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Abusageah F, Hakami A, Zogel B, Zaalah S, Alfaifi S, Shubayli S, Hakami K, Qadah E, Aldharman S, Hakami F, Alqasemi M, Mobarki M, Alhazmi AH. A Cross-Sectional Study about Knowledge, Attitude, and Practices among Primary Health Care Physicians in Jazan Province, Saudi Arabia, Regarding Rome IV Criteria for Diagnosis of Irritable Bowel Syndrome. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121811. [PMID: 36557013 PMCID: PMC9785885 DOI: 10.3390/medicina58121811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
Background and objectives: Most individuals with irritable bowel syndrome (IBS) are diagnosed by primary health care (PHC) physicians. However, a significant percentage of patients remain undiagnosed or misdiagnosed owing to the lack of knowledge or a systematic strategy regarding the use of ROME IV criteria for the diagnosis of IBS. Thus, in this study, we aimed to assess the knowledge, attitude, and practices among primary health care physicians in Jazan Province, Saudi Arabia, regarding ROME IV criteria for the diagnosis of IBS. Methods: A cross-sectional study was conducted using a pretested self-administered questionnaire that determines participants' sociodemographic data and measures knowledge about ROME IV criteria, targeting PHC physicians in Jazan Province, Saudi Arabia. Data were analyzed using the Statistical Package for Social Sciences (SPSS) v.23. Results: We included 200 participants, and the majority of participants in our study (approximately 78%) were aware of the ROME IV diagnostic criteria for IBS; this awareness was associated with age, nationality, specialty, and classification. The participants' mean level of knowledge was 4.30 (out of 6). However, knowledge was higher among Saudi and family medicine doctors in this study, as compared to non-Saudi and doctors of other specialties. More than two-thirds of participants who were aware of ROME IV criteria thought that they are sufficient to diagnose IBS; however, only 47.5% of physicians reported using ROME IV frequently in their daily practice. Conclusions: Most of the participants of this study are aware of ROME IV criteria, and better knowledge was noted among Saudi and family medicine physicians. About 70% thought that ROME IV criteria are effective enough to diagnose IBS, and only about half of the participants use ROME IV criteria in their practice. Therefore, due to its high prevalence in the region, further efforts are required to disseminate basic knowledge and improve attitudes and practices related to ROME IV criteria among PHC physicians of all specialties.
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Affiliation(s)
- Faisal Abusageah
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Alwaleed Hakami
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Basem Zogel
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Shaden Zaalah
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Samar Alfaifi
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Sahar Shubayli
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Khalid Hakami
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Entsar Qadah
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Sarah Aldharman
- Faculty of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
| | - Faisal Hakami
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Maram Alqasemi
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Mousa Mobarki
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Abdulaziz H. Alhazmi
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
- Correspondence: ; Tel.: +966-7329-5000
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Addiego FM, Zajur K, Knack S, Jamieson J, Rayhan RU, Baraniuk JN. Subcortical brain segment volumes in Gulf War Illness and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Life Sci 2021; 282:119749. [PMID: 34214570 DOI: 10.1016/j.lfs.2021.119749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/20/2021] [Accepted: 06/11/2021] [Indexed: 01/29/2023]
Abstract
AIMS There is controversy about brain volumes in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (CFS) and Gulf War Illness (GWI). Subcortical regions were assessed because of significant differences in blood oxygenation level dependent signals in the midbrain between these diseases. MATERIALS AND METHOD Magnetization-prepared rapid acquisition with gradient echo (MPRAGE) images from 3 Tesla structural magnetic resonance imaging scans from sedentary control (n = 34), CFS (n = 38) and GWI (n = 90) subjects were segmented in FreeSurfer. Segmented subcortical volumes were regressed against intracranial volume and age, then iteratively analyzed by multivariate general linear modeling with disease status, gender and demographics as independent co-variates. KEY FINDINGS The optimal model for all subjects used disease status and gender as fixed factors with independent variables eliminated after iteration. Volumes of anterior and midanterior corpus callosum were significantly larger in GWI than CFS. Gender was a significant variable for many segment volumes, and so female and male subjects were analyzed separately. CFS females had smaller left putamen, right caudate and left cerebellum white matter than control women. CFS males had larger left hippocampus than GWI males. Orthostatic status and posttraumatic distress syndrome were not significant covariates. SIGNIFICANCE CFS and GWI were appropriate "illness controls" for each other. The different patterns of adjusted segment volumes suggested that sexual dimorphisms contributed to pathological changes. Previous volumetric studies may need to be reevaluated to account for gender differences. The findings are framed by comparison to the spectrum of magnetic resonance imaging outcomes in the literature.
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Affiliation(s)
| | - Kristina Zajur
- Pain Fatigue Research Alliance, Georgetown University, Washington, DC 20007-2197, USA
| | - Sarah Knack
- Pain Fatigue Research Alliance, Georgetown University, Washington, DC 20007-2197, USA
| | - Jessie Jamieson
- Pain Fatigue Research Alliance, Georgetown University, Washington, DC 20007-2197, USA
| | - Rakib U Rayhan
- Pain Fatigue Research Alliance, Georgetown University, Washington, DC 20007-2197, USA
| | - James N Baraniuk
- Pain Fatigue Research Alliance, Georgetown University, Washington, DC 20007-2197, USA.
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Circulating Anti-cytolethal Distending Toxin B and Anti-vinculin Antibodies as Biomarkers in Community and Healthcare Populations With Functional Dyspepsia and Irritable Bowel Syndrome. Clin Transl Gastroenterol 2020; 10:e00064. [PMID: 31356481 PMCID: PMC6708662 DOI: 10.14309/ctg.0000000000000064] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Anti-cytolethal distending toxin B (CdtB) and anti-vinculin antibodies have been proposed as biomarkers that discriminate irritable bowel syndrome (IBS) diarrhea from inflammatory bowel disease; however, it is unknown whether they can also discriminate patients with IBS and IBS subtypes and functional dyspepsia (FD) from healthy individuals in the general population. We aimed to determine whether anti-CdtB and anti-vinculin can discriminate IBS and FD from health and from organic gastrointestinal (GI) disease. METHODS Adults were enrolled from 2 Australian studies: (i) a random, population-based study (n = 331) with subjects diagnosed with IBS (n = 63) or FD (n = 61) by modified Rome III criteria or healthy control subjects (n = 246) who did not meet criteria for IBS and/or FD and (ii) an outpatient-based study with subjects diagnosed with IBS (n = 256) and/or FD (n = 55) or organic GI disease (n = 182) by an independent clinician. Serum levels of anti-CdtB/anti-vinculin antibodies were determined by enzyme-linked immunosorbent assay. RESULTS There was a significantly higher mean value of anti-CdtB in FD vs healthy controls (mean = 2.46 [SD = 0.72] vs mean = 2.14 [SD = 0.77]; P = 0.005) and IBS/FD overlap vs healthy controls (mean = 2.47 [SD = 0.78] vs mean = 2.14 [SD = 0.77]; P = 0.02). There were no significant differences in anti-CdtB in IBS and FD outpatients or IBS/FD subgroups compared with patients with organic GI disease. In terms of anti-vinculin, there were no significant differences between IBS and FD and healthy controls or between IBS and FD and organic GI disease controls. DISCUSSION We did not confirm that anti-CdtB/anti-vinculin discriminated IBS diarrhea from organic GI disease in Australian subjects. However, we did find higher anti-CdtB in FD and IBS/FD overlap vs healthy controls. Postinfectious FD may be more common than currently recognized.
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Van den Houte K, Carbone F, Pannemans J, Corsetti M, Fischler B, Piessevaux H, Tack J. Prevalence and impact of self-reported irritable bowel symptoms in the general population. United European Gastroenterol J 2019; 7:307-315. [PMID: 31080615 PMCID: PMC6498809 DOI: 10.1177/2050640618821804] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 11/20/2018] [Indexed: 12/12/2022] Open
Abstract
Background and aims The symptom-based diagnostic criteria for irritable bowel syndrome (IBS) have recently been revised in the Rome IV consensus. On the other hand, with rising public awareness of IBS, self-diagnosis and self-management is also increasing. We compared the prevalence and impact of Rome IV-based IBS vs self-diagnosed IBS in the general population. Methods An internet panel filled out an online survey on bowel symptoms and their impact on health care utilization and daily activities. Results A representative internet panel of 1012 individuals completed the online survey. Bowel symptoms were present in 68.6% of the population. Of these, 21% consulted a physician for these symptoms in the last year and 42% earlier. Rome IV IBS criteria were fulfilled by 5.5%, and these were younger and more likely to be female. In this subset, 37% had consulted a physician for IBS symptoms in the preceding year and 29% had done so earlier. A colonoscopy had been performed in 22%. Based on a brief description, 17.6% of the population self-identified as suffering from IBS (p < 0.001 compared to Rome IV IBS prevalence), and these were more likely to be female. Concordance with the Rome IV criteria was only 25%, but except for a lower reporting of pain, the symptom pattern, severity, impact on daily life, inability to work and health care utilization were similar to the Rome IV group. A total of 134 days of absence from work were attributed to bowel symptoms in those self-reporting with IBS. Conclusion In the general population, bowel symptoms are highly prevalent, and the self-reported "IBS" is three times more prevalent than according to Rome IV criteria. Self-reported IBS is associated with a similar impact on health care utilization and quality of life but a higher impact on absence from work.
