Am J Gastroenterol. 2003 Oct;98(10):2209-18. Related Articles, Links
A randomized controlled trial of cognitive behavior therapy, relaxation training,
and routine clinical care for the irritable bowel syndrome.
Boyce PM, Talley NJ, Balaam
B, Koloski NA, Truman G.
Department of Psychological
Medicine, University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia.
OBJECTIVES: Psychological treatments are considered
to be useful in the irritable bowel syndrome (IBS), although the evidence is based on small, often flawed trials. Although
cognitive behavior therapy (CBT) and relaxation therapy have both been promising, we hypothesized that CBT would be superior
to relaxation and standard care alone in IBS patients. The objective of this study was to test this assumption by comparing
the effects of cognitive behavior therapy with relaxation therapy and routine clinical care alone in individuals with IBS.
METHODS: Patients (n = 105) with Rome I criteria for IBS were recruited from advertisement (n = 51) and outpatient clinics
(n = 54); those patients with resistant IBS were not included. A randomized controlled trial with three arms (standard care
for all groups plus either CBT or relaxation) for 8 wk was conducted, which applied blinded outcome assessments using validated
measures with 1 yr of follow-up. The primary outcome for this study was bowel symptom severity. RESULTS: Of 105 patients at
the commencement of treatment, the mean bowel symptom frequency score for the whole sample was 21.1 and at the end of treatment
had fallen to 18.1; this persisted at the 52-wk follow-up, with a significant linear trend for scores to change over time
(F = 39.57 p < 0.001). However, there were no significant differences among the three treatment conditions. Significant
changes over time were found for physical functioning (F = 4.37, p < 0.001), pain (F = 3.12, p < 0.05), general health
(F = 2.71, p < 0.05), vitality (F = 2.94, p < 0.05), and the social functioning scales on the Medical Outcomes Study
Short Form 36 (F = 4.08, p < 0.05); however, all three arms showed similar improvement. There were significant reductions
in anxiety, depression, and locus of control scales, but no significant differences among the treatment groups were detected.
CONCLUSION: Cognitive behavior and relaxation therapy seem not to be superior to standard care alone in IBS.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 14572570 [PubMed - indexed for MEDLINE]
Gut. 2003 Nov;52(11):1623-9. Related Articles, Links
Long term benefits of hypnotherapy for irritable
bowel syndrome.
Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ.
Department of Medicine, University Hospital of
South Manchester, Manchester, UK. wgonsalkorale@compuserve.com
BACKGROUND AND AIMS: There is now good evidence
from several sources that hypnotherapy can relieve the symptoms of irritable bowel syndrome in the short term. However, there
is no long term data on its benefits and this information is essential before the technique can be widely recommended. This
study aimed to answer this question. PATIENTS AND METHODS: 204 patients prospectively completed questionnaires scoring symptoms,
quality of life, anxiety, and depression before, immediately after, and up to six years following hypnotherapy. All subjects
also subjectively assessed the effects of hypnotherapy retrospectively in order to define their "responder status". RESULTS:
71% of patients initially responded to therapy. Of these, 81% maintained their improvement over time while the majority of
the remaining 19% claimed that deterioration of symptoms had only been slight. With respect to symptom scores, all items at
follow up were significantly improved on pre-hypnotherapy levels (p<0.001) and showed little change from post-hypnotherapy
values. There were no significant differences in the symptom scores between patients assessed at 1, 2, 3, 4, or 5+ years following
treatment. Quality of life and anxiety or depression scores were similarly still significantly improved at follow up (p<0.001)
but did show some deterioration. Patients also reported a reduction in consultation rates and medication use following the
completion of hypnotherapy. CONCLUSION: This study demonstrates that the beneficial effects of hypnotherapy appear to last
at least five years. Thus it is a viable therapeutic option for the treatment of irritable bowel syndrome.
PMID: 14570733 [PubMed - indexed for MEDLINE]
Pain. 2003 Sep;105(1-2):17-25. Related Articles, Links
The contributions of suggestion, desire, and expectation
to placebo effects in irritable bowel syndrome patients. An empirical investigation.
Vase L, Robinson ME, Verne GN, Price DD.
Department of Psychology, University of Aarhus,
Asylvej 4, 8240 Risskov, Denmark.
In order to investigate external factors that
may influence the magnitude of placebo analgesia as well as psychological factors that mediate placebo analgesia, 13 irritable
bowl syndrome (IBS) patients rated evoked rectal distension and cutaneous heat pain under the conditions of natural history
(NH), rectal placebo (RP), rectal nocebo (RN), rectal lidocaine (RL) and oral lidocaine (OL). Patients were given verbal suggestions
for pain relief and rated expected pain levels and desire for pain relief for both evoked visceral and cutaneous pain, respectively.
Large reductions in pain intensity and pain unpleasantness ratings were found in the RP, RL and OL condition as compared to
the natural history condition, whereas no significant difference in pain reduction between the three treatment conditions
was found. Ratings during RN and NH were not statistically different. Compared to a previous study, which shows that rectal
lidocaine reverses visceral and cutaneous hyperalgesia, these results suggest that adding a verbal suggestion for pain relief
can increase the magnitude of placebo analgesia to that of an active agent. Since IBS patients rate these stimuli as much
higher than do normal control subjects and since placebo effects were very large, they probably reflect anti-hyperalgesic
mechanisms to a major extent. Expected pain levels and desire for pain relief accounted for large amounts of the variance
in visceral pain intensity in the RP, RL, and OL condition (up to 81%), and for lower amounts of the variance in cutaneous
pain intensity. Hence, the combination of expected pain levels and desire for pain relief may offer an alternative means of
assessing the contribution of placebo factors during analgesia.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 14499416 [PubMed - indexed for MEDLINE]
Rev Gastroenterol Disord. 2003;3 Suppl 2:S18-24. Related Articles, Links
Traditional therapies for irritable bowel syndrome:
an evidence-based appraisal.
Fennerty MB.
Division of Gastroenterology, Oregon Health and
Science University, Portland, Oregon, USA.
Irritable bowel syndrome (IBS) is a common chronic
disease that adversely effects quality of life and is associated with substantial direct and indirect health care costs. It
is defined by a constellation of symptoms in conjunction with an alteration in bowel function and defecation, and its underlying
pathophysiological basis remains unknown. Numerous therapies are available, but many relieve only one symptom of the syndrome,
and their effectiveness has not been demonstrated with adequate evidence from high-quality studies. This article reviews the
criteria for appropriate design of any treatment study as well as those criteria specific to studies of treatment for functional
gastrointestinal diseases. Using these criteria, the author evaluates the published investigations of "traditional" IBS
therapies (antidepressants, bulking agents/fiber, antispasmodics, antidiarrheals) and "alternative" IBS therapies (Chinese
herbal supplements, peppermint oil, behavioral therapies). Based on this evaluation, the author concludes that the available
evidence does not support the effectiveness of any of these treatments and, therefore, none of these treatments can be reliably
recommended.
Publication Types:
Review
Review, Tutorial
PMID: 12775999 [PubMed - indexed for MEDLINE]
Dig Dis Sci. 2004 Jan;49(1):73-7. Links
A 14-day elemental diet is highly effective in
normalizing the lactulose breath test.
Pimentel M, Constantino T, Kong Y, Bajwa M, Rezaei
A, Park S.
GI Motility Program, Division of Gastroenterology,
Department of Medicine, Cedars-Sinai Medical Center, CSMC Burns & Allen Research Institute, Los Angeles, California 90048,
USA. mark.pimentel@cshs.org
Treatment of small intestinal bacterial overgrowth
is frustrated by the low efficacy of antibiotics. Elemental diets have been shown to reduce enteric flora. In this study,
we evaluate the ability of an elemental diet to normalize the lactulose breath test (LBT) in IBS subjects with abnormal breath
test findings. Consecutive subjects with IBS and abnormal LBT suggesting the presence of bacterial overgrowth underwent a
2-week exclusive elemental diet. The diet consisted of Vivonex Plus (Novartis Nutrition Corp., Minneapolis, MN) in a quantity
based on individual caloric requirement. On day 15 (prior to solid food), subjects returned for a follow-up breath test and
those with an abnormal LBT were continued on the diet for an additional 7 days. The ability of an elemental diet to normalize
the LBT was determined for days 15 and 21. A chart review was then conducted to evaluate any clinical benefit 1 month later.
