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Irritable Bowel Syndrome: HELP
Articles from Northwestern University
Based on 60 articles published since 2009
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These are the 60 published articles about Irritable Bowel Syndrome that originated from Northwestern University during 2009-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Guideline Best Practice Update: Incorporating Psychogastroenterology Into Management of Digestive Disorders. 2018

Keefer, Laurie / Palsson, Olafur S / Pandolfino, John E. ·Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: laurie.keefer@mssm.edu. · University of North Carolina Chapel Hill, North Carolina. · Northwestern University Feinberg School of Medicine, Chicago, Illinois. ·Gastroenterology · Pubmed #29410117.

ABSTRACT: Chronic digestive diseases, including irritable bowel syndrome, gastroesophageal reflux disease, and inflammatory bowel diseases, cannot be disentangled from their psychological context-the substantial burden of these diseases is co-determined by symptom and disease severity and the ability of patients to cope with their symptoms without significant interruption to daily life. The growing field of psychogastroenterology focuses on the application of scientifically based psychological principles and techniques to the alleviation of digestive symptoms. In this Clinical Practice Update, we describe the structure and efficacy of 2 major classes of psychotherapy-cognitive behavior therapy and gut-directed hypnotherapy. We focus on the impact of these brain-gut psychotherapies on gastrointestinal symptoms, as well as their ability to facilitate improved coping, resilience, and self-regulation. The importance of the gastroenterologist in the promotion of integrated psychological care cannot be overstated, and recommendations are provided on how to address psychological issues and make an effective referral for brain-gut psychotherapy in routine practice.

2 Review Current US Food and Drug Administration-Approved Pharmacologic Therapies for the Treatment of Irritable Bowel Syndrome with Diarrhea. 2019

Brenner, Darren M / Sayuk, Gregory S. ·Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. darren-brenner@northwestern.edu. · Washington University School of Medicine, Saint Louis, MO, USA. · St Louis Veterans Affairs Medical Center, Saint Louis, MO, USA. ·Adv Ther · Pubmed #31707713.

ABSTRACT: Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain and alterations in stool form and/or frequency, leading to reduced quality of life. Pharmacologic agents currently approved by the US Food and Drug Administration for treatment of IBS with diarrhea (IBS-D) in adults are the nonsystemic antibiotic rifaximin, the mixed µ- and κ-opioid receptor agonist/δ-opioid antagonist eluxadoline, and the selective serotonin 5-HT

3 Review Recommendations for pharmacological clinical trials in children with irritable bowel syndrome: the Rome foundation pediatric subcommittee on clinical trials. 2016

Saps, M / van Tilburg, M A L / Lavigne, J V / Miranda, A / Benninga, M A / Taminiau, J A / Di Lorenzo, C. ·Division of Pediatric Gastroenterology, Hepatology & Nutrition, Nationwide Children's Hospital, Columbus, OH, USA. miguel.saps@nationwidechildrens.org. · Division of Gastroenterology and Hepatology, Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, NC, USA. · Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. · Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. · Mary Ann and J. Milburn Smith Child Health Research Program, Chicago, IL, USA. · Children's Hospital of Chicago Research Center, Chicago, IL, USA. · Division of Pediatric Gastroenterology Hepatology & Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA. · Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands. · Member of the Pediatric Committee (PDCO) European Medicines Agency, London, UK. · Division of Pediatric Gastroenterology, Hepatology & Nutrition, Nationwide Children's Hospital, Columbus, OH, USA. ·Neurogastroenterol Motil · Pubmed #27477090.

ABSTRACT: BACKGROUND: There is little published evidence of efficacy for the most commonly used treatments. Thus, there is an urgent need to conduct clinical trials on existing and novel therapies. PURPOSE: In order to address these issues the Rome Foundation and members of the Pediatric Committee of the European Medicines Agency formed a subcommittee on clinical trials to develop guidelines for the design of clinical trials in children with irritable bowel syndrome (IBS). The following recommendations are based on evidence from published data when available and expert opinion. KEY RECOMMENDATIONS: The subcommittee recommends randomized, double-blind, placebo-controlled, parallel-group, clinical trials to assess the efficacy of new drugs. The combined endpoints for abdominal pain are a decrease in intensity of at least 30% compared with baseline and to meet or exceed the Reliable Change Index (RCI) for the sample. Stool consistency is measured with the Bristol Stool Scale Form (BSFS). The subcommittee recommends as entry criteria for abdominal pain a weekly average of worst abdominal pain in past 24 h of at least 3.0 on a 0-10 point scale or at least 30 mm in 100 mm Visual Analog Scale. For stool endpoints the committee recommends an average stool consistency lower than 3 in the BSFS during the run-in period for clinical trials on IBS-C and an average stool consistency greater than 5 in the BSFS during the run-in period for clinical trials on IBS-D. Changes in stool consistency are the primary endpoints for both IBS with diarrhea (IBS-D) and IBS with constipation (IBS-C).

4 Review Psychosocial impact of irritable bowel syndrome: A brief review. 2015

Ballou, Sarah / Bedell, Alyse / Keefer, Laurie. ·Sarah Ballou, Alyse Bedell, Laurie Keefer, Division of Gastroenterology, Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, United States. ·World J Gastrointest Pathophysiol · Pubmed #26600969.

ABSTRACT: Irritable bowel syndrome (IBS) is a common disorder of the gastrointestinal tract with unclear etiology and no reliable biomarker. Like other chronic and functional disorders, medical treatments for IBS are suboptimal and the overall illness burden is high. Patients with IBS report high rates of psychopathology, low quality of life, and increased suicidal ideation. These patients also miss more days of work, are less productive at work, and use many healthcare resources. However, little is known about the burden of IBS on daily functioning. The primary aim of this paper is to review the current literature on the burden of IBS and to highlight the need for further research to evaluate the impact of IBS on daily activities. This research would contribute to our existing understanding of the impact of IBS on overall quality of life and well-being.

