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Irritable Bowel Syndrome: HELP
Articles from Los Angeles area
Based on 170 articles published since 2008
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These are the 170 published articles about Irritable Bowel Syndrome that originated from Los Angeles area during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7
1 Editorial Small Intestinal Bacterial Overgrowth and Coronary Artery Disease: What Is in the CArDs? 2018

Adkins, Christopher / Rezaie, Ali. ·GI Motility Program, Division of Gastroenterology, Department of Medicine, Cedars-Sinai, 8730 Alden Drive, Thalians Bldg, #E226, Los Angeles, CA, 90048, USA. · GI Motility Program, Division of Gastroenterology, Department of Medicine, Cedars-Sinai, 8730 Alden Drive, Thalians Bldg, #E226, Los Angeles, CA, 90048, USA. ali.rezaie@cshs.org. ·Dig Dis Sci · Pubmed #29307000.

ABSTRACT: -- No abstract --

2 Editorial A definitive blood test for post-infectious irritable bowel syndrome? 2016

Barlow, Gillian M / Rezaie, Ali / Lin, Eugenia / Pimentel, Mark. ·a GI Motility Program , Cedars-Sinai Medical Center , Los Angeles , CA , USA. ·Expert Rev Gastroenterol Hepatol · Pubmed #27682513.

ABSTRACT: -- No abstract --

3 Review Colonic immune cells in irritable bowel syndrome: A systematic review and meta-analysis. 2018

Bashashati, M / Moossavi, S / Cremon, C / Barbaro, M R / Moraveji, S / Talmon, G / Rezaei, N / Hughes, P A / Bian, Z X / Choi, C H / Lee, O Y / Coëffier, M / Chang, L / Ohman, L / Schmulson, M J / McCallum, R W / Simren, M / Sharkey, K A / Barbara, G. ·Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, TX, USA. · Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran. · Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada. · Department of Medical and Surgical Sciences, Centre for Applied Biomedical Research, University of Bologna, Bologna, Italy. · Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA. · Fred and Pamela Buffet Cancer Center, Omaha, NE, USA. · Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. · Centre for Nutritional and Gastrointestinal Diseases, Department of Medicine, University of Adelaide and South Australian Health Medical Health Research Institute, Adelaide, SA, Australia. · School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China. · Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea. · Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea. · Normandie Univ, INSERM unit 1073 "Nutrition, inflammation and brain-gut axis", Institute for Research and Innovation in Biomedicine, Rouen Medical University and Rouen University Hospital, Rouen, France. · G Oppenheimer Center of Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. · Departments of Internal Medicine and Clinical Nutrition and Microbiology and Immunology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. · Laboratorio de Hígado, Páncreas y Motilidad (HIPAM), Unidad de Investigación en Medicina Experimental, Facultad de Medicina-Universidad Nacional Autónoma de México (UNAM), Hospital General de México, Mexico City, Mexico. · Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. · Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC, USA. · Hotchkiss Brain Institute and Snyder Institute for Chronic Diseases, Department of Physiology and Pharmacology, University of Calgary, Calgary, AB, Canada. ·Neurogastroenterol Motil · Pubmed #28851005.

ABSTRACT: BACKGROUND & AIMS: Increases in mucosal immune cells have frequently been observed in irritable bowel syndrome (IBS) patients. However, this finding is not completely consistent between studies, possibly due to a combination of methodological variability, population differences and small sample sizes. We performed a meta-analysis of case-control studies that compared immune cell counts in colonic biopsies of IBS patients and controls. METHODS: PubMed and Embase were searched in February 2017. Results were pooled using standardized mean difference (SMD) and were considered significant when zero was not within the 95% confidence interval (CI). Heterogeneity was assessed based on I KEY RESULTS: Twenty-two studies on 706 IBS patients and 401 controls were included. Mast cells were increased in the rectosigmoid (SMD: 0.38 [95% CI: 0.06-0.71]; P = .02) and descending colon (SMD: 1.69 [95% CI: 0.65-2.73]; P = .001) of IBS patients. Increased mast cells were observed in both constipation (IBS-C) and diarrhea predominant IBS (IBS-D). CD3 CONCLUSIONS & INFERENCES: Mast cells and CD3