Of the 93 subjects available for analysis, 74 (80%) had a normal LBT on day 15 of the elemental diet. When those who continued
to day 21 were included, five additional patients normalized the breath test (85%). On chart review, subjects who successfully
normalized their breath test had a 66.4 +/- 36.1% improvement in bowel symptoms, compared to 11.9 +/- 22.0% in those who failed
to normalize (P < 0.001). An elemental diet is highly effective in normalizing an abnormal LBT in IBS subjects, with a
concomitant improvement in clinical symptoms.
Publication Types:
Evaluation Studies
PMID: 14992438 [PubMed - indexed for MEDLINE]Turk
J Gastroenterol. 2003 Jun;14(2):128-31. Related Articles, Links
Irritable bowel syndrome prevalence in city center
of Sivas.
Karaman N, Turkay C, Yonem O.
Department of Internal Medicine, Cumhuriyet University,
Sivas, Turkey.
BACKGROUND/AIMS: We planned to determine irritable
bowel syndrome prevalence in our region with its distribution according to clinical characteristics of patients and the factors
which are considered to be related with irritable bowel syndrome. METHODS: 998 of 1250 individuals (mean age 38.99+0.44) replied
to our questionnaire including Rome II criteria. RESULTS: We found the irritable bowel syndrome prevalence in the city center
of Sivas to be 19.1%. Distribution of irritable bowel syndrome (+) patients age groups showed no significant difference but
irritable bowel syndrome was significantly more common in females. The most common occupation showing irritable bowel syndrome
positivity was workers. Irritable bowel syndrome prevalence was also significantly higher in persons not eating three regular
meals per day. There was a significantly positive correlation between irritable bowel syndrome prevalence and psychological
events, previous abdominal operations and infections. A change in bowel habitus was observed in 41.8% of irritable bowel syndrome
patients, and the most common change was constipation. 39.8% of the irritable bowel syndrome patients had applied to the doctor,
most often to doctors of internal medicine. We found the irritable bowel syndrome prevalence not to be related with educational
status, smoking, daily tea and coffee consumption, alcohol intake, menstrual periods or weight loss. CONCLUSION: Irritable
bowel syndrome prevalence in our region with its demographic characteristics was similar to the results seen in western countries.
PMID: 14614640 [PubMed - indexed for MEDLINE]
Minerva Med. 2002 Oct;93(5):403-12. Related Articles, Links
Role of food hypersensitivity in irritable bowel
syndrome.
Zar S, Kumar D, Kumar D.
OGEM Department, St. Georges Hospital Medical
School, London, UK.
A significant proportion of IBS patients attribute
their symptoms to adverse food reactions. Dietary elimination and re-challenge studies support the role of diet in the pathogenesis
of IBS. The aetiopathogenesis of IBS is thought to be multifactorial involving an interaction between diet, infection, antibiotics
and psychosocial factors. Serum IgE and IgG4 antibodies are elevated in food hypersensitivity induced atopic conditions and
a similar mechanism has been postulated in IBS. Increased number of mast cells is present in the ileocaecal region of IBS
patients. Once sensitized, they are capable of inducing secretory and sensorimotor abnormalities of the gut. The management
of IBS is usually aimed at controlling symptoms, however, evaluation of food hypersensitivity may provide a useful adjunct
in those with severe symptoms or a clear history of adverse food reaction. There are no well-established tests available
but skin prick tests and food specific serum IgG4 and IgE antibodies may help in identifying the offending foods. Other options,
which may be explored in individual cases, include sequential dietary exclusion, use of hypoallergenic diets, disodium cromoglycate
and novel techniques such as colonoscopic allergen provocation test. Pathophysiology of hypersensitivity induced IBS has been
discussed in the light of current data and a management algorithm has been proposed for managing food hypersensitivity in
IBS.
Publication Types:
Review
Review Literature
PMID: 12410172 [PubMed - indexed for MEDLINE]
Br J Nutr. 2002 Sep;88 Suppl 1:S67-72. Related Articles, Links
A review of the role of the gut microflora in
irritable bowel syndrome and the effects of probiotics.
Madden JA, Hunter JO.
Gastroenterology Research Unit, Unit E7, Box 201
A, Addenbrookes NHS Trust, Hill's Road, CB2 2QQ, Cambridge, UK.
Irritable bowel syndrome (IBS) is a multi-factorial
gastrointestinal condition affecting 8-22 % of the population with a higher prevalence in women and accounting for 20-50 %
of referrals to gastroenterology clinics. It is characterised by abdominal pain, excessive flatus, variable bowel habit and
abdominal bloating for which there is no evidence of detectable organic disease. Suggested aetiologies include gut motility
and psychological disorders, psychophysiological phenomena and colonic malfermentation. The faecal microflora in IBS has been
shown to be abnormal with higher numbers of facultative organisms and low numbers of lactobacilli and bifidobacteria. Although
there is no evidence of food allergy in IBS, food intolerance has been identified and exclusion diets are beneficial to many
IBS patients. Food intolerance may be due to abnormal fermentation of food residues in the colon, as a result of disruption
of the normal flora. The role of probiotics in IBS has not been clearly defined. Some studies have shown improvements
in pain and flatulence in response to probiotic administration, whilst others have shown no symptomatic improvement. It is
possible that the future role of probiotics in IBS will lie in prevention, rather than cure.
Publication Types:
Review
Review, Tutorial
PMID: 12215182 [PubMed - indexed for MEDLINE]
J Clin Gastroenterol. 2002 Jul;35(1 Suppl):S45-52. Related Articles, Links
Diet in the irritable bowel syndrome.
Floch MH, Narayan R.
Gastroenterology & Nutrition Section, Norwalk
Hospital, Yale University School of Medicine, Norwalk, Connecticut, USA. martinfloch@snet.net
Patients with irritable bowel syndrome (IBS) often
request dietary recommendations. They must eat, and they want to know what to eat. Present national guidelines recommend dietary
treatment with fiber for IBS patients with constipation. Diet recommendations are made based on symptoms. There may be different
dietary recommendations for constipation, diarrhea, and pain or bloating. This article reviews the relationship of foods to
IBS and issues of food intolerances and hypersensitivities, and recommendations for diet therapy. The role of dietary fiber,
both soluble and insoluble, is reviewed. Although there are few studies to substantiate exact diets, broad dietary
plans are recommended for the different symptoms of IBS. In addition, the recent literature on probiotics and prebiotics pertinent
to IBS is reviewed.
Publication Types:
Review
Review, Tutorial
PMID: 12184139 [PubMed - indexed for MEDLINE]
Expert Opin Investig Drugs. 2001 Jul;10(7):1211-22. Related Articles, Links
Irritable bowel syndrome: an update on therapeutic
modalities.
Farhadi A, Bruninga K, Fields J, Keshavarzian
A.
Department of Internal Medicine (Division of Digestive
Disease), Pharmacology, Molecular Biophysics and Physiology, Rush University Medical Center, Chicago IL, USA.
Irritable bowel syndrome (IBS) is the most common
condition that a physician faces in the GI clinic. Of the general population, 10 - 25% suffer from symptoms judged to be IBS.