5 Review Multicultural considerations in the diagnosis and management of irritable bowel syndrome: a selective summary. 2013

Ballou, Sarah K / Keefer, Laurie. ·Department of Medicine, Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA. sarahballou2015@u.northwestern.edu ·Eur J Gastroenterol Hepatol · Pubmed #23778308.

ABSTRACT: Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that is characterized by chronic and recurrent abdominal symptoms with no associated organic abnormalities. Although IBS has traditionally been considered to be more common in western cultures, a review of the literature reveals that IBS is truly a worldwide illness, affecting people in many different cultural and geographic areas. According to this review, a reasonable range for the worldwide prevalence of IBS is between 5 and 15%. Several theories for varying prevalence rates around the world are presented in this paper and methodological difficulties are discussed. Finally, this short review provides an analysis of cultural, biological, and socioeconomic differences in IBS presentation and treatment around the world.

6 Review Environmental factors of abdominal pain. 2009

Chogle, Ashish / Saps, Miguel. ·Department of Gastroenterology, Hepatology & Nutrition, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, USA. ·Pediatr Ann · Pubmed #19685660.

ABSTRACT: -- No abstract --

7 Review Bifidobacterium infantis 35624: a novel probiotic for the treatment of irritable bowel syndrome. 2009

Brenner, Darren M / Chey, William D. ·Division of Gastroenterology, Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. ·Rev Gastroenterol Disord · Pubmed #19367213.

ABSTRACT: Irritable bowel syndrome (IBS) is a common disorder with widespread prevalence. Due to its heterogeneous pathogenesis, efficacious treatments are lacking. The few medications that are effective for treating global IBS symptoms have either been withdrawn or restricted due to detrimental side effects; thus, safe and effective alternatives are urgently needed. Increasing data have revealed that inflammatory changes may play a role in the development of IBS, and probiotics, commensal organisms with inherent health benefits, may alter that milieu. Although their exact mechanisms of action remain elusive, it is clear that the beneficial properties inherent to each probiotic species are strain specific. Bifidobacterium infantis 35624 ( B infantis 35624; Bifantis, The Procter & Gamble Company, Cincinnati, OH), is a probiotic with unique abilities to reduce intestinal inflammation. Two randomized, controlled trials have validated its efficacy for treating both individual and global IBS symptoms without evidence to suggest an increase in adverse events. B. infantis 35624 appears safe and effective for the treatment of IBS.

8 Review Pharmacotherapy for functional gastrointestinal disorders in children. 2009

Saps, Miguel / Di Lorenzo, Carlo. ·Division of Pediatric Gastroenterology, Children's Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. ·J Pediatr Gastroenterol Nutr · Pubmed #19300118.

ABSTRACT: Therapy of pediatric functional gastrointestinal disorders is best done within the context of a multidisciplinary biopsychosocial approach. Pharmacotherapy is often sought by patients and families who hope to find a "pill" that will lead to rapid symptom relief. Yet, there is only scant published evidence for the efficacy of a variety of medical interventions in childhood functional abdominal pain and irritable bowel syndrome. This article reviews the pediatric studies that have addressed pharmacotherapy in children with pain predominant functional gastrointestinal disorders.

9 Review The utility of probiotics in the treatment of irritable bowel syndrome: a systematic review. 2009

Brenner, Darren M / Moeller, Matthew J / Chey, William D / Schoenfeld, Philip S. ·Division of Gastroenterology, Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Ann Arbor, Michigan, USA. darren-brenner@northwestern.edu ·Am J Gastroenterol · Pubmed #19277023.

ABSTRACT: OBJECTIVES: Irritable bowel syndrome (IBS) is a common disorder and available therapies have limited efficacy. Mucosal inflammation and alterations in gut microflora may contribute to the development of IBS symptoms, and researchers have hypothesized that probiotics might improve these symptoms. The aim of this study was to perform a systematic review of randomized controlled trials (RCTs) evaluating the efficacy, safety, and tolerability of probiotics in the treatment of IBS. METHODS: Comprehensive literature searches of multiple databases were performed. Study selection criteria were as follows: (i) RCTs, (ii) adults with IBS defined by Manning or Rome II criteria, (iii) single or combination probiotic vs. placebo, and (iv) improvement in IBS symptoms and/or decrease in frequency of adverse events reported. Data about study design and results were extracted in duplicate using standardized data extraction forms. Owing to variability in outcome measures, quantitative pooling of data was not feasible. RESULTS: A total of 16 RCTs met selection criteria. Of those, 11 studies showed suboptimal study design with inadequate blinding, inadequate trial length, inadequate sample size, and/or lack of intention-to-treat analysis. None of the studies provided quantifiable data about both tolerability and adverse events. Bifidobacterium infantis 35624 showed significant improvement in the composite score for abdominal pain/discomfort, bloating/distention, and/or bowel movement difficulty compared with placebo (P<0.05) in two appropriately designed studies. No other probiotic showed significant improvement in IBS symptoms in an appropriately designed study. CONCLUSIONS: B. infantis 35624 has shown efficacy for improvement of IBS symptoms. Most RCTs about the utility of probiotics in IBS have not used an appropriate study design and do not adequately report adverse events. Therefore, there is inadequate data to comment on the efficacy of other probiotics. Future probiotic studies should follow Rome II recommendations for appropriate design of an RCT.

10 Clinical Trial Efficacy, safety, and tolerability of plecanatide in patients with irritable bowel syndrome with constipation: results of two phase 3 randomized clinical trials. 2018

Brenner, Darren M / Fogel, Ronald / Dorn, Spencer D / Krause, Richard / Eng, Paul / Kirshoff, Robert / Nguyen, Anhthu / Crozier, Robert A / Magnus, Leslie / Griffin, Patrick H. ·Division of Gastroenterology and Hepatology, Northwestern University-Feinberg School of Medicine, Chicago, iL, USA. Clinical Research institute of Michigan, Chesterfield, Mi, USA. Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA. WR-Clinsearch, Chattanooga, TN, USA. Synergy Pharmaceuticals inc, New York, NY, USA. †Deceased: Paul Eng. ·Am J Gastroenterol · Pubmed #29545635.

