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Irritable Bowel Syndrome: HELP
Articles from Manchester, UK
Based on 79 articles published since 2009
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These are the 79 published articles about Irritable Bowel Syndrome that originated from Manchester, UK during 2009-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Editorial Editorial: understanding differences in patient response to ondansetron in irritable bowel syndrome with diarrhoea-are we any closer? Authors' reply. 2019

Gunn, David / Garsed, Klara / Lam, Ching / Singh, Gulzar / Lingaya, Melanie / Wahl, Verena / Niesler, Beate / Henry, Amanda / Hall, Ian / Whorwell, Peter / Spiller, Robin. ·Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK. · Derby Teaching Hospitals NHS Foundation Trust, Nottingham, UK. · Northern General Hospital, Sheffield, UK. · The NIHR Nottingham Biomedical Research Centre at Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK. · NIHR Nottingham Biomedical Research Centre, Nottingham, UK. · Human Molecular Genetics, University of Heidelberg, Heidelberg, Germany. · Department of Therapeutics and Molecular Medicine, University of Nottingham, Nottingham, UK. · Gastroenterology, Wythenshawe Hospital, Wythenshawe, UK. · Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK. ·Aliment Pharmacol Ther · Pubmed #31532555.

ABSTRACT: -- No abstract --

2 Editorial Editorial: preventing unnecessary investigation and surgery in the irritable bowel syndrome-the critical role of the general practitioner. 2018

Whorwell, P J. ·Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK. ·Aliment Pharmacol Ther · Pubmed #29878437.

ABSTRACT: -- No abstract --

3 Review Review article: the incidence and risk factors for irritable bowel syndrome in population-based studies. 2019

Creed, Francis. ·Neuroscience and Mental Health, University of Manchester, Manchester, UK. ·Aliment Pharmacol Ther · Pubmed #31313850.

ABSTRACT: BACKGROUND: In the absence of prior gastrointestinal infection, the risk factors for irritable bowel syndrome (IBS) are not well established. AIM: To identify the incidence and risk factors for IBS in general population samples METHODS: Narrative review of population-based studies. Electronic databases were searched using the keywords "incidence," "onset," "epidemiology," "population," "risk factors" with "irritable bowel syndrome" with subsequent hand searching. Inclusion criteria were: population-based, adults, prospective design (including retrospective case cohorts), clinical or research diagnosis of IBS and exclusion of individuals who had IBS prior to recruitment. RESULTS: Of 1963 papers, 38 were included; all provided data on risk factors, 27 reported incidence. The median incidence of physician-diagnosed IBS in 19 general population cohorts was 38.5 per 10 000 person-years (interquartile range = 20-45.3). In 14 cohorts with specific medical disorders, median incidence was 92 per 10 000 person-years (IQR: 73.9-119). Apart from gastroenteritis, the most common risk factors were other medical disorders, female sex, age (both young and old), anxiety and depression, life events/stress, frequent healthcare use, pain and sleep disorders. The results were conflicting for alcohol consumption, smoking and BMI. Incidence rates were similar in different countries but risk factors differed. CONCLUSIONS: Incidence rates were generally lower than previous estimates reflecting physician-diagnosed IBS. The results highlight the importance of other medical and psychosocial problems in the onset of IBS in addition to prior gastrointestinal infections. Aetiological research could be enhanced by studying the underlying mechanisms relating to all of these risk factors.

4 Review Targeting mu opioid receptors to modulate gastrointestinal function: what have we learnt so far from the studies in functional bowel disorders? 2019

Corsetti, Maura / Pannemans, Jasper / Whorwell, Peter. ·NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK. · Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK. · Catholic University of Leuven, KU Leuven, Translational Research Center for Gastrointestinal Disorders (TARGID), Leuven, Belgium. · Centre for Gastrointestinal Sciences, University of Manchester, Manchester, UK. ·F1000Res · Pubmed #30863534.

ABSTRACT: Opioids have recently received much attention because of the epidemic in their use in some countries such as the USA and the UK. Concerns have been raised about the possibility that they can increase mortality in patients when used on a long-term basis. Moreover, they are known to induce paradoxical hyperalgesia as well as alterations of gut function. The analgesic properties of opioids are mediated by receptors located in the brain, but as opioid receptors are also expressed in the gastrointestinal tract, new drugs acting on these receptors have recently been developed to treat two functional disorders, namely irritable bowel syndrome with diarrhoea and opioid-induced constipation. The aim of this article is to highlight some interesting observations resulting from the development of these drugs in the field of functional gastrointestinal disorders.

5 Review Gut-focused hypnotherapy for Functional Gastrointestinal Disorders: Evidence-base, practical aspects, and the Manchester Protocol. 2019

Vasant, Dipesh H / Whorwell, Peter J. ·Neurogastroenterology Unit, Gastroenterology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK. · Division of Diabetes, Endocrinology & Gastroenterology, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK. ·Neurogastroenterol Motil · Pubmed #30815936.