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Affiliation(s)
- K Van den Houte
- Department of Chronic Diseases, Metabolism and
Ageing, University of Leuven, Translational Research Center for Gastrointestinal
Disorders (TARGID), Leuven, Belgium
| | - F Carbone
- Department of Chronic Diseases, Metabolism and
Ageing, University of Leuven, Translational Research Center for Gastrointestinal
Disorders (TARGID), Leuven, Belgium
| | - J Pannemans
- Department of Chronic Diseases, Metabolism and
Ageing, University of Leuven, Translational Research Center for Gastrointestinal
Disorders (TARGID), Leuven, Belgium
| | - M Corsetti
- Department of Chronic Diseases, Metabolism and
Ageing, University of Leuven, Translational Research Center for Gastrointestinal
Disorders (TARGID), Leuven, Belgium
| | - B Fischler
- Department of Chronic Diseases, Metabolism and
Ageing, University of Leuven, Translational Research Center for Gastrointestinal
Disorders (TARGID), Leuven, Belgium
| | - H Piessevaux
- Department of Chronic Diseases, Metabolism and
Ageing, University of Leuven, Translational Research Center for Gastrointestinal
Disorders (TARGID), Leuven, Belgium
| | - J Tack
- Department of Chronic Diseases, Metabolism and
Ageing, University of Leuven, Translational Research Center for Gastrointestinal
Disorders (TARGID), Leuven, Belgium
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Chang JY, Almazar AE, Richard Locke G, Larson JJ, Atkinson EJ, Talley NJ, Saito YA. Quantifying Rome symptoms for diagnosis of the irritable bowel syndrome. Neurogastroenterol Motil 2018; 30:e13356. [PMID: 29701271 DOI: 10.1111/nmo.13356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 03/21/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder, diagnosed on symptom-based criteria. Many have reported discrepancies between formal Rome criteria and diagnoses made in clinical practice. The aim of the study was to explore whether a quantitative version of the Rome criteria would better represent a clinical diagnosis of IBS than the current dichotomous criteria for symptom measure. METHODS As part of a large, case-control study, participants completed a validated bowel disease questionnaire. Rome criteria were analyzed based on 15 individual symptoms. Penalized logistic regression model with stepwise selection was used to identify significant symptoms of IBS which were independently associated with case-control status. KEY RESULTS In cases with a clinical diagnosis of IBS, 347 (70%) met Rome criteria for IBS. Increasing number of Rome symptoms were found related to the odds of being diagnosed with IBS. Nearly half of the Rome-negative case group experienced infrequent symptoms suggesting milder disease. Five of 15 Rome symptoms were associated with predicting case-control status in the final model, with 96% correctly classified among Rome-positive cases, 76% for Rome-negative cases, and 91% for controls. CONCLUSIONS AND INFERENCES Irritable bowel syndrome appears to be a spectrum disorder. Quantifying individual symptoms of Rome criteria has greater utility than the current application in representing the degree of IBS affectedness and appears to better reflect a clinical diagnosis of IBS applied by physicians. The use of a quantitative diagnostic Rome "score" may be helpful in clinical practice and research studies to better reflect the degree an individual is affected with IBS.
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Affiliation(s)
- J Y Chang
- Enteric NeuroScience Program, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - A E Almazar
- Enteric NeuroScience Program, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - G Richard Locke
- Enteric NeuroScience Program, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - J J Larson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - E J Atkinson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - N J Talley
- Enteric NeuroScience Program, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.,Pro Vice-Chancellor, Global Research, University of Newcastle, New Lambton, NSW, Australia
| | - Y A Saito
- Enteric NeuroScience Program, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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Wang JK, Liu J. Neuromuscular electrical stimulation as an adjunctive therapy to drotaverine hydrochloride for treating patients with diarrhea-predominant irritable bowel syndrome: A retrospective study. Medicine (Baltimore) 2018; 97:e11478. [PMID: 30024524 PMCID: PMC6086520 DOI: 10.1097/md.0000000000011478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This retrospective study investigated the effectiveness and safety of neuromuscular electrical stimulation (NMES) as an adjunctive therapy to drotaverine hydrochloride (DHC) in patients with diarrhea-predominant irritable bowel syndrome (BP-IBS).A total of 108 patient cases with BP-IBS were included in this study. Of these, 54 cases were assigned to a treatment group and received NMES and DHC, whereas the other 54 subjects were assigned to a control group and underwent DHC alone. All patients were treated for a total of 4 weeks. Primary outcomes were measured by the visual analog scale (VAS), and average weekly stool frequency. Secondary outcome was measured by the Bristol scale. In addition, adverse events were documented. All outcome measurements were analyzed before and after 4-week treatment.Patients in the treatment group did not show better effectiveness in VAS (P = .14), and average weekly stool frequency (P = .42), as well as the Bristol scale (P = .71), compared with the patients in the control group. Moreover, no significant differences in adverse events were found between 2 groups.The results of this study showed that NMES as an adjunctive therapy to DHC may be not efficacious for patients with BP-IBS after 4-week treatment.
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Ghoshal UC. Pros and Cons While Looking Through an Asian Window on the Rome IV Criteria for Irritable Bowel Syndrome: Pros. J Neurogastroenterol Motil 2017; 23:334-340. [PMID: 28672432 PMCID: PMC5503282 DOI: 10.5056/jnm17020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/04/2017] [Accepted: 06/07/2017] [Indexed: 01/06/2023] Open
Abstract
A decade after Rome III, in 2016, Rome IV criteria were published. There are major differences between Rome IV and the earlier iteration, some of which are in line with Asian viewpoints. The clinical applicability of the Rome IV criteria of irritable bowel syndrome (IBS) in Asian perspective is reviewed here. Instead of considering functional gastrointestinal disorders (FGIDs) to be largely psychogenic, Rome IV suggested the importance of the gut over brain (“disorders of gut-brain interaction” not “brain-gut interaction”). The word “functional” is underplayed. Multi-dimensional clinical profile attempts to recognize micro-organic nature, like slow colon transit and fecal evacuation disorders in constipation and dietary intolerance including that of lactose and fructose, bile acid malabsorption, non-celiac wheat sensitivity, small intestinal bacterial overgrowth, and gastrointestinal infection in diarrhea. Overlap between different FGIDs has been recognized as Rome IV suggests these to be a spectrum rather than discrete disorders. Bloating, common in Asia, received attention, though less. Sub-typing of IBS may be more clinician-friendly now as the patient-reported stool form may be used than a diary. However, a few issues, peculiar to Asia, need consideration; Rome IV, like Rome III, suggests that Bristol type I–II stool to denote constipation though Asian experts include type III as well. Work-up for physiological factors should be given greater importance. Language issue is important. Bloating, common in IBS, should be listed in the criteria. Threshold values for symptoms in Rome IV criteria are based on Western data. Post-infectious malabsorption (tropical sprue) should be excluded to diagnose post-infectious IBS, particularly in Asia.
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Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Jones MP, Tack J, Van Oudenhove L, Walker MM, Holtmann G, Koloski NA, Talley NJ. Mood and Anxiety Disorders Precede Development of Functional Gastrointestinal Disorders in Patients but Not in the Population. Clin Gastroenterol Hepatol 2017; 15:1014-1020.e4. [PMID: 28087404 DOI: 10.1016/j.cgh.2016.12.032] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/26/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Understanding the interactions between brain and gastrointestinal disorders requires analysis of the order of disease onset. We analyzed data from 2 independent studies to determine the proportion of individuals with diagnoses of functional gastrointestinal disorders (FGIDs) before diagnoses of mood or anxiety disorders (gut to brain), and vice versa (brain to gut). METHODS We collected data from a retrospective study of 4966 patients diagnosed with a FGID (irritable bowel syndrome, dyspepsia, or constipation) and mood or anxiety disorder at general practices in the United Kingdom (health care seekers) over an average period of 13.1 years; we recorded which diagnosis appeared first and compared these with patients' sex and socioeconomic factors. We also collected data from a population study of 1002 randomly selected individuals in Australia (non-heath care seekers) followed from 1997 through 2009; we determined whether subjects were free of either FGID or an anxiety or mood disorder at baseline but developed either one after a 12-year follow-up period. RESULTS Among the 4966 health care seekers, 3279 patients were diagnosed with a mood or anxiety disorder before an FGID (ratio of 2:1). This ratio increased with socioeconomic disadvantage. The time period between diagnosis of mood or anxiety disorder and FGID was longer (median, 3.5 years) than time period between diagnosis of an FGID and a mood or anxiety disorder (median, 1.8 years). Among non-heath care seekers (population study), equal proportions were diagnosed with a mood or anxiety disorder before versus after an FGID. CONCLUSIONS In an analysis of data from a study of patients and a population-based study of individuals with these diagnoses, we found 2-fold more patients to receive a diagnosis of a mood or anxiety disorder before an FGID, but equal proportions of individuals in the population to be diagnosed with the mood or anxiety disorder before versus after an FGID. Among patients, the mood or anxiety disorder was on average diagnosed more than 3 years before the FGID, offering opportunity for prevention. Our findings support a role for adverse socioeconomic factors in development of FGIDs in patients with psychological disorders.
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Affiliation(s)
- Michael P Jones
- Psychology Department, Macquarie University, North Ryde, New South Wales, Australia.