ABSTRACT: OBJECTIVES: Two identical, phase 3, randomized, double-blind, placebo-controlled trials evaluated the efficacy and safety of plecanatide in patients with irritable bowel syndrome with constipation (IBS-C). METHODS: Adults meeting Rome III criteria for IBS-C were randomized (1:1:1) to placebo or plecanatide (3 or 6 mg) for 12 weeks. The primary efficacy end point was the percentage of overall responders (patients reporting ≥30% reduction from baseline in worst abdominal pain plus an increase of ≥1 complete spontaneous bowel movement (CSBM)/week from baseline in the same week for ≥6 of 12 treatment weeks). Safety was assessed by adverse events (AEs). RESULTS: Overall, 2189 individuals were randomized across the two studies and 1879 completed the studies. Demographic and baseline characteristics were similar across treatment groups and between studies. The percentage of overall responders in Study 1 was 30.2% and 29.5% for plecanatide 3 and 6 mg, respectively, vs. 17.8% placebo (P < 0.001 for each dose vs. placebo), and in Study 2 was 21.5% (P = 0.009) and 24.0% (P < 0.001) for plecanatide 3 and 6 mg, respectively, compared to 14.2% for placebo. The percentage of sustained efficacy responders (overall responders plus weekly responders for ≥2 of last 4 weeks of the 12-week treatment period) was significantly greater for both doses of plecanatide vs. placebo across both studies. All secondary end points (stool frequency/consistency, straining, abdominal symptoms) showed statistically significant improvements compared with placebo. The most common AE was diarrhea (3 mg, 4.3%; 6 mg, 4.0%; placebo, 1.0%). Discontinuation due to diarrhea was infrequent (3 mg, 1.2%; 6 mg, 1.4%; placebo, 0). CONCLUSIONS: Plecanatide significantly improved both abdominal pain and constipation symptoms of IBS-C with minimal associated side effects and high levels of tolerability.

11 Clinical Trial Clinical Presentation of Acute Gastroenteritis in Children With Functional Abdominal Pain Disorders. 2017

Saps, Miguel / Mintjens, Stijn / Pusatcioglu, Cenk K / Cohen, Daniel M / Sternberg, Petra. ·*Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH †Department of Pediatrics, Emma Kinderziekenhuis, Academic Medical Centre, Amsterdam, the Netherlands ‡Division of Pediatric Gastroenterology Hepatology and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL §Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, OH. ·J Pediatr Gastroenterol Nutr · Pubmed #28737570.

ABSTRACT: Visceral hypersensitivity and abnormal coping are common in children with functional abdominal pain disorders (FAPDs). Thus, it would be expected that children with visceral hypersensitivity would report more pain if their gut is acutely inflamed. The aim of the study was to compare clinical symptoms and somatization of children with and without FAPDs at time of an episode of acute gastroenteritis. Seventy children with acute gastroenteritis and their parents completed the Rome III Diagnostic Questionnaire for Pediatric Functional GI Disorders and the Children's Somatization Inventory. Twenty-one percent of children were diagnosed with an FAPD. Children with FAPDs showed significantly more nongastrointestinal somatic symptoms than children without FAPDs. There were no significant differences in abdominal pain, nausea, vomiting, or school absenteeism between both groups at time of consultation.

12 Article Efficacy and Safety of Eluxadoline in Patients With Irritable Bowel Syndrome With Diarrhea Who Report Inadequate Symptom Control With Loperamide: RELIEF Phase 4 Study. 2019

Brenner, Darren M / Sayuk, Gregory S / Gutman, Catherine R / Jo, Esther / Elmes, Steven J R / Liu, Louis W C / Cash, Brooks D. ·Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. · Washington University School of Medicine, St. Louis, Missouri, USA. · St. Louis VA Medical Center, St Louis, Missouri, USA. · Allergan plc, Madison, New Jersey, USA. · Allergan plc, Irvine, California, USA. · Toronto Western Hospital, University Health Network, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. · McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA. ·Am J Gastroenterol · Pubmed #31356229.

ABSTRACT: OBJECTIVES: Irritable bowel syndrome with diarrhea (IBS-D) is a functional gastrointestinal disorder with limited effective treatment options. We evaluated the efficacy and safety of eluxadoline in patients with IBS-D who reported inadequate symptom control with prior loperamide. METHODS: Three hundred forty-six adults with IBS-D (Rome III criteria) were randomly assigned to placebo or eluxadoline 100 mg twice daily for 12 weeks. Patients recorded daily IBS-D symptoms, including worst abdominal pain (WAP) and stool consistency (through Bristol Stool Scale). The primary endpoint was proportion of composite responders, defined as patients who met daily composite response criteria (≥40% WAP improvement and <5 Bristol Stool Scale score) for at least 50% of treatment days, and recorded ≥60 days of diary entries over the 12-week period. RESULTS: Over 12 weeks, a significantly greater proportion of eluxadoline patients achieved the primary composite responder endpoint compared to placebo (22.7% vs 10.3%, P = 0.002), and component endpoints of improvements in stool consistency (27.9% vs 16.7%, P = 0.01) and WAP (43.6% vs 31.0%, P = 0.02). Additionally, a greater proportion of eluxadoline patients met the composite responder endpoint assessed at monthly intervals compared to placebo (weeks 1-4: 14.0% vs 6.9%, P = 0.03; weeks 5-8: 26.7% vs 14.9%, P = 0.006; weeks 9-12: 30.8% vs 16.7%, P = 0.002). Rates of adverse events were comparable in both groups (37.4% vs 35.3%); no treatment-related serious adverse event, cases of sphincter of Oddi spasm, or pancreatitis were reported. DISCUSSION: Eluxadoline appears safe and effective for treating IBS-D symptoms in patients with an intact gallbladder reporting inadequate relief with prior loperamide use.

13 Article Fecal Microbiota Transplant for Irritable Bowel Syndrome: Panacea or Placebo? 2019

Shaukat, Aasma / Brenner, Darren M. ·Department of Medicine, Section of Gastroenterology Minneapolis VA Medical Center and University of Minnesota, Minneapolis, Minnesota, USA. · Department of Medicine, Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. ·Am J Gastroenterol · Pubmed #31082878.