4 Review Sex-Related Differences in GI Disorders. 2017

Prusator, Dawn K / Chang, Lin. ·Oklahoma Center for Neuroscience, University of Oklahoma Health Science Center, Oklahoma City, OK, USA. · G. Oppenheimer Center for Neurobiology of Stress and Resilience, 10833 Le Conte Avenue, CHS 42-210, Los Angeles, CA, 90095-7378, USA. LinChang@mednet.ucla.edu. ·Handb Exp Pharmacol · Pubmed #28233176.

ABSTRACT: Epidemiological studies indicate sex-related differences among functional gastrointestinal disorders (FGIDs) wherein females are more likely to receive a diagnosis than their male counterparts. However, the mechanism by which females exhibit an increased vulnerability for development of these pathophysiologies remains largely unknown, and therapeutic treatments are limited. The current chapter focuses on clinical research outlining our current knowledge of factors that contribute to the female predominance among FGID patients such as the menstrual cycle and sex hormones. In addition, we will discuss progress in preclinical research, including animal models, which serve as valuable tools for the investigation of the development and long term manifestation of symptoms observed within the patient population. Although much progress has been made, additional longitudinal studies in both clinical and preclinical research are necessary to identify more specific mechanisms underlying sex-related differences in FGIDs as well as targets for improved therapeutic approaches.

5 Review Irritable bowel syndrome. 2016

Enck, Paul / Aziz, Qasim / Barbara, Giovanni / Farmer, Adam D / Fukudo, Shin / Mayer, Emeran A / Niesler, Beate / Quigley, Eamonn M M / Rajilić-Stojanović, Mirjana / Schemann, Michael / Schwille-Kiuntke, Juliane / Simren, Magnus / Zipfel, Stephan / Spiller, Robin C. ·Department of Internal Medicine VI (Psychosomatic Medicine and Psychotherapy), University Hospital Tübingen, Tübingen, Germany. · Wingate Institute of Neurogastroenterology, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK. · Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, Bologna, Italy. · Department of Behavioural Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. · Oppenheimer Center for Neurobiology of Stress, Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. · Department of Human Molecular Genetics, University of Heidelberg, Heidelberg, Germany. · Lynda K and David M Underwood Center for Digestive Disorders, Division of Gastroenterology and Hepatology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, Texas, USA. · Department of Biochemical Engineering and Biotechnology, Faculty of Technology and Metallurgy, University of Belgrade, Belgrade, Serbia. · Department of Human Biology, Technical University Munich, Freising-Weihenstephan, Germany. · Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. · NIHR Nottingham Digestive Diseases Biomedical Research Unit, University of Nottingham, Nottingham, UK. ·Nat Rev Dis Primers · Pubmed #27159638.

ABSTRACT: Irritable bowel syndrome (IBS) is a functional gastrointestinal disease with a high population prevalence. The disorder can be debilitating in some patients, whereas others may have mild or moderate symptoms. The most important single risk factors are female sex, younger age and preceding gastrointestinal infections. Clinical symptoms of IBS include abdominal pain or discomfort, stool irregularities and bloating, as well as other somatic, visceral and psychiatric comorbidities. Currently, the diagnosis of IBS is based on symptoms and the exclusion of other organic diseases, and therapy includes drug treatment of the predominant symptoms, nutrition and psychotherapy. Although the underlying pathogenesis is far from understood, aetiological factors include increased epithelial hyperpermeability, dysbiosis, inflammation, visceral hypersensitivity, epigenetics and genetics, and altered brain-gut interactions. IBS considerably affects quality of life and imposes a profound burden on patients, physicians and the health-care system. The past decade has seen remarkable progress in our understanding of functional bowel disorders such as IBS that will be summarized in this Primer.