ABSTRACT: BACKGROUND: Despite their high prevalence and advances in the field of neurogastroenterology, there remain few effective treatment options for functional gastrointestinal disorders (FGIDs). It is recognized that approximately 25% of sufferers will have symptoms refractory to existing therapies, causing significant adverse effects on quality of life and increased healthcare utilization and morbidity. Gut-focused hypnotherapy, when delivered by trained therapists, has been shown to be highly effective in severe refractory FGIDs. However, hypnotherapy continues to be surrounded by much misunderstanding and skepticism. PURPOSE: The purpose of this review is to provide a contemporary overview of the principles of gut-focused hypnotherapy, its effects on gut-brain interactions, and the evidence-base for its efficacy in severe FGIDs. As supplementary material, we have included a hypnotherapy protocol, providing the reader with an insight into the practical aspects of delivery, and as a guide, an example of a script of a gut-focused hypnotherapy session.

6 Review Irritable bowel syndrome diagnosis and management: A simplified algorithm for clinical practice. 2017

Moayyedi, Paul / Mearin, Fermín / Azpiroz, Fernando / Andresen, Viola / Barbara, Giovanni / Corsetti, Maura / Emmanuel, Anton / Hungin, A Pali S / Layer, Peter / Stanghellini, Vincenzo / Whorwell, Peter / Zerbib, Frank / Tack, Jan. ·Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton, ON, Canada. · 152997 · Institute of Functional and Motor Digestive Disorders, Centro Médico Teknon, Barcelona, Spain. · Digestive System Research Unit, University Hospital Vall d'Hebron, CIBERehd, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain. · Israelitic Hospital, University of Hamburg, Hamburg, Germany. · Department of Medical and Surgical Sciences, Centre for Applied Biomedical Research, University of Bologna, Bologna, Italy. · Nottingham Digestive Diseases Biomedical Research Centre, National Institute for Health Research, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK. · National Hospital for Neurology and Neurosurgery, University College London, London, UK. · School of Medicine and Health, Durham University, Centre for Integrated Health Research, Wolfson Research Institute, Stockton on Tees, UK. · Centre for Gastrointestinal Sciences, University of Manchester, Manchester, UK. · Department of Gastroenterology, Bordeaux University Hospital and Université de Bordeaux, Bordeaux, France. · Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium. ·United European Gastroenterol J · Pubmed #29026591.

ABSTRACT: BACKGROUND: Effective management of irritable bowel syndrome (IBS), a common functional gastrointestinal disorder, can be challenging for physicians because of the lack of simple diagnostic tests and the wide variety of treatment approaches available. OBJECTIVE: The objective of this article is to outline a simple algorithm for day-to-day clinical practice to help physicians navigate key stages to reaching a positive IBS diagnosis and guidance on how to prioritise the use of specific management strategies. METHODS: This algorithm was based on the opinion of an expert panel evaluating current evidence. RESULTS: The key principles forming the foundation of this evidence-supported algorithm are: confidently naming and explaining an IBS diagnosis for the patient, followed by assessment of key patient characteristics likely to influence the choice of therapy, such as predominant symptoms, and exploring the patient agenda and preferences. Consultation should always include education and reassurance with an explanatory model of IBS tailored to the patient. Individualised lifestyle changes, dietary modifications, pharmacological therapies, psychological strategies or a combination of interventions may be used to optimise treatment for each patient. CONCLUSION: The simple visual tools developed here navigate the key stages to reaching a positive diagnosis of IBS, and provide a stepwise approach to patient-centred management targeted towards the most bothersome symptoms. Establishing a strong patient-physician relationship is central to all stages of the patient journey from diagnosis to effective management.

7 Review The global impact of IBS: time to think about IBS-specific models of care? 2017

Corsetti, Maura / Whorwell, Peter. ·Nottingham Digestive Diseases Biomedical Research Centre, National Institute for Health Research, Nottingham University Hospitals NHS Trust, University of Nottingham, UK. · Centre for Gastrointestinal Sciences, University of Manchester, Manchester, UK. ·Therap Adv Gastroenterol · Pubmed #28932273.

ABSTRACT: Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal (GI) disorder that can significantly erode the quality of life (QoL) of sufferers and places a major cost burden on healthcare services. This paper reviews the literature on the impact of IBS on healthcare services and society, including a recent report on the subject, in order to formulate a plan for the future. A completely different model of care for these patients is recommended based on this review and the experience of the two authors who have been treating patients with functional GI disorders for 20 and 35 years, respectively.

8 Review New therapeutic options for IBS: the role of the first in class mixed µ- opioid receptor agonist and δ-opioid receptor antagonist (mudelta) eluxadoline. 2017

Corsetti, Maura / Whorwell, Peter. ·a Nottingham Digestive Diseases Biomedical Research Unit , National Institute for Health Research, Nottingham University Hospitals NHS Trust, University of Nottingham , Nottingham , UK. · b Centre for Gastrointestinal Sciences , University of Manchester , Manchester , UK. ·Expert Rev Gastroenterol Hepatol · Pubmed #28276811.

