Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Irritable Bowel Syndrome: HELP
Articles from US Dept of Veterans Affairs
Based on 77 articles published since 2008
||||

These are the 77 published articles about Irritable Bowel Syndrome that originated from US Dept of Veterans Affairs during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Guideline American Gastroenterological Association Institute Guideline on the pharmacological management of irritable bowel syndrome. 2014

Weinberg, David S / Smalley, Walter / Heidelbaugh, Joel J / Sultan, Shahnaz / Anonymous4010806. ·Fox Chase Cancer Center, Philadelphia, Pennsylvania. · VA Tennessee Valley Healthcare System, Vanderbilt University, Nashville, Tennessee. · University of Michigan Ann Arbor, Michigan. · 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 #25224526.

ABSTRACT: -- No abstract --

2 Editorial Gastroenterology for the Internist. 2019

Dunbar, Kerry B. ·VA Gastroenterology Section, Dallas VA Medical Center-VA North Texas Healthcare System, Internal Medicine, University of Texas, Southwestern Medical Center, GI Lab, CA 111-B1, 4500 South Lancaster Road, Dallas, TX 75216, USA. Electronic address: Kerry.Dunbar@va.gov. ·Med Clin North Am · Pubmed #30466680.

ABSTRACT: -- No abstract --

3 Editorial IBS with constipation, functional constipation, painful and non-painful constipation: e Pluribus…Plures? 2014

Cremonini, Filippo / Lembo, Anthony. ·Southern Nevada VA Healthcare System, Las Vegas, Nevada, USA. · Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. ·Am J Gastroenterol · Pubmed #24896758.

ABSTRACT: IBS with constipation (IBS-C) and chronic constipation (CC) can be difficult to distinguish clinically. The Rome III criteria create mutual exclusion between IBS-C and CC, based on the presence of abdominal pain, which is a defining criterion for IBS-C. Previous surveys found that up to 45% of CC patients have abdominal pain and other IBS features. A Spanish general population study proposes a subclassification of patients with CC based on abdominal pain and other features of IBS. As the Rome criteria evolve, these and other observations provide the basis for further efforts in discerning key features of IBS-C and CC.

4 Review Enzyme therapy for functional bowel disease-like post-prandial distress. 2018

Graham, David Y / Ketwaroo, Gyanprakash A / Money, Mary E / Opekun, Antone R. ·Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, Texas. · Baylor College of Medicine, Houston, Texas. · Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, Maryland. · Department of Internal Medicine, Meritus Medical Center, Hagerstown, Maryland. ·J Dig Dis · Pubmed #30101562.

ABSTRACT: Post-prandial gastrointestinal symptoms such as diarrhea, abdominal distension, flatulence, bloating and a feeling of fullness are common complaints of often unknown etiology and pathogenesis. There is a long history of trials reporting the successful use of products containing a variety of combinations of digestive enzymes including a number of randomized placebo-controlled trials. We provide a narrative review of studies describing the use of multi-digestive enzymes for symptoms consistent with irritable bowel syndrome. We describe clinical trials reported over the past 60 years including double-blinded randomized, placebo-controlled studies and recent trials that focused on post-prandial diarrhea consistent with diarrhea-predominant irritable bowel syndrome. Disaccharidase deficiencies or deficiencies of other carbohydrate digesting enzymes were excluded. Worldwide studies have generally reported success with multi-enzyme preparations although none used a factorial design to identify subgroups or attempted to link specific symptom responses to specific components of therapy. Although there is a long history of the successful use of multi-enzyme preparations for post-prandial symptoms consistent with irritable bowel syndrome, long-term studies using validated scoring systems and factorial designs are needed to confirm the results for specific symptoms and the components of the combination drugs received.

5 Review New concepts on intestinal microbiota and the role of the non-absorbable antibiotics with special reference to rifaximin in digestive diseases. 2018

Bajaj, Jasmohan S / Barbara, Giovanni / DuPont, Herbert L / Mearin, F / Gasbarrini, Antonio / Tack, Jan. ·Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA. · Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. · Center for Infectious Diseases, The University of Texas School of Public Health, Baylor College of Medicine, Kelsey Research Foundation, Houston, TX, USA. · Institute of Functional and Motor Digestive Disorders, Centro Médico Teknon, Barcelona, Spain. · Catholic University of Rome, Gemelli University Hospital, Rome, Italy. Electronic address: antonio.gasbarrini@unicatt.it. · Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, University of Leuven, Belgium; Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium. ·Dig Liver Dis · Pubmed #29807873.