6 Review Review article: potential mechanisms of action of rifaximin in the management of irritable bowel syndrome with diarrhoea. 2016

Pimentel, M. ·GI Motility Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA. ·Aliment Pharmacol Ther · Pubmed #26618924.

ABSTRACT: BACKGROUND: The role of gut microbiota in the pathophysiology of irritable bowel syndrome (IBS) is supported by various lines of evidence, including differences in mucosal and faecal microbiota between patients with IBS and healthy individuals, development of post-infectious IBS, and the efficacy of some probiotics and nonsystemic antibiotics (e.g. rifaximin). AIM: To review the literature regarding the role of rifaximin in IBS and its potential mechanism(s) of action. METHODS: A literature search was conducted using the terms 'rifaximin', 'irritable bowel syndrome' and 'mechanism of action'. RESULTS: Rifaximin was approved in 2015 for the treatment of IBS with diarrhoea. In contrast to other currently available IBS therapies that require daily administration to maintain efficacy, 2-week rifaximin treatment achieved symptom improvement that persisted ≥12 weeks post-treatment. The mechanisms of action of rifaximin, therefore, may extend beyond direct bactericidal effects. Data suggest that rifaximin may decrease host proinflammatory responses to bacterial products in patients with IBS. In some cases, small intestinal bacterial overgrowth (SIBO) may play a role in the clinical symptoms of IBS. Because of the high level of solubility of rifaximin in the small intestine, rifaximin may reset microbial diversity in this environment. Consistent with this hypothesis, rifaximin has antibiotic efficacy against isolates derived from patients with SIBO. CONCLUSION: Resetting microbial diversity via rifaximin use may lead to a decrease in bacterial fermentation and a reduction in the clinical symptoms of IBS.

7 Review Review article: inhibition of methanogenic archaea by statins as a targeted management strategy for constipation and related disorders. 2016

Gottlieb, K / Wacher, V / Sliman, J / Pimentel, M. ·Synthetic Biologics, Inc., Rockville, MD, USA. · Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. ·Aliment Pharmacol Ther · Pubmed #26559904.

ABSTRACT: BACKGROUND: Observational studies show a strong association between delayed intestinal transit and the production of methane. Experimental data suggest a direct inhibitory activity of methane on the colonic and ileal smooth muscle and a possible role for methane as a gasotransmitter. Archaea are the only confirmed biological sources of methane in nature and Methanobrevibacter smithii is the predominant methanogen in the human intestine. AIM: To review the biosynthesis and composition of archaeal cell membranes, archaeal methanogenesis and the mechanism of action of statins in this context. METHODS: Narrative review of the literature. RESULTS: Statins can inhibit archaeal cell membrane biosynthesis without affecting bacterial numbers as demonstrated in livestock and humans. This opens the possibility of a therapeutic intervention that targets a specific aetiological factor of constipation while protecting the intestinal microbiome. While it is generally believed that statins inhibit methane production via their effect on cell membrane biosynthesis, mediated by inhibition of the HMG-CoA reductase, there is accumulating evidence for an alternative or additional mechanism of action where statins inhibit methanogenesis directly. It appears that this other mechanism may predominate when the lactone form of statins, particularly lovastatin lactone, is administered. CONCLUSIONS: Clinical development appears promising. A phase 2 clinical trial is currently in progress that evaluates the effect of lovastatin lactone on methanogenesis and symptoms in patients with irritable bowel syndrome with constipation. The review concludes with an outlook for the future and subsequent work that needs to be done.

8 Review Towards a systems view of IBS. 2015

Mayer, Emeran A / Labus, Jennifer S / Tillisch, Kirsten / Cole, Steven W / Baldi, Pierre. ·Department of Medicine, University of California at Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095-7378, USA. · Department of Medicine, University of California at Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095-7378, USA and West Los Angeles VA Medical Center, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA. · Institute for Genomics and Bioinformatics, University of California at Irvine, 4038 Bren Hall, Irvine, CA 92697-3435, USA. ·Nat Rev Gastroenterol Hepatol · Pubmed #26303675.