The negative impact of this disease includes not only pain, suffering and direct medical expenses but also significant social
and job-related consequences. IBS can be the result of dysfunction in any part of the brain-gut axis: alterations in the CNS
caused by psychological or other factors, abnormal gastrointestinal motility, or heightened visceral sensations. Diagnosis
is based on either the Manning or Rome-II criteria. Education, reassurance and emotional support are the cornerstones of successful
treatment. The mainstays of the current therapeutic approach continue to be: stress management strategies, dietary modification
entailing addition of dietary fibre and pharmacotherapy. Pharmacotherapy is still limited to treating symptoms. Newer drugs
that modulate motility or drugs that modulate visceral sensation may be useful in selected cases. Psychopharmacological agents
are useful in the treatment of IBS, especially in those with psychological co-morbidity. Alternative therapies such as homeopathy,
acupuncture, special diets, herbal medication and several forms of psychological treatments and hypnotherapy are sought by
many patients and are now being offered by physicians as treatment options, either alone or in conjunction with conventional
forms of therapy in patients with refractory symptoms.
Publication Types:
Review
Review, Tutorial
PMID: 11772245 [PubMed - indexed for MEDLINE]
Am J Gastroenterol. 1998 Jul;93(7):1131-5. Related Articles, Links
Peppermint oil for irritable bowel syndrome: a
critical review and metaanalysis.
Pittler MH, Ernst E.
Department of Complementary Medicine, Postgraduate
Medical School, University of Exeter, United Kingdom.
OBJECTIVE: Peppermint oil is the major constituent
of several over-the-counter remedies for symptoms of irritable bowel syndrome (IBS). As the etiology of IBS is not known and
treatment is symptomatic, there is a ready market for such products. However, evidence to support their use is sparse. The
aim of this study was to review the clinical trials of extracts of peppermint (Mentha X piperita L.) as a symptomatic treatment
for IBS. METHODS: Computerized literature searches were performed to identify all randomized controlled trials of peppermint
oil for IBS. Databases included Medline, Embase, Biosis, CISCOM, and the Cochrane Library. There were no restrictions on the
language of publication. Data were extracted in a standardized, predefined fashion, independently by both authors. Five double
blind, randomized, controlled trials were entered into a metaanalysis. RESULTS: Eight randomized, controlled trials were located.
Collectively they indicate that peppermint oil could be efficacious for symptom relief in IBS. A metaanalysis of five placebo-controlled,
double blind trials seems to support this notion. In view of the methodological flaws associated with most studies, no
definitive judgment about efficacy can be given. CONCLUSION: The role of peppermint oil in the symptomatic treatment of IBS
has so far not been established beyond reasonable doubt. Well designed and carefully executed studies are needed to clarify
the issue.
Publication Types:
Meta-Analysis
PMID: 9672344 [PubMed - indexed for MEDLINE]
JAMA. 1998 Nov 11;280(18):1585-9. Related Articles, Links
Comment in:
ACP J Club. 1999 May-Jun;130(3):74.
JAMA. 1999 Sep 15;282(11):1035-6; author reply
1036-7.
JAMA. 1999 Sep 15;282(11):1035; author reply 1036-7.
JAMA. 1999 Sep 15;282(11):1036-7.
Treatment of irritable bowel syndrome with Chinese
herbal medicine: a randomized controlled trial.
Bensoussan A, Talley NJ, Hing M, Menzies R, Guo
A, Ngu M.
Research Unit for Complementary Medicine, University
of Western Sydney Macarthur, Campbelltown, New South Wales, Australia. a.bensoussan@uws.edu.au
CONTEXT: Irritable bowel syndrome (IBS) is a common
functional bowel disorder for which there is no reliable medical treatment. OBJECTIVE: To determine whether Chinese herbal
medicine (CHM) is of any benefit in the treatment of IBS. DESIGN: Randomized, double-blind, placebo-controlled trial conducted
during 1996 through 1997. SETTING: Patients were recruited through 2 teaching hospitals and 5 private practices of gastroenterologists,
and received CHM in 3 Chinese herbal clinics. PATIENTS: A total of 116 patients who fulfilled the Rome criteria, an established
standard for diagnosis of IBS. INTERVENTION: Patients were randomly allocated to 1 of 3 treatment groups: individualized Chinese
herbal formulations (n = 38), a standard Chinese herbal formulation (n = 43), or placebo (n = 35). Patients received 5 capsules
3 times daily for 16 weeks and were evaluated regularly by a traditional Chinese herbalist and by a gastroenterologist. Patients,
gastroenterologists, and herbalists were all blinded to treatment group. MAIN OUTCOME MEASURES: Change in total bowel symptom
scale scores and global improvement assessed by patients and gastroenterologists and change in the degree of interference
in life caused by IBS symptoms assessed by patients. RESULTS: Compared with patients in the placebo group, patients in the
active treatment groups (standard and individualized CHM) had significant improvement in bowel symptom scores as rated by
patients (P=.03) and by gastroenterologists (P=.001), and significant global improvement as rated by patients (P=.007) and
by gastroenterologists (P=.002). Patients reported that treatment significantly reduced the degree of interference with life
caused by IBS symptoms (P=.03). Chinese herbal formulations individually tailored to the patient proved no more effective
than standard CHM treatment. On follow-up 14 weeks after completion of treatment, only the individualized CHM treatment group
maintained improvement. CONCLUSION: Chinese herbal formulations appear to offer improvement in symptoms for some patients
with IBS.
Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled Trial
PMID: 9820260 [PubMed - indexed for MEDLINE]
Curr Treat Options Gastroenterol. 2003 Aug;6(4):339-345.
Related Articles, Links
Food Intolerance: Dietary Treatments in Functional
Bowel Disorders.
O'Sullivan M, O'Morain C.
Department of Gastroenterology, Adelaide & Meath Hospital, Trinity
College, Tallaght, Dublin 24, Ireland. maria.osullivan@amnch.ie
Currently, there is little convincing scientific evidence
from well-designed trials to support the role of dietary modification or exclusions in irritable bowel syndrome (IBS). Similarly,
there is an absence of conclusive data linking any dietary components directly to the pathogenesis of IBS. The role of diet,
as a single modality, is unlikely to play a major role in treating IBS. Dietary modifications should be viewed as a valuable
part of a multicomponent management approach in combination with other strategies such as lifestyle, behavioral, and pharmacologic
therapy.
PMID: 12846943 [PubMed - as supplied by publisher]
Eur J Gastroenterol Hepatol. 2001 Aug;13(8):941-4.
Related Articles, Links
The effect of a lactose-restricted diet in
patients with a positive lactose tolerance test, earlier diagnosed as irritable bowel syndrome: a 5-year follow-up study.
Bohmer
CJ, Tuynman HA.
Department of Gastroenterology, Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands. CJM.Bohmer@azvu.nl
DESIGN
AND METHODS: Prospectively, the effect of a lactose-restricted diet was evaluated among irritable bowel syndrome patients
with lactose malabsorption. Lactose malabsorption was defined by a positive hydrogen breath test and a positive blood-glucose
test. An analysis of symptoms was completed before, during, 6 weeks after and 5 years after starting the diet. In addition,
the number of visits made by the patients to the outpatient clinic was scored during 6 years. RESULTS: In 17 out of 70 irritable
bowel syndrome patients (24.3%), lactose malabsorption was detected. There was no difference in the symptom score between
patients with a positive lactose tolerance test and patients with a negative lactose tolerance test. After 6 weeks of the
lactose-restricted diet, symptoms were markedly improved in lactose malabsorption-positive patients (P < 0.001). After
5 years, one patient was lost for follow-up, and 14 out of the remaining 16 lactose malabsorption patients (87.5%) still had
no complaints during the lactose-restricted diet. Two patients chose not to follow the diet continuously and accepted the
discomfort caused by lactose intake. Only two out of 16 patients (12.5%) no longer experienced any benefit from lactose restriction.