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders, Division of Gastroenterology, University of Leuven, Leuven, Belgium
| | - Lukas Van Oudenhove
- Translational Research Center for Gastrointestinal Disorders, Division of Gastroenterology, University of Leuven, Leuven, Belgium; University Psychiatric Centre, Liaison Psychiatry, University Hospital Gasthuisberg, Leuven, Belgium
| | - Marjorie M Walker
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Gerald Holtmann
- Department of Gastroenterology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Natasha A Koloski
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia; Department of Gastroenterology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Nicholas J Talley
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
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Bai T, Xia J, Jiang Y, Cao H, Zhao Y, Zhang L, Wang H, Song J, Hou X. Comparison of the Rome IV and Rome III criteria for IBS diagnosis: A cross-sectional survey. J Gastroenterol Hepatol 2017; 32:1018-1025. [PMID: 27862281 DOI: 10.1111/jgh.13642] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/30/2016] [Accepted: 11/03/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The aims of this study were to investigate the proportion of clinical irritable bowel syndrome (IBS) at a tertiary hospital in China, to compare the Rome III and Rome IV criteria with regard to IBS diagnosis, to describe the agreement between the Rome III and Rome IV criteria, and to identify differences between Rome IV-positive and -negative IBS patients. METHODS A cross-sectional survey was performed among outpatients in the gastrointestinal (GI) department of a tertiary hospital. The patients were categorized as having IBS using Rome III and Rome IV criteria. RESULTS In total, 1,376 (91.7%) patients completed a GI symptom questionnaire. Among them, 352 were suspected of having IBS and 175 were diagnosed with IBS using the Rome III or Rome IV criteria. In particular, 170 (12.4%) patients were diagnosed with IBS using the Rome III criteria, and 84 (6.1%) patients were diagnosed using the Rome IV criteria. Rome IV IBS patients experienced more pain symptoms (P<0.01) and showed higher IBS severity scores. In contrast, no significant differences were noted for demographic characteristics, stool frequency, IBS subtype, disease course, operation history or GI infection history between Rome IV IBS patients and IBS patients not diagnosed with the Rome IV criteria. CONCLUSIONS Rome IV-positive IBS patients represented approximately half of Rome III-positive IBS patients at a tertiary hospital in China. More specifically, Rome IV-positive IBS was mainly a subgroup of Rome III-positive IBS with more serious symptoms.
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Affiliation(s)
- Tao Bai
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Xia
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yudong Jiang
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huan Cao
- Department of Clinical College, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Zhao
- Department of Clinical College, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Zhang
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huan Wang
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Song
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaohua Hou
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Rajindrajith S, Devanarayana NM, Crispus Perera BJ, Benninga MA. Childhood constipation as an emerging public health problem. World J Gastroenterol 2016; 22:6864-6875. [PMID: 27570423 PMCID: PMC4974585 DOI: 10.3748/wjg.v22.i30.6864] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/16/2016] [Accepted: 06/13/2016] [Indexed: 02/06/2023] Open
Abstract
Functional constipation (FC) is a significant health problem in children and contrary to common belief, has serious ramifications on the lives of children and their families. It is defined by the Rome criteria which encourage the use of multiple clinical features for diagnosis. FC in children has a high prevalence (0.7%-29%) worldwide, both in developed and developing countries. Biopsychosocial risk factors such as psychological stress, poor dietary habits, obesity and child maltreatment are commonly identified predisposing factors for FC. FC poses a significant healthcare burden on the already overstretched health budgets of many countries in terms of out-patient care, in-patient care, expenditure for investigations and prescriptions. Complications are common and range from minor psychological disturbances, to lower health-related quality of life. FC in children also has a significant impact on families. Many paediatric clinical trials have poor methodological quality, and drugs proved to be useful in adults, are not effective in relieving symptoms in children. A significant proportion of inadequately treated children have similar symptoms as adults. These factors show that constipation is an increasing public health problem across the world with a significant medical, social and economic impact. This article highlights the potential public health impact of FC and the possibility of overcoming this problem by concentrating on modifiable risk factors rather than expending resources on high cost investigations and therapeutic modalities.
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Hungin APS, Molloy-Bland M, Claes R, Heidelbaugh J, Cayley WE, Muris J, Seifert B, Rubin G, de Wit N. Systematic review: the perceptions, diagnosis and management of irritable bowel syndrome in primary care--a Rome Foundation working team report. Aliment Pharmacol Ther 2014; 40:1133-45. [PMID: 25230281 DOI: 10.1111/apt.12957] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 04/29/2014] [Accepted: 08/27/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To review studies on the perceptions, diagnosis and management of irritable bowel syndrome (IBS) in primary care. METHODS Systematic searches of PubMed and Embase. RESULTS Of 746 initial search hits, 29 studies were included. Relatively few primary care physicians were aware of (2-36%; nine studies) or used (0-21%; six studies) formal diagnostic criteria for IBS. Nevertheless, most could recognise the key IBS symptoms of abdominal pain, bloating and disturbed defaecation. A minority of primary care physicians [7-32%; one study (six European countries)] preferred to refer patients to a specialist before making an IBS diagnosis, and few patients [4-23%; three studies (two European, one US)] were referred to a gastroenterologist by their primary care physician. Most PCPs were unsure about IBS causes and treatment effectiveness, leading to varied therapeutic approaches and broad but frequent use of diagnostic tests. Diagnostic tests, including colon investigations, were more common in older patients (>45 years) than in younger patients [<45 years; five studies (four European, one US)]. CONCLUSIONS There has been much emphasis about the desirability of an initial positive diagnosis of IBS. While it appears most primary care physicians do make a tentative IBS diagnosis from the start, they still tend to use additional testing to confirm it. Although an early, positive diagnosis has advantages in avoiding unnecessary investigations and costs, until formal diagnostic criteria are conclusively shown to sufficiently exclude organic disease, bowel investigations, such as colonoscopy, will continue to be important to primary care physicians.
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Affiliation(s)
- A P S Hungin
- School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
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12
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Fadgyas-Stanculete M, Buga AM, Popa-Wagner A, Dumitrascu DL. The relationship between irritable bowel syndrome and psychiatric disorders: from molecular changes to clinical manifestations. J Mol Psychiatry 2014; 2:4. [PMID: 25408914 PMCID: PMC4223878 DOI: 10.1186/2049-9256-2-4] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 06/15/2014] [Indexed: 12/19/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a functional syndrome characterized by chronic abdominal pain accompanied by altered bowel habits. Although generally considered a functional disorder, there is now substantial evidence that IBS is associated with a poor quality of life and significant negative impact on work and social domains. Neuroimaging studies documented changes in the prefrontal cortex, ventro-lateral and posterior parietal cortex and thalami, and implicate alteration of brain circuits involved in attention, emotion and pain modulation. Emerging data reveals the interaction between psychiatric disorders including generalized anxiety disorder, panic disorder, major depressive disorder, bipolar disorder, and schizophrenia and IBS, which suggests that this association should not be ignored when developing strategies for screening and treatment. Psychological, social and genetic factors appear to be important in the development of IBS symptomatology through several mechanisms: alteration of HPA axis modulation, enhanced perception of visceral stimuli or psychological vulnerability. Elucidating the molecular mechanisms of IBS with or without psychiatric comorbidities is crucial for elucidating the pathophysiology and for the identification of new therapeutical targets in IBS.
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Affiliation(s)
- Mihaela Fadgyas-Stanculete
- />Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ana-Maria Buga
- />Department of Psychiatry, University of Medicine, Rostock, Germany
| | - Aurel Popa-Wagner
- />Department of Psychiatry, University of Medicine, Rostock, Germany
- />Department of Molecular Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dan L Dumitrascu
- />2nd Department of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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13
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Bellini M, Gambaccini D, Salvadori S, Tosetti C, Urbano MT, Costa F, Monicelli P, Mumolo MG, Ricchiuti A, De Bortoli N, Marchi S. Management of chronic constipation in general practice. Tech Coloproctol 2014; 18:543-549. [PMID: 24272606 DOI: 10.1007/s10151-013-1093-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 11/01/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic constipation is often diagnosed and treated by general practitioners (GPs). The aim of the study was to evaluate the management of constipation by a cohort of Italian GPs. METHODS Over the course of 1 month, 41 GPs recorded tests and therapies suggested to patients complaining of chronic constipation. They were classified according to the Rome III criteria as constipated irritable bowel syndrome (C-IBS), functional constipation (FC), or "self-perceived constipation" (SPC) (not consistent with the Rome criteria). RESULTS The most frequently prescribed tests for the 229 patients (147 FC, 50 C-IBS, 32 SPC) were routine blood tests (59.3 %), abdominal ultrasounds (37.2 %), thyroid function (36.7 %), fecal occult blood tests (36.7 %), and tumor markers (35 %). Patient sex and age, GP age, and whether the diagnosis was new influenced the GP's request, but FC, C-IBS, or SPC status did not. Dietary suggestions (81.9 %), fiber supplements (59.7 %), reassurance (50.9 %), and laxatives (30.5 %) were the most frequently prescribed treatments. Antispasmodics were more frequently suggested for C-IBS patients; dietary suggestions, fiber, and enemas were more frequently prescribed in SPC patients. Patient and GP age and whether the diagnosis was new influenced the GP's choice of treatment. CONCLUSIONS The Rome III criteria do not influence diagnostic strategies and only slightly influence therapeutic strategies of GPs. Other factors (age, gender, new or old diagnosis) have more influence on GPs choice of investigations and treatment.
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Affiliation(s)
- M Bellini
- Gastrointestinal Unit, Department of Gastroenterology, University of Pisa, Via Paradisa No. 2, 56100, Pisa, Italy,
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Kaneko H, Tsuboi H. Analysis on Awareness of Functional Dyspepsia and Rome Criteria Among Japanese Internists by the Self-administered Questionnaires. J Neurogastroenterol Motil 2014; 20:94-103. [PMID: 24466450 PMCID: PMC3895615 DOI: 10.5056/jnm.2014.20.1.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 10/06/2013] [Accepted: 10/23/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND/AIMS Functional dyspepsia (FD) is one of the commonest diseases in the field of Internal Medicine. The Japanese Society of Gastroenterology (JSGE) has been enlightening the term and concept of FD. Aim of this survey was to elucidate the understanding status of FD and Rome criteria and attitude toward FD among Japanese internists. METHODS Data were collected at the time of lifelong education course for certified members of Japanese Society of Internal Medicine. Self-administered questionnaires were delivered to the medical doctors prior to the lectures. RESULTS Analysis subjects were 1,623 (24-90 years old) internists among 1,660 medical doctors out of 4,264 attendees. The terms related to FD were known in 62.0-68.9% of internists, whereas 95.5% understood chronic gastritis. Internists who had been taking care of FD patients informed them as chronic gastritis (50.0%), FD in Japanese Kanji character (50.8%) and FD in Kanji and Katakana (18.6%). Logistic linear regression analysis revealed that positive factors for the understanding of FD and intensive care for FD patients were practitioner, caring many patients and certified physician by JSGE. Existence of Rome criteria was known in 39.9% of internists, and 31.8% out of them put it to practical use. The certified physician by JSGE was a positive factor for awareness, but not for utilization. CONCLUSIONS The results suggest the needs of enlightening the medical term FD in Japan and revision of Rome criteria for routine clinical practice. Precise recognition of FD may enhance efficient patient-based clinical practice.