ABSTRACT: Irritable bowel syndrome (IBS) is a common disorder of heterogeneous pathogenesis, and alterations in the gut microbiome/dysbiosis play a role in the development of symptoms in a subset of individuals with IBS. Consequently, it stands to reason that modulation of the microbiome via fecal microbial transplant (FMT) may serve as an effective treatment strategy because this has proven effective for treating other illnesses such as Clostridium difficile colitis. Small studies completed to date have offered conflicting results and the strains used, route of administration, and IBS subtypes may all play a role in treatment outcomes. A better understanding of the altered microbiome of patients with IBS and more rigorous trials are warranted before the utility of fecal microbial transplant for IBS symptoms can be determined.

14 Article Food-related quality of life in patients with inflammatory bowel disease and irritable bowel syndrome. 2019

Guadagnoli, Livia / Mutlu, Ece A / Doerfler, Bethany / Ibrahim, Ammoura / Brenner, Darren / Taft, Tiffany H. ·Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street Suite 1400, Chicago, IL, 60611, USA. · Division of Digestive Diseases and Nutrition, Rush Medical College, Chicago, IL, USA. · Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street Suite 1400, Chicago, IL, 60611, USA. ttaft@northwestern.edu. ·Qual Life Res · Pubmed #30900206.

ABSTRACT: BACKGROUND: Food-related quality of life (FRQoL) evaluates the impact of diet, eating behaviors, and food-related anxiety on a person's quality of life. This is the first study to evaluate FRQoL in inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), two illnesses where food and diet are of importance. METHODS: One hundred seventy-five participants (80 IBS, 95 IBD) participated in the study by completing measures evaluating FRQoL, psychological distress, and health-related quality of life. Primary analyses evaluated differences in FRQoL between IBD and IBS patients. Secondary analyses compared differences based on remission status, dietary use, and dietary consultation, as well as evaluated potential predictors of FRQoL. RESULTS: IBD patients in remission report the highest FRQoL (IBD-remission: 91.2 (26.5) vs. IBD-active: 67.7 (19.6) and IBS-active: 67.6 (18.3), p < .001). Using more dietary treatments is associated with decreased FRQoL for IBS (r = - 0.23, p < .05) and IBD patients (r = - 0.31, p < .01). IBS patients are more likely to use dietary treatments than IBD (IBS = 81% vs. IBD = 64%, p < .01), with self-directed diets being the most commonly used approach. Symptom severity is the strongest predictor of FRQoL in both groups (IBD: R CONCLUSION: FRQoL is a unique construct for IBD and IBS patients that can be influenced by several clinical and dietary factors, including number of diets and type of diet used, depending on the diagnosis. Thus, FRQoL should be considered when working with both IBD and IBS patients.

15 Article Initial Assessment of Post-traumatic Stress in a US Cohort of Inflammatory Bowel Disease Patients. 2019

Taft, Tiffany H / Bedell, Alyse / Craven, Meredith R / Guadagnoli, Livia / Quinton, Sarah / Hanauer, Stephen B. ·Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. ·Inflamm Bowel Dis · Pubmed #30840762.

ABSTRACT: BACKGROUND: Post-traumatic stress (PTS), or the psycho-physiological response to a traumatic or life-threatening event, is implicated in medical patient outcomes. Emerging evidence suggests a complex relationship between PTS, the brain-gut axis, the gut microbiome, and immune function. Inflammatory bowel disease (IBD) may be susceptible to PTS and its subsequent impacts. To date, no study has evaluated PTS in IBD in the United States. METHODS: Adult patients with IBD were recruited from an outpatient gastroenterology practice, via social media, and via a research recruitment website. Patients with irritable bowel syndrome (IBS) were recruited as a comparison group. Participants completed demographic and disease information, surgical and hospitalization history, and the PTSD Checklist-Civilian Version (PCL-C). Statistical analyses evaluated rates of PTS in IBD and IBS, including differences between groups for PTS severity. Regression analyses determined potential predictors of PTS. RESULTS: One hundred eighty-eight participants (131 IBD, 57 IBS) completed the study. Thirty-two percent of IBD and 26% of IBS patients met the criteria for significant PTS symptoms based on PCL-C cutoffs. Inflammatory bowel disease patients are more likely to attribute PTS to their disease than IBS patients. Crohn's disease (CD) patients appear to be the most likely to experience PTS, including those being hospitalized or undergoing ileostomy surgery. Symptom severity is the greatest predictor of PTS for ulcerative colitis and IBS. CONCLUSIONS: Although PTS is relevant in both IBS and IBD, IBD patients are seemingly more susceptible to PTS due their disease experiences, especially CD patients. The nature of PTS symptoms may contribute to IBD disease processes, most notably through sleep disturbance and ANS arousal. Clinicians should assess for PTS in IBD patients as standard of care, especially after a hospitalization or surgery.

16 Article Durability and Decay of Treatment Benefit of Cognitive Behavioral Therapy for Irritable Bowel Syndrome: 12-Month Follow-Up. 2019

Lackner, Jeffrey M / Jaccard, James / Radziwon, Christopher D / Firth, Rebecca S / Gudleski, Gregory D / Hamilton, Frank / Katz, Leonard A / Keefer, Laurie / Krasner, Susan S / Ma, Chang-Xing / Sitrin, Michael D / Brenner, Darren M. ·Department of Medicine, Jacobs School of Medicine, Divisions of Behavioral Medicine and Gastroenterology, University at Buffalo, Buffalo, NY, USA. · School of Social Work, New York University, New York, NY, USA. · Division of Digestive Disease and Nutrition, NIDDK, Bethesda, MD, USA. · Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. · Departments of Anesthesiology, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA. · Department of Biostatistics, University at Buffalo SUNY, Buffalo, NY, USA. · Department of Medicine, Feinberg School of Medicine, Division of Gastroenterology, Northwestern University, Chicago, IL, USA. ·Am J Gastroenterol · Pubmed #30429592.