ABSTRACT: INTRODUCTION: Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder which represents a major cost to healthcare services. IBS-D patients represent about one-third of the IBS population and are currently treated with antispasmodics, loperamide, bile acid sequestrants and antidepressants. Alosetron and rifaximin are also available in USA, ramosetron in Japan, Korea and Thailand and ondansetron as an off-label treatment. Areas covered: This article focuses on eluxadoline, a novel pharmacological agent that has recently been approved by both the FDA and EMA for treatment of patients with IBS-D. Expert commentary: The efficacy and safety of eluxadoline in treating bowel habit alterations and pain, both in the short and long-term, make the drug a welcome addition to our therapeutic alternatives in IBS-D. Its positioning in any IBS algorithm will depend on the 'real world' prevalence of the small risk of sphincter of Oddi spasm and mild pancreatitis.

9 Review Progress with treating the microbial dysbiosis associated with irritable bowel syndrome. 2017

Pearson, James S / Whorwell, Peter J. ·aNeurogastroenterology Unit, University Hospital of South ManchesterbCentre for Digestive Diseases, University of Manchester, Manchester, UK. ·Curr Opin Gastroenterol · Pubmed #28134688.

ABSTRACT: PURPOSE OF REVIEW: Microbial dysbiosis is receiving increasing attention as possibly being important in the pathophysiology of irritable bowel syndrome. This review will summarize the most recent literature addressing attempts to explore and target the microbiome in patients with irritable bowel syndrome. RECENT FINDINGS: Manipulation of the intestinal microbiota in irritable bowel syndrome is receiving increasing attention. Traditionally, dietary manipulation has been utilized. There is now evidence that a low fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet has not only been able to improve symptoms, but may have an effect on the gut microbiota. Probiotics are a safe and attractive option for the manipulation of the microbiota. There have been a number of well-designed trials examining the efficacy of certain strains of bacteria, and even yeasts are receiving attention. The role of antibiotics remains controversial and it seems likely that their use should currently be limited to those individuals with small intestinal bacterial overgrowth. Interest in the role of faecal microbiota transplantation for the treatment of a number of gastrointestinal conditions has intensified and irritable bowel syndrome is no exception. SUMMARY: The manipulation of the microbial dysbiosis is gaining momentum. Further research, however, is required in order to identify the most appropriate treatment option for each individual patient.

10 Review Nocturia Work Productivity and Activity Impairment Compared with Other Common Chronic Diseases. 2016

Miller, Paul S J / Hill, Harry / Andersson, Fredrik L. ·Miller Economics Ltd., BioHub Alderley Edge, Alderley Park, SK10 4TG, UK. paul@millereconomicsltd.com. · Centre for Health Economics, Institute of Population Health/School of Dentistry, University of Manchester, 4.306, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. · Global Health Economics and Outcomes Research, Ferring Pharmaceuticals A/S, Kay Fiskers Plads 11, 2300, Copenhagen, Denmark. · Center for Medical Technology Assessment (CMT), Linköping University, 581 83, Linköping, Sweden. ·Pharmacoeconomics · Pubmed #27581788.

ABSTRACT: OBJECTIVES: The International Continence Society defines nocturia as the need to void one or more times during the night, with each of the voids preceded and followed by sleep. The chronic sleep disturbance and sleep deprivation experienced by patients with nocturia affects quality of life, compromising both mental and physical well-being. This paper aims to characterise the burden of nocturia by comparing published data from patients with nocturia with data from patients with any of 12 other common chronic conditions, specifically focusing on its impact on work productivity and activity impairment, as measured by the instrument of the same name (WPAI). METHODS: A systematic literature review of multiple data sources identified evaluable studies for inclusion in the analysis. Study eligibility criteria included use of the WPAI instrument in patients with one of a predefined list of chronic conditions. We assessed the quality of each included study using the Newcastle-Ottawa scale and extracted basic study information, work and activity impairment data. To assess how work and activity impairment from nocturia compares with impairment from other common chronic diseases, we conducted two data syntheses (pooled and unpooled). RESULTS: The number of evaluable studies and the range of overall work productivity impairment reported, respectively, were as follows: nocturia (3; 14-39 %), overactive bladder (5; 11-41 %), irritable bowel syndrome/constipation (14; 21-51 %), gastroesophageal reflux disease (GERD) (13; 6-42 %), asthma/allergies (11; 6-40 %), chronic obstructive pulmonary disease (COPD) (7; 19-42 %), sleep problems (3; 12-37 %), arthritis (13; 21-69 %), pain (9; 29-64 %), depression (4; 15-43 %) and gout (2; 20-37 %). CONCLUSIONS: The overall work productivity impairment as a result of nocturia is substantial and was found to be similar to impairment observed as a result of several other more frequently researched common chronic diseases. Greater awareness of the burden of nocturia, a highly bothersome and prevalent condition, will help policy makers and healthcare decision makers provide appropriate management of nocturia.