In the 5 years before their diagnosis of lactose malabsorption, these 16 patients visited the outpatient clinic a total of
192 times (mean 2.4 visits per year per person; range 1-7 visits). In the 5 years after diagnosis, they visited the outpatient
clinic a total of 45 times (mean 0.6 visits per year per person; range 0-6 visits; P < 0.0001). CONCLUSIONS: In a large
majority of irritable bowel syndrome patients with lactose malabsorption, which was previously clinically unrecognized, a
lactose-restricted diet improved symptoms markedly both in the short term and the long term. Furthermore, visits by all patients
to the outpatient clinic were reduced by 75%. We conclude that diet therapy is extremely cost- and time-saving. Therefore,
it is strongly recommended that lactose malabsorption, which is easily treatable, is excluded before diagnosing irritable
bowel syndrome.
PMID: 11507359 [PubMed - indexed for MEDLINE]
Minerva Med. 2002 Oct;93(5):403-12. Related Articles, Links
Role of food hypersensitivity in irritable bowel
syndrome.
Zar S, Kumar D, Kumar D.
OGEM Department, St. Georges Hospital Medical School, London, UK.
A
significant proportion of IBS patients attribute their symptoms to adverse food reactions. Dietary elimination and re-challenge
studies support the role of diet in the pathogenesis of IBS. The aetiopathogenesis of IBS is thought to be multifactorial
involving an interaction between diet, infection, antibiotics and psychosocial factors. Serum IgE and IgG4 antibodies are
elevated in food hypersensitivity induced atopic conditions and a similar mechanism has been postulated in IBS. Increased
number of mast cells is present in the ileocaecal region of IBS patients. Once sensitized, they are capable of inducing secretory
and sensorimotor abnormalities of the gut. The management of IBS is usually aimed at controlling symptoms, however, evaluation
of food hypersensitivity may provide a useful adjunct in those with severe symptoms or a clear history of adverse food reaction.
There are no well-established tests available but skin prick tests and food specific serum IgG4 and IgE antibodies may help
in identifying the offending foods. Other options, which may be explored in individual cases, include sequential dietary exclusion,
use of hypoallergenic diets, disodium cromoglycate and novel techniques such as colonoscopic allergen provocation test. Pathophysiology
of hypersensitivity induced IBS has been discussed in the light of current data and a management algorithm has been proposed
for managing food hypersensitivity in IBS.
Publication Types:
Review
Review Literature
PMID: 12410172 [PubMed - indexed for MEDLINE]
Eur J Gastroenterol Hepatol. 2001 Mar;13(3):219-25.
Related
Articles, Links
Irritable bowel syndrome: is the search for
lactose intolerance justified?
Parker TJ, Woolner JT, Prevost AT, Tuffnell Q, Shorthouse M, Hunter JO.
Department
of Gastroenterology, Addenbrooke's Hospital, Cambridge, UK.
OBJECTIVES: To determine if confirmation of hypolactasia
offers any benefit to the dietary treatment of patients with irritable bowel syndrome (IBS). METHODS: One hundred and twenty-two
consecutive IBS patients (37 male, 85 female) were given lactose hydrogen breath tests (LHBT). Those with positive LHBT followed
a low lactose diet for 3 weeks. Those improving on the diet were given double-blind, placebo-controlled challenges (DBPCC)
with 5 g, 10 g and 15 g of lactose and a placebo, to confirm lactose intolerance. Those who did not respond to the low lactose
diet followed either an exclusion or low fibre diet. Symptoms scores were kept prior to the LHBT, 8 h post-LHBT and daily
whilst following any dietary change. Patients with negative LHBT returned to clinic and subsequent dietary interventions were
recorded. RESULTS: LHBT was positive in 33/122 (27%) IBS patients. Syrr otom scores prior to LHBT were not significantly different
between the two groups, but after LHBT the symptoms in the positive group were significantly worse. Twenty-three patients
followed a low-lactose diet of which only nine (39%) improved. Six who did not improve followed an exclusion diet, three improved
and all were intolerant of milk. Three tried a low fibre diet with two improving. DBPCC were inconclusive. In the negative
LHBT group 35 agreed to try a diet and 24 improved (69%). Eight were intolerant of cow's milk. CONCLUSIONS: Use of a low
lactose diet was disappointing in IBS patients with lactose malabsorption. Food intolerance was demonstrated in IBS patients
with positive or negative LHBT and milk was identified as a problem in both groups. DBPCC were inconclusive. There appears
to be little advantage in trying to separate patients who malabsorb lactose from others with IBS.
PMID: 11293439 [PubMed
- indexed for MEDLINE]
Scand J Gastroenterol. 2000 Oct;35(10):1048-52.
Related Articles, Links
Fructose- and sorbitol-reduced diet improves
mood and gastrointestinal disturbances in fructose malabsorbers.
Ledochowski M, Widner B, Bair H, Probst T, Fuchs D.
Dept.
of Clinical Nutrition, Institute of Medical Chemistry and Biochemistry, University of Innsbruck, Austria.
BACKGROUND:
Fructose malabsorption is characterized by the inability to absorb fructose efficiently. As a consequence fructose reaches
the colon where it is broken down by bacteria to short fatty acids, CO2 and H2. Bloating, cramps, osmotic diarrhea and other
symptoms of irritable bowel syndrome are the consequences and can be seen in about 50% of fructose malabsorbers. We have previously
shown that fructose malabsorption is associated with early signs of mental depression and low serum tryptophan concentrations.
It was therefore of interest whether a fructose-reduced diet could not only improve gastrointestinal complaints but also depressive
signs seen in fructose malabsorbers. METHODS: Fifty-three adults (12 males, 41 females), who were identified as fructose malabsorbers
according to their breath-H2 concentrations, filled out a Beck's depression inventory-questionnaire, and a questionnaire with
arbitrary scales for measurement of meteorism, stool frequency and quality of life for a 4-week period before dietary intervention
and 4 weeks after dietary change as for fructose- and sorbitol-reduced diet. RESULTS: Depression scores were reduced by 65.2%
after 4 weeks of diet (P < 0.0001), and there was a significant reduction of meteorism (P < 0.0001) and stool frequency
(P < 0.01). Improvement of signs of depression and of meteorism was more pronounced in females than in males. CONCLUSION:
Fructose- and sorbitol-reduced diet in subjects with fructose malabsorption does not
only reduce gastrointestinal symptoms but also improves mood and early signs of depression.
Publication Types:
Clinical Trial
PMID: 11099057 [PubMed - indexed for MEDLINE]
Indian J Gastroenterol. 2000 Oct-Dec;19(4):161-4.
Related Articles, Links
Comment in:
Indian J Gastroenterol. 2000 Oct-Dec;19(4):156-7.
Effect of cold pressor test and a high-chilli
diet on rectosigmoid motility in irritable bowel syndrome.
Shah SK, Abraham P, Mistry FP.
Department of Gastroenterology,
KEM Hospital, Mumbai.
AIM: Visceral hypersensitivity characterizes the irritable bowel syndrome (IBS). We evaluated
the effect of a cold pressor test (CPT)--hand immersion in ice water for 1 minute, which evokes a sympathetic response--on
rectosigmoid motility in patients with IBS and normal volunteers. Since many Indian patients with IBS complain of worsening
of symptoms following a spicy meal, we also evaluated whether a high-chilli diet affects symptoms or changes rectosigmoid
motility. METHODS: Fifteen men with IBS and 13 normal volunteers (all men) were studied. Baseline rectosigmoid manometry was
done for 2 h, i.e., 1 h pre- and 1 h post-CPT. The subjects were then kept in hospital on a regular diet (approximately 5
g chilli daily) for 3 days, following which symptoms were reassessed and manometry repeated for 1 h. This was followed by
a high-chilli diet (approximately 15 g/day) for 3 days, after which symptoms were reassessed and manometry repeated for 1
h. RESULTS: There was no difference in the baseline study in the pre-CPT period between patients and control subjects. CPT
did not change rectosigmoid motility in either group. IBS patients had varied effect on symptoms but no change in rectosigmoid
motility after the high-chilli diet. In the normal volunteers, there was increased activity in the low rectum after the high-chilli
diet. CONCLUSIONS: Cold pressor test does not affect rectosigmoid motility in patients with IBS or normal subjects. A high-chilli
diet has varied effect on symptoms in patients with IBS and does not affect rectosigmoid motility.
