, Michigan, USA. · Furiex Pharmaceuticals, Inc., an affiliate of Allergan plc, Parsippany, New Jersey, USA. ·Am J Gastroenterol · Pubmed #27922029.

ABSTRACT: OBJECTIVES: Eluxadoline is a mixed μ-opioid receptor (OR) and κ-OR agonist and δ-OR antagonist, approved for the treatment of irritable bowel syndrome with diarrhea (IBS-D). This analysis evaluated the safety and tolerability of eluxadoline 75 and 100 mg twice daily (BID) in one Phase 2 (IBS-2001) and two Phase 3 (IBS-3001 and IBS-3002) studies. METHODS: Adults with IBS-D (Rome III criteria) were randomized to placebo or eluxadoline (75 or 100 mg) BID for 12 (IBS-2001), 26 (IBS-3002), or 52 (IBS-3001) weeks. Safety data were pooled. Adverse events (AEs) were assessed, with special focus on opioid-related AEs, including suspected sphincter of Oddi spasm (SOS) events. RESULTS: 2,776 patients were included in the enrolled set; the safety set comprised 2,814 patients, based on actual treatments received. The most frequent AEs in the placebo and eluxadoline 75 and 100 mg groups were constipation (2.5, 7.4, and 8.1%, respectively) and nausea (5.0, 8.1, and 7.1%, respectively); discontinuation due to constipation was uncommon (0.3, 1.1, and 1.5%, respectively). Ten SOS events (10/1,839; 0.5%) occurred in eluxadoline-treated patients, manifesting as acute abdominal pain with elevated aminotransferases or lipase, or pancreatitis; all occurred in patients without a gallbladder. Eight of these events occurred with the higher dose of eluxadoline, within 1 week of initiation of therapy, and all resolved with eluxadoline discontinuation. There were five events independently adjudicated as pancreatitis not associated with SOS, three of which were associated with heavy alcohol use. CONCLUSIONS: Eluxadoline was well tolerated in Phase 2 and 3 trials, with constipation and nausea the most common AEs. Consistent with the known adverse effects of opioid agonists, clinically apparent SOS events were observed in eluxadoline-treated patients. All occurred in patients without a gallbladder and the majority were observed in patients on the higher dose of eluxadoline, suggesting a possible association.

22 Clinical Trial Eluxadoline for Irritable Bowel Syndrome with Diarrhea. 2016

Lembo, Anthony J / Lacy, Brian E / Zuckerman, Marc J / Schey, Ron / Dove, Leonard S / Andrae, David A / Davenport, J Michael / McIntyre, Gail / Lopez, Rocio / Turner, Lisa / Covington, Paul S. ·From Harvard Medical School, Boston (A.J.L.) · Geisel School of Medicine at Dartmouth, Hanover, NH (B.E.L.) · Texas Tech University Health Sciences Center, El Paso (M.J.Z.) · School of Medicine, Temple University, Philadelphia (R.S.) · and Furiex Pharmaceuticals, Morrisville, NC (L.S.D., D.A.A., J.M.D., G.M., R.L., L.T., P.S.C.). ·N Engl J Med · Pubmed #26789872.

ABSTRACT: Background Effective and safe treatments are needed for patients who have irritable bowel syndrome (IBS) with diarrhea. We conducted two phase 3 trials to assess the efficacy and safety of eluxadoline, a new oral agent with mixed opioid effects (μ- and κ-opioid receptor agonist and δ-opioid receptor antagonist), in patients with IBS with diarrhea. Methods We randomly assigned 2427 adults who had IBS with diarrhea to eluxadoline (at a dose of 75 mg or 100 mg) or placebo twice daily for 26 weeks (IBS-3002 trial) or 52 weeks (IBS-3001 trial). The primary end point was the proportion of patients who had a composite response of decrease in abdominal pain and improvement in stool consistency on the same day for at least 50% of the days from weeks 1 through 12 and from weeks 1 through 26. Results For weeks 1 through 12, more patients in the eluxadoline groups (75 mg and 100 mg) than in the placebo group reached the primary end point (IBS-3001 trial, 23.9% with the 75-mg dose and 25.1% with the 100-mg dose vs. 17.1% with placebo; P=0.01 and P=0.004, respectively; IBS-3002 trial, 28.9% and 29.6%, respectively, vs. 16.2%; P<0.001 for both comparisons). For weeks 1 through 26, the corresponding rates in IBS-3001 were 23.4% and 29.3% versus 19.0% (P=0.11 and P<0.001, respectively), and the corresponding rates in IBS-3002 were 30.4% and 32.7% versus 20.2% (P=0.001 and P<0.001, respectively). The most common adverse events associated with 75 mg of eluxadoline and 100 mg of eluxadoline, as compared with placebo, were nausea (8.1% and 7.5% vs. 5.1%), constipation (7.4% and 8.6% vs. 2.5%), and abdominal pain (5.8% and 7.2% vs. 4.1%). Pancreatitis developed in 5 (2 in the 75-mg group and 3 in the 100-mg group) of the 1666 patients in the safety population (0.3%). Conclusions Eluxadoline is a new therapeutic agent that reduced symptoms of IBS with diarrhea in men and women, with sustained efficacy over 6 months in patients who received the 100-mg dose twice daily. (Funded by Furiex Pharmaceuticals, an affiliate of Allergan; IBS-3001 and IBS-3002 ClinicalTrials.gov numbers, NCT01553591 and NCT01553747 , respectively.).