11 Review Phenotyping of subjects for large scale studies on patients with IBS. 2016

Boeckxstaens, G E / Drug, V / Dumitrascu, D / Farmer, A D / Hammer, J / Hausken, T / Niesler, B / Pohl, D / Pojskic, L / Polster, A / Simren, M / Goebel-Stengel, M / Van Oudenhove, L / Vassallo, M / Wensaas, K-A / Aziz, Q / Houghton, L A / Anonymous3490872. ·Translational Research Center for Gastrointestinal Disorders, KULeuven & Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium. · Gastroenterology Department, University Hospital "St Spiridon", Gr. T.Popa University of Medicine and Pharmacy, Iasi, Romania. · 2nd Medical Dept., Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. · Wingate Institute of Neurogastroenterology, Barts and The London School of Medicine and Dentistry, London, UK. · Department of Gastroenterology, University Hospitals of North Midlands, Stoke on Trent, UK. · Medizinische Universität Wien, Universitätsklinik für Innere Medizin 3, Vienna, Austria. · Department of Medicine, Unit of Gastroenterology, Haukeland University Hospital, Bergen, Norway. · Department of Human Molecular Genetics, University of Heidelberg, Heidelberg, Germany. · Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland. · Institute for Genetic Engineering and Biotechnology, University of Sarajevo, Sarajevo, Bosnia and Herzegovina. · Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. · Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. · Department of Internal Medicine, Martin-Luther-Krankenhaus, Berlin, Germany. · Department of Medicine, Mater Dei Hospital, Tal-Qroqq, Malta. · Uni Research Health, Research Unit for General Practice, Bergen, Norway. · Leeds Institute of Biomedical and Clinical Sciences, University of Leeds and Leeds Gastroenterology Institute, Leeds Teaching Hospitals Trust, Leeds, UK. · Centre for Gastrointestinal Sciences, University of Manchester, Manchester, UK. · Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA. ·Neurogastroenterol Motil · Pubmed #27319981.

ABSTRACT: BACKGROUND: Irritable bowel syndrome (IBS) is a complex condition with multiple factors contributing to its aetiology and pathophysiology. Aetiologically these include genetics, life-time events and environment, and physiologically, changes in motility, central processing, visceral sensitivity, immunity, epithelial permeability and gastrointestinal microflora. Such complexity means there is currently no specific reliable biomarker for IBS, and thus IBS continues to be diagnosed and classified according to symptom based criteria, the Rome Criteria. Carefully phenotyping and characterisation of a 'large' pool of IBS patients across Europe and even the world however, might help identify sub-populations with accuracy and consistency. This will not only aid future research but improve tailoring of treatment and health care of IBS patients. PURPOSE: The aim of this position paper is to discuss the requirements necessary to standardize the process of selecting and phenotyping IBS patients and how to organise the collection and storage of patient information/samples in such a large multi-centre pan European/global study. We include information on general demographics, gastrointestinal symptom assessment, psychological factors, quality of life, physiological evaluation, genetic/epigenetic and microbiota analysis, biopsy/blood sampling, together with discussion on the organisational, ethical and language issues associated with implementing such a study. The proposed approach and documents selected to be used in such a study was the result of a thoughtful and thorough four-year dialogue amongst experts associated with the European COST action BM1106 GENIEUR (www.GENIEUR.eu).

12 Review Novel pharmacological therapies for irritable bowel syndrome. 2016

Corsetti, Maura / Whorwell, Peter. ·a Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven , Leuven , Belgium. · b Centre for Gastrointestinal Sciences , University Manchester , Manchester , UK. ·Expert Rev Gastroenterol Hepatol · Pubmed #26907518.

ABSTRACT: Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder, which represents a major cost to healthcare services. Current pharmacological treatment includes fibre supplements, antispasmodics, laxatives, loperamide and antidepressants. This article reviews the novel pharmacological treatments already or recently approved for patients with IBS-C (lubiprostone, linaclotide) and IBS-D (alosetron, ramosetron, rifaximin, eluxadoline). Furthermore, results for drugs in development (plecanatide, ibudutant and ebastine) or used in chronic constipation or for other indications, with potential application in IBS (prucalopride, elobixibat, mesalazine, ondansetron and colesevelam) are also reviewed.

13 Review Immunoglobulin E in irritable bowel syndrome: another target for treatment? A case report and literature review. 2015

Pearson, James S / Niven, Robert M / Meng, Jie / Atarodi, Sima / Whorwell, Peter J. ·Neurogastroenterology Department, Wythenshawe Hospital, University Hospital of South Manchester, 1st Floor F Block, Yellow Zone, Manchester M23 9LT, UK. · Department of Respiratory Medicine, University Hospital of South Manchester, Manchester, UK. · Department of Gastroenterology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China. · Neurogastroenterology Unit, University Hospital of South Manchester, Manchester, UK. · Centre for Gastrointestinal Sciences, University of Manchester, Manchester, UK. ·Therap Adv Gastroenterol · Pubmed #26327917.

ABSTRACT: Irritable bowel syndrome (IBS) is notoriously difficult to treat and this situation is unlikely to change until the pathophysiology is better understood. There is no doubt that IBS is a multifactorial condition but it is likely that the relative contribution of the various factors involved varies from patient to patient. Consequently, in some individuals one mechanism may have such a strong effect that its elimination may lead to a substantial improvement in symptoms. This paper describes a patient with severe asthma and IBS where the administration of an anti-Immunoglobulin E (IgE) monoclonal antibody not only improved her asthma but also resulted in an almost complete resolution of her IBS symptoms. This observation suggests that some form of allergic process, which may be mediated by IgE, might be driving IBS in some patients and there is evidence from the literature that atopy is more common in this condition. Therefore, in patients with IBS and atopy where the response to standard treatment is poor, it may be worth considering targeting the allergic diathesis. Possible approaches include skin testing with food antigens followed by an appropriate exclusion diet or pharmacological mast cell stabilization.