ABSTRACT: Despite an extensive body of reported information about peripheral and central mechanisms involved in the pathophysiology of IBS symptoms, no comprehensive disease model has emerged that would guide the development of novel, effective therapies. In this Review, we will first describe novel insights into some key components of brain-gut interactions, starting with the emerging findings of distinct functional and structural brain signatures of IBS. We will then point out emerging correlations between these brain networks and genomic, gastrointestinal, immune and gut-microbiome-related parameters. We will incorporate this new information, as well as the reported extensive literature on various peripheral mechanisms, into a systems-based disease model of IBS, and discuss the implications of such a model for improved understanding of the disorder, and for the development of more-effective treatment approaches in the future.

9 Review American Gastroenterological Association Institute Technical Review on the pharmacological management of irritable bowel syndrome. 2014

Chang, Lin / Lembo, Anthony / Sultan, Shahnaz. ·Division of Digestive Diseases, David Geffen School of Medicine University of California, Los Angeles, Los Angeles, California. · Harvard Medical School, Beth Israel Deaconess, Boston, Massachusetts. · Department of Veterans Affairs Medical Center, Gastroenterology Section, North Florida/South Georgia Veterans Health System, Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida; Minneapolis Veterans Affairs Health System, University of Minnesota, Minneapolis, Minnesota. ·Gastroenterology · Pubmed #25224525.

ABSTRACT: -- No abstract --

10 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 / Anonymous3660802. ·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 --

11 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.

12 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.

13 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.

14 Review Evaluating the functional net value of pharmacologic agents in treating irritable bowel syndrome. 2014

Shah, E / Pimentel, M. ·GI Motility Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA. ·Aliment Pharmacol Ther · Pubmed #24612075.

ABSTRACT: BACKGROUND: The recent FDA provisional endpoint incorporates a one-tailed measure of improvement for IBS based on the underlying motility complaint. However, motility exists along a spectrum. Patients may experience diarrhoea resulting from therapy for their constipation-predominant IBS (IBS-C) or constipation during treatment for diarrhoea-predominant IBS (IBS-D), but still meet a unidirectional motility-based FDA endpoint. AIM: To weigh the reported efficacy of existing therapies based on patient-reported outcomes with negative intestinal side effects in controlled clinical trial data. METHODS: We analysed the difference between 'attributable risk' of efficacy based on number needed to treat (NNT) in the literature and percentage of adverse events (AE) of opposite intestinal complaints in placebo-controlled trials identified through a literature search of IBS trials. This calculation was coined 'functional net value' (FNV) or net benefit of the given drug. RESULTS: For treating IBS-C, lubiprostone caused diarrhoea in excess of placebo in 3.9% of patients, leading to a FNV of 3.9 percentage units. Linaclotide caused diarrhoea in 15.3% resulting in negative FNV (-1.0 percentage unit). For IBS-D, alosetron and tricyclic anti-depressants caused constipation among a respective 16.9% and 13.0% resulting in a FNV of -3.6 and -0.5 percentage units. Among all therapies, only rifaximin did not cause the adverse event opposite the underlying motility complaint and the drug only had benefit, not detriment. CONCLUSIONS: Functional net value (FNV) offers a method of evaluating the net benefit of a drug in IBS. Most IBS treatments have a negative effect on IBS that exceeds the benefits.