23 Article Presentation and Characteristics of Abdominal Pain Vary by Irritable Bowel Syndrome Subtype: Results of a Nationwide Population-Based Study. 2020

Shah, Eric D / Almario, Christopher V / Spiegel, Brennan M / Chey, William D. ·Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. · Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California. · Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan. ·Am J Gastroenterol · Pubmed #31913193.

ABSTRACT: INTRODUCTION: Abdominal pain is a cardinal feature of irritable bowel syndrome (IBS); however, differences in abdominal pain among IBS subtypes remain unknown. We aimed to characterize abdominal pain symptoms among established IBS subtypes using data from the National Gastrointestinal (GI) Survey. METHODS: Individuals participating in the National GI Survey completed National Institutes of Health GI Patient-Reported Outcomes Measurement Information System (GI-PROMIS) questionnaires. Adults meeting modified Rome III IBS criteria and reporting abdominal pain in the previous 7 days were eligible. Outcomes included abdominal pain severity, bothersomeness, interference with daily activities, frequency, and location. Results were stratified by subtype (diarrhea [IBS-D], constipation [IBS-C], and mixed [IBS-M]). Regression models adjusted for demographics and comorbidities. RESULTS: One thousand one hundred fifty-eight individuals (245 IBS-D, 232 IBS-C, and 681 IBS-M) with active IBS symptoms (defined as abdominal pain in the past 7 days) were included. Demographics were similar among the subtypes except for age, race/ethnicity, education, and marital status. The GI-PROMIS score was lower for IBS-D (percentile score of 68.6, SD = 25.1; P = 0.001) and IBS-M (69.1, SD = 25.1; P < 0.001) compared with IBS-C (75.5, SD = 20.7). Abdominal pain was more bothersome (P = 0.001), caused more interference with daily activities (P = 0.03), and was more frequent (P = 0.047) for individuals with IBS-C compared with individuals with IBS-D. No differences in these domains were seen between individuals with IBS-D and IBS-M. Individuals with IBS-C and IBS-M had more widespread pain compared with those with IBS-D. DISCUSSION: In this population-based study, we found that abdominal pain characteristics differ between the IBS subtypes. Namely, individuals with IBS-C experience more bothersome, frequent, and diffuse abdominal pain compared with those with IBS-D.

24 Article Quality of Care and the Irritable Bowel Syndrome: Is Now the Time to Set Standards? 2018

Lacy, Brian E / Ford, Alexander C / Talley, Nicholas J. ·Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA. · Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK. · Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK. · Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia. · Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA. · Karolinska Institute, Stockholm, Sweden. ·Am J Gastroenterol · Pubmed #29206817.

ABSTRACT: -- No abstract --

25 Article Response to Croteau and Barkin. 2017

Cash, Brooks D / Lacy, Brian E / Schoenfeld, Philip S / Dove, Leonard S / Covington, Paul S. ·University of South Alabama, Mobile, Alabama, USA. · Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA. · University of Michigan School of Medicine, Ann Arbor, Michigan, USA. · Allergan plc, Parsippany, New Jersey, USA. · Furiex Pharmaceuticals, Allergan plc, Parsippany, New Jersey, USA. ·Am J Gastroenterol · Pubmed #28978962.

ABSTRACT: -- No abstract --

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