14 Review Irritable bowel syndrome in adults in primary care: summary of updated NICE guidance. 2015

Hookway, Cheryl / Buckner, Sara / Crosland, Paul / Longson, Damien. ·National Institute for Health and Care Excellence, Clinical Guideline Updates Team, Manchester M1 4BT, UK cheryl.hookway@NICE.org.uk. · National Institute for Health and Care Excellence, Clinical Guideline Updates Team, London, UK. · Department of Psychiatry, Manchester Mental Health and Social Care Trust, Manchester, UK. ·BMJ · Pubmed #25716701.

ABSTRACT: -- No abstract --

15 Review IBS in 2014: Developments in pathophysiology, diagnosis and management. 2015

Whorwell, Peter J. ·Education and Research Centre, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK. ·Nat Rev Gastroenterol Hepatol · Pubmed #25534505.

ABSTRACT: -- No abstract --

16 Review Irritable bowel syndrome: the problem and the problem of treating it - is there a role for probiotics? 2014

Santos, Antonieta R / Whorwell, P J. ·Neurogastroenterology Unit,University Hospital of South Manchester,Manchester,UK. ·Proc Nutr Soc · Pubmed #25156472.

ABSTRACT: The aim of this review is to highlight the impact of irritable bowel syndrome (IBS) in those patients who consult the medical profession and examine the therapeutic potential of probiotics in this condition, where there is a strong need for new treatment options. Traditionally, IBS is frequently regarded as a trivial condition which is certainly not life threatening and mainly psychological in origin. However, these preconceptions are misplaced, as in some patients the condition can be devastating with the pain being as severe as that of childbirth coupled with incapacitating bowel dysfunction. In addition, patients suffer from a variety of non-colonic symptoms such as low backache, constant lethargy, nausea and genito-urinary problems, all of which lead to these patients having extremely poor quality of life. Unfortunately, the treatment of IBS is very unsatisfactory with only one new medication being developed for this condition in the last 25 years. It is now recognised that IBS is a multifactorial condition with symptoms being triggered by a variety of factors, some of which appear to be influenced by probiotics, resulting in speculation that they may have therapeutic potential in this condition. There have been over thirty controlled clinical trials of probiotics in IBS with approximately two-thirds of these studies showing evidence of an improvement in symptoms. However, not all probiotics appear to be effective with different symptoms being improved by different strains and some improving symptoms more than others. Consequently, the ideal probiotic for the treatment of IBS has yet to be defined, but the evidence is good enough to encourage further research with the aim of identifying an optimal strain or strains.

17 Review Abdominal bloating and distension: what is the role of the microbiota. 2012

Issa, B / Wafaei, N A / Whorwell, P J. ·Neurogastroenterology Unit, Department of Translational Medicine, University of Manchester, Manchester, UK. ·Dig Dis Sci · Pubmed #21800157.

ABSTRACT: Most patients with irritable bowel syndrome complain of a sensation of an increase in pressure within their abdomen during the course of the day which is called bloating and, in approximately half of these individuals, this symptom is accompanied by an actual increase in abdominal girth, which is referred to as distension. The pathophysiology of these two phenomena is somewhat different and it is now recognised that a whole variety of overlapping mechanisms are involved. Some of these are potentially amenable to treatment by modification of the bacterial flora of the gut and this article reviews the evidence for this.

18 Review Imagery, colour and illness: a review. 2011

Carruthers, Helen R. ·Department of Medical Illustration, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK. Helen.carruthers@uhsm.nhs.uk ·J Vis Commun Med · Pubmed #22023001.

ABSTRACT: This paper reviews research on the role of colour and imagery in relation to illness and examines how this might improve communication between the sufferer and those treating or caring for them. It describes a method by which colour can be related to situations such as an individual's mood and how this might be used to predict response to treatment. Furthermore, it provides evidence that documenting the imagery of an illness might give insight into the patients' fears and concerns about their condition as well as helping non-sufferers to understand what they are going through.

19 Review Emerging drugs for irritable bowel syndrome. 2009

Shekhar, Chander / Whorwell, Peter J. ·University of Manchester, Neurogastroenterology Unit, University Hospital of South Manchester NHS Trust, Manchester, M23 9LT, UK. peter.whorwell@UHSM.NHS.UK ·Expert Opin Emerg Drugs · Pubmed #19939211.

ABSTRACT: Irritable bowel syndrome is extremely common and its severity is widely underestimated. Unfortunately, the current pharmacological treatment of this condition is far from satisfactory which might suggest that it would be an area in which the pharmaceutical industry would take a great interest. However, drug development in this field, especially in relation to 5-hydroxytryptamine (5-HT), has been beset by difficulties with side effects and, what some authorities would claim, an unnecessarily strict regulatory climate based on the perception that irritable bowel syndrome is not a particularly serious condition. This has resulted in a rapid withdrawal from the scene by a number of companies although with the identification of some potential new therapeutic targets, the area has not been totally abandoned.