ABSTRACT: BACKGROUND: There is a need for safe and effective IBS treatments that provide immediate and sustained improvement of IBS symptoms, particularly among more severe patients. The aim was to assess long-term clinical response of cognitive behavioral therapy (CBT) with reference to IBS education. METHODS: A total of 436 Rome III-diagnosed IBS patients (80% F, M age = 41 years) were randomized to: 4 session home-based CBT (minimal contact (MC-CBT)), 10 session clinic-based CBT (standard (S-CBT)), or 4 session IBS education (EDU). Follow-up occurred at 2 weeks and 3, 6, 9, and 12 months following treatment completion. Treatment response was based a priori on the Clinical Global Improvement Scale (global IBS symptom improvement) and IBS Symptom Severity Scale (IBS-SSS). RESULTS: Post-treatment CGI gains were generally maintained by MC-CBT patients at quarterly intervals through 12-month follow-up with negligible decay. For MC-CBT and S-CBT, 39 and 33% of respondents maintained treatment response at every follow-up assessment. The corresponding percent for EDU was 19%, which was significantly lower (p < 0.05) than for the CBT groups. On the IBS-SSS, therapeutic gains also showed a pattern of maintenance with trends towards increased efficacy over time in all conditions, with the mean unit reductions between baseline and follows-up being approximately -76 at immediate and approximately -94 at 12 months (-50 = clinically significant). CONCLUSIONS: For treatment-refractory IBS patients, home- and clinic-based CBT resulted in substantial and enduring relief of multiple IBS symptoms that generally extended to 12-month post treatment.

17 Article The International Collaborative on Fatigue Following Infection (COFFI). 2018

Katz, Ben Z / Collin, Simon M / Murphy, Gabrielle / Moss-Morris, Rona / Wyller, Vegard Bruun / Wensaas, Knut-Arne / Hautvast, Jeannine L A / Bleeker-Rovers, Chantal P / Vollmer-Conna, Ute / Buchwald, Dedra / Taylor, Renée / Little, Paul / Crawley, Esther / White, Peter D / Lloyd, Andrew. ·Department of Pediatrics, Northwestern University Feinberg School of Medicine, Division of Infectious Diseases, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, USA. · Centre for Child & Adolescent Health, School of Social & Community Medicine, University of Bristol, UK. · Royal Free London NHS Foundation Trust, London, UK. · Health Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK. · Division of Medicine and Laboratory Sciences, University of Oslo, Norway. · Research Unit for General Practice, Uni Research Health, Bergen, Norway. · Department of Primary and Community Care, Radboud university medical centre, Nijmegen, NL. · Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Centre, Nijmegen, NL. · School of Psychiatry, University of New South Wales, Sydney, Australia. · Department of Psychiatry and Behavioral Sciences, University of Washington, USA. · Department of Occupational Therapy, University of Illinois at Chicago, USA. · Primary Care and Population Sciences Division, University of Southampton, Southampton, UK. · Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK. · Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia. ·Fatigue · Pubmed #30666281.

ABSTRACT: Background: The purpose of the Collaborative on Fatigue Following Infection (COFFI) is for investigators of post-infection fatigue (PIF) and other syndromes to collaborate on these enigmatic and poorly understood conditions by studying relatively homogeneous populations with known infectious triggers. Utilizing COFFI, pooled data and stored biosamples will support both epidemiological and laboratory research to better understand the etiology and risk factors for development and progression of PIF. Methods: COFFI consists of prospective cohorts from the UK, Netherlands, Norway, USA, New Zealand and Australia, with some cohorts closed and some open to recruitment. The 9 cohorts closed to recruitment total over 3,000 participants, including nearly 1000 with infectious mononucleosis (IM), > 500 with Q fever, > 800 with giardiasis, > 600 with campylobacter gastroenteritis (CG), 190 with Legionnaires disease and 60 with Ross River virus. Follow-ups have been at least 6 months and up to 10 years. All studies use the Fukuda criteria for defining chronic fatigue syndrome (CFS). Results: Preliminary analyses indicated that risk factors for non-recovery from PIF included lower physical fitness, female gender, severity of the acute sickness response, and autonomic dysfunction. Conclusions: COFFI (https://internationalcoffi.wordpress.com/) is an international collaboration which should be able to answer questions based on pooled data that are not answerable in the individual cohorts. Possible questions may include the following: Do different infectious triggers different PIF syndromes (e.g., CFS vs. irritable bowel syndrome)?; What are longitudinal predictors of PIF and its severity?

18 Article Improvement in Gastrointestinal Symptoms After Cognitive Behavior Therapy for Refractory Irritable Bowel Syndrome. 2018

Lackner, Jeffrey M / Jaccard, James / Keefer, Laurie / Brenner, Darren M / Firth, Rebecca S / Gudleski, Gregory D / Hamilton, Frank A / Katz, Leonard A / Krasner, Susan S / Ma, Chang-Xing / Radziwon, Christopher D / Sitrin, Michael D. ·Division of Gastroenterology, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York. Electronic address: lackner@buffalo.edu. · School of Social Work, New York University, New York, New York. · Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. · Division of Gastroenterology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. · Division of Gastroenterology, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York. · Division of Digestive Disease and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland. · Division of Gastroenterology, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York; Department of Anesthesiology, Jacobs School of Medicine, University at Buffalo, Buffalo, New York. · Department of Biostatistics, University at Buffalo, SUNY, Buffalo, New York. ·Gastroenterology · Pubmed #29702118.

