Irritable Bowel Syndrome: Li BU

Li BU. · No affiliation provided · Pediatr Ann. · Pubmed #19476294 No free full text.

Abstract: From the array of articles, one can readily see the clinical and scientific progress made in symptom-based diagnosis and management of functional abdominal pain disorders over the past 5 years. We have provided a series of useful tools to approach these patients. We have provided the symptom-based diagnostic criteria plus the red flags to help you avoid missing an organic diagnosis. We have placed these disorders squarely within the complex biopsychosocial framework by identifying early life stress and many environmental factors that are key factors in the development of pain. We have identified the role of psychological comorbidities of anxiety and depression and the need to address them directly in order to rehabilitate a disabled child. Finally, pharmacologic, psychological, dietary, and complementary approaches are reviewed and recommended as empiric therapy in functional abdominal pain, functional dyspepsia, and irritable bowel syndrome. Use these new tools well.

Noe JD, Li BU. · Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, W1 53226, USA. · Pediatr Ann. · Pubmed #19476298 No free full text.

Abstract: Recurrent abdominal pain is a common chronic complaint that presents to your office. The constant challenge is one of detecting those with organic disease from the majority who have a functional pain disorder including functional dyspepsia, irritable bowel syndrome, functional abdominal pain, and abdominal migraine. Beginning with a detailed history and physical exam, you can: 1) apply the symptom-based Rome III criteria to positively identify a functional disorder, and 2) filter these findings through the diagnostic clues and red flags that point toward specific organic disease and/or further testing. Once a functional diagnosis has been made or an organic disease is suspected, you can initiate a self-limited empiric therapeutic trial. With this diagnostic approach, you should feel confident navigating through the initial evaluation, management, and consultation referral for a child or adolescent with recurrent abdominal pain.

Besedovsky A, Li BU. · Division of Gastroenterology, Hepatology, and Nutrition, Children's Memorial Hospital, 2300 Children's Plaza, #57, Chicago, IL 60614-3394, USA. · Curr Gastroenterol Rep. · Pubmed #15128493 No free full text.

Abstract: Irritable bowel syndrome is a common functional gastrointestinal disorder that affects children and adults. The lack of consensus diagnostic criteria and pathophysiologic understanding has hampered clinical progress in diagnosing and treating this disorder. The recent development of the Rome diagnostic criteria, mapping of brain-gut pathways using neuroimaging, and serotonergic pharmacology have greatly advanced the field. Chronic and acute life stress, especially during childhood, has been recognized as central to the initiation of the disorder and the induction of acute symptoms. We propose a developmental continuum whereby the clinical presentation of irritable bowel syndrome changes with age from irritability during infancy, to diarrhea in toddlers, to recurring abdominal pain during school age, and to pain and altered bowel habits during later adolescence and adulthood.

Boles RG, Adams K, Li BU. · Division of Medical Genetics and the Saban Research Institute, Childrens Hospital Los Angeles, Los Angeles, California, USA. · Am J Med Genet A. · Pubmed #15643622 No free full text.

Abstract: Cyclic vomiting syndrome (CVS), characterized by severe discrete episodes of nausea, vomiting, and lethargy, is a fairly common, disabling, predominately-childhood condition most often associated with migraine and dysautonomic features. Our group recently reported that children with CVS and additional neuromuscular disease manifestations demonstrate strong maternal inheritance of multiple disease manifestations and abnormal urine organic acids, suggesting the presence of predisposing mitochondrial DNA (mtDNA) sequence variants. In order to determine if maternal inheritance is present in CVS in general, a clinical interview was administered regarding 80 unrelated individuals with CVS ascertained randomly from the database of the Cyclic Vomiting Syndrome Association (CVSA). Disease manifestations consistent with potential mitochondrial dysfunction were far more common in matrilineal (sharing the same mtDNA sequence) versus in non-matrilineal relatives, including mothers versus fathers (P = 3 x 10(-9)) and maternal versus paternal grandmothers (P = 2 x 10(-6)). Maternal inheritance is suggested in 52% of the 23 subjects with two or more neuromuscular abnormalities ("CVS+") and in 54% of the 44 subjects without any neuromuscular abnormalities ("CVS-"). In both the CVS+ and CVS- sub-groups, subjects, and affected matrilineal relatives of all ages suffer at a far higher incidence from several dysautonomic-related conditions, including migraine and irritable bowel, as well as depression and hypothyroidism, while neuromuscular and cognitive disorders such as hypotonia and ADHD are common only in affected children. We conclude that mtDNA sequences predispose towards the development of protean disease manifestations in CVS patients ascertained through a disease-specific association, as well as among their matrilineal relatives, whether or not neuromuscular disease is present in the proband. Since CVS was absent in all but one matrilineal relative of our probands, CVS is apparently a rare clinical presentation in individuals carrying the predisposing mtDNA sequences. The four conditions reported most frequently among the matrilineal relatives of our cases, migraine, depression, irritable bowel, and hypothyroidism, are known to segregate together in families, and our findings suggest that a common predisposing genetic factor is likely present on the mtDNA.