RECENT FINDINGS: Disordered immune reactions and release of cytokines with resultant gut inflammation and dysfunction appear to be key features of PI-IBS. Disordered brain-gut-microbiota interactions, type of infecting agent, and host-genetic susceptibility are risk factors but also are reasons for the varying spectrum of clinical severity. Although prognosis is generally good, symptoms and inflammation may persist for a long time. Symptomatic relief with antidiarrheals, antispasmodics, 5HT3 antagonists, mesalamine, probiotics, and low-dose antidepressants remain the primary approaches, but in some difficult cases, a combination of drugs that target the pathophysiology may be helpful. PI-IBS has many overlapping features with IBS-D and shares similar pathophysiology and management approaches.
METHODS: All the tertiary referrals seen by an FODMAP-trained dietician were reviewed (2013-2016). Patients were evaluated for IBS symptoms by a questionnaire (four-point Likert scale). Subsequently, advice regarding the low FODMAP diet was given. Symptoms' response was assessed at 3-, 6-, and 12-month follow-up, by use of the same questionnaire. Re-introduction of high FODMAP foods was aimed to commence at the subsequent follow-up.
RESULTS: A total of 164 patients were identified. Thirty-seven patients were excluded due to failure to attend for follow-up. Hundred and twenty-seven patients (77% patients, of which 85% were female) completed the initial 3-month follow-up. Forty-five percent (74/164) and twenty-five percent (41/164) of the patients had continued follow-up at 6 and 12 months, respectively. Of the 127 patients who returned for follow-up, their commonest baseline symptoms were lethargy (92%), bloating (91%), flatulence (91%), and abdominal pain (89%). All symptoms were significantly improved at the initial follow-up (p
METHODS: Articles published in PubMed, MEDLINE, CINAHL and Science Direct from 2005 to 2015 were searched systematically. Studies were included if constipation satisfied the Rome II and or III criteria. Study populations consisted of Asian adults above 18 years old and with sample size above 50.
RESULTS: Of 2812 articles screened, 11 met the eligibility criteria. Constipation among Asian adults was characterized by three core symptoms of 'straining' at 82.8%, 'lumpy and hard stool' at 74.2% and 'sensation of incomplete evacuation' at 68.1% and the least frequent symptom was 'manual maneuver to facilitate defecation' at 23.3%. There was heterogeneity in frequency patterns of core symptoms between different Asian studies but also differences in core symptoms between constipation subtypes of functional constipation and irritable bowel syndrome with constipation.
CONCLUSIONS: In general, Asian adults perceive constipation symptoms in a similar but not equivalent manner to the West. Recognition of core symptoms will increase the diagnostic confidence of constipation and its subtypes but more studies of the various specific Asian populations are needed to address their differences.
DESIGN: A single-centre cohort study of 155 patients infected with Campylobacter jejuni. Features of the initial illness as well as current bowel symptoms and the intestinal microbiota composition were recorded soon after infection (visit 1, <40 days) as well as 40-60 days and >80 days later (visits 2 and 3). Microbiota were assessed using 16S rRNA sequencing.
RESULTS: PI-BD was found in 22 of the 99 patients who completed the trial. The cases reported significantly looser stools, with more somatic and gastrointestinal symptoms. Microbiota were assessed in 22 cases who had significantly lower diversity and altered microbiota composition compared with the 44 age-matched and sex-matched controls. Moreover 60 days after infection, cases showed a significantly lower abundance of 23 taxa including phylum Firmicutes, particularly in the order Clostridiales and the family Ruminoccocaceae, increased Proteobacteria abundance and increased levels of Fusobacteria and Gammaproteobacteria. The microbiota changes were linked with diet; higher fibre consumption being associated with lower levels of Gammaproteobacteria.
CONCLUSION: The microbiota of PI-BD patients appeared more disturbed by the initial infection compared with the microbiota of those who recovered. The prebiotic effect of high fibre diets may inhibit some of the disturbances seen in PI-BD.
TRIAL REGISTRATION NUMBER: NCT02040922.
METHOD: A longitudinal study of consecutive adult patients with various DGBI attending this institution's gastroenterology clinic was conducted. Following 2 years of treatment, the proportion of patients with symptom improvement, details of clinical therapy, factors associated with and the impact of 'no symptom improvement' were determined.
RESULTS: A total of 289 patients (median age 68 years; 64.7% females; 28.4% irritable bowel syndrome (IBS), 20.1% functional dyspepsia (FD), 8.7% functional constipation (FC), 42.9% overlap syndrome) were recruited. After 2 years, 66.1% patients reported symptom improvement. Patients with overlap syndrome were less likely to have symptomatic improvement compared to those with a single DGBI (Overlap 55.6% vs IBS 74.4% vs FD 72.4% vs FC 76.0%, p = 0.014). Reassurance was associated with symptom improvement (p
Methods: a cross sectional study was conducted among the medical students from semester 6 to semester 9 (year 3, year 4 and year 5) of a Malaysian private university. The questionnaire consisted of 2 main sections. Section A was on demographic data and section B consisted of the Hospital Anxiety and Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PSQI) and the Rome IV Questionnaire for IBS. Association between the factors gathered and IBS was assessed using the Chi-Square test. Variables with a p-value of less than 0.2 in the univariate analysis were entered into a multivariate analysis model.
Results: number of students who responded were 190 (56.3%) were females, 66.3% were Chinese and 37.9% were from semester 9. Twenty-eight (14.7%) students had symptoms consistent with a diagnosis of IBS. Depression was found to be significantly associated with IBS (adjusted OR: 4.749, CI: 1.809-12.470).
Conclusion: this study suggests that IBS is common among Malaysian medical students. There was a significant association between IBS and depression.
METHODS: A total of 163 patients were randomized into two groups: Group A to consume 350 mL of sterilized probiotic with 5.85 g polydextrose daily for 1 week and Group B without polydextrose. Intestinal transit time, fecal pH, fecal weight, and modified Garrigues questionnaires for pre- and post-consumption were assessed.
RESULTS: Median intestinal transit time was significantly reduced from 58 (IQR 43-72) to 45 (IQR 24-59) hours and 48 (IQR 31-72) to 30 (IQR 24-49) hours for Groups A and B, respectively (p bowel syndrome patients. However, daily consumption of sterilized probiotic containing L. helveticus with or without polydextrose for a week alleviated constipation-related symptoms and objectively reduced both fecal pH and intestinal transit time.