ABSTRACT: BACKGROUND & AIMS: There is an urgent need for safe treatments for irritable bowel syndrome (IBS) that relieve treatment-refractory symptoms and their societal and economic burden. Cognitive behavior therapy (CBT) is an effective treatment that has not been broadly adopted into routine clinical practice. We performed a randomized controlled trial to assess clinical responses to home-based CBT compared with clinic-based CBT and patient education. METHODS: We performed a prospective study of 436 patients with IBS, based on Rome III criteria, at 2 tertiary centers from August 23, 2010, through October 21, 2016. Subjects (41.4 ± 14.8 years old; 80% women) were randomly assigned to groups that received the following: standard-CBT (S-CBT, n = 146, comprising 10 weekly, 60-minute sessions that emphasized the provision of information about brain-gut interactions; self-monitoring of symptoms, their triggers, and consequences; muscle relaxation; worry control; flexible problem solving; and relapse prevention training), or 4 sessions of primarily home-based CBT requiring minimal therapist contact (MC-CBT, n = 145), in which patients received home-study materials covering the same procedures as S-CBT), or 4 sessions of IBS education (EDU, n = 145) that provided support and information about IBS and the role of lifestyle factors such as stress, diet, and exercise. The primary outcome was global improvement of IBS symptoms, based on the IBS-version of the Clinical Global Impressions-Improvement Scale. Ratings were performed by patients and board-certified gastroenterologists blinded to treatment allocation. Efficacy data were collected 2 weeks, 3 months, and 6 months after treatment completion. RESULTS: A higher proportion of patients receiving MC-CBT reported moderate to substantial improvement in gastrointestinal symptoms 2 weeks after treatment (61.0% based on ratings by patients and 55.7% based on ratings by gastroenterologists) than those receiving EDU (43.5% based on ratings patients and 40.4% based on ratings by gastroenterologists) (P < .05). Gastrointestinal symptom improvement, rated by gastroenterologists, 6 months after the end of treatment also differed significantly between the MC-CBT (58.4%) and EDU groups (44.8%) (P = .05). Formal equivalence testing applied across multiple contrasts indicated that MC-CBT is at least as effective as S-CBT in improving IBS symptoms. Patients tended to be more satisfied with CBT vs EDU (P < .05) based on immediate posttreatment responses to the Client Satisfaction Questionnaire. Symptom improvement was not significantly related to concomitant use of medications. CONCLUSIONS: In a randomized controlled trial, we found that a primarily home-based version of CBT produced significant and sustained gastrointestinal symptom improvement for patients with IBS compared with education. Clinicaltrials.gov no.: NCT00738920.

19 Article Radar plots: A novel modality for displaying disparate data on the efficacy of eluxadoline for the treatment of irritable bowel syndrome with diarrhea. 2018

Brenner, D M / Dove, L S / Andrae, D A / Covington, P S / Gutman, C / Chey, W D. ·Northwestern University Feinberg School of Medicine, Chicago, IL, USA. · Consultant to Allergan plc, Madison, NJ, USA. · Former employee of Allergan plc, Madison, NJ, USA. · Former employee of Furiex Pharmaceuticals, Inc., an affiliate of Allergan plc, Madison, NJ, USA. · Allergan plc, Madison, NJ, USA. · University of Michigan, Ann Arbor, MI, USA. ·Neurogastroenterol Motil · Pubmed #29575372.

ABSTRACT: BACKGROUND: Patients with irritable bowel syndrome with diarrhea (IBS-D) experience a range of abdominal and bowel symptoms; successful management requires alleviation of this constellation of symptoms. Eluxadoline, a locally active mixed μ- and κ-opioid receptor agonist and δ-opioid receptor antagonist, is approved for the treatment of IBS-D in adults based on the results of 2 Phase 3 studies. Radar plots can facilitate comprehensive, visual evaluation of diverse but interrelated efficacy endpoints. METHODS: Two double-blind, placebo-controlled, Phase 3 trials (IBS-3001 and IBS-3002) randomized patients meeting Rome III criteria for IBS-D to twice-daily eluxadoline 75 or 100 mg or placebo. Radar plots were prepared showing pooled Weeks 1-26 response rates for the primary efficacy composite endpoint (simultaneous improvement in abdominal pain and stool consistency), stool consistency, abdominal pain, urgency-free days, and adequate relief, and change from baseline to Week 26 in IBS-D global symptom score, abdominal discomfort, abdominal pain, abdominal bloating, and daily number of bowel movements. KEY RESULTS: The studies enrolled 2428 patients. Eluxadoline increased Weeks 1-26 responder proportions vs placebo for the composite endpoint, stool consistency, abdominal pain, urgency-free days, and adequate relief. Changes from baseline to Week 26 in IBS-D global symptom score, abdominal discomfort, abdominal pain, abdominal bloating, and number of bowel movements were greater with eluxadoline vs placebo. CONCLUSIONS AND INFERENCES: Data presentation in radar plot format facilitates interpretation across multiple domains, demonstrating that eluxadoline treatment led to improvements vs placebo across 13 endpoints representing the range of symptoms experienced by patients with IBS-D.

20 Article Gut Microbiota-Based Therapies for Irritable Bowel Syndrome. 2018

Stern, Emily K / Brenner, Darren M. ·Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. ·Clin Transl Gastroenterol · Pubmed #29446765.

ABSTRACT: Irritable bowel syndrome (IBS) is a common, heterogeneous disorder characterized by abdominal pain associated with changes in bowel habits. The pathogenesis of IBS is multifactorial and may relate to alterations in the gut microbiota, changes in visceral sensation and motility, and genetic and environmental factors. Administration of systemic antibiotics may increase the risk of IBS by altering gastrointestinal homeostasis. Therapeutic interventions for IBS with diarrhea that are thought to target alterations in the gut microbiota include the nonsystemic antibiotic rifaximin, the medical food serum-derived bovine immunoglobulin, prebiotics, probiotics, and dietary modification. SYN-010 is a modified-release statin formulation that reduces methane production by Methanobrevibacter smithii and is currently in development for the treatment of patients with constipation-predominant IBS. Use of these interventions in the management of patients with IBS may function to restore a healthy gut microbiota and ameliorate symptoms of IBS.