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Affiliation(s)
- Hiroshi Kaneko
- Department of Internal Medicine, Hoshigaoka Maternity Hospital, Chikusa, Nagoya, Aichi, Japan
| | - Hirohito Tsuboi
- Department of Drug Management and Policy, Institute of Medical, Pharmaceutical & Health Sciences, Kanazawa University, Kakuma-machi, Kanazawa, Ishikawa, Japan
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15
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El-Salhy M, Gundersen D, Gilja OH, Hatlebakk JG, Hausken T. Is irritable bowel syndrome an organic disorder? World J Gastroenterol 2014; 20:384-400. [PMID: 24574708 PMCID: PMC3923014 DOI: 10.3748/wjg.v20.i2.384] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/05/2013] [Accepted: 11/13/2013] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that is generally considered to be functional because there appears to be no associated anatomical defect. Stress and psychological factors are thought to play an important role in IBS. The gut neuroendocrine system (NES), which regulates all functions of the gastrointestinal tract, consists of endocrine cells that are scattered among the epithelial cells of the mucosa, and the enteric nervous system. Although it is capable of operating independently from the central nervous system (CNS), the gut NES is connected to and modulated by the CNS. This review presents evidence for the presence of an anatomical defect in IBS patients, namely in the gastrointestinal endocrine cells. These cells have specialized microvilli that project into the lumen and function as sensors for the luminal content and respond to luminal stimuli by releasing hormones into the lamina propria, which starts a chain reaction that progresses throughout the entire NES. The changes in the gastrointestinal endocrine cells observed in IBS patients are highly consistent with the other abnormalities reported in IBS patients, such as visceral hypersensitivity, dysmotility, and abnormal secretion.
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Pajak R, Lackner J, Kamboj SK. A systematic review of minimal-contact psychological treatments for symptom management in irritable bowel syndrome. J Psychosom Res 2013; 75:103-12. [PMID: 23915765 DOI: 10.1016/j.jpsychores.2013.05.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 05/13/2013] [Accepted: 05/14/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Psychological treatments are effective in alleviating symptoms of IBS but are not widely available. The need for wider dissemination of treatments has encouraged the development of 'minimal-contact' therapies requiring fewer resources than existing psychological treatments which rely on face-to-face contact. METHOD Using comprehensive search terms, the Embase, Medline and PsychInfo databases (all years) were searched. RESULTS Twelve studies--nine RCTs and three non-controlled preliminary studies - meeting inclusion criteria were reviewed and assessed for quality using objective criteria. Apart from one study of expressive writing, all interventions were based on cognitive (and/or) behavioural principles or hypnosis and tended to be adaptations of existing therapist-led interventions. Compared to control conditions, minimal-contact interventions were efficacious, the majority of studies showing statistically significant improvements by the end of treatment. For cognitive-behaviour-therapy-based interventions effects sizes were large. The two studies that compared minimal-contact with therapist-delivered interventions broadly suggest comparable outcomes between these modalities. CONCLUSIONS Minimal-contact cognitive-behavioural interventions show promise in the treatment of IBS. Because of the lower quality of studies of hypnosis and those involving interventions delivered entirely remotely, further support is needed before such approaches can be recommended for widespread use. More generally, future research should use representative samples, active control conditions, and intention to treat analysis. Nonetheless, existing high quality studies suggest that minimal-contact therapies may be a safe, effective means of achieving scaleability of psychological treatments for IBS.
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Affiliation(s)
- Rosanna Pajak
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Rayhan RU, Ravindran MK, Baraniuk JN. Migraine in gulf war illness and chronic fatigue syndrome: prevalence, potential mechanisms, and evaluation. Front Physiol 2013; 4:181. [PMID: 23898301 PMCID: PMC3721020 DOI: 10.3389/fphys.2013.00181] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 06/25/2013] [Indexed: 01/13/2023] Open
Abstract
Objective: To assess the prevalence of headache subtypes in Gulf War Illness (GWI) and Chronic Fatigue Syndrome (CFS) compared to controls. Background: Approximately, 25% of the military personnel who served in the 1990–1991 Persian Gulf War have developed GWI. Symptoms of GWI and CFS have considerable overlap, including headache complaints. Migraines are reported in CFS. The type and prevalence of headaches in GWI have not been adequately assessed. Methods: 50 GWI, 39 CFS and 45 controls had structured headache evaluations based on the 2004 International Headache Society criteria. All subjects had history and physical examinations, fatigue and symptom related questionnaires, measurements of systemic hyperalgesia (dolorimetry), and assessments for exclusionary conditions. Results: Migraines were detected in 64% of GWI (odds ratio = 11.6 [4.1–32.5]) (mean [±95% CI]) and 82% of CFS subjects (odds ratio = 22.5 [7.8–64.8]) compared to only 13% of controls. There was a predominance of females in the CFS compared to GWI and controls. However, migraine status was independent of gender in GWI and CFS groups (x2 = 2.7; P = 0.101). Measures of fatigue, pain, and other ancillary criteria were comparable between GWI and CFS subjects with and without headache. Conclusion: The high prevalence of migraine in CFS was confirmed and extended to GWI subjects. GWI and CFS may share dysfunctional central pathophysiological pathways that contribute to migraine and subjective symptoms. The high migraine prevalence warrants the inclusion of a structured headache evaluation in GWI and CFS subjects, and treatment when present.
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Affiliation(s)
- Rakib U Rayhan
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Georgetown University Washington, DC, USA
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18
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Rayhan RU, Stevens BW, Raksit MP, Ripple JA, Timbol CR, Adewuyi O, VanMeter JW, Baraniuk JN. Exercise challenge in Gulf War Illness reveals two subgroups with altered brain structure and function. PLoS One 2013; 8:e63903. [PMID: 23798990 PMCID: PMC3683000 DOI: 10.1371/journal.pone.0063903] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 04/08/2013] [Indexed: 11/18/2022] Open
Abstract
Nearly 30% of the approximately 700,000 military personnel who served in Operation Desert Storm (1990-1991) have developed Gulf War Illness, a condition that presents with symptoms such as cognitive impairment, autonomic dysfunction, debilitating fatigue and chronic widespread pain that implicate the central nervous system. A hallmark complaint of subjects with Gulf War Illness is post-exertional malaise; defined as an exacerbation of symptoms following physical and/or mental effort. To study the causal relationship between exercise, the brain, and changes in symptoms, 28 Gulf War veterans and 10 controls completed an fMRI scan before and after two exercise stress tests to investigate serial changes in pain, autonomic function, and working memory. Exercise induced two clinical Gulf War Illness subgroups. One subgroup presented with orthostatic tachycardia (n = 10). This phenotype correlated with brainstem atrophy, baseline working memory compensation in the cerebellar vermis, and subsequent loss of compensation after exercise. The other subgroup developed exercise induced hyperalgesia (n = 18) that was associated with cortical atrophy and baseline working memory compensation in the basal ganglia. Alterations in cognition, brain structure, and symptoms were absent in controls. Our novel findings may provide an understanding of the relationship between the brain and post-exertional malaise in Gulf War Illness.
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Affiliation(s)
- Rakib U Rayhan
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, United States of America.
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Engsbro AL, Begtrup LM, Kjeldsen J, Larsen PV, de Muckadell OS, Jarbøl DE, Bytzer P. Patients suspected of irritable bowel syndrome--cross-sectional study exploring the sensitivity of Rome III criteria in primary care. Am J Gastroenterol 2013; 108:972-80. [PMID: 23419383 DOI: 10.1038/ajg.2013.15] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The Rome III criteria for irritable bowel syndrome (IBS) are recommended by guidelines to help identify the syndrome. The majority of IBS patients are managed in primary care, where a pragmatic approach to diagnosis is usually adopted, using clinical judgment and knowledge about the patient. Many general practitioners (GPs) have no or limited knowledge of the diagnostic criteria, few use them, and many consider IBS a diagnosis of exclusion. The aim of this study is to explore the sensitivity of the Rome III criteria in relation to a GP-based clinical diagnosis of IBS, to identify differences between Rome III-positive and -negative patients, and to describe the agreement between the various symptom-based criteria. METHODS Patients aged 18-50 years, presenting in primary care with gastrointestinal complaints and identified as IBS patients by their GP, were referred for enrollment. The Manning and Rome I-III criteria were evaluated through interviews and patients completed the questionnaires The Gastrointestinal Symptom Rating Scale (GSRS)/The Gastrointestinal Symptom Rating Scale modified for use in patients with IBS (GSRS-IBS), Short Form 36, Irritable Bowel Syndrome Quality of Life measurement, Work Productivity and Activity Impairment questionnaire-irritable bowel version, and a questionnaire on use of health-care resources. RESULTS A total of 604 patients were referred and 499 were included (mean age 32.8 (s.d. 9.5) years, 75% were female). The Rome III criteria were fulfilled by 376 patients (sensitivity 0.75, 95% CI 71-79%). Rome III-positive patients more frequently reported disturbed defecation, had a higher symptom burden, and lower disease-specific health-related quality of life compared with Rome III-negative patients. The various symptom-based criteria identified slightly different subpopulations with the highest agreement between the Rome II and III criteria. CONCLUSIONS The Rome III criteria identified three in four patients labeled with IBS in primary care. The relevance of the Rome III for IBS in primary care is supported.
