Irritable Bowel Syndrome

Vanner S. · No affiliation provided · Am J Gastroenterol. · Pubmed #18371132 No free full text.

Abstract: The findings of the lactulose breath test in irritable bowel syndrome patients have been used to suggest that most patients have small intestinal bacterial overgrowth (SIBO), and this association has spawned the widespread use of antibiotics in IBS. The study by Bratten and colleagues demonstrates that this test does not discriminate between IBS patients and healthy controls when criteria from recent clinical IBS studies are applied. When the findings from this large study are combined with previous smaller studies, they challenge the hypothesis that SIBO underlies the symptoms of IBS and undermine the current rationale for the use of antibiotics in IBS.

Qian JM. · No affiliation provided · Chin Med J (Engl). · Pubmed #18167177 links to  free full text

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Naliboff BD. · No affiliation provided · Am J Gastroenterol. · Pubmed #18042107 No free full text.

Abstract: There is an increasing interest in understanding the etiology and treatment of patients who present with multiple chronic symptoms. The thesis of this comment is that the understanding of these problems and progress on effective treatment will be greatly enhanced by emerging new models that go beyond dualistic distinctions like those between organic versus functional disorders and psychological versus physiological causation. The outline of this new model includes a focus on common neurobiological and behavioral mechanisms that operate across disorders including altered pain modulation, affect regulation, and illness coping. Exciting new areas of research include functional and structural brain imaging studies and more recent studies linking imaging with genetic markers, behavior, and autonomic responses. These new studies, carried out across illness populations, hold great promise to tie together the data on psychosocial, genetic, and biological mechanisms of these complicated clinical problems.

Husby S. · No affiliation provided · Ugeskr Laeger. · Pubmed #18031653 No free full text.

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Whitehead WE. · No affiliation provided · Am J Gastroenterol. · Pubmed #17897338 No free full text.

Abstract: Twin studies have traditionally been used to assess the heritability of diseases such as irritable bowel syndrome (IBS) by comparing concordance rates in monozygotic twins (identical genetic endowment) to dizygotic twins (half of genes shared). Wojczynski et al. used twins in a novel way-they studied monozygotic twins who were discordant for IBS (but who shared identical genes) to show that the comorbidity of IBS with major depressive disorder could NOT be due to genetic influences. This paradigm provides the most rigorous method for separating genetic from environmental influences and should be adopted by other researchers. However, the authors' conclusion that major depressive disorder and IBS are part of the same pathophysiological process is questioned on the basis of (a) incomplete co-occurrence of IBS and major depressive disorder (13-45% co-occurrence) and (b) lack of specificity-the authors show that chronic widespread pain (related to fibromyalgia) and chronic fatigue are also strongly associated with IBS. This study provides precise, generalizable estimates from a large population-based study for the comorbidity of IBS with major depressive disorder, chronic widespread pain, and chronic fatigue.

Brown RJ. · No affiliation provided · Clin Psychol Rev. · Pubmed #17707564 No free full text.