Publication Types:
Clinical Trial
Controlled Clinical Trial
PMID: 11059180 [PubMed - indexed for MEDLINE]
Gut. 2003 May;52(5):663-70. Related Articles, Links
Comment in:
Gut. 2003 May;52(5):619-21.
Increased platelet depleted plasma 5-hydroxytryptamine
concentration following meal ingestion in symptomatic female subjects with diarrhoea predominant irritable bowel syndrome.
Houghton
LA, Atkinson W, Whitaker RP, Whorwell PJ, Rimmer MJ.
Academic Department of Medicine, University Hospital of South
Manchester, Manchester, UK. lahoughton@man.ac.uk
BACKGROUND: Meal ingestion is often associated with exacerbation of
gastrointestinal symptoms in subjects with irritable bowel syndrome (IBS). Furthermore, recent preliminary data suggest that
5-hydroxytryptamine (5-HT) concentration in platelet poor plasma is elevated following meal ingestion in some subjects with
diarrhoea predominant IBS (d-IBS) compared with healthy subjects, although it is not known whether this is related to postprandial
symptomatology. Aim: To expand on previous data by evaluating a larger number of subjects but also to assess plasma 5-hydroxyindole
acetic acid (5-HIAA) concentrations, 5-HT turnover, platelet 5-HT stores, and any relationship to symptomatology. METHODS:
We assessed platelet depleted plasma 5-HT and 5-HIAA concentrations for two hours (60 minute intervals) under fasting conditions,
and then for a further four hours (30 minute intervals) after a standard carbohydrate meal (457 kcal), together with fasting
platelet 5-HT concentrations in 39 female subjects with d-IBS (aged 19-52 years; mean age 33) and 20 healthy female volunteers
(aged 20-46 years, mean age 28). IBS symptomatology, in particular abdominal pain and bloating, and urgency to defecate were
assessed throughout the study RESULTS: When related to fasting levels, there was no statistically significant difference in
postprandial plasma 5-HT concentrations between d-IBS and healthy subjects. However, when fasting levels were not taken into
consideration, d-IBS subjects exhibited higher postprandial plasma 5-HT concentrations compared with healthy subjects (p=0.040).
Furthermore, d-IBS subjects who exhibited postprandial symptomatology had higher levels of postprandial plasma 5-HT, whether
assessed with respect to fasting baseline levels (p=0.069) or not (p=0.047), compared with d-IBS subjects who did not report
postprandial symptomatology. This appeared to be associated with a concomitant increase in plasma 5-HIAA (p=0.161) but reduction
in turnover (p=0.058). Lastly, d-IBS subjects had higher platelet concentrations of 5-HT than healthy subjects (p=0.009).
CONCLUSIONS: These data suggest that postprandial symptomatology may be associated with increased platelet depleted plasma
5-HT concentrations in female subjects with d-IBS. In addition, the presence of increased platelet stores of 5-HT may act
as a useful marker for the diagnosis and management of d-IBS.
PMID: 12692050 [PubMed - indexed for MEDLINE]
Arch Intern Med. 2003 Feb 10;163(3):265-74. Related Articles, Links
A systematic review of alternative therapies in
the irritable bowel syndrome.
Spanier JA, Howden CW, Jones MP.
Department of Internal Medicine, Northwestern
Memorial Hospital, 251 E Huron, Galter 4-104, Chicago, IL 60611, USA.
The irritable bowel syndrome is a common disorder
associated with a significant burden of illness, poor quality of life, high rates of absenteeism, and high health care utilization.
Management can be difficult and treatment unrewarding; these facts have led physicians and patients toward alternative therapies.
We explored a variety of treatments that exist beyond the scope of commonly used therapies for irritable bowel syndrome. Guarded
optimism exists for traditional Chinese medicine and psychological therapies, but further well-designed trials are needed.
Oral cromolyn sodium may be useful in chronic unexplained diarrhea and appears as effective as and safer than elimination
diets. The roles of lactose and fructose intolerance remain poorly understood. Alterations of enteric flora may play a
role in irritable bowel syndrome, but supporting evidence for bacterial overgrowth or probiotic therapy is lacking.
Publication
Types:
Review
Review, Academic
PMID: 12578506 [PubMed - indexed for MEDLINE]
Curr Treat Options Gastroenterol. 2002 Aug;5(4):267-278.
Related Articles, Links
Irritable Bowel Syndrome.
Sach JA, Chang
L.
UCLA/CURE Neuroenteric Disease Program, 11301 Wilshire Blvd Bldg 115, Room 213, Los Angeles, CA 90073, USA. E-mail:
joelsach@yahoo.com
Because treatment of irritable bowel syndrome (IBS) patients can be frustrating to the clinician
and patient as well, the physician should strive to gain the patient's confidence with a concise, appropriate work-up and
by offering reassurance and education that IBS is a functional disorder without significant long-term health risks. First-line
treatment should be aimed at treating the most bothersome symptom. Tricyclic antidepressants are superior to placebo in reducing
abdominal pain scores, as well as improving global symptom severity. Loperamide is superior to placebo in managing IBS-associated
diarrhea. Whereas fiber has a role in treating constipation, its value for IBS or, specifically, in the relief of abdominal
pain or diarrhea associated with IBS is controversial. Although certain antispasmodics have demonstrated superiority over
placebo in managing abdominal pain, none of these agents are available in the United States. Probiotic therapy using Lactobacillus
plantarum has demonstrated superiority to placebo in improving pain, regulating bowel habits, and decreasing flatulence.
As studied in a recent placebo-controlled prospective study, Chinese herbal medicines significantly improved bowel symptom
scores and global symptom profile, and reduced IBS-related quality of life impairment. Some of the most promising emerging
therapies in IBS revolve around targeted pharmacotherapeutic modulation of serotonin receptors (ie, 5-HT3 and 5-HT4 subtypes),
which are involved in sensory and motor functions of the gut. Other investigational agents that are also being explored include
cholecystokinin antagonists, alpha2-adrenergic agonists (eg, clonidine), serotonin reuptake inhibitors (eg, citalopram), and
neurokinin antagonists. IBS is best understood through the biopsychosocial paradigm, and therefore, its effective management
requires a comprehensive multidisciplinary approach based on patient education and reassurance, enhanced by diet recommendations
and lifestyle modifications, and complemented by pharmacotherapy and psychosocial intervention in more severe cases.
PMID:
12095474 [PubMed - as supplied by publisher]
Lancet. 2002 Aug 17;360(9332):555-64. Related Articles, Links
Irritable bowel syndrome: a little understood
organic bowel disease?
Talley NJ, Spiller R.
Department of Medicine, University of Sydney, NSW, Australia. ntalley@med.usyd.edu
Irritable
bowel syndrome affects 10% of adults with an unexplained female predominance. Although only a few people see their family
doctor, the disease causes reduced quality of life and represents a multi-billion pound health-care problem. The disorder
clusters in families, which is possibly because of intra-familial learning and a genetic predisposition. Visceral hypersensitivity
is a key feature in most patients. Results of imaging studies of regional cerebral blood flow during rectal distension suggest
underlying disturbances of central processing of afferent signals, though this is not unique to the disorder, since it is
seen in other chronic pain syndromes. Environmental factors that are strongly implicated in at least some patients include
gastrointestinal infection and inflammation and chronic stress. Diagnosis is based on positive symptoms and absence of any
alarm indicators. Treatment remains unsatisfactory and hinges on an excellent doctor-patient relationship, with drugs for
symptom exacerbations. Cognitive behavioural treatment, psychotherapy, and hypnosis could provide long-lasting benefit in
some patients. Tricyclic antidepressants in low doses seem to be the most effective class of drugs for the disorder on the
basis of limited data.