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Baraniuk JN, El-Amin S, Corey R, Rayhan R, Timbol C. Carnosine treatment for gulf war illness: a randomized controlled trial. Glob J Health Sci 2013; 5:69-81. [PMID: 23618477 PMCID: PMC4209301 DOI: 10.5539/gjhs.v5n3p69] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 01/31/2013] [Indexed: 12/28/2022] Open
Abstract
About 25% of 1990-1991 Persian Gulf War veterans experience disabling fatigue, widespread pain, and cognitive dysfunction termed Gulf War illness (GWI) or Chronic Multisymptom Illness (CMI). A leading theory proposes that wartime exposures initiated prolonged production of reactive oxygen species (ROS) and central nervous system injury. The endogenous antioxidant L-carnosine (β-alanyl-L-histidine) is a potential treatment since it is a free radical scavenger in nervous tissue. To determine if nutritional supplementation with L-carnosine would significantly improve pain, cognition and fatigue in GWI, a randomized double blind placebo controlled 12 week dose escalation study involving 25 GWI subjects was employed. L-carnosine was given as 500, 1000, and 1500 mg increasing at 4 week intervals. Outcomes included subjective fatigue, pain and psychosocial questionnaires, and instantaneous fatigue and activity levels recorded by ActiWatch Score devices. Cognitive function was evaluated by WAIS-R digit symbol substitution test. Carnosine had 2 potentially beneficial effects: WAIS-R scores increased significantly, and there was a decrease in diarrhea associated with irritable bowel syndrome. No other significant incremental changes were found. Therefore, 12 weeks of carnosine (1500 mg) may have beneficial cognitive effects in GWI. Fatigue, pain, hyperalgesia, activity and other outcomes were resistant to treatment.
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Affiliation(s)
- James Nicholas Baraniuk
- Division od Rheumatology, Immunology and Allergy, Georgetown University, Washington, DC 20007-2197, USA.
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El-Salhy M. Irritable bowel syndrome: Diagnosis and pathogenesis. World J Gastroenterol 2012; 18:5151-63. [PMID: 23066308 PMCID: PMC3468846 DOI: 10.3748/wjg.v18.i37.5151] [Citation(s) in RCA: 125] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 06/18/2012] [Accepted: 07/18/2012] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) disorder that considerably reduces the quality of life. It further represents an economic burden on society due to the high consumption of healthcare resources and the non-productivity of IBS patients. The diagnosis of IBS is based on symptom assessment and the Rome III criteria. A combination of the Rome III criteria, a physical examination, blood tests, gastroscopy and colonoscopy with biopsies is believed to be necessary for diagnosis. Duodenal chromogranin A cell density is a promising biomarker for the diagnosis of IBS. The pathogenesis of IBS seems to be multifactorial, with the following factors playing a central role in the pathogenesis of IBS: heritability and genetics, dietary/intestinal microbiota, low-grade inflammation, and disturbances in the neuroendocrine system (NES) of the gut. One hypothesis proposes that the cause of IBS is an altered NES, which would cause abnormal GI motility, secretions and sensation. All of these abnormalities are characteristic of IBS. Alterations in the NES could be the result of one or more of the following: genetic factors, dietary intake, intestinal flora, or low-grade inflammation. Post-infectious IBS (PI-IBS) and inflammatory bowel disease-associated IBS (IBD-IBS) represent a considerable subset of IBS cases. Patients with PI- and IBD-IBS exhibit low-grade mucosal inflammation, as well as abnormalities in the NES of the gut.
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Dang J, Ardila-Hani A, Amichai MM, Chua K, Pimentel M. Systematic review of diagnostic criteria for IBS demonstrates poor validity and utilization of Rome III. Neurogastroenterol Motil 2012; 24:853-e397. [PMID: 22632582 DOI: 10.1111/j.1365-2982.2012.01943.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND In the absence of a clear biomarker for irritable bowel syndrome (IBS), clinical criteria are used. In this study, we conduct a systematic review to examine the validation and utilization of IBS criteria. METHODS A systematic review was performed in two stages. The first was a review of literature from 1978 validating IBS diagnostic criteria. The second stage of review was to select studies published in IBS between 1992 and 2011. This time period was divided into three segments (Rome I era from 1992 to 1999, Rome II era from 2000 to 2006, and Rome III era from 2007 to 2011). The number and type of study (RCT or other) and criteria used were evaluated for each era. KEY RESULTS The first stage of the systematic review identified only 14 published studies validating diagnostic tests for IBS (with three studies evaluating more than one criterion). There were eight validations for Manning, three validations for Kruis, four validations for Rome I, three validations for Rome II, and no validation for Rome III. In the second review of utilization of Rome criteria, only 25.7% of published IBS papers used Rome III criteria during the Rome III era (Rome II was used most in 64.8% of studies). CONCLUSIONS & INFERENCES This review identified that comparator groups varied widely between studies making comparison of criteria impossible. Manning criteria are the most valid and accurate criteria. More importantly, Rome III is not validated and is poorly adopted in clinical research trial enrollment.
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Affiliation(s)
- J Dang
- GI Motility Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Olafsdottir LB, Gudjonsson H, Jonsdottir HH, Jonsson JS, Bjornsson E, Thjodleifsson B. Irritable bowel syndrome: Physicians' awareness and patients' experience. World J Gastroenterol 2012; 18:3715-20. [PMID: 22851864 PMCID: PMC3406424 DOI: 10.3748/wjg.v18.i28.3715] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 05/11/2012] [Accepted: 06/08/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To study if and how physicians use the irritable bowel syndrome (IBS) diagnostic criteria and to assess treatment strategies in IBS patients.
METHODS: A questionnaire was sent to 191 physicians regarding IBS criteria, diagnostic methods and treatment. Furthermore, 94 patients who were diagnosed with IBS underwent telephone interview.
RESULTS: A total of 80/191 (41.9%) physicians responded to the survey. Overall, 13 patients were diagnosed monthly with IBS by specialists in gastroenterology (SGs) and 2.5 patients by general practitioners (GPs). All the SGs knew of the criteria to diagnose IBS, as did 46/70 (65.7%) GPs. Seventy-nine percent used the patient’s history, 38% used a physical examination, and 38% exclusion of other diseases to diagnose IBS. Only 18/80 (22.5%) physicians used specific IBS criteria. Of the patients interviewed, 59/94 (62.8%) knew they had experienced IBS. Two out of five patients knew IBS and had seen a physician because of IBS symptoms. Half of those received a diagnosis of IBS. A total of 13% were satisfied with treatment. IBS affected daily activities in 43% of cases.
CONCLUSION: Half of the patients with IBS who consulted a physician received a diagnosis. Awareness and knowledge of diagnostic criteria for IBS differ between SGs and GPs.
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Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a common gastrointestinal disorder often diagnosed and managed by primary care physicians (PCPs). Despite the high prevalence of IBS, symptom severity is often underappreciated and inadequately managed. The goal of this review is to discern IBS treatment gaps and identify opportunities for improving its management in the primary care setting, as well as describe the most current clinical experience with alosetron, a targeted treatment for severe diarrhea-predominant IBS (IBS-D) in women. SCOPE PubMed was searched for English language articles using combinations of the following key words: 'irritable bowel syndrome,' 'diarrhea-predominant irritable bowel syndrome,' 'diagnosis,' 'guidelines,' 'general practice,' 'primary care,' 'quality of life,' 'burden,' 'prevalence,' 'patient satisfaction,' 'patient survey,' 'severe,' 'severity,' and 'alosetron.' FINDINGS Establishing the diagnosis of IBS in primary care represents a clinical challenge for many healthcare professionals. While many patients seek care for IBS symptoms in the primary care setting, evidence shows that PCPs are often unaware of established diagnostic criteria for IBS. Establishing the severity of IBS is also problematic, given the lack of consensus guidelines defining severe IBS, which in turn complicates treatment decisions. Severe IBS is often inferred after inadequate response to conventional agents; the level of disease impact on quality of life and patient functioning also defines severity. The selective 5-HT(3) antagonist alosetron has been shown to provide improvement across multiple symptom domains, and the incidence of adverse events continues to be low since the implementation of the Prescribing Program for Lotronex. Alosetron is the only agent approved by the US Food and Drug Administration for treatment of severe IBS-D in women. CONCLUSION PCPs often are required to evaluate and treat suspected IBS. The diagnosis and management of IBS in the primary care setting could be optimized through the use of published diagnostic criteria, adequate assessment of symptom severity, and a thorough knowledge of the therapeutic agents that have provided evidence of effectiveness. In the subset of women who suffer from IBS-D, targeted serotonergic therapy with alosetron has been shown to provide symptom relief across multiple domains, including improvement of the patient's quality of life.
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Affiliation(s)
- Scott Bleser
- Bellbrook Medical Center, Inc., Bellbrook, OH 45305-2742, USA.