ABSTRACT: Digestive diseases are a broad range of chronic disorders that substantially and negatively impact the patients' quality of life. Here, we review our current understanding on the pathophysiology of hepatic encephalopathy, irritable bowel syndrome, and diverticular disease, with a special focus on the gut microbiota composition associated with these disorders. Furthermore, we review the current clinical practice for their therapeutic treatments, including probiotics, diet change, non-adsorbable disaccharides, and antibiotics. We highlight that broad-spectrum non-adsorbable antibiotics, such as rifaximin, are quite effective and safe for the treatment of all essayed digestive diseases.

6 Review Irritable Bowel Syndrome. 2017

Sultan, Shahnaz / Malhotra, Ashish. ·From the University of Minnesota and Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota. ·Ann Intern Med · Pubmed #28586906.

ABSTRACT: This issue provides a clinical overview of irritable bowel syndrome, focusing on diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

7 Review The gut peptide neuropeptide Y and post-traumatic stress disorder. 2017

Rasmusson, Ann M. ·aNational Center for PTSD, Women's Health Science Division, Department of Veterans Affairs bVA Boston Healthcare System cBoston University School of Medicine, Boston, Massachusetts, USA. ·Curr Opin Endocrinol Diabetes Obes · Pubmed #27898588.

ABSTRACT: PURPOSE OF REVIEW: This article reviews the role of neuropeptide Y (NPY) in the pathophysiology of post-traumatic stress disorder (PTSD) and gastrointestinal disorders such as irritable bowel syndrome (IBS) with which PTSD is highly comorbid. NPY is low in the cerebrospinal fluid and plasma of male combat veterans with PTSD and correlates negatively with sympathetic nervous system (SNS) hyperreactivity, PTSD symptoms and time to recovery. NPY regulation has not yet been evaluated in women with PTSD. RECENT FINDINGS: NPY levels in bowel tissue are low in IBS with diarrhea (IBS-D) versus IBS with constipation. The density of ghrelin containing cells of the gastric oxyntic mucosa is markedly increased in IBS-D. PTSD-related SNS hyperreactivity may interact with this substrate to increase ghrelin release, which activates receptors in the lumbosacral spinal cord and basolateral amygdala to increase colonic motility and amygdala hyperreactivity, respectively. Loss of function gene polymorphisms in adrenergic α2-autoreceptors and increased corticotropin-releasing hormone, as observed in PTSD, are also thought to contribute to IBS-D. SUMMARY: Knowledge of shared underlying NPY system-related neurobiological factors that contribute to the comorbidity of PTSD and gastrointestinal disorders may help guide research, development and prescription of targeted and more effective individualized therapeutic interventions.

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 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.

11 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.

12 Review Linaclotide: a novel agent for chronic constipation and irritable bowel syndrome. 2014

Love, Bryan L / Johnson, Audrey / Smith, Lisa S. ·Bryan L. Love, Pharm.D., BCPS, is Associate Professor, Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, and Clinical Pharmacy Specialist-Gastroenterology/Hepatology, William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia, SC. Audrey Johnson is a Pharm.D. candidate, South Carolina College of Pharmacy. Lisa S. Smith, Pharm.D., BCPS, is Assistant Dean of Faculty Development and Associate Professor, Wingate University School of Pharmacy, Wingate, NC. loveb@sccp.sc.edu. · Bryan L. Love, Pharm.D., BCPS, is Associate Professor, Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, and Clinical Pharmacy Specialist-Gastroenterology/Hepatology, William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia, SC. Audrey Johnson is a Pharm.D. candidate, South Carolina College of Pharmacy. Lisa S. Smith, Pharm.D., BCPS, is Assistant Dean of Faculty Development and Associate Professor, Wingate University School of Pharmacy, Wingate, NC. ·Am J Health Syst Pharm · Pubmed #24939497.