Publication Types:
Review
Review Literature
PMID: 12241674 [PubMed - indexed for MEDLINE]
Br J Nutr. 2002 Sep;88 Suppl 1:S67-72. Related Articles, Links
A review of the role of the gut microflora in
irritable bowel syndrome and the effects of probiotics.
Madden JA, Hunter JO.
Gastroenterology Research Unit,
Unit E7, Box 201 A, Addenbrookes NHS Trust, Hill's Road, CB2 2QQ, Cambridge, UK.
Irritable bowel syndrome (IBS)
is a multi-factorial gastrointestinal condition affecting 8-22 % of the population with a higher prevalence in women and accounting
for 20-50 % of referrals to gastroenterology clinics. It is characterised by abdominal pain, excessive flatus, variable
bowel habit and abdominal bloating for which there is no evidence of detectable organic disease. Suggested aetiologies include
gut motility and psychological disorders, psychophysiological phenomena and colonic malfermentation. The faecal microflora
in IBS has been shown to be abnormal with higher numbers of facultative organisms and low numbers of lactobacilli and bifidobacteria.
Although there is no evidence of food allergy in IBS, food intolerance has been identified and exclusion diets are beneficial
to many IBS patients. Food intolerance may be due to abnormal fermentation of food residues in the colon, as a result of disruption
of the normal flora. The role of probiotics in IBS has not been clearly defined. Some studies have shown improvements in pain
and flatulence in response to probiotic administration, whilst others have shown no symptomatic improvement. It is possible
that the future role of probiotics in IBS will lie in prevention, rather than cure.
Publication Types:
Review
Review, Tutorial
PMID: 12215182 [PubMed - indexed for MEDLINE]
Dig Dis Sci. 2002 Aug;47(8):1697-704. Related Articles, Links
High-fiber diet supplementation in patients
with irritable bowel syndrome (IBS): a multicenter, randomized, open trial comparison between wheat bran diet and partially
hydrolyzed guar gum (PHGG).
Parisi GC, Zilli M, Miani MP, Carrara M, Bottona E, Verdianelli G, Battaglia G, Desideri
S, Faedo A, Marzolino C, Tonon A, Ermani M, Leandro G.
Servizio di Gastroenterologia, Casa di Cura Abano Terme USL
16, Padova, Italy.
High-fiber diet supplementation is commonly used in IBS, although it poses several management problems.
Partially hydrolyzed guar gum (PHGG) has shown beneficial effects in animal and human studies, but its potential role in IBS
symptom relief has not been evaluated yet. We investigated PHGG in IBS patients and compared it to a wheat bran diet. Abdominal
pain, bowel habits, and subjective overall rating were longitudinally evaluated in 188 adult IBS patients (139 women and 49
men) for 12 weeks. Patients were classified as having diarrhea-predominant, constipation-predominant, or changeable bowel
habits and were randomly assigned to groups receiving fiber (30 g/day of wheat bran) or PHGG (5 g/day). After four weeks,
patients were allowed to switch group, depending on their subjective evaluation of their symptoms. Significantly more patients
switched from fiber to PHGG (49.9%) than from PHGG to fiber (10.9%) at four weeks. Per protocol analysis showed that both
fiber and PHGG were effective in improving pain and bowel habits, but no difference was found between the two groups. Conversely,
intention-to-treat analysis showed a significantly greater success in the PHGG group (60%) than in the fiber group (40%).
Moreover, significantly more patients in the PHGG group reported a greater subjective improvement than those in the Fiber
group. In conclusion, improvements in core IBS symptoms (abdominal pain and bowel habits) were observed with both bran and
PHGG, but the latter was better tolerated and preferred by patients, revealing a higher probability of success than bran and
a lower probability of patients abandoning the prescribed regimen, suggesting that it can increase the benefits deriving from
fiber intake in IBS, making it a valid option to consider for high-fiber diet supplementation.
Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled Trial
PMID: 12184518 [PubMed - indexed for MEDLINE]
Aliment Pharmacol Ther. 2002 Aug;16(8):1395-406.
Related Articles, Links
The treatment of irritable bowel syndrome.
Thompson
WG.
University of Ottawa, Ottawa, Ontario, Canada. wgthomson@rogers.com
The efforts of clinical researchers,
lay organizations and pharmaceutical companies have increased the public profile of irritable bowel syndrome and made it a
respectable diagnosis. Diagnostic symptom criteria encourage a firm clinical diagnosis, which is the foundation of a logical
management strategy. This begins with education. Reassurance that no structural disease threatens should be tempered with
the reality that symptoms are likely to recur over many years. Patients expect diet and lifestyle advice, even if this is
not specific to irritable bowel syndrome. Only a few of those with irritable bowel syndrome see doctors, and even fewer see
specialists. Therefore, the treating physician should ascertain the reason for the visit, the patient's fears and the presence
of any comorbid illness, such as depression, that might require treatment in its own right. No drug treatment is useful for
all of the symptoms of irritable bowel syndrome, and many patients require no drug at all. If used, drugs should target the
predominant symptom. Alosetron, a 5-HT3 antagonist, is effective in treating women with irritable bowel syndrome who also
have diarrhoea. Tegaserod, a 5-HT4 agonist, is useful for women with irritable bowel syndrome who are constipated. Most patients
with irritable bowel syndrome need psychological support. Reassurance, discussion and relaxation techniques can be provided
by the family doctor. Difficult psychopathology may require referral to a mental health professional, and the gastroenterologist
can settle diagnostic uncertainties. In all cases, successful treatment depends on a confident diagnosis and the strength
of the doctor-patient relationship.
Publication Types:
Review
Review, Tutorial
PMID: 12182740 [PubMed - indexed for MEDLINE]
Am J Gastroenterol. 2002 Jun;97(6):1463-7. Related
Articles, Links
Comment in:
Am J Gastroenterol. 2003 Mar;98(3):707-8.
Celiac disease and irritable bowel-type symptoms.
O'Leary
C, Wieneke P, Buckley S, O'Regan P, Cronin CC, Quigley EM, Shanahan F.
Department of Medicine, National University
of Ireland, Cork.
OBJECTIVES: Previous reports have linked irritable bowel syndrome (IBS) etiologically with various
forms of mucosal inflammation, including infectious enterocolitides and inflammatory bowel disease. The mechanism is uncertain
but may involve sensitization by inflammatory mediators. The enteropathy of celiac disease has theoretical advantages as a
study model because it can be controlled with dietary gluten exclusion; however, whether it also predisposes to functional
bowel disorders is unclear. Therefore, we assessed the prevalence of IBS-type symptoms in adult celiac patients and correlated
this with dietary compliance with gluten exclusion. METHODS: Adult patients (n = 150; 106 women and 44 men) with confirmed
celiac disease were randomly selected from a computerized database of >350 patients, and were asked to complete a bowel
questionnaire and the Short Form 36 Health Survey (SF-36). The control group (n = 162; 133 women and 29 men) had no history
of celiac disease and had similar mean age and sex profile. RESULTS: Of 150 celiac patients reviewed, 30 of 150 (20%) fulfilled
the Rome criteria compared with eight of 162 (5%) controls. Of the celiac patients 10 of 46 (22%) had partial or no compliance
with a gluten-free diet, whereas 20 of 104 patients (19%) adhered to the diet; this difference did not achieve statistical
significance. Celiac patients with IBS-type symptoms had a markedly lower quality of life than those without, all eight domains
being impaired to a clinically significant extent. Dietary gluten exclusion improved QOL in four of eight scales measured.
CONCLUSIONS: The hypothesis that mucosal inflammation in celiac disease may have a sensitizing effect or may predispose to
IBS-type symptoms is supported by these results. Failure to attain optimal subjective well-being is common in celiac patients,
particularly in those with coexisting IBS. Compliance with a gluten-free diet confers some benefit.