Abstract: This special issue is devoted to the topic of medically unexplained symptoms (MUS), a heterogeneous group of conditions characterized by persistent physical symptoms that cannot be explained by medical illness or injury. Although psychological factors have long been regarded as central to these problems, patients with MUS have typically been managed within medical settings and referrals to mental health services have been relatively rare. In recent years, however, interest in the psychological nature and treatment of MUS has expanded, culminating in the development of tailored psychological interventions for these conditions. This, coupled with the increasing willingness of practitioners to diagnose conditions such as chronic fatigue syndrome, fibromyalgia and irritable bowel syndrome, has led to an increase in the number of patients who are referred for psychological treatment. At present, however, many psychological therapists are unfamiliar with the literature on MUS. With this in mind, this special issue presents a series of papers that provide an overview of what is known about the nature, aetiology and treatment of medically unexplained illness. This introductory paper provides general information about the clinical presentation, diagnosis, classification, terminology and epidemiology of MUS in adults, and concludes with an examination of important areas for future development in the field. Subsequent papers address the psychological mechanisms [Deary, V., Chalder, T., & Sharpe, M. (2007-this issue). The cognitive behavioural model of medically unexplained symptoms: A theoretical and empirical review. Clinical Psychology Review; Iverson, A., Chalder, T., & Wessely, S. (2007-this issue). Gulf war illness: Lessons from medically unexplained illness. Clinical Psychology Review; Rief, W., & Broadbent, E. (2007-this issue). Explaining medically unexplained symptoms: Models and mechanisms. Clinical Psychology Review; Roelofs, K., & Spinhoven, P. (2007-this issue). Trauma and medically unexplained symptoms: Towards an integration of cognitive and neuro-biological accounts. Clinical Psychology Review] and management [Deary, V., Chalder, T., & Sharpe, M. (2007-this issue). The cognitive behavioural model of medically unexplained symptoms: A theoretical and empirical review. Clinical Psychology Review] of these conditions. A separate overview of the literature on MUS in children and adolescents is provided by Eminson [Eminson, J. (2007-this issue). Medically unexplained symptoms in children and adolescents. Clinical Psychology Review].

Tan KY, Seow-Choen F. · No affiliation provided · World J Gastroenterol. · Pubmed #17696243 links to  free full text

Abstract: Whilst fruits and vegetables are an essential part of our dietary intake, the role of fiber in the prevention of colorectal diseases remains controversial. The main feature of a high-fiber diet is its poor digestibility. Soluble fiber like pectins, guar and ispaghula produce viscous solutions in the gastrointestinal tract delaying small bowel absorption and transit. Insoluble fiber, on the other hand, pass largely unaltered through the gut. The more fiber is ingested, the more stools will have to be passed. Fermentation in the intestines results in build up of large amounts of gases in the colon. This article reviews the physiology of ingestion of fiber and defecation. It also looks into the impact of dietary fiber on various colorectal diseases. A strong case cannot be made for a protective effect of dietary fiber against colorectal polyp or cancer. Neither has fiber been found to be useful in chronic constipation and irritable bowel syndrome. It is also not useful in the treatment of perianal conditions. The fiber deficit - diverticulosis theory should also be challenged. The authors urge clinicians to keep an open mind about fiber. One must be aware of the truths and myths about fiber before recommending it.

Gwee KA, Wong RK. · No affiliation provided · J Gastroenterol Hepatol. · Pubmed #17688656 No free full text.

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Labus JS. · No affiliation provided · Gastroenterology. · Pubmed #17681186 No free full text.

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Shanahan F. · No affiliation provided · Gastroenterology. · Pubmed #17631152 No free full text.

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Bjarnason I. · No affiliation provided · Scand J Gastroenterol. · Pubmed #17613917 No free full text.

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Whorwell PJ. · No affiliation provided · Clin Exp Allergy. · Pubmed #17517093 No free full text.

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Crowell MD, Wessinger SB. · No affiliation provided · Expert Opin Investig Drugs. · Pubmed #17501688 No free full text.

Abstract: Interactions between the enteric nervous system of the gut and the brain occur bidirectionally over sympathetic and parasympathetic pathways. Coordinated actions of the central, autonomic and enteric nervous systems modulate intestinal motor, sensory and secretory activities by neuromodulators, including 5-HT, noradrenaline and dopamine. 5-HT is an important signaling molecule in the brain-gut axis and the 5-HT released from enterochromaffin cells modulates peristaltic, secretory, vasodilatory, vagal and nociceptive reflexes. Irritable bowel syndrome is associated with altered motility, secretion and sensation; enteric 5-HT signaling may be defective in this disorder. In this editorial, recent data are reviewed and the potential for the development of pharmacologic intervention is assessed.

