Irritable Bowel Syndrome

Spiller R, Aziz Q, Creed F, Emmanuel A, Houghton L, Hungin P, Jones R, Kumar D, Rubin G, Trudgill N, Whorwell P, Anonymous00175. · Wolfson Digestive Diseases Centre, University of Nottingham, Nottingham, UK. · Gut. · Pubmed #17488783 No free full text.

Abstract: BACKGROUND: IBS affects 5-11% of the population of most countries. Prevalence peaks in the third and fourth decades, with a female predominance. AIM: To provide a guide for the assessment and management of adult patients with irritable bowel syndrome. METHODS: Members of the Clinical Services Committee of The British Society of Gastroenterology were allocated particular areas to produce review documents. Literature searching included systematic searches using electronic databases such as Pubmed, EMBASE, MEDLINE, Web of Science, and Cochrane databases and extensive personal reference databases. RESULTS: Patients can usefully be classified by predominant bowel habit. Few investigations are needed except when diarrhoea is a prominent feature. Alarm features may warrant further investigation. Adverse psychological features and somatisation are often present. Ascertaining the patients' concerns and explaining symptoms in simple terms improves outcome. IBS is a heterogeneous condition with a range of treatments, each of which benefits a small proportion of patients. Treatment of associated anxiety and depression often improves bowel and other symptoms. Randomised placebo controlled trials show benefit as follows: cognitive behavioural therapy and psychodynamic interpersonal therapy improve coping; hypnotherapy benefits global symptoms in otherwise refractory patients; antispasmodics and tricyclic antidepressants improve pain; ispaghula improves pain and bowel habit; 5-HT(3) antagonists improve global symptoms, diarrhoea, and pain but may rarely cause unexplained colitis; 5-HT(4) agonists improve global symptoms, constipation, and bloating; selective serotonin reuptake inhibitors improve global symptoms. CONCLUSIONS: Better ways of identifying which patients will respond to specific treatments are urgently needed.

Anonymous00001, Michail S, Sylvester F, Fuchs G, Issenman R. · No affiliation provided · J Pediatr Gastroenterol Nutr. · Pubmed #17033538 No free full text.

Abstract: Probiotics are marketed in several countries and widely used by pediatric health care providers. Although probiotics can be helpful for specific disorders, they have been broadly prescribed for disorders without clear evidence to support their use. Furthermore, in certain specific conditions, probiotics cause clinical deterioration. This report is a review and evaluation of the evidence or lack thereof to support a beneficial effect of probiotic agents in a variety of pediatric conditions and to review the safety and potential adverse events that may be encountered when using probiotics. It is also important to emphasize that probiotics are highly heterogeneous with differences in composition, biological activity, and dose among the different probiotic preparations.

Tort S, Balboa A, Marzo M, Carrillo R, Mínguez M, Valdepérez J, Alonso-Coello P, Mascort JJ, Ferrándiz J, Bonfill X, Piqué JM, Mearin F, Anonymous00284, Anonymous00285, Anonymous00286. · Centro Cochrame Iberoamericano, Asociación Española de Gastroentología (AEG), Sociedad Española de Medicina de Familia y Comunitaria (SEMFYC). · Gastroenterol Hepatol. · Pubmed #17020681 No free full text.

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Schoenfeld P, Anonymous00106. · Gastroenterology Outcomes Research, University of Michigan School of Medicine, Ann Arbor, USA. · MedGenMed. · Pubmed #14603112 links to  free full text

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Anonymous00032. · No affiliation provided · Gastroenterology. · Pubmed #12454865 No free full text.

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Anonymous00104. · No affiliation provided · Am J Gastroenterol. · Pubmed #12425585 No free full text.

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Boukes FS, van der Horst HE, Assendelft WJ, Anonymous00196. · Nederlands Huisartsen Genootschap, Postbus 3231, 3502 GE Utrecht. · Ned Tijdschr Geneeskd. · Pubmed #12014237 No free full text.

Abstract: The diagnosis of 'irritable bowel syndrome' can usually already be established after history-taking and a limited physical examination, particularly if the symptoms have persisted for many years in the same form. Additional investigations are indicated in the case of diarrhoea which lasts longer than 2 weeks, especially if the patient is also severely unwell or has rectal bleeding; further investigations are also required if older patients experience the symptoms for the first time, if there is blood loss upon defecation, if unintentional weight loss occurs or if a mass is felt on the left side of the abdomen. Further investigations consist of a rectal examination, measurement of the sedimentation, haemoglobin concentration and leukocyte count, sigmoidoscopy and an X-ray of the colon. Treatment should aim to reduce unnecessary concern and avoidance behaviour, and to positively influence additional stress-inducing factors, nutrition and physical activity. Medication is not indicated except for laxatives if constipation plays an important role and if advice about nutrition and physical activity provide insufficient relief.

Jones J, Boorman J, Cann P, Forbes A, Gomborone J, Heaton K, Hungin P, Kumar D, Libby G, Spiller R, Read N, Silk D, Whorwell P. · Division of Gastroenterology, University Hospital, Nottingham, UK. · Gut. · Pubmed #11053260 links to  free full text

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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.

Morley JE, Steinberg KE. · No affiliation provided · J Am Med Dir Assoc. · Pubmed #19426933 No free full text.

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Simrén M. · No affiliation provided · Gastroenterology. · Pubmed #19327731 No free full text.

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Camilleri M. · No affiliation provided · Am J Gastroenterol. · Pubmed #19293789 No free full text.