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Chua ASB. Prevalence of irritable bowel syndrome in northern India. J Neurogastroenterol Motil 2011; 17:6-8. [PMID: 21369486 PMCID: PMC3042220 DOI: 10.5056/jnm.2011.17.1.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 12/17/2010] [Accepted: 12/18/2010] [Indexed: 12/15/2022] Open
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Camacho S, Bernal F, Abdo M, Awad RA. Endoscopic and symptoms analysis in Mexican patients with irritable Bowel syndrome, dyspepsia, and gastroesophageal reflux disease. AN ACAD BRAS CIENC 2010; 82:953-962. [PMID: 21152770 DOI: 10.1590/s0001-37652010000400018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Accepted: 08/17/2010] [Indexed: 02/08/2023] Open
Abstract
The aim of this study was to analyze the data of endoscopy and symptoms in 118 Mexican patients with irritable bowel syndrome (IBS), dyspepsia, non-erosive reflux disease (NERD) and erosive esophagitis (EE). IBS criteria were fulfilling for dyspepsia patients in 47%, for NERD in 48%, and for EE patients in 48% of cases. Esophagitis was present in 42% of patients with IBS and in 45% of patients with dyspepsia. A higher prevalence of hiatus hernia was found in EE vs. NERD. Heartburn and acid eructation were associated with the presence of esophagitis; acid eructation, regurgitation and nocturnal pain with duodenitis; and heartburn and regurgitation with hiatus hernia. Males more frequently reported: mucus in feces, abdominal distension, nausea and gastritis; and women more frequently reported esophagitis and duodenitis. Patients with NERD (OR 2.54, 95% CI 1.08 to 5.99, p=0.04), tenesmus and early satiety, and men had an increase risk for reporting hard or lumpy stools. In conclusion, nearly half of the Mexican patients with NERD, EE and dyspepsia fulfill criteria for IBS. A large number of symptoms were correlated with endoscopy, which can be used to improve the indication of the endoscopy and its implementation in clinical studies.
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Affiliation(s)
- Santiago Camacho
- Gastroenterology Service U-107, Endoscopy Uni, Experimental Medicine and Motility Unit, Mexico City General Hospital, México, DF, Mexico
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Abstract
BACKGROUND Numerous meta-analyses have recently assessed the overall clinical benefit of single therapy options and groups of therapies in the irritable bowel syndrome (IBS). By large, this should enable physicians to select from a number of therapy options available. METHODS We entered dichotomous outcome data from 121 IBS trials published over the last 35 years with different groups and subgroups of drugs (antispasmodics, motility-affecting agents, antidepressants, peppermint oil), dietary interventions (bran, probiotics), and psychotherapy (cognitive behavioral, psychodynamic, hypnotherapy, relaxation techniques) into meta-analytic tools and estimate the overall efficacy (odds ratio, number needed to treat). RESULTS Highest efficacy is currently found for peppermint oil, followed by psychotherapeutic and psychopharmacological interventions and probiotics. Traditional antispasmodic therapy has a moderate efficacy, whereas the list of (partially failed or cancelled) motility affecting drugs yielded weak clinical results, and therapies by bran and fibers are of no value in IBS. CONCLUSION Evidence-based therapy in IBS provides a number of effective treatment options beyond the fact that many novel compounds under development have failed to reach the market. An algorithm for clinical therapy decision is proposed.
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How reliable are the Rome III criteria for the assessment of functional gastrointestinal disorders in children? Am J Gastroenterol 2010; 105:2697-701. [PMID: 20808296 DOI: 10.1038/ajg.2010.350] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Functional gastrointestinal disorders (FGIDs) are common in children. Diagnosis of these conditions is based on the pediatric Rome criteria. In the past, we have shown that there was low inter-rater reliability (IRR) among pediatric gastroenterologists using the Rome II criteria. Since then, a new version of the criteria has been issued. The reliability of the Rome III criteria has not been established. METHODS A total of 10 pediatric gastroenterologist specialists and 10 pediatric gastroenterology fellows were provided with 20 clinical vignettes and a list of 17 possible diagnoses (all pediatric categories of the Rome criteria plus "none of the above" or "not enough information") and instructed to select one or more diagnosis for each vignette. RESULTS The average percentage of agreement among the raters was 50% for the pediatric gastroenterologists and 45% for the pediatric gastroenterology fellows. The inter-rater percentage of agreement per clinical case was >50% in only 7 out of 20 (35%) vignettes for the gastroenterologists and only 6 out of 20 (30%) cases for the fellows. The inter-rater percentage of agreement was <25% in 2 out of 20 (10%) vignettes for the gastroenterologists and 4 out of 20 (20%) vignettes for the fellows. The κ coefficient was 0.45 for the specialists (P<0.0001) and 0.39 for the fellows (P<0.0001). In a subanalysis of the groups of pain and constipation-related disorders, the inter-rater percentage of agreement per clinical case ranged between 27 and 100% (mean 57%, κ=0.37, P<0.0001) for the gastroenterologists and between 36 and 80% (mean 52%, κ=0.33, P<0.0001) for the fellows in the constipation subgroup. The inter-rater percentage of agreement per clinical case for the pain subgroup ranged between 22 and 80% (mean 48%, κ=0.36, P<0.0001) for the gastroenterologists and 22 and 62% (mean 39%, κ=0.29, P<0.0001) for the fellows in the pain subgroup. The κ coefficient for specialists with expertise in FGIDs was 0.37 (P<0.0001) and for those with expertise in other gastroenterology conditions was 0.53 (P<0.0001). CONCLUSIONS The IRR among pediatric gastroenterologists and fellows was found to be fair to moderate for the Rome III criteria. Only slight to fair agreement between raters existed for important subcategories of pain and constipation. The results from our current study are almost similar to that of the IRR study done for the Rome II criteria. This indicates the need for further refinement of the Rome criteria to make them more encompassing and user friendly.
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Gwee KA, Bak YT, Ghoshal UC, Gonlachanvit S, Lee OY, Fock KM, Chua ASB, Lu CL, Goh KL, Kositchaiwat C, Makharia G, Park HJ, Chang FY, Fukudo S, Choi MG, Bhatia S, Ke M, Hou X, Hongo M. Asian consensus on irritable bowel syndrome. J Gastroenterol Hepatol 2010; 25:1189-1205. [PMID: 20594245 DOI: 10.1111/j.1440-1746.2010.06353.x] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS Many of the ideas on irritable bowel syndrome (IBS) are derived from studies conducted in Western societies. Their relevance to Asian societies has not been critically examined. Our objectives were to bring to attention important data from Asian studies, articulate the experience and views of our Asian experts, and provide a relevant guide on this poorly understood condition for doctors and scientists working in Asia. METHODS A multinational group of physicians from Asia with special interest in IBS raised statements on IBS pertaining to symptoms, diagnosis, epidemiology, infection, pathophysiology, motility, management, and diet. A modified Delphi approach was employed to present and grade the quality of evidence, and determine the level of agreement. RESULTS We observed that bloating and symptoms associated with meals were prominent complaints among our IBS patients. In the majority of our countries, we did not observe a female predominance. In some Asian populations, the intestinal transit times in healthy and IBS patients appear to be faster than those reported in the West. High consultation rates were observed, particularly in the more affluent countries. There was only weak evidence to support the perception that psychological distress determines health-care seeking. Dietary factors, in particular, chili consumption and the high prevalence of lactose malabsorption, were perceived to be aggravating factors, but the evidence was weak. CONCLUSIONS This detailed compilation of studies from different parts of Asia, draws attention to Asian patients' experiences of IBS.
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Affiliation(s)
- Kok-Ann Gwee
- Stomach Liver and Bowel Clinic, Gleneagles Hospital, Singapore.
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Introduction: a practical evidence-based approach to the diagnosis of the functional gastrointestinal disorders. Am J Gastroenterol 2010; 105:743-6. [PMID: 20372125 DOI: 10.1038/ajg.2010.64] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Validation of symptom-based diagnostic criteria for irritable bowel syndrome: a critical review. Am J Gastroenterol 2010; 105:814-20; quiz 813, 821. [PMID: 20179688 PMCID: PMC3856202 DOI: 10.1038/ajg.2010.56] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This article reviews the evidence for validity of symptom-based criteria (Manning, Rome I, Rome II, and Rome III) for irritable bowel syndrome (IBS). Two kinds of validations are reported: (i) studies testing whether symptom criteria discriminate patients with structural disease at colonoscopy from patients without structural disease; and (ii) studies testing whether symptom criteria discriminate patients presumed to have IBS by positive diagnosis from healthy subjects or patients with other functional and structural disorders. The first study type addresses an important clinical management question but cannot provide meaningful information on the sensitivity or positive predictive value because IBS is defined only by exclusion of structural disease. Specificity is modest (about 0.7) but can be improved to 0.9 by the addition of red flag signs and symptoms. The second type of study judges validity by whether the symptom criteria consistently perform as predicted by theory. Here, factor analysis confirms consistent clusters of symptoms corresponding to IBS; symptom-based criteria agree reasonably well (sensitivity, 0.4-0.9) with clinical diagnoses made by experienced clinicians; and patients with a clinical diagnosis of IBS who fulfill Rome II criteria have greater symptom severity and poorer quality of life than patients with a clinical diagnosis of IBS who do not fulfill Rome criteria. There are no consistent differences in sensitivity or specificity between Manning, Rome I, and Rome II. Both study types support the validity of symptom-based IBS criteria. Tests of Rome III are needed.
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Abstract
The diagnosis of irritable bowel syndrome (IBS) is a clinical diagnosis, based on the Rome III criteria. The identification of alarm features (red flags), associated with an organic digestive pathology is a key point during the initial screening. Age over 50 years, blood in feces, and diarrhea seem to be the three most specific red flags. Biological and morphological examinations must be performed cautiously; their profitability is low in patients with Rome criteria. In the majority of clinical situations encountered in daily clinical practice, a positive diagnosis of IBS can be made.