15 Review The bile acid TGR5 membrane receptor: from basic research to clinical application. 2014

Duboc, Henri / Taché, Yvette / Hofmann, Alan F. ·Department of Medicine, CURE/Digestive Diseases Center and Center for Neurobiology of Stress, Digestive Diseases Division, University of California at Los Angeles, Los Angeles, CA, USA; Veterans Affairs Greater Los Angeles Healthcare System, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; University Paris Diderot, Sorbonne Paris Cité, AP-HP, Louis Mourier Hospital, Department of Gastroenterology and Hepatology, Paris, France; University Pierre and Marie Curie, ERL INSERM U 1057/UMR 7203, AP-HP, Saint-Antoine Hospital, Paris, France. Electronic address: henri.duboc@gmail.com. · Department of Medicine, CURE/Digestive Diseases Center and Center for Neurobiology of Stress, Digestive Diseases Division, University of California at Los Angeles, Los Angeles, CA, USA; Veterans Affairs Greater Los Angeles Healthcare System, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. · Division of Gastroenterology, Department of Medicine, University of California, San Diego, USA. Electronic address: AFHofmann@gmail.com. ·Dig Liver Dis · Pubmed #24411485.

ABSTRACT: The TGR5 receptor (or GP-BAR1, or M-BAR) was characterized ten years ago as the first identified G-coupled protein receptor specific for bile acids. TGR5 gene expression is widely distributed, including endocrine glands, adipocytes, muscles, immune organs, spinal cord, and the enteric nervous system. The effect of TGR5 activation depends on the tissue where it is expressed and the signalling cascade that it induces. Animal studies suggest that TGR5 activation influences energy production and thereby may be involved in obesity and diabetes. TGR5 activation also influences intestinal motility. This review provides an overview of TGR5-bile acid interactions in health as well as the possible involvement of TGR5 in human disease.

16 Review Mindfulness-based therapies in the treatment of somatization disorders: a systematic review and meta-analysis. 2013

Lakhan, Shaheen E / Schofield, Kerry L. ·Global Neuroscience Initiative Foundation, Los Angeles, California, United States of America. ·PLoS One · Pubmed #23990997.

ABSTRACT: BACKGROUND: Mindfulness-based therapy (MBT) has been used effectively to treat a variety of physical and psychological disorders, including depression, anxiety, and chronic pain. Recently, several lines of research have explored the potential for mindfulness-therapy in treating somatization disorders, including fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome. METHODS: Thirteen studies were identified as fulfilling the present criteria of employing randomized controlled trials to determine the efficacy of any form of MBT in treating somatization disorders. A meta-analysis of the effects of mindfulness-based therapy on pain, symptom severity, quality of life, depression, and anxiety was performed to determine the potential of this form of treatment. FINDINGS: While limited in power, the meta-analysis indicated a small to moderate positive effect of MBT (compared to wait-list or support group controls) in reducing pain (SMD = -0.21, 95% CI: -0.37, -0.03; p<0.05), symptom severity (SMD = -0.40, 95% CI: -0.54, -0.26; p<0.001), depression (SMD = -0.23, 95% CI: -0.40, -0.07, p<0.01), and anxiety (SMD = -0.20, 95% CI: -0.42, 0.02, p = 0.07) associated with somatization disorders, and improving quality of life (SMD = 0.39, 95% CI: 0.19, 0.59; p<0.001) in patients with this disorder. Subgroup analyses indicated that the efficacy of MBT was most consistent for irritable bowel syndrome (p<0.001 for pain, symptom severity, and quality of life), and that mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MCBT) were more effective than eclectic/unspecified MBT. CONCLUSIONS: Preliminary evidence suggests that MBT may be effective in treating at least some aspects of somatization disorders. Further research is warranted.

17 Review Impaired emotional learning and involvement of the corticotropin-releasing factor signaling system in patients with irritable bowel syndrome. 2013

Labus, Jennifer S / Hubbard, Catherine S / Bueller, Joshua / Ebrat, Bahar / Tillisch, Kirsten / Chen, Michelle / Stains, Jean / Dukes, George E / Kelleher, Dennis L / Naliboff, Bruce D / Fanselow, Michael / Mayer, Emeran A. ·Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, University of California, Los Angeles, Los Angeles, California; Department of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Psychiatry, University of California, Los Angeles, Los Angeles, California. ·Gastroenterology · Pubmed #23954313.