ABSTRACT: PURPOSE: The pharmacology, pharmaco-kinetics, and clinical efficacy and safety of linaclotide in the management of chronic constipation (CC) and constipation-predominant irritable bowel syndrome (IBS-C) are reviewed. SUMMARY: Linaclotide (Linzess, Forest Pharmaceuticals) is a 14-amino acid peptide indicated for the treatment of adults with CC and IBS-C. Linaclotide acts on guanylate cyclase-C receptors on the luminal membrane to increase chloride and bicarbonate secretions into the intestine and inhibit the absorption of sodium ions, thus increasing the secretion of water into the lumen and improving defecation; the drug is minimally absorbed into the systemic circulation. Linaclotide is approved by the Food and Drug Administration (FDA) for oral once-daily administration at doses of 145 μg for CC and 290 μg for IBS-C. In placebo-controlled Phase III clinical trials, linaclotide significantly increased weekly spontaneous bowel movements and complete spontaneous bowel movements (CSBMs) while reducing abdominal pain in patients with CC. In patients with IBS-C, linaclotide was demonstrated to be effective in meeting FDA-recommended endpoints such as reductions of at least 30% from baseline in abdominal pain scores and CSBM frequency. The most common adverse effect of linaclotide is diarrhea, which was reported in 16-20% of clinical trial participants. CONCLUSION: Linaclotide is an important advance in the treatment of CC and IBS-C, with a novel mechanism of action resulting in accelerated intestinal transit. In clinical trials, linaclotide demonstrated efficacy relative to placebo for treatment of both CC and IBS-C. Linaclotide's adverse effects are generally mild and confined to the gastrointestinal tract.

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 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.

15 Review New insights into visceral hypersensitivity--clinical implications in IBS. 2011

Zhou, QiQi / Verne, G Nicholas. ·Department of Medicine, Research Service, Cincinnati VA Medical Center, 3200 Vine Street, Cincinnati, OH 45220, USA. ·Nat Rev Gastroenterol Hepatol · Pubmed #21643039.

ABSTRACT: A subset of patients with IBS have visceral hypersensitivity and/or somatic hypersensitivity. Visceral hypersensitivity might have use as a clinical marker of IBS and could account for symptoms of urgency for bowel movements, bloating and abdominal pain. The mechanisms that lead to chronic visceral hypersensitivity in patients who have IBS are unclear. However, several working models may be considered, including: nociceptive input from the colon that leads to hypersensitivity; increased intestinal permeability that induces a visceral nociceptive drive; and alterations in the expression of microRNAs in gastrointestinal tissue that might be delivered via blood microvesicles to other target organs, such as the peripheral and/or central nervous system. As such, the chronic visceral hypersensitivity that is present in a subset of patients with IBS might be maintained by both peripheral and central phenomena. The theories underlying the development of chronic visceral hypersensitivity in patients with IBS are supported by findings from new animal models in which hypersensitivity follows transient inflammation of the colon. The presence of somatic hypersensitivity and an alteration in the neuroendocrine system in some patients who have IBS suggests that multisystemic factors are involved in the overall disorder. Thus, IBS is similar to other chronic pain disorders, such as fibromyalgia, chronic regional pain disorder and temporomandibular joint disorder, as chronic nociceptive mechanisms are activated in all of these disorders.

16 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.

17 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.

18 Review The role of experimental models in developing new treatments for irritable bowel syndrome. 2011

Holschneider, Daniel P / Bradesi, Sylvie / Mayer, Emeran A. ·VA Greater Los Angeles Healthcare System, LA, CA, USA. ·Expert Rev Gastroenterol Hepatol · Pubmed #21309671.

ABSTRACT: Irritable bowel syndrome (IBS) is characterized by chronic, recurrent abdominal pain and altered bowel habits and is currently defined by symptom criteria and the absence of detectable organic disease. The underlying pathophysiology remains incompletely understood. Despite considerable efforts by the scientific community and the pharmaceutical industry to develop novel pharmacological treatments aimed at chronic visceral pain, the traditional approach to identifying and evaluating novel drugs for this target have largely failed to translate into effective IBS treatments. However, several novel drugs aimed at normalizing bowel movements have produced clinical effects, not only on the primary target, but also on pain and discomfort. While some of the commonly used experimental animal models for the pain dimension of IBS have some face and construct validity, the predictive validity of most of the models is either unknown, or has been disappointing. A reverse translational approach is proposed, which is based on identification and characterization of brain endophenotypes in patients, followed by translation of these endophenotypes for pharmacological studies in rodent models.

19 Review Stress-related modulation of inflammation in experimental models of bowel disease and post-infectious irritable bowel syndrome: role of corticotropin-releasing factor receptors. 2010

Kiank, Cornelia / Taché, Yvette / Larauche, Muriel. ·David Geffen School of Medicine at UCLA, CURE: Digestive Diseases Research Center-Animal Core, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. ckiank@mednet.ucla.edu ·Brain Behav Immun · Pubmed #19698778.