21 Article Morphology of subcortical brain nuclei is associated with autonomic function in healthy humans. 2018

Ruffle, James K / Coen, Steven J / Giampietro, Vincent / Williams, Steven C R / Apkarian, A Vania / Farmer, Adam D / Aziz, Qasim. ·Centre for Neuroscience and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, 26 Ashfield Street, London, E1 2AJ, United Kingdom. · Medical Acute Assessment Unit, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, Whitechapel, London, E1 1BB, United Kingdom. · Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, United Kingdom. · Department of Neuroimaging, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, SE5 8AF, United Kingdom. · Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, 60611. · Department of Gastroenterology, University Hospitals Midlands NHS Trust, Stoke on Trent, Staffordshire, ST4 6QG, United Kingdom. ·Hum Brain Mapp · Pubmed #29080228.

ABSTRACT: The autonomic nervous system (ANS) is a brain body interface which serves to maintain homeostasis by influencing a plethora of physiological processes, including metabolism, cardiorespiratory regulation and nociception. Accumulating evidence suggests that ANS function is disturbed in numerous prevalent clinical disorders, including irritable bowel syndrome and fibromyalgia. While the brain is a central hub for regulating autonomic function, the association between resting autonomic activity and subcortical morphology has not been comprehensively studied and thus was our aim. In 27 healthy subjects [14 male and 13 female; mean age 30 years (range 22-53 years)], we quantified resting ANS function using validated indices of cardiac sympathetic index (CSI) and parasympathetic cardiac vagal tone (CVT). High resolution structural magnetic resonance imaging scans were acquired, and differences in subcortical nuclei shape, that is, 'deformation', contingent on resting ANS activity were investigated. CSI positively correlated with outward deformation of the brainstem, right nucleus accumbens, right amygdala and bilateral pallidum (all thresholded to corrected P < 0.05). In contrast, parasympathetic CVT negatively correlated with inward deformation of the right amygdala and pallidum (all thresholded to corrected P < 0.05). Left and right putamen volume positively correlated with CVT (r = 0.62, P = 0.0047 and r = 0.59, P = 0.008, respectively), as did the brainstem (r = 0.46, P = 0.049). These data provide novel evidence that resting autonomic state is associated with differences in the shape and volume of subcortical nuclei. Thus, subcortical morphological brain differences in various disorders may partly be attributable to perturbation in autonomic function. Further work is warranted to investigate these findings in clinical populations. Hum Brain Mapp 39:381-392, 2018. © 2017 Wiley Periodicals, Inc.

22 Article (Can't Get No) Patient Satisfaction: The Predictive Power of Demographic, GI, and Psychological Factors in IBS Patients. 2018

Quigley, Brian M / Sova, Christopher C / Brenner, Darren M / Keefer, Laurie A / Sitrin, Michael D / Radziwon, Christopher D / Krasner, Susan S / Lackner, Jeffrey M. ·Department of Medicine. · Research Institute on Addictions, University at Buffalo, SUNY, Buffalo, NY. · Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. ·J Clin Gastroenterol · Pubmed #28787357.

ABSTRACT: GOALS: The goal of this study is to assess: (1) the relative contribution of patient factors to satisfaction ratings in irritable bowel syndrome (IBS) patients and (2) the relationship between patient satisfaction (PS) and the number of diagnostic tests patients underwent prior to receiving IBS diagnosis. BACKGROUND: Although PS is regarded as an important indicator of quality of care, little is known about its determinants. STUDY: A total of 448 Rome III-diagnosed patients (M age=41 y; 79% F), whose GI symptoms were at least moderate in severity completed patient-reported outcome measures as part of pretreatment evaluation of an NIH-funded clinical trial. PS was measured with the 11-point Hospital Consumer Assessment of Healthcare Providers and Systems global rating scale modified to assess for IBS treatments. A series of multiple regression analyses were conducted for demographic, IBS-specific, general physical health, and psychological predictors before running a final model of significant predictors from each domain. RESULTS: The final regression model was significant, F6,419=6.34, P<0.001, R=0.08, with race, insurance, number of diagnostic tests, and lower neuroticism predicting PS. Medical tests were rendered nonsignificant when history of seeking care from a gastroenterologist was introduced into the equation. CONCLUSIONS: Contrary to hypotheses, neither the IBS symptom severity nor quality of life impairment predicted PS. Patient factors such as a neurotic personality style and sociodemographic profile had a significant but modest impact on PS. Pattern of regression analyses suggests that patients may turn to their gastroenterologist for testing for reassurance, which may in the long-term fuel demand for more testing.

23 Article Predictors of medical and mental health care use in patients with irritable bowel syndrome in the United States. 2017

Gudleski, Gregory D / Satchidanand, Nikhil / Dunlap, Laura J / Tahiliani, Varnita / Li, Xiaohua / Keefer, Laurie / Lackner, Jeffrey M / Anonymous2500894. ·Department of Medicine, University at Buffalo School of Medicine, SUNY, Buffalo, NY, United States. · Department of Family Medicine, University at Buffalo, SUNY, Buffalo, NY, United States. · Behavioral Health Economics, RTI International, Research Triangle Park, NC, United States. · Department of Biostatistics, School of Public Health and Health Professions University at Buffalo, Buffalo, NY, United States. · Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States. · Department of Medicine, University at Buffalo School of Medicine, SUNY, Buffalo, NY, United States. Electronic address: lackner@buffalo.edu. ·Behav Res Ther · Pubmed #28110677.

ABSTRACT: Because health care demand among IBS patients imposes a heavy economic burden, identifying high utilizers has potential for improving quality and efficiency of care. Previous research has not identified reliable predictors of utilization of IBS patients. We sought to identify factors predictive of health care utilization among severe IBS patients. 291 IBS patients completed testing whose content mapped onto the Andersen model of health care utilization. 2-stage hurdle models were used to determine predictors of health care use (probability and frequency). Separate analyses were conducted for mental health and medical services. Whether patients used any medical care was predicted by diet and insurance status. Tobacco use, education, and health insurance predicted the probability of using mental health care. The frequency of medical care was associated with alcohol use and physical health status, while frequency of mental health services was associated with marital status, tobacco use, education, distress, stress, and control beliefs over IBS symptoms. For IBS patients, the demand for health care involves a complex decision-making process influenced by many factors. Particularly strong determinants include predisposing characteristics (e.g., dietary pattern, tobacco use) and enabling factors (e.g., insurance coverage) that impede or facilitate demand. Which factors impact use depends on whether the focus is on the decision to use care or how much care is used. Decisions to use medical and mental health care are not simply influenced by symptom-specific factors but by a variety of lifestyle (e.g., dietary pattern, education, smoking) and economic (e.g., insurance coverage) factors.