PMID: 12094866
[PubMed - indexed for MEDLINE]
Clin Pediatr (Phila). 2002 Apr;41(3):145-50. Related
Articles, Links
Irritable bowel syndrome and nonspecific diarrhea
in infancy and childhood--relationship with juice carbohydrate malabsorption.
Moukarzel AA, Lesicka H, Ament ME.
Division
of Pediatric Gastroenterology and Nutrition, State University of New York Health Sciences at Brooklyn, USA.
Lactose
intolerance and malabsorbed carbohydrate present in some fruit juice may trigger symptoms commonly seen in irritable bowel
syndrome. In a two-site study, 28 subjects 9 months to 18 years old (mean 6.9 +/- 5.9 years) with significant intake of apple
juice or pear nectar (> 6 oz a day) with the diagnoses of irritable bowel syndrome, functional abdominal pain, or chronic
nonspecific diarrhea were recruited. Breath hydrogen tolerance tests utilizing lactose, sucrose, and apple juice in the amount
they typically consumed were positive in 32%, 0%, and 50%, respectively. Subjects were asked to refrain from the ingestion
ofjuice for 1 month: 13 of the 28 (46%) subjects improved while 15 (54%) showed no change in their symptoms. In fact, none
consuming 6 to 12 oz of apple or pear juice daily improved, 27% of those consuming 12 to 16 oz improved, and 91% of those
consuming > 16 oz improved (P < 0.02). Subjects were then given comparable amounts of white grape juice for 1 year.
The initial symptoms did not recur in any of the subjects who initially responded to the juice-free diet. Of the 15 subjects
who did not respond to the juice-free diet, seven became asymptomatic. Overall, 20 subjects (71%) were asymptomatic, and eight
(29%) had no change in their symptoms. Some individuals with irritable bowel syndrome have their symptoms based on their malabsorption
of carbohydrates present in apple juice and pear nectar and may improve with adequate choices of fruit juice such as changing
to white grape juice.
PMID: 11999677 [PubMed - indexed for MEDLINE]
Dig Dis Sci. 2002 Feb;47(2):345-55. Related Articles, Links
Distal colonic motor activity in four subgroups
of patients with irritable bowel syndrome.
Cole SJ, Duncan HD, Claydon AH, Austin D, Bowling TE, Silk DB.
Department
of Gastroenterology and Nutrition, Central Middlesex Hospital, London, United Kingdom.
With the aim of improving end
organ treatment, we describe a new system of classifying irritable bowel syndrome (IBS) according to clinical features into
four groups, spastic colon syndrome (SCS), functional diarrhea (FD), diarrhea-predominant spastic colon syndrome (DPSCS),
and midgut dysmotility (MGD). The aim of the study was to investigate fasting and postprandial distal colonic motility in
the four groups of patients and to compare the results with normal controls. Distal colonic motility studies were performed
in the unprepared colon. 2.5-hr recordings were made from four channels with a standard meal administered at 0.5 hr. The intubated
colon was treated as a study segment and data analyzed for study segment activity index (SSAI) and number and mean amplitude
of pressure peaks over 30-min epochs. Patients with SCS had significantly higher (P < 0.05) mean amplitude of pressure
peaks (60 min, 120 min) and SSAI (120 min) than controls and patients with FD, DPSCS, and MGD. In contrast, patients with
FD and DPSCS had significantly (P < 0.05) lower postprandial SSAI than controls and patients with SCS (60 min, 120 min).
With the exception of raised postprandial mean amplitude of pressure peaks (120 min), MGD patients had normal distal colonic
motility. Division of IBS patients into subgroups has highlighted significant differences in distal colonic motility that
provide insights into etiopathogenesis and should assist targeting of current and newly developed therapies, particularly
receptor active agents.
PMID: 11858232 [PubMed - indexed for MEDLINE]
Eur J Gastroenterol Hepatol. 2001 Aug;13(8):933-9.
Related Articles, Links
The management of irritable bowel syndrome:
a European, primary and secondary care collaboration.
Thompson WG, Hungin AP, Neri M, Holtmann G, Sofos S, Delvaux
M, Caballero-Plasencia A.
University of Ottawa, Ontario, Canada. wgthompson@home.com
OBJECTIVE: To develop recommendations
for the diagnosis and management of irritable bowel syndrome for European doctors delivering primary care. These recommendations
can be adapted by local medical groups according to their language, custom and health-care systems. METHODS: Twenty-one general
practitioners and gastroenterologists from Europe attended a workshop planned by a steering committee. After a state-of-the-art
symposium, four working groups considered the following aspects of irritable bowel syndrome management: what to tell the patient,
diagnosis, non-medical treatment and psychosocial management. Current and future drug management was reviewed by the steering
committee. The resulting recommendations were considered at two plenary sessions during the meeting, and by circulation of
the material during development of the manuscript. RESULTS: The process permitted a unique dialogue between general practitioners
and gastroenterologists, in which it was necessary to reconcile the specialists' emphasis on thoroughness with the practical,
epidemiological and economic realities of primary care. Despite this dichotomy, consensus was achieved. CONCLUSIONS: European
general practitioners and gastroenterologists have produced recommendations that emphasize education of the patient, a positive
symptom-based diagnosis, diet and lifestyle advice, psychological support and a critical analysis of current specific
psychological and pharmacological treatments.
Publication Types:
Consensus Development Conference
Review
PMID: 11507358 [PubMed - indexed for MEDLINE]
Aliment Pharmacol Ther. 2003 Mar 1;17(5):635-42.
Related Articles, Links
Gut-focused hypnotherapy normalizes disordered
rectal sensitivity in patients with irritable bowel syndrome.
Lea R, Houghton LA, Calvert EL, Larder S, Gonsalkorale
WM, Whelan V, Randles J, Cooper P, Cruickshanks P, Miller V, Whorwell PJ.
Academic Department of Medicine, University
Hospital of South Manchester, UK.
BACKGROUND: We have previously shown that hypnotherapy alters rectal sensitivity
in some patients with irritable bowel syndrome. However, this previous study used incremental volume distension of a latex
balloon, which might be susceptible to subject response bias and might compromise the assessment of compliance. In addition,
the study group was symptomatically rather than physiologically defined. AIM: To assess the effect of hypnotherapy on rectal
sensitivity in hypersensitive, hyposensitive and normally sensitive irritable bowel syndrome patients using a distension technique
(barostat) that addresses these technical issues. METHODS: Twenty-three irritable bowel syndrome (Rome I) patients (aged 24-72
years) were assessed before and after 12 weeks of hypnotherapy in terms of rectal sensitivity, symptomatology, anxiety and
depression. Normal values for sensitivity were established in 17 healthy volunteers (aged 20-55 years). RESULTS: Compared
with controls, 10 patients were hypersensitive, seven hyposensitive and six normally sensitive before treatment. Following
hypnotherapy, the mean pain sensory threshold increased in the hypersensitive group (P = 0.04) and decreased in the hyposensitive
group, although the latter failed to reach statistical significance (P = 0.19). Normal sensory perception was unchanged. Sensory
improvement in the hypersensitive patients tended to correlate with a reduction in abdominal pain (r = 0.714, P = 0.07). CONCLUSION:
Hypnotherapy improves abnormal sensory perception in irritable bowel syndrome, leaving normal sensation unchanged.
PMID:
12641511 [PubMed - indexed for MEDLINE]
Am J Gastroenterol. 2003 Jan;98(1):135-43. Related
Articles, Links
Irritable bowel syndrome patients show enhanced
modulation of visceral perception by auditory stress.
Dickhaus B, Mayer EA, Firooz N, Stains J, Conde F, Olivas TI,
Fass R, Chang L, Mayer M, Naliboff BD.
University of California, Department of Medicine, Los Angeles (UCLA)/CNS: Center
for Neurovisceral Sciences & Women's Health, VA Greater Los Angeles Healthcare System, Los Angeles, California 90073,
USA.