ABSTRACT: BACKGROUND & AIMS: Alterations in central corticotropin-releasing factor signaling pathways have been implicated in the pathophysiology of anxiety disorders and irritable bowel syndrome (IBS). We aimed to characterize the effects of the corticotropin-releasing factor receptor 1 (CRF-R1) antagonist, GW876008, on brain and skin conductance responses during acquisition and extinction of conditioned fear to the threat of abdominal pain in subjects with IBS and healthy individuals (controls). METHODS: We performed a single-center, randomized, double-blind, 3-period crossover study of 11 women with IBS (35.50 ± 12.48 years old) and 15 healthy women (controls) given a single oral dose (20 mg or 200 mg) of the CRF-R1 antagonist or placebo. Blood-oxygen level-dependent responses were analyzed using functional magnetic resonance imaging in a tertiary care setting. RESULTS: Controls had greater skin conductance responses during acquisition than extinction, validating the fear-conditioning paradigm. In contrast, during extinction, women with IBS had greater skin conductance responses than controls-an effect normalized by administration of a CRF-R1 antagonist. Although the antagonist significantly reduced activity in the thalamus in patients with IBS and controls during acquisition, the drug produced greater suppression of blood-oxygen level-dependent activity in a wide range of brain regions in IBS patients during extinction, including the medial prefrontal cortex, pons, hippocampus, and anterior insula. CONCLUSIONS: Although CRF signaling via CRF-R1 is involved in fear acquisition and extinction learning related to expected abdominal pain in patients with IBS and controls, this system appears to be up-regulated in patients with IBS. This up-regulation might contribute to the previously reported abnormal brain responses to expected abdominal pain.

18 Review Antibiotics for irritable bowel syndrome: rationale and current evidence. 2012

Sachdev, Amit H / Pimentel, Mark. ·GI Motility Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. ·Curr Gastroenterol Rep · Pubmed #22945316.

ABSTRACT: Irritable bowel syndrome (IBS) is the most common gastrointestinal condition effecting adults in developed countries worldwide. Over the last decade, evidence has emerged suggesting that gut bacteria play a role in the pathophysiology of IBS. While difficult to identify using noninvasive means, one of the most common attributable bacterial concepts in IBS is the small intestinal bacterial overgrowth hypothesis (SIBO). In this article, we review the different mechanisms by which gut flora and, specifically, SIBO may contribute to IBS and the evidence supporting the use of various antibiotic therapies in treating IBS.

19 Review Overlap between functional GI disorders and other functional syndromes: what are the underlying mechanisms? 2012

Kim, S E / Chang, L. ·Oppenheimer Family Center of Neurobiology of Stress, Los Angeles, CA, USA. ·Neurogastroenterol Motil · Pubmed #22863120.

ABSTRACT: BACKGROUND: Irritable bowel syndrome and other gastrointestinal (GI) and non-GI disorders such as functional dyspepsia, fibromyalgia, temporomandibular joint disorder, interstitial cystitis/painful bladder syndrome, and chronic fatigue syndrome are known as functional pain syndromes. They commonly coexist within the same individual. The pathophysiologic mechanisms of these disorders are not well understood, but it has been hypothesized that they share a common pathogenesis. PURPOSE: The objective of this review is to discuss the proposed pathophysiologic mechanisms, which have been similarly studied in these conditions. These mechanisms include enhanced pain perception, altered regional brain activation, infectious etiologies, dysregulations in immune and neuroendocrine function, and genetic susceptibility. Studies suggest that these functional disorders are multifactorial, but factors which increase the vulnerability of developing these conditions are shared.

20 Review Systematic review of diagnostic criteria for IBS demonstrates poor validity and utilization of Rome III. 2012

Dang, J / Ardila-Hani, A / Amichai, M M / Chua, K / Pimentel, M. ·GI Motility Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA. ·Neurogastroenterol Motil · Pubmed #22632582.