24 Article Abdominal Pain-Associated Functional Gastrointestinal Disorder Prevalence in Children and Adolescents with Celiac Disease on Gluten-Free Diet: A Multinational Study. 2017

Saps, Miguel / Sansotta, Naire / Bingham, Sean / Magazzu, Giuseppe / Grosso, Caterina / Romano, Simone / Pusatcioglu, Cenk / Guandalini, Stefano. ·Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH. · Department of Pediatrics, University of Verona, Verona, Italy. · Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH. Electronic address: sean.bingham@nationwidechildrens.org. · Pediatric Gastroenterology, University of Messina, Messina, Italy. · Department of Pediatrics, University of Messina, Messina, Italy. · Department of Internal Medicine, University of Verona, Verona, Italy. · Division of Pediatric Gastroenterology Hepatology & Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. · Department of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Chicago Celiac Disease Center, The University of Chicago Medicine, Chicago, IL. ·J Pediatr · Pubmed #27979583.

ABSTRACT: OBJECTIVE: To test the hypothesis that children with celiac disease (CD) on gluten-free diet are at increased risk of abdominal pain (AP) associated-functional gastrointestinal disorders (FGIDs). STUDY DESIGN: This was a multinational cross-sectional study performed from 2014 to 2015. Patients 4-18 years of age with CD on gluten-free diet for longer than 6 months were recruited from pediatric CD clinics in US and Italy. Control groups included siblings of children with CD (with normal tissue transglutaminase levels) and unrelated controls. Subjects or parents completed the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III. RESULTS: Children (n = 289) were recruited (55% US, 45% Italy): 96 children with CD, 96 sibling controls, and 97 unrelated controls. Chronic AP was present in 30 (30.9%) subjects with CD, 22 (22.7%) sibling controls, and 21 (21.6%) unrelated controls (P = .26 patients with CD vs siblings; P = .18 patients with CD vs unrelated; P = .96 siblings vs unrelated). AP-FGIDs were present in 8 (8.2%) subjects with CD, 8 (8.2%) sibling controls, and 2 (2.1%) unrelated controls (P = 1.00 subjects with CD vs sibling controls; P = .06 subjects with CD vs unrelated controls; P = .06 sibling controls vs unrelated controls). CONCLUSION: This multinational study evaluated the prevalence of chronic abdominal pain and AP-FGIDs in the pediatric population with CD. We found that subjects with CD and controls have a similar prevalence of chronic AP and AP-FGIDs. This suggests that not all types of gastrointestinal inflammation result in AP-FGIDs in children.

25 Article Gastrointestinal symptoms predictors of health-related quality of life in pediatric patients with functional gastrointestinal disorders. 2017

Varni, James W / Shulman, Robert J / Self, Mariella M / Nurko, Samuel / Saps, Miguel / Saeed, Shehzad A / Patel, Ashish S / Dark, Chelsea Vaughan / Bendo, Cristiane B / Pohl, John F / Anonymous16570884. ·Professor Emeritus, Department of Pediatrics, College of Medicine, Texas A&M University, 3137 TAMU, College Station, TX, 77843-3137, USA. jvarni@tamu.edu. · Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, TX, USA. jvarni@tamu.edu. · Department of Pediatrics, Baylor College of Medicine, Children's Nutrition Research Center, Texas Children's Hospital, Houston, TX, USA. · Departments of Psychiatry and Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA. · Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. · Division of Gastroenterology, Hepatology and Nutrition, Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. · Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. · Division of Pediatric Gastroenterology, Children's Medical Center of Dallas, University of Texas Southwestern Medical School, Dallas, TX, USA. · Department of Psychology, Texas A&M University, College Station, TX, USA. · Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil. · Department of Pediatric Gastroenterology, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA. ·Qual Life Res · Pubmed #27743332.

ABSTRACT: OBJECTIVES: To investigate the patient-reported multidimensional gastrointestinal symptoms predictors of generic health-related quality of life (HRQOL) in pediatric patients with functional gastrointestinal disorders (FGIDs). METHODS: The Pediatric Quality of Life Inventory™ (PedsQL™) Gastrointestinal Symptoms Scales and PedsQL™ 4.0 Generic Core Scales were completed in a 9-site study by 259 pediatric patients with functional constipation, functional abdominal pain (FAP), or irritable bowel syndrome (IBS). Gastrointestinal Symptoms Scales measuring stomach pain, stomach discomfort when eating, food and drink limits, trouble swallowing, heartburn and reflux, nausea and vomiting, gas and bloating, constipation, blood in poop, and diarrhea were identified as clinically important symptom differentiators from healthy controls based on prior findings, and subsequently tested for bivariate and multivariate linear associations with overall HRQOL. RESULTS: Gastrointestinal symptoms were differentially associated with decreased HRQOL in bivariate analyses for the three FGIDs. In predictive models utilizing hierarchical multiple regression analyses controlling for age, gender, and race/ethnicity, gastrointestinal symptoms differentially accounted for an additional 47, 40, and 60 % of the variance in patient-reported HRQOL for functional constipation, FAP, and IBS, respectively, reflecting large effect sizes. Significant individual gastrointestinal symptoms predictors were identified after controlling for the other gastrointestinal symptoms in the FGID-specific predictive models. CONCLUSIONS: Gastrointestinal symptoms represent potentially modifiable predictors of generic HRQOL in pediatric patients with FGIDs. Identifying the condition-specific gastrointestinal symptoms that are the most important predictors from the patient perspective facilitates a patient-centered approach to targeted interventions designed to ameliorate impaired overall HRQOL.

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