OBJECTIVES: Symptoms in irritable bowel syndrome (IBS) patients are sensitive to psychological stressors. These
effects may operate through an enhanced responsiveness of the emotional motor system, a network of brain circuits that modulate
arousal, viscerosomatic perception, and autonomic responses associated with emotional responses, including anxiety and anger.
The aim of this study was to test the primary hypothesis that IBS patients show altered perceptual responses to rectal balloon
distention during experimentally induced psychological stress compared with healthy control subjects. METHODS: A total of
15 IBS patients (nine women and six men) and 14 healthy controls (seven women and seven men) were studied during two laboratory
sessions: 1) a mild stress condition (dichotomous listening to two conflicting types of music), and 2) a control condition
(relaxing nature sounds). The stress and relaxation auditory stimuli were delivered over a 10-min listening period preceding
rectal distentions and during the rectal distentions but not during the distention rating process. Ratings of intensity and
unpleasantness of the visceral sensations, subjective emotional responses, heart rate, and neuroendocrine measures (norepinephrine,
cortisol, adrenocorticotropic hormone [ACTH], and prolactin) were obtained during the study. RESULTS: IBS patients, but
not healthy controls, rated the 45-mm Hg visceral stimulus significantly higher in terms of intensity and unpleasantness during
the stress condition compared with the relaxation condition. IBS patients also reported higher ratings of stress, anger,
and anxiety during the stress compared with the relaxing condition, whereas controls had smaller and nonsignificant subjective
responses. Heart rate measurements, but not other neuroendocrine stress measures, were increased under the stress condition
in both groups. CONCLUSION: These findings confirm the hypothesis of altered stress-induced modulation of visceral perception
in IBS patients.
PMID: 12526949 [PubMed - indexed for MEDLINE]
Behav Res Ther. 2002 May;40(5):541-6. Related Articles, Links
A one year follow-up of relaxation response
meditation as a treatment for irritable bowel syndrome.
Keefer L, Blanchard EB.
Center for Stress and Anxiety
Disorders, University at Albany, State University of New York, 12203, USA. lannekeefer@aol.com
Ten of thirteen original
participants with Irritable Bowel Syndrome (IBS) participated in a one year follow-up study to determine whether the effects
of Relaxation Response Meditation (RRM) on IBS symptom reduction were maintained over the long-term. From pre-treatment to
one-year follow-up, significant reductions were noted for the symptoms of abdominal pain (p = 0.017), diarrhea (p =
0.045), flatulence (p = 0.030), and bloating (p = 0.018). When we examined changes from the original three month follow-up
point to the one year follow-up, we noted significant additional reductions in pain (p = 0.03) and bloating (p = 0.04), which
tended to be the most distressing symptoms of IBS. It appears that: (1) continued use of meditation is particularly effective
in reducing the symptoms of pain and bloating; and (2) RRM is a beneficial treatment for IBS in the both short- and the long-term.
PMID:
12038646 [PubMed - indexed for MEDLINE]
Am J Gastroenterol. 2002 Apr;97(4):954-61. Related
Articles, Links
Hypnotherapy in irritable bowel syndrome:
a large-scale audit of a clinical service with examination of factors influencing responsiveness.
Gonsalkorale WM,
Houghton LA, Whorwell PJ.
Department of Medicine, University Hospital of South Manchester, United Kingdom.
OBJECTIVES:
Hypnotherapy has been shown to be effective in the treatment of irritable bowel syndrome in a number of previous research
studies. This has led to the establishment of the first unit in the United Kingdom staffed by six therapists that provides
this treatment as a clinical service. This study presents an audit on the first 250 unselected patients treated, and these
large numbers have also allowed analysis of data in terms of a variety of other factors, such as gender and bowel habit type,
that might affect outcome. METHODS: Patients underwent 12 sessions of hypnotherapy over a 3-month period and were required
to practice techniques in between sessions. At the beginning and end of the course of treatment, patients completed questionnaires
to score bowel and extracolonic symptoms, quality of life, and anxiety and depression, allowing comparisons to be made. RESULTS:
Marked improvement was seen in all symptom measures, quality of life, and anxiety and depression (all ps < 0.001), in keeping
with previous studies. All subgroups of patients appeared to do equally well, with the notable exception of males with diarrhea,
who improved far less than other patients (p < 0.001). No factors, such as anxiety and depression or other prehypnotherapy
variables, could explain this lack of improvement. CONCLUSIONS: This study clearly demonstrates that hypnotherapy remains
an extremely effective treatment for irritable bowel syndrome and should prove more cost-effective as new, more expensive
drugs come on to the market. It may be less useful in males with diarrhea-predominant bowel habit, a finding that may have
pathophysiological implications.
PMID: 12003432 [PubMed - indexed for MEDLINE]
The Relaxation Response
Dr. Benson describes the practice of the" Relaxation Response" technique as follows:
1.
Sit quietly in a comfortable position.
2.
Close your eyes.
3.
Deeply relax all your muscles, beginning at your feet and progressing up to your face. Keep them relaxed.
4.
Breathe through your nose. Become aware of your breathing. As you breathe out, say the word, "ONE," silently to yourself.
For example breathe IN... OUT, "ONE; IN...OUT, "ONE", etc. Breathe easily and naturally.
5.
Continue for 10 to 20 minutes. You may open your eyes to check the time, but do not use an alarm. When you finish, sit quietly
for several minutes, at first with your eyes closed and later with your eyes opened. Do not stand up for a few minutes.
6.
Maintain a passive attitude and permit relaxation to occur at its own pace. When distracting thoughts occur, try to ignore
them by not dwelling on them and return to repeating "ONE". With practice, the response should come with little effort. Practice
the technique once or twice daily, but not within two hours after any meal, since the digestive processes seem to interfere
with the elicitation of the Relaxation Response.
Resource: Benson, Herbert, The Relaxation Response, New York: William Morrow and Company, Inc., 1977, p.114]
Why
do the relaxation technique?
Irritable Bowel Syndrome (IBS): By three month follow-up, significant improvements in flatulence, belching, bloating, and diarrhea were shown by symptom
diary. Constipation changes approached significance. Benson's Relaxation Response
Meditation appears to be a viable treatment for IBS. Behav Res Ther 2001
Jul;39(7):801-11
Insomnia: A multifactor intervention
(relaxation response and stimulus control) may be more effective than stimulus control alone for treatment of sleep-onset
insomnia. Behav Modif 1993 Oct;17(4):498-509
PMS: We conclude that regular elicitation
of the relaxation response is an effective treatment for physical and emotional premenstrual symptoms, and is most
effective in women with severe symptoms. Obstet Gynecol 1990 Apr;75(4):649-55
Anxiety, depression, fatigue, and infertility: The first 54 women to complete a behavioral treatment program based on the elicitation of the relaxation response showed
statistically significant decreases in anxiety, depression, and fatigue as well as increases in vigor. In addition,
34% of these women became pregnant within 6 months of completing the program. These findings established a role for stress
reduction in the long-term treatment of infertility. Fertil Steril 1990
Feb;53(2):246-9
Migraine: These results suggest
that relaxation-response training, with or without biofeedback training, combined with pain behavior management, is an effective
alternative treatment for pediatric migraine. Dev Med Child Neurol 1986
Apr;28(2):139-46
High blood pressure: Evidence indicates
that relaxation therapy in combination with medical treatment results in significantly greater reductions in systolic and
diastolic blood pressure than the use of medical treatment alone. J Fam Pract
1980 Nov;11(6):901-8
As an adjunct to heart medication: The
relaxation response is a simple, no cost, non-pharmacological mechanism without side-effects which seemed to decrease the
frequency of P.C.V.s in most patients with ischemic heart-disease. Lancet
1975 Aug 30;2(7931):380-2
Want to do it but can't concentrate? Isometric squeeze relaxation (and progressive relaxation) may be more appropriate for individuals who
have difficulty focusing, and meditation for those who already possess well-developed relaxation skills. Percept Mot Skills 1992 Dec;75(3 Pt 2):1263-71