Abstract: There is controversy on the validity of binary end points used in irritable bowel syndrome (IBS) clinical trials. In a usual-care observational study, baseline severity influenced the response measured as satisfactory relief. This editorial reviews the observations from a non-pharmacological study to assess the effect of baseline severity on the performance of binary end points in large drug trials. The pivotal finding is that once the patients who reported adequate relief at baseline were excluded from the analysis, baseline severity no longer affected the proportion of patients reporting adequate relief of IBS with treatment. As large drug trials enriched the study cohorts for at least moderate severity after a no-treatment, run-in period, it seems likely that the precaution of excluding mild disease de facto resolved the hypothetical weakness of the adequate relief end point. Given the high responsiveness and longitudinal construct validity demonstrated with adequate relief end point, it should be accepted as a trial end point.

Alonso C, Santos J. · No affiliation provided · Am J Gastroenterol. · Pubmed #19174802 No free full text.

Abstract: Irritable bowel syndrome remains a bothersome and frustrating disorder that imposes a heavy and growing socio-economic toll on its sufferers, two-thirds of whom are women, and on health care systems. The biomedical community must take a giant step forward into the discipline of women's gastrointestinal health. Efforts and accomplishments, such as the one reported in this month's issue by Cremon et al., are certainly welcome.

Tobin MC, Keshavazian A, Farhardi A. · No affiliation provided · Expert Rev Gastroenterol Hepatol. · Pubmed #19072394 No free full text.

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Chiarioni G, Palsson OS, Whitehead WE. · No affiliation provided · World J Gastroenterol. · Pubmed #19009639 links to  free full text

Abstract: Hypnosis is a therapeutic technique that primarily involves attentive receptive concentration. Even though a small number of health professionals are trained in hypnosis and lingering myths and misconceptions associated with this method have hampered its widespread use to treat medical conditions, hypnotherapy has gained relevance as an effective treatment for irritable bowel syndrome not responsive to standard care. More recently, a few studies have addressed the potential influence of hypnosis on upper digestive function and disease. This paper reviews the efficacy of hypnosis in the modulation of upper digestive motor and secretory function. The present evidence of the effectiveness of hypnotherapy as a treatment for functional and organic diseases of the upper bowel is also summarized, coupled with a discussion of potential mechanisms of its therapeutic action.

Jones R. · No affiliation provided · BMJ. · Pubmed #19008267 No free full text.

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Curtiss FR. · No affiliation provided · J Manag Care Pharm. · Pubmed #19006445 links to  free full text

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Quigley EM. · No affiliation provided · Clin Gastroenterol Hepatol. · Pubmed #18996497 No free full text.

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Hanauer SB. · No affiliation provided · Nat Clin Pract Gastroenterol Hepatol. · Pubmed #18974750 No free full text.

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Youssef NN, Perez ME. · No affiliation provided · J Pediatr. · Pubmed #18940348 No free full text.

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Enck P, Klosterhalfen S, Zipfel S, Martens U. · No affiliation provided · J Psychosom Res. · Pubmed #18501255 No free full text.

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Fairman KA. · No affiliation provided · J Manag Care Pharm. · Pubmed #18500916 links to  free full text

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Huett A, Xavier RJ. · No affiliation provided · Gastroenterology. · Pubmed #18486617 No free full text.

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Brandt LJ. · No affiliation provided · Am J Gastroenterol. · Pubmed #18477347 No free full text.

Abstract: The authors conducted a well-designed, multinational, large study of women younger than 65 yr of age with irritable bowel syndrome (IBS) with a mixed pattern of diarrhea and constipation (IBS-M) or constipation (IBS-C) and showed that a statistically greater percentage of patients in each group responded to tegaserod compared with patients treated with placebo. Practicality looms large, however, in that the Food and Drug Administration (FDA) disallowed the continued marketing of tegaserod because of cardiovascular safety concerns, and it now is only available under a restricted access program. The wisdom of this decision aside, it is disturbing that the FDA revealed a zero-tolerance for any significant risk of disease when a drug (e.g., tegaserod) was used for a nonlife-threatening condition; the FDA chose to neglect any potential benefit of significant improvement in quality of life, while at the same time allowing the continued availability of sildenifil for erectile dysfunction and other medications (e.g., rosiglitazone and nonsteroidal anti-inflammatory drugs [NSAIDs]), each with a far greater risk of cardiovascular complications. Whether tegaserod will be re-released and, if so, under what conditions, is yet to be determined, as is the question of whether the FDA will decide to allow a more transparent decision-making process with input from all interested parties affected by their decision.

McFarland LV. · No affiliation provided · World J Gastroenterol. · Pubmed #18461647 links to  free full text

Abstract: Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are two of the leading causes of chronic intestinal conditions in the world. This issue of World Journal of Gastroenterology (WJG) presents a series of papers from world experts who discuss the current knowledge and opinions on these important conditions. Although great strides have been made in the diagnosis, treatment and pathology of IBS and IBD; much has yet to be explained. The etiologies and risk factors of these multifactorial conditions remain elusive. Specific diagnostic biomarkers need to be developed and safer treatments developed. The burden of IBS and IBD on the healthcare system is felt with repeated medical care visits and high costs. IBS and IBD patients can account for 30%-50% of office visits at gastroenterology services/clinics. Over one million people have IBD in the United States, with 30000 new cases being diagnosed every year. One-quarter million people in the UK are afflicted with IBD. The cost of medical care in the United States for IBD is estimated to be 1.8 billion dollars/year.