North CS, Hong BA, Alpers DH. · No affiliation provided · World J Gastroenterol. · Pubmed #17465442 links to  free full text

Abstract: This article revisits the links between psychopathology and functional gastrointestinal disorders such as irritable bowel syndrome (IBS), discusses the rational use of antidepressants as well as non-pharmacological approaches to the management of IBS, and suggests guidelines for the treatment of IBS based on an interdisciplinary perspective from the present state of knowledge. Relevant published literature on psychiatric disorders, especially somatization disorder, in the context of IBS, and literature providing direction for management is reviewed, and new directions are provided from findings in the literature. IBS is a heterogeneous syndrome with various potential mechanisms responsible for its clinical presentations. IBS is typically complicated with psychiatric issues, unexplained symptoms, and functional syndromes in other organ systems. Most IBS patients have multiple complaints without demonstrated cause, and that these symptoms can involve systems other than the intestine, e.g. bones and joints (fibromyalgia, temporomandibular joint syndrome), heart (non-cardiac chest pain), vascular (post-menopausal syndrome), and brain (anxiety, depression). Most IBS patients do not have psychiatric illness per se, but a range of psychoform (psychological complaints in the absence of psychiatric disorder) symptoms that accompany their somatoform (physical symptoms in the absence of medical disorder) complaints. It is not correct to label IBS patients as psychiatric patients (except those more difficult patients with true somatization disorder). One mode of treatment is unlikely to be universally effective or to resolve most symptoms. The techniques of psychotherapy or cognitive-behavioral therapy can allow IBS patients to cope more readily with their illness. Specific episodes of depressive or anxiety disorders can be managed as appropriate for those conditions. Medications designed to improve anxiety or depression are not uniformly useful for psychiatric complaints in IBS, because the psychoform symptoms that sound similar to those seen in psychiatric disorders may not have the same significance in patients with IBS.

Barbara G. · No affiliation provided · Clin Gastroenterol Hepatol. · Pubmed #17428740 No free full text.

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Hecht G. · No affiliation provided · Gastroenterology. · Pubmed #17258742 No free full text.

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Spiller R, Bennett A. · No affiliation provided · Gastroenterology. · Pubmed #17241891 No free full text.

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Hungin P. · No affiliation provided · Occup Med (Lond). · Pubmed #17200127 No free full text.

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Drossman DA. · No affiliation provided · Ann Intern Med. · Pubmed #17043344 links to  free full text

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Geeraerts B, van Oudenhove L, Tack J. · No affiliation provided · Neurogastroenterol Motil. · Pubmed #17040405 No free full text.

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Azpiroz F. · No affiliation provided · Gastroenterology. · Pubmed #17030200 No free full text.

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Lacy BE. · No affiliation provided · J Clin Gastroenterol. · Pubmed #17016129 No free full text.

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Kaneko H. · No affiliation provided · J Gastroenterol. · Pubmed #16988774 No free full text.

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Hicks GA. · No affiliation provided · Neurogastroenterol Motil. · Pubmed #16918723 No free full text.

Abstract: Transient receptor potential (TRP) channels are involved in a wide range of processes ranging from osmoregulation, thermal, chemical and sensory signalling, and potentially in the pathophysiology associated with several diseases. Patents for TRPV1 antagonists alone span diseases ranging across chronic pain, neuropathies, headache, bladder disorders, irritable bowel syndrome (IBS), gastro-oesophageal reflux disease (GORD), and cough amongst others. Most research is currently focused around those TRP channels involved in sensory processes, with the neurogastroenterology and motility field playing a major role, for example, through recent discoveries of differential roles for TRPV receptor subtypes in chemosensitivity and mechanosensitivity of visceral afferents. At this time, however, the understanding of the role of even TRPV1, let alone most of the other TRP channels in disease pathophysiology is only just beginning, and although enthusiasm around the therapeutic potential for modulators of these channels is understandable, based largely upon the experience of the effects of natural ligands, such as capsaicin, the sheer size and complexity of the TRP family as a whole must serve as a warning against expecting too much too soon from drug discovery efforts.

Aziz Q. · No affiliation provided · Gastroenterology. · Pubmed #16890617 No free full text.

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