ABSTRACT: BACKGROUND: In the absence of a clear biomarker for irritable bowel syndrome (IBS), clinical criteria are used. In this study, we conduct a systematic review to examine the validation and utilization of IBS criteria. METHODS: A systematic review was performed in two stages. The first was a review of literature from 1978 validating IBS diagnostic criteria. The second stage of review was to select studies published in IBS between 1992 and 2011. This time period was divided into three segments (Rome I era from 1992 to 1999, Rome II era from 2000 to 2006, and Rome III era from 2007 to 2011). The number and type of study (RCT or other) and criteria used were evaluated for each era. KEY RESULTS: The first stage of the systematic review identified only 14 published studies validating diagnostic tests for IBS (with three studies evaluating more than one criterion). There were eight validations for Manning, three validations for Kruis, four validations for Rome I, three validations for Rome II, and no validation for Rome III. In the second review of utilization of Rome criteria, only 25.7% of published IBS papers used Rome III criteria during the Rome III era (Rome II was used most in 64.8% of studies). CONCLUSIONS & INFERENCES: This review identified that comparator groups varied widely between studies making comparison of criteria impossible. Manning criteria are the most valid and accurate criteria. More importantly, Rome III is not validated and is poorly adopted in clinical research trial enrollment.

21 Review Celiac disease, wheat allergy, and gluten sensitivity: when gluten free is not a fad. 2012

Pietzak, Michelle. ·University of Southern California Keck School of Medicine, Los Angeles, California 90033, USA. pietzak@usc.edu ·JPEN J Parenter Enteral Nutr · Pubmed #22237879.

ABSTRACT: As the gluten-free diet (GFD) gains in popularity with the general public, health practitioners are beginning to question its real health benefits. For those patients with celiac disease (CD), the GFD is considered medical nutrition therapy, as well as the only proven treatment that results in improvements in symptomatology and small bowel histology. Those with wheat allergy also benefit from the GFD, although these patients often do not need to restrict rye, barley, and oats from their diet. Gluten sensitivity is a controversial subject, where patients who have neither CD nor wheat allergy have varying degrees of symptomatic improvement on the GFD. Conditions in this category include dermatitis herpetiformis (DH), irritable bowel syndrome (IBS), and neurologic diseases such as gluten-sensitive ataxia and autism. It is important for patients and healthcare practitioners to understand the differences between these conditions, even though they may all respond to a GFD. Patients with CD can experience comorbid nutrition deficiencies and are at higher risk for the development of cancers and other autoimmune conditions. Those with wheat allergy and gluten sensitivity are thought not to be at higher risk for these complications. Defining the symptoms and biochemical markers for gluten-sensitive conditions is an important area for future investigations, and high-quality, large-scale randomized trials are needed to prove the true benefits of the GFD in this evolving field.

22 Review Stress and visceral pain: from animal models to clinical therapies. 2012

Larauche, Muriel / Mulak, Agata / Taché, Yvette. ·CURE/Digestive Diseases Research Center, Digestive Diseases Division, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA 90073, USA. mlarauche@mednet.ucla.edu ·Exp Neurol · Pubmed #21575632.

ABSTRACT: Epidemiological studies have implicated stress (psychosocial and physical) as a trigger of first onset or exacerbation of irritable bowel syndrome (IBS) symptoms of which visceral pain is an integrant landmark. A number of experimental acute or chronic exteroceptive or interoceptive stressors induce visceral hyperalgesia in rodents although recent evidence also points to stress-related visceral analgesia as established in the somatic pain field. Underlying mechanisms of stress-related visceral hypersensitivity may involve a combination of sensitization of primary afferents, central sensitization in response to input from the viscera and dysregulation of descending pathways that modulate spinal nociceptive transmission or analgesic response. Biochemical coding of stress involves the recruitment of corticotropin releasing factor (CRF) signaling pathways. Experimental studies established that activation of brain and peripheral CRF receptor subtype 1 plays a primary role in the development of stress-related delayed visceral hyperalgesia while subtype 2 activation induces analgesic response. In line with stress pathways playing a role in IBS, non-pharmacologic and pharmacologic treatment modalities aimed at reducing stress perception using a broad range of evidence-based mind-body interventions and centrally-targeted medications to reduce anxiety impact on brain patterns activated by visceral stimuli and dampen visceral pain.