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Duracinsky M, Chassany O. [How can an effective drug to treat irritable bowel syndrome be successfully developed?]. ACTA ACUST UNITED AC 2010; 33 Suppl 1:S26-34. [PMID: 19303535 DOI: 10.1016/s0399-8320(09)71522-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a prevalent disorder, and although the pharmaceutical industry knows the potential fallout of a successful drug launch in this area, effective drug treatments are rare. AIM To give an overview of the main factors interfering with the development of IBS drugs and to provide pertinent methodological indications to improve their investigation in clinical trials. RESULTS Developing IBS drugs remains a major challenge, as numerous factors, related or unrelated to the nature of the disease itself, interfere with the demonstration of efficacy : the multiplicity of physiopathological mechanisms, wide variation in symptoms across patients and over time, associated psychological traits and environmental aspects, and a very significant placebo effect. There can be no question of developing drugs to target a single receptor in the hope of thereby impacting the whole range of factors involved in the genesis of IBS symptoms. Drug safety is, moreover, a prime consideration, given that this pathology, while certainly disabling, is not life-threatening. If a significant difference between a new treatment and placebo is to be demonstrated on a clinical trial, inclusion and efficacy criteria and study treatment duration must be predefined very precisely. The primary endpoint is abdominal pain, but the assessment of relief of the patient's symptoms has been also recommended, even if there is as yet no consensus as to its definition. The impact of a new IBS drug on patient's quality of life is an important secondary endpoint. CONCLUSION In IBS more, perhaps, than in other pathologies, study design needs very careful consideration if new IBS drug trials are to be conclusive. However, some critical methodological issues (e.g., definite primary endpoint, interpretation of results, and definition of responders) are still unresolved.
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Affiliation(s)
- M Duracinsky
- Service de Médecine Interne, Hôpital Bicêtre, AP-HP, Kremlin-Bicêtre, France
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Jellema P, van der Windt DAWM, Schellevis FG, van der Horst HE. Systematic review: accuracy of symptom-based criteria for diagnosis of irritable bowel syndrome in primary care. Aliment Pharmacol Ther 2009; 30:695-706. [PMID: 19575763 DOI: 10.1111/j.1365-2036.2009.04087.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite the trend towards making a positive diagnosis of irritable bowel syndrome (IBS), many health care providers approach IBS as a diagnosis of exclusion. AIM To summarize available evidence on the diagnostic performance of symptom-based IBS criteria in excluding organic diseases, and of individual signs and symptoms in diagnosing IBS and to additionally assess the influence of sources of heterogeneity on diagnostic performance. METHODS We searched PubMed and EMBASE and screened references. Studies were selected if the design was a primary diagnostic study; the patients were adults consulting because of non-acute abdominal symptoms; the diagnostic test included an externally validated set of IBS criteria, signs, or symptoms. Data extraction and quality assessment were performed by two reviewers independently. The review adhered to the most recent guidelines as described in the Cochrane Diagnostic Reviewers' Handbook. RESULTS A total of 25 primary diagnostic studies were included in the review. The performance of symptom-based criteria in the exclusion of organic disease was highly variable. Patients fulfilling IBS criteria had, however, a lower risk of organic diseases than those not fulfilling the criteria. CONCLUSIONS With none of the criteria showing sufficiently homogeneous and favourable results, organic disease cannot be accurately excluded by symptom-based IBS criteria alone. However, the low pre-test probability of organic disease especially among patients who meet symptom-based criteria in primary care argues against exhaustive diagnostic evaluation. We advise validation of the new Rome III criteria in primary care populations.
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Affiliation(s)
- P Jellema
- Department of General Practice, EMGO Institute for Health and Care research, VU university medical center, Amsterdam, The Netherlands
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Anastasiou F, Mouzas IA, Moschandreas J, Kouroumalis E, Lionis C. Exploring the agreement between diagnostic criteria for IBS in primary care in Greece. BMC Res Notes 2008; 1:127. [PMID: 19055782 PMCID: PMC2639592 DOI: 10.1186/1756-0500-1-127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 12/03/2008] [Indexed: 02/07/2023] Open
Abstract
Background Irritable Bowel Syndrome (IBS) is frequently diagnosed in primary care. Its diagnosis is based on diagnostic criteria but their use is limited in primary care. We aimed to assess the diagnostic agreement between the older (Manning's and Rome II) and the new (Rome III) criteria for the diagnosis of IBS in primary care in Greece. Methods Medical records of 5 Health Centers in rural Crete, Greece, were reviewed for a four-year period and patients with the diagnosis of IBS were invited to a structured interview. Kappa agreement of the Rome III criteria with the criteria of Manning and Rome II was estimated. One hundred and twenty three patients were eligible for interview and 67 (54.5%) participated. Forty-six (69%) fulfilled the Manning, 32(48%) the Rome II, and 16(24%) the Rome III criteria. Twenty-seven (40%) patients were identified as IBS according to the questionnaire for the identification of functional gastrointestinal diseases (FGIDs). The agreement of Rome III with Manning criteria was poor (kappa = 0.25). The agreement between the FGIDs questionnaire and the Manning, Rome II and Rome III criteria was: kappa = 0.30, 0.31 and 0.24 respectively. Moderate agreement was found between the Rome II and III criteria (kappa = 0.51). Conclusion Questionnaires and criteria deriving from expert's consensus meetings or tertiary hospitals are not easy to apply in rural primary care where symptoms are often underestimated by patients and complicated questions can be confusing.
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Affiliation(s)
- Foteini Anastasiou
- Clinic of Social and Family Medicine, Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece.
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Saito YA, Zimmerman JM, Harmsen WS, De Andrade M, Locke GR, Petersen GM, Talley NJ. Irritable bowel syndrome aggregates strongly in families: a family-based case-control study. Neurogastroenterol Motil 2008. [PMID: 18221250 DOI: 10.1111/j.1365-2982.2007.01077.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Irritable bowel syndrome (IBS) runs in families. Prior family studies surveyed patients inquiring about family history without surveying family members. The stigma associated with IBS may lead relatives to not share information with others,resulting in underestimates of familial aggregation of IBS. The aim of the study was to evaluate the accuracy of patient-report of family history of IBS in cases and controls, and to estimate familial aggregation of IBS using both a case-control and a family-study design. Fifty cases and 53 controls completed symptom questionnaires and provided contact information for first-degree relatives. Questionnaires were mailed to relatives. Relatives were considered to have IBS if they met Rome criteria and did not have an alternate GI diagnosis. Cases and controls identified 573 relatives in their families. A total of 202 (51%) of 396 living relatives participated. The kappa statistics between proband- and relative-reported IBS for case- and control-relatives were 0.27 and 0.04. Cases reported 21%of relatives had IBS; relative-reports showed 37%(P = 0.003). Controls reported 4% of relatives had IBS;relative-reports showed 16% (P = 0.013). Regardless of whether the proband or the relative themselves were the information source, case-relatives were three fold as likely to have IBS than control-relatives (P < 0.05).However, overall rates were higher when data collected from relatives were used. Regardless of approach, strong familial aggregation of IBS was observed. Cases and controls underestimated the frequency of IBS in their relatives and agreement between proband- and relative-report of IBS status was extremely poor, thus emphasizing the need for direct data collection from relatives in IBS family studies.
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Affiliation(s)
- Y A Saito
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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Abstract
BACKGROUND Comorbid nongastrointestinal symptoms account for two-thirds of excess health-care costs in irritable bowel syndrome (IBS). OBJECTIVES To determine whether IBS patients are at greater risk for specific comorbid disorders versus showing a general tendency to overreport symptoms; whether patients with inflammatory bowel disease (IBD) show patterns of comorbidity similar to IBS; whether comorbidity is explained by psychiatric disease; and whether excess comorbidity occurs in all IBS patients. METHODS All 3,153 patients in a health maintenance organization with a diagnosis of IBS in 1994-1995 were compared to 3,153 age- and gender-matched controls, and to 571 IBD patients. All diagnoses in a 4-yr period beginning 1 yr before their index visit were categorized as gastrointestinal, psychiatric, or nongastrointestinal somatic. Nongastrointestinal somatic diagnoses were further divided into symptom-based versus biological marker-based diagnoses. RESULTS Forty-eight of 51 symptom-based and 16 of 25 biomarker-based diagnoses were significantly more common in IBS versus controls. However, there were no unique associations. Bacterial, viral, and fungal infections and stroke were among diagnoses made more frequently in IBS. IBD patients were similar to controls. Greater somatic comorbidity was associated with concurrent psychiatric diagnosis. Only 16% of IBS patients had abnormally high numbers of comorbid diagnoses. CONCLUSIONS Comorbidity in IBS is due to a general amplification of symptom reporting and physician consultation rather than a few unique associations; this suggests biased symptom perception rather than shared pathophysiology. Comorbidity is influenced by, but is not explained by, psychiatric illness. Excess comorbidity is present in only a subset of IBS patients.
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Affiliation(s)
- William E Whitehead
- Center for Functional GI and Motility Disorders at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7555, USA
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Barakzai MD, Gregory J, Fraser D. The effect of culture on symptom reporting: Hispanics and irritable bowel syndrome. ACTA ACUST UNITED AC 2007; 19:261-7. [PMID: 17489959 DOI: 10.1111/j.1745-7599.2007.00223.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To explore whether the symptoms reported by Mexican-American patients with irritable bowel syndrome (IBS) meet the current diagnostic criteria. DATA SOURCES A retrospective review of charts of Mexican-American patients diagnosed with IBS at three large medical centers in central California was performed. Demographic information was extracted, and descriptive statistics were used to determine how symptoms were reported and whether the described symptoms met the Rome II criteria. CONCLUSIONS Only 63% of the Mexican-American patients in this study reported symptoms that met any of the nine Rome II criteria. There was no significant difference between patients who were English dominant and those who were monolingual Spanish in the concordance of their presenting complaint and the current diagnostic criteria. In addition, there was no significant gender difference in the rate at which symptoms met the Rome II criteria. IMPLICATIONS FOR PRACTICE Assessment of illness and its symptoms requires that the practitioner have a clear understanding of what the illness means to the patient in order to develop an accurate diagnosis and an appropriate and timely plan of treatment. This study highlights the necessity of revising the symptom-based criteria for diagnosing IBS to include a wider array of reported complaints, taking into account the impact of culture on the perception and description of symptoms.