20 Review Hypnotherapy for functional gastrointestinal disorders: a review. 2009

Miller, Vivien / Whorwell, Peter J. ·University of Manchester, Manchester, United Kingdom. ·Int J Clin Exp Hypn · Pubmed #19459089.

ABSTRACT: Patients with functional gastrointestinal disorders, such as irritable bowel syndrome, functional dyspepsia, and noncardiac chest pain, can suffer from a range of severe symptoms that often substantially erode quality of life. Unfortunately, these conditions are notoriously difficult to treat, with many patients failing to improve despite being prescribed a wide variety of conventional medications. As a consequence, the potential benefits of hypnotherapy have been explored with evidence that this approach not only relieves symptoms but also appears to restore many of the putative psychological and physiological abnormalities associated with these conditions toward normal. These observations suggest that this form of treatment has considerable potential in aiding the management of functional gastrointestinal disorders and should be integrated into the ongoing medical care that these patients are receiving.

21 Article Treatment of irritable bowel syndrome with diarrhoea using titrated ondansetron (TRITON): study protocol for a randomised controlled trial. 2019

Gunn, David / Fried, Ron / Lalani, Rabia / Farrin, Amanda / Holloway, Ivana / Morris, Tom / Olivier, Catherine / Kearns, Rachael / Corsetti, Maura / Scott, Mark / Farmer, Adam / Emmanuel, Anton / Whorwell, Peter / Yiannakou, Yan / Sanders, David / Mclaughlin, John / Kapur, Kapil / Eugenicos, Maria / Akbar, Ayesha / Trudgill, Nigel / Houghton, Lesley / Dinning, Phil G / Ford, Alexander C / Aziz, Qasim / Spiller, Robin. ·NIHR Nottingham Digestive Diseases Biomedical Research Centre, University of Nottingham, Nottingham, UK. · Nottingham Digestive Diseases Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK. · Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. · Wingate Institute of Neurogastroenterology, Queen Mary University of London, London, UK. · Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK. · Royal Stoke Hospital, University Hospitals of North Midlands NHS Trust, Stoke, UK. · University College London Hospital, University College London Hospitals NHS Foundation Trust, London, UK. · Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK. · County Durham and Darlington Foundation Trust, University Hospital of North Durham, Durham, UK. · Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. · Salford Royal NHS Foundation Trust, Salford Royal University Hospital, Manchester, UK. · Barnsley Hospital, Barnsley Hospital NHS Foundation Trust, Barnsley, UK. · Western General Hospital Edinburgh, NHS Lothian, Edinburgh, UK. · London North West Healthcare NHS Trust, St Mark's Hospital, London, UK. · Sandwell General Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK. · St James's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK. · Discipline of Surgery and Gastroenterology, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia. · NIHR Nottingham Digestive Diseases Biomedical Research Centre, University of Nottingham, Nottingham, UK. robin.spiller@nottingham.ac.uk. · Nottingham Digestive Diseases Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK. robin.spiller@nottingham.ac.uk. ·Trials · Pubmed #31429811.

ABSTRACT: BACKGROUND: Irritable bowel syndrome with diarrhoea (IBS-D) affects up to 4% of the general population. Symptoms include frequent, loose, or watery stools with associated urgency, resulting in marked reduction of quality of life and loss of work productivity. Ondansetron, a 5HT METHODS: This trial is a phase III, parallel group, randomised, double-blind, multi-centre, placebo-controlled trial, with embedded mechanistic studies. Participants (n = 400) meeting Rome IV criteria for IBS-D will be recruited from outpatient and primary care clinics and by social media to receive either ondansetron (dose titrated up to 24 mg daily) or placebo for 12 weeks. Throughout the trial, participants will record their worst abdominal pain, worst urgency, stool frequency, and stool consistency on a daily basis. The primary endpoint is the proportion of "responders" in each group, using Food and Drug Administration (FDA) recommendations. Secondary endpoints include pain intensity, stool consistency, frequency, and urgency. Mood and quality of life will also be assessed. Mechanistic assessments will include whole gut transit, faecal tryptase and faecal bile acid concentrations at baseline and between weeks 8 and 11. A subgroup of participants will also undergo assessment of sensitivity (n = 80) using the barostat, and/or high-resolution colonic manometry (n = 40) to assess motor patterns in the left colon and the impact of ondansetron. DISCUSSION: The TRITON trial aims to assess the effect of ondansetron across multiple centres. By defining ondansetron's mechanisms of action we hope to better identify patients with IBS-D who are likely to respond. TRIAL REGISTRATION: ISRCTN, ISRCTN17508514 , Registered on 2 October 2017.