ABSTRACT: The interaction between gut inflammatory processes and stress is gaining increasing recognition. Corticotropin-releasing factor (CRF)-receptor activation in the brain is well established as a key signaling pathway initiating the various components of the stress response including in the viscera. In addition, a local CRF signaling system has been recently established in the gut. This review summarize the present knowledge on mechanisms through which both brain and gut CRF receptors modulate intestinal inflammatory processes and its relevance towards increased inflammatory bowel disease (IBD) activity and post-infectious irritable bowel syndrome (IBS) susceptibility induced by stress.

20 Review Role of biological rhythms in gastrointestinal health and disease. 2009

Hoogerwerf, Willemijntje A. ·Department of Internal Medicine, Division of Gastroenterology, VA Ann Arbor Healthcare System, University of Michigan, 2215 Fuller Road, Ann Arbor, MI 48105, USA. willemij@umich.edu ·Rev Endocr Metab Disord · Pubmed #19798581.

ABSTRACT: The molecular basis for biological rhythms is formed by clock genes. Clock genes are functional in the liver, within gastrointestinal epithelial cells and neurons of the enteric nervous system. These observations suggest a possible role for clock genes in various circadian functions of the liver and the gastrointestinal tract through the modulation of organ specific clock-controlled genes. Consequently, disruptions in circadian rhythmicity may lead to adverse health consequences. This review will focus on the current understanding of the role of circadian rhythms in the pathogenesis of gastrointestinal- and hepatic disease such as obesity, non-alcoholic fatty liver disease, alcoholic fatty liver disease and alterations in colonic motility.

21 Review The burden of IBS: looking at metrics. 2009

Spiegel, Brennan M R. ·VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, UCLA/VA Center for Outcomes Research and Education, 11301 Wilshire Boulevard, Building 115, Room 215, Los Angeles, CA 90073, USA. bspiegel@mednet.ucla.edu ·Curr Gastroenterol Rep · Pubmed #19615301.

ABSTRACT: Irritable bowel syndrome (IBS) is a prevalent and expensive condition that significantly impairs health-related quality of life (HRQOL) and reduces work productivity. Based on strict criteria, 7% to 10% of people have IBS worldwide. Community-based data indicate that IBS-diarrhea and IBS-mixed subtypes are more prevalent than IBS-constipation, and that patients may switch among subtype groups. IBS is 1.5 times more common in women than in men, more common in lower socioeconomic groups, and more commonly diagnosed in patients younger than 50 years of age. Patients with IBS visit the doctor more frequently, use more diagnostic tests, consume more medications, miss more workdays, have lower work productivity, are hospitalized more frequently, and consume more overall direct costs than those without IBS. Resource utilization is highest in patients with severe symptoms and poor HRQOL. Treatment decisions should be tailored to the severity of each patient's symptoms and HRQOL decrement.

22 Review Gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS)--is it one disease or an overlap of two disorders? 2009

Gasiorowska, Anita / Poh, Choo Hean / Fass, Ronnie. ·Neuroenteric Clinical Research Group, Southern Arizona VA Health Care System, University of Arizona, GI Section (1-111G-1), Tucson, AZ 85723-0001, USA. ·Dig Dis Sci · Pubmed #19082721.

ABSTRACT: Up to 79% of IBS patients report gastroesophageal reflux disease (GERD) symptoms, and up to 71% of GERD patients report irritable bowel syndrome (IBS) symptoms. There are two principal hypotheses for the common presence of IBS symptoms in GERD patients. The first theory suggests that GERD and IBS overlap in a significant number of patients. The second theory suggests that IBS-like symptoms are part of the spectrum of GERD manifestation. The first theory is supported by genetic studies and similarities in gastrointestinal sensory-motor abnormalities potentially due to general gastrointestinal disorder of smooth muscle or sensory afferents. The other theory is primarily supported by studies demonstrating improvement of IBS-like symptoms in GERD patients receiving anti-reflux treatment. The close relationship between GERD and IBS could be explained by either GERD affecting different levels of the GI tract or a high overlap rate between GERD and IBS due to similar underlying GI dysfunction.

23 Review New treatments for irritable bowel syndrome in women. 2008

Adeyemo, Mopelola A / Chang, Lin. ·Center for Neurobiology of Stress, Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 11301 Wilshire Blvd, Building 115, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. madeyemo@mednet.ucla.edu ·Womens Health (Lond) · Pubmed #19072463.