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Affiliation(s)
- Mary D Barakzai
- Department of Nursing, California State University, Fresno, Fresno, California 93740, USA.
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Sayuk GS, Elwing JE, Lustman PJ, Clouse RE. High somatic symptom burdens and functional gastrointestinal disorders. Clin Gastroenterol Hepatol 2007; 5:556-62. [PMID: 17258513 DOI: 10.1016/j.cgh.2006.11.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Unexplained, multi-system somatic symptoms and syndromes, the hallmark features of somatization, are prevalent in patients with functional gastrointestinal disorders (FGIDs). We studied outpatients attending a gastroenterology clinic to see whether current somatic symptom burdens (a somatization state measure) or number of prior functional diagnoses (a somatization trait measure) could predict the presence of an FGID over structural gastrointestinal disease, and whether the predictive value was dependent on comorbid depression or anxiety disorders. METHODS Clinical data from 327 consecutive new referrals to an outpatient gastroenterology practice were reviewed, 187 with an FGID and 140 with a structural illness. Somatization state and trait were measured by using self-reported current symptoms and functional diagnoses recorded in the medical history, respectively. Psychiatric comorbidity (depression or anxiety disorders) was extracted from chart review. RESULTS FGID subjects endorsed more somatization state symptoms, had more somatization trait diagnoses, and had greater likelihood of psychiatric comorbidity (P < .001 for each). Logistic regression analysis adjusting for age and sex differences showed that each of these features independently predicted the likelihood of an FGID over structural disease (P < .05 for each). When high ratings on the somatization measures were present together with psychiatric comorbidity, the positive predictive value exceeded 0.95. CONCLUSIONS Higher burdens of either current somatic symptoms or functional diagnoses in the medical history are strong predictors of an FGID in outpatients presenting with gastrointestinal complaints. The mechanism is not solely dependent on a relationship with affective disorders, which independently predicts FGID, at least in part, through another path.
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Affiliation(s)
- Gregory S Sayuk
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
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Quigley EMM, Bytzer P, Jones R, Mearin F. Irritable bowel syndrome: the burden and unmet needs in Europe. Dig Liver Dis 2006; 38:717-23. [PMID: 16807154 DOI: 10.1016/j.dld.2006.05.009] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2006] [Revised: 05/08/2006] [Accepted: 05/10/2006] [Indexed: 12/11/2022]
Abstract
Irritable bowel syndrome affects approximately 10-15% of the European population, although prevalence rates vary depending on the classification used and the country surveyed. This may be due to differences in patterns of medical care and diagnosis of the condition. Up to 70% of individuals with irritable bowel syndrome may not have been formally diagnosed. The disorder affects 1.5-3 times as many women as men and poses a significant economic burden in Europe, estimated at euro 700-euro 1600 per person per year. It also reduces quality of life and is associated with psychological distress, disturbed work and sleep, and sexual dysfunction. It is a chronic disorder, which affects many individuals for more than 10 years. Most patients are managed in primary care, although some are referred to gastroenterologists and other specialists. Patients with irritable bowel syndrome undergo more abdomino-pelvic surgery than the general population. We propose that a positive diagnosis of the condition may avoid the delay in diagnosis many patients experience. We conclude that, in Europe, there are significant unmet needs including lack of familiarity with irritable bowel syndrome, difficulties in diagnosis and lack of effective treatments for the multiple symptoms of the disorder. The development of pan-European guidelines for irritable bowel syndrome will benefit patients with this condition in Europe.
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Affiliation(s)
- E M M Quigley
- Alimentary Pharmabiotic Centre, Department of Medicine, National University of Ireland, Cork University Hospital, Wilton, Cork, Ireland.
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Linzer M, Myerburg RJ, Kutner JS, Wilcox CM, Oddone E, DeHoratius RJ, Naccarelli GV. Exploring the generalist-subspecialist interface in internal medicine. Am J Med 2006; 119:528-537. [PMID: 16750973 DOI: 10.1016/j.amjmed.2006.03.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2006] [Accepted: 03/13/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Mark Linzer
- Section of General Internal Medicine, University of Wisconsin, Madison, WI 53705, USA.
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Bellini M, Tosetti C, Stasi C, Biagi S, Costa F, Bruzzi P, Marchi S. The general practitioner's management of patients with a new diagnosis of irritable bowel syndrome. J Clin Gastroenterol 2006; 40:87. [PMID: 16340642 DOI: 10.1097/01.mcg.0000190779.50279.6f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Baraniuk JN, Casado B, Maibach H, Clauw DJ, Pannell LK, Hess S S. A Chronic Fatigue Syndrome - related proteome in human cerebrospinal fluid. BMC Neurol 2005; 5:22. [PMID: 16321154 PMCID: PMC1326206 DOI: 10.1186/1471-2377-5-22] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Accepted: 12/01/2005] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Chronic Fatigue Syndrome (CFS), Persian Gulf War Illness (PGI), and fibromyalgia are overlapping symptom complexes without objective markers or known pathophysiology. Neurological dysfunction is common. We assessed cerebrospinal fluid to find proteins that were differentially expressed in this CFS-spectrum of illnesses compared to control subjects. METHODS Cerebrospinal fluid specimens from 10 CFS, 10 PGI, and 10 control subjects (50 mul/subject) were pooled into one sample per group (cohort 1). Cohort 2 of 12 control and 9 CFS subjects had their fluids (200 mul/subject) assessed individually. After trypsin digestion, peptides were analyzed by capillary chromatography, quadrupole-time-of-flight mass spectrometry, peptide sequencing, bioinformatic protein identification, and statistical analysis. RESULTS Pooled CFS and PGI samples shared 20 proteins that were not detectable in the pooled control sample (cohort 1 CFS-related proteome). Multilogistic regression analysis (GLM) of cohort 2 detected 10 proteins that were shared by CFS individuals and the cohort 1 CFS-related proteome, but were not detected in control samples. Detection of >or=1 of a select set of 5 CFS-related proteins predicted CFS status with 80% concordance (logistic model). The proteins were alpha-1-macroglobulin, amyloid precursor-like protein 1, keratin 16, orosomucoid 2 and pigment epithelium-derived factor. Overall, 62 of 115 proteins were newly described. CONCLUSION This pilot study detected an identical set of central nervous system, innate immune and amyloidogenic proteins in cerebrospinal fluids from two independent cohorts of subjects with overlapping CFS, PGI and fibromyalgia. Although syndrome names and definitions were different, the proteome and presumed pathological mechanism(s) may be shared.
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Affiliation(s)
- James N Baraniuk
- Georgetown University Proteomics Laboratory, Division of Rheumatology, Immunology & Allergy, Room B-105, Lower Level Kober-Cogan Building, Georgetown University, 3800 Reservoir Road, N.W., Washington DC 20007-2197, USA
| | - Begona Casado
- Georgetown University Proteomics Laboratory, Division of Rheumatology, Immunology & Allergy, Room B-105, Lower Level Kober-Cogan Building, Georgetown University, 3800 Reservoir Road, N.W., Washington DC 20007-2197, USA
- Dipartimento di Biochimica A. Castellani, Universita di Pavia, Italy
| | - Hilda Maibach
- Georgetown University Proteomics Laboratory, Division of Rheumatology, Immunology & Allergy, Room B-105, Lower Level Kober-Cogan Building, Georgetown University, 3800 Reservoir Road, N.W., Washington DC 20007-2197, USA
| | - Daniel J Clauw
- Center for the Advancement of Clinical Research, The University of Michigan, Ann Arbor, MI, USA
| | - Lewis K Pannell
- Proteomics and Mass Spectrometry Facility, Cancer Research Institute, University of South Alabama, Mobile, AL, USA
- Proteomics and Mass Spectrometry Facility, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892-0508, USA
| | - Sonja Hess S
- Proteomics and Mass Spectrometry Facility, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892-0508, USA
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Abstract
PURPOSE OF REVIEW Irritable bowel syndrome is a common and likely a multifactorial gastrointestinal disorder in which a disturbed brain-gut axis has been thought to have a mandatory role. Recent clinical and experimental studies imply that dietary factors may be more important in the pathogenesis of irritable bowel syndrome than was earlier anticipated. The purpose of this review is to present those studies and discuss their findings in relation to the crosstalk between the gastrointestinal immune and nervous systems. RECENT FINDINGS Food elimination based on serum immunoglobulin G antibodies in irritable bowel syndrome has been found to result in a significant decrease in symptoms, compared with diets in which dietary restrictions are not guided by those antibodies. Both numbers of mast cells and their mediators have been shown to be increased in intestinal mucosa in patients with irritable bowel syndrome, especially in the close proximity of intestinal nerves. Animal studies have demonstrated that this increase in intestinal mast cell density could be a consequence of local hypersensitivity to food antigens. That kind of local gastrointestinal hypersensitivity seems to be beyond the reach of current diagnostic methods available in clinical practice. SUMMARY Dietary factors may significantly contribute to the pathophysiology of irritable bowel syndrome. Elimination diets based on the detection of local food hypersensitivity may offer a treatment option for irritable bowel syndrome patients in the future.
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Affiliation(s)
- Marko A Kalliomäki
- Department of Paediatrics, University of Turku and Turku University Hospital, Finland.
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Corsetti M, Tack J. Are symptom-based diagnostic criteria for irritable bowel syndrome useful in clinical practice? Digestion 2005; 70:207-9. [PMID: 15627767 DOI: 10.1159/000082890] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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