22 Article Abnormalities of mucosal serotonin metabolism and 5-HT 2019

Gunn, David / Garsed, Klara / Lam, Ching / Singh, Gulzar / Lingaya, Melanie / Wahl, Verena / Niesler, Beate / Henry, Amanda / Hall, Ian P / Whorwell, Peter / Spiller, Robin. ·NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK. · Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK. · Royal Derby Hospital, Derby, UK. · Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. · Department of Human Molecular Genetics, Institute of Human Genetics, University Hospital Heidelberg and Interdisciplinary Center for Neurosciences (IZN), University of Heidelberg, Heidelberg, Germany. · Department of Therapeutics and Molecular Medicine, NIHR Nottingham Biomedical Research Centre, Nottingham, UK. · Department of Neurogastroenterology, University of South Manchester Wythenshawe General Hospital, Manchester, UK. ·Aliment Pharmacol Ther · Pubmed #31342534.

ABSTRACT: BACKGROUND: Irritable bowel syndrome with diarrhoea (IBS-D) is a common condition, greatly reducing the quality of life with few effective treatment options available. AIM: To report the beneficial response shown in our trial with the 5-hydroyxtryptamine (5-HT) receptor 3 antagonist, ondansetron in IBS-D METHODS: A randomised, placebo-controlled, cross-over trial of 5 weeks of ondansetron versus placebo in 125 patients meeting modified Rome III criteria for IBS-D as previously described. Patients were compared to 21 healthy controls. 5-HT and 5-HIAA were measured in rectal biopsies. Whole gut transit time was assessed using a radio-opaque marker technique. Whole blood DNA was genotyped for an insertion polymorphism in the promoter region of the serotonin transporter gene SLC6A4, as well as single nucleotide polymorphisms (SNPs) of the tryptophan hydroxylase gene TPH1 and 5-HT RESULTS: Patients' biopsies showed significantly higher 5-HIAA levels (2.1 (1.2-4.2) pmol/mg protein vs 1.1 (0.4-1.5) in controls, P < .0001). 39 patients used < 4 mg/d ("super-responders") while 55 required ≥ 4 mg/d. 5-HT concentrations in rectal biopsies were significantly lower in super-responders (21.3 (17.0-31.8) vs 37.7 (21.4-61.4), P = .0357) and the increase in transit time on ondansetron was significantly greater (15.6 (1.8-31) hours vs 3.9 (-5.1-17.9) hours). Stool consistency responders were more likely to carry the CC genotype of the SNP p.N163K rs6766410 of the HTR3C gene (33% vs 14%, P = .0066). CONCLUSION: IBS-D patients have significant abnormalities in mucosal 5-HT metabolism. Those with the lowest concentration of 5-HT in rectal biopsies showed the greatest responsiveness to ondansetron.

23 Article SKYPE HYPNOTHERAPY FOR IRRITABLE BOWEL SYNDROME: Effectiveness and Comparison with Face-to-Face Treatment. 2019

Hasan, Shariq S / Pearson, James S / Morris, Julie / Whorwell, Peter J. ·a Neurogastroenterology Unit , Wythenshawe Hospital , Manchester , UK. ·Int J Clin Exp Hypn · Pubmed #30702396.

ABSTRACT: Gut-focused hypnotherapy is an effective treatment for irritable bowel syndrome but is not widely available. This study assessed whether providing hypnotherapy by Skype might partially overcome this problem. Using a 50-point or more reduction in the IBS Symptom Severity Score as the primary outcome measure, 65% of subjects responded to Skype hypnotherapy with all other outcomes significantly improving. The primary outcome figure for face-to-face hypnotherapy was 76%. When other outcome scores for Skype and face-to-face treatment were compared, the mean changes were these: symptom severity (-94.1 vs. -129.2), noncolonic score (-52.3 vs. -64.8), quality of life (+56.4 vs. +66.2), anxiety (-3.3 vs. -3.0), depression (-1.7 vs. -2.5), and a 30% or more pain reduction (44% vs. 62%). Skype hypnotherapy is effective but slightly less so than face-to-face treatment. However, many patients would have been unable to access treatment without the Skype option.

24 Article Efficacy of individual and group hypnotherapy in irritable bowel syndrome (IMAGINE): a multicentre randomised controlled trial. 2019

Flik, Carla E / Laan, Wijnand / Zuithoff, Nicolaas P A / van Rood, Yanda R / Smout, André J P M / Weusten, Bas L A M / Whorwell, Peter J / de Wit, Niek J. ·Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands. Electronic address: c.e.flik@umcutrecht.nl. · Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands. · Psychiatric Policlinic, Leiden University Medical Centre, Leiden, Netherlands. · Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, Netherlands. · Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, Netherlands; Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, Netherlands. · Education and Research Centre, Wythenshawe Hospital, Manchester, UK. ·Lancet Gastroenterol Hepatol · Pubmed #30473202.