23 Review Questioning the bacterial overgrowth hypothesis of irritable bowel syndrome: an epidemiologic and evolutionary perspective. 2011

Spiegel, Brennan M R. ·Department of Gastroenterology, VA Greater Los Angeles Healthcare System, California, USA. bspiegel@mednet.ucla.edu ·Clin Gastroenterol Hepatol · Pubmed #21397724.

ABSTRACT: Although studies indicate that small intestinal bacterial overgrowth (SIBO) is prevalent in irritable bowel syndrome (IBS), it remains unclear whether SIBO causes IBS. This review presents an epidemiologic and evolutionary inquiry that questions the bacterial overgrowth hypothesis of IBS, as follows. (1) Although the hypothesis may be biologically plausible, there is also a strong rationale for competing hypotheses; it is unlikely that SIBO is the predominant cause of IBS in all comers, because competing explanations are sensible and defensible. Moreover, data indicate that the test used to promulgate the SIBO hypothesis - the lactulose hydrogen breath test - may not have measured SIBO in the first place. (2) We do not have evidence of SIBO being absent before IBS symptoms, and present after IBS emerges. (3) There is not a dose-response relationship between small intestinal microbiota and IBS symptoms. (4) The relationship between SIBO and IBS is highly inconsistent among studies. (5) Many effective IBS therapies do not address SIBO at all, yet have a more favorable "number needed to treat" than antibiotics. (6) IBS does not behave like a traditional infectious disease, suggesting that microbes may not principally cause the syndrome. (7) Other factors may confound the relationship between SIBO and IBS, including proton pump inhibitors. (8) Whereas the brain-gut hypothesis is evolutionary sensible, the bacterial hypothesis is harder to defend from an evolutionary perspective. The article concludes that bacteria may contribute to some IBS symptoms, but that bacteria cannot be the only explanation, and a causal link between SIBO and IBS is not secure.

24 Review Inflammation and microflora. 2011

Pimentel, Mark / Chang, Christopher. ·GI Motility Program, Cedars-Sinai Medical Center, 8730 Alden Drive, Suite 225E, Los Angeles, CA 90048, USA. pimentelm@cshs.org ·Gastroenterol Clin North Am · Pubmed #21333901.

ABSTRACT: Irritable bowel syndrome (IBS) is the most common gastrointestinal condition, affecting 10% to 20% of adults in developed countries. Over the last few years, growing evidence has supported a new hypothesis for IBS based on alterations in intestinal bacterial composition. This article reviews the evidence for a bacterial concept in IBS and begins to formulate a hypothesis of how these bacterial systems could integrate in a new pathophysiologic mechanism in the development of IBS. Data suggesting an interaction between this gut flora and inflammation in the context of IBS is also presented.

25 Review The effect of irritable bowel syndrome on health-related quality of life and health care expenditures. 2011

Agarwal, Nikhil / Spiegel, Brennan M R. ·Department of Gastroenterology, Veterans Affairs Greater Los Angeles Healthcare System, David Geffen School of Medicine at University of California Los Angeles, 11301 Wilshire Boulevard, Building 115, Room 215, Los Angeles, CA 90073, USA. ·Gastroenterol Clin North Am · Pubmed #21333898.

ABSTRACT: Irritable bowel syndrome (IBS) is a highly prevalent condition with a large health economic burden of illness marked by impaired health-related quality of life (HRQOL), diminished work productivity, and high expenditures. Clinicians should routinely screen for diminished HRQOL by performing a balanced biopsychosocial history rather than focusing just on bowel symptoms. HRQOL decrements should be acknowledged and addressed when making treatment decisions.

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