ABSTRACT: The estimated prevalence of irritable bowel syndrome (IBS) in Western countries is 7-15%, with a female:male ratio of 2-2.5:1 in IBS patients who seek healthcare services; however, the female predominance is lower in the general population. IBS has a significant impact on health-related quality of life and is associated with a significant healthcare and economic burden. Management of IBS is comprised of general measures and pharmacologic and nonpharmacologic treatment. However, there are ongoing efforts to find more effective therapeutic approaches. As advancements in the understanding of the pathophysiology of IBS continue to grow, new and effective treatments with novel mechanisms of action that have the potential to improve relief of IBS symptoms over current treatments are likely to be developed. This article provides an overview of current and emerging therapies for IBS and also highlights sex and gender differences in clinical trials and treatment response.

24 Review Complementary and alternative medicine for IBS in adults: mind-body interventions. 2008

Kearney, David J / Brown-Chang, Janelle. ·Gastroenterology Section, University of Washington School of Medicine, VA Puget Sound Health Care System, Seattle, WA 98108, USA. kearney@u.washington.edu ·Nat Clin Pract Gastroenterol Hepatol · Pubmed #18825145.

ABSTRACT: Standard treatment for IBS focuses on the management or alleviation of the predominant gastrointestinal presenting symptoms, such as diarrhea or constipation, often using pharmacological therapy. For many patients, this approach is unsatisfactory, and patients frequently seek the advice of complementary and alternative medicine (CAM) practitioners in order to explore other treatment options. CAM practices include a broad range of modalities, and mind-body interventions hold particular promise as treatment modalities for IBS because psychological factors could have an important role in IBS symptomatology and quality of life. Psychological stressors are postulated to result in gastrointestinal symptoms through alteration of intestinal function mediated by the autonomic nervous system, hypothalamic-pituitary-adrenal axis and immune system. Hypnotherapy has the strongest supportive evidence as a beneficial mind-body intervention for IBS. Clinical studies of hypnotherapy have uniformly shown improvement of gastrointestinal symptoms, anxiety, depression and quality of life in patients with IBS. Mindfulness meditation remains unstudied for IBS, but is theoretically attractive as a stress-reduction technique. There is a suggestion that relaxation therapy or multimodal therapy (a combination of relaxation therapy, education and psychotherapy) is beneficial for IBS. The most generally accepted psychological mind-body intervention is cognitive behavioral therapy, and clinical trials support the beneficial effects of cognitive behavioral therapy in patients with IBS.

25 Review Meta-analysis of probiotics for the treatment of irritable bowel syndrome. 2008

McFarland, Lynne V / Dublin, Sascha. ·Department of Health Services Research and Development, VA Puget Sound Health Care System, Seattle WA 98101, United States. lynne.mcfarland@va.gov ·World J Gastroenterol · Pubmed #18461650.

ABSTRACT: Irritable bowel syndrome (IBS) is a chronic condition affecting 3%-25% of the general population. As no curative treatment is available, therapy is aimed at reducing symptoms, often with little success. Because alteration of the normal intestinal microflora has been observed in IBS, probiotics (beneficial microbes taken to improve health) may be useful in reducing symptoms. This paper systematically reviews randomized, controlled, blinded trials of probiotics for the treatment of IBS and synthesizes data on efficacy across trials of adequate quality. PubMed, Medline, Google Scholar, NIH registry of clinical trials, metaRegister, and the Cochrane Central Register of Controlled Trials were searched from 1982-2007. We also conducted secondary searches of reference lists, reviews, commentaries, relevant articles on associated diseases, books and meeting abstracts. Twenty trials with 23 probiotic treatment arms and a total of 1404 subjects met inclusion criteria. Probiotic use was associated with improvement in global IBS symptoms compared to placebo [pooled relative risk (RR pooled) 0.77, 95% confidence interval (95% CI) 0.62-0.94]. Probiotics were also associated with less abdominal pain compared to placebo [RR pooled = 0.78 (0.69-0.88)]. Too few studies reported data on other IBS symptoms or on specific probiotic strains to allow estimation of a pooled RR. While our analyses suggest that probiotic use may be associated with improvement in IBS symptoms compared to placebo, these results should be interpreted with caution, given the methodological limitations of contributing studies. Probiotics warrant further study as a potential therapy for IBS.

Next