ABSTRACT: BACKGROUND: Hypnotherapy for irritable bowel syndrome (IBS) has been used primarily in patients with refractory symptoms in specialised departments and delivered on an individual basis. We aimed to test the hypothesis that hypnotherapy would be more effective than educational supportive therapy, and that group hypnotherapy would be non-inferior to individual hypnotherapy for patients with IBS referred from primary and secondary care. METHODS: We did a multicentre randomised controlled trial (IMAGINE) in 11 hospitals in the Netherlands. Patients with IBS, aged 18-65 years, who were referred from primary or secondary care were randomly allocated (3:3:1) in blocks of six using a computer-based random number table procedure by staff not involved in the treatment to receive six sessions of individual or group hypnotherapy or group educational supportive therapy (control group). The primary outcome was adequate relief of IBS symptoms, with responders defined as patients who reported adequate relief when asked once weekly on three or four occasions in 4 consecutive weeks. We compared hypnotherapy (both groups) with control in the intention-to-treat population (excluding individuals subsequently found to be ineligible for enrolment), and assessed non-inferiority of group hypnotherapy versus individual hypnotherapy in the per-protocol population (with a non-inferiority margin of 15%) at 3 months and 12 months. This trial is registered with ISRCTN, number ISRCTN22888906, and is completed. FINDINGS: Between May 31, 2011, and April 6, 2016, 494 patients referred for psychological treatment for IBS were assessed for eligibility, of whom 354 were randomly allocated to the three groups: 150 to individual hypnotherapy, 150 to group hypnotherapy, and 54 to educational supportive therapy. After exclusion of individuals subsequently found to be ineligible for enrolment, 142 patients in the individual hypnotherapy group, 146 in the group hypnotherapy group, and 54 in the control group were included in the intention-to-treat population. Of these, 22 (15%) patients in the individual hypnotherapy group, 22 (15%) in the group hypnotherapy group, and 11 (20%) in the control group dropped out before or during therapy. In the intention-to-treat analysis, the adequate response rate was 40·8% (95% CI 31·7-50·5) in the individual hypnotherapy group, 33·2% (24·3-43·5) in the group hypnotherapy group, and 16·7% (7·6-32·6) in the control group at 3 months. At 12 months, 40·8% (31·3-51·1) of patients in the individual hypnotherapy group, 49·5% (38·8-60·0) of patients in the group hypnotherapy group, and 22.6% (11·5-39·5) of patients in the control group reported adequate relief. Hypnotherapy was more effective than control at 3 months (odds ratio 2·9, 95% CI 1·2-7·4, p=0·0240) and 12 months (2·8, 1·2-6·7, p=0·0185). In the per-protocol analysis, 49·9% (39·2-60·6) in the individual hypnotherapy group and 42·7% (32·3-53·8) in the group hypnotherapy group had adequate relief at 3 months, and 55·5% (43·4-67·1) of individual and 51·7% (40·2-63·0) of group hypnotherapy patients reported adequate relief at 12 months. Group hypnotherapy was therefore non-inferior to individual hypnotherapy. Eight unexpected serious adverse reactions (six in the individual hypnotherapy group and two in the group hypnotherapy group) were reported, most of which were cancer or inflammatory bowel disease, and were judged by the medical ethics committee as not being related to the therapy. INTERPRETATION: Hypnotherapy should be considered as a possible treatment for patients with IBS in primary and secondary care. Furthermore, group therapy could allow many more patients to be treated for the same cost. FUNDING: None.

25 Article UK clinical experience up to 52 weeks with linaclotide for irritable bowel syndrome with constipation. 2018

Yiannakou, Yan / Agrawal, Anu / Allen, Patrick B / Arebi, Naila / Brown, Steven R / Eugenicos, Maria P / Farmer, Adam D / McLain-Smith, Su / McLaughlin, John / Sanders, David S / Lawrance, Dominic / Emmanuel, Anton. ·University Hospital of North Durham, County Durham and Darlington NHS Foundation Trust, North Road, Durham DH1 5TW, UK. · Doncaster Royal Infirmary, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, UK. · The Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, UK. · St Mark's Hospital, London North West University Healthcare NHS Trust and Imperial College, London, UK. · Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. · Western General Hospital, NHS Lothian, Edinburgh, UK. · University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK and Institute of Applied Clinical Sciences, University of Keele, Keele, UK. · pH Associates Ltd, Marlow, UK. · The University of Manchester, Manchester, UK, Salford Royal NHS Foundation Trust, Salford, UK and Manchester Academic Health Sciences Centre, Manchester, UK. · Allergan plc, Marlow, UK. · University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK. ·Therap Adv Gastroenterol · Pubmed #30302125.

ABSTRACT: Background: Linaclotide, a guanylate cyclase C agonist, has been shown in clinical trials to improve symptoms of irritable bowel syndrome with constipation (IBS-C). Here we report data from a real-world study of linaclotide in the UK. Methods: This 1-year, multicentre, prospective, observational study in the UK enrolled patients aged 18 years and over initiating linaclotide for IBS-C. The primary assessment was change from baseline in IBS Symptom Severity Scale (IBS-SSS) score at 12 weeks, assessed in patients with paired baseline and 12-week data. Change from baseline in IBS-SSS score at 52 weeks was a secondary assessment. Adverse events were recorded. Results: In total, 202 patients were enrolled: 185 (91.6%) were female, median age was 44.9 years (range 18.1-77.2) and 84 (41.6%) reported baseline laxative use. Mean (standard deviation) baseline IBS-SSS score was 339 (92), with most patients ( Conclusion: Linaclotide significantly improved IBS-SSS score at 12 and 52 weeks. These results provide insights into outcomes with linaclotide treatment over 1 year in patients with IBS-C in real-world clinical practice.

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