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Characteristics of functional bowel disorder patients: a cross-sectional survey using the Rome III criteria.

https://arctichealth.org/en/permalink/ahliterature256920
Source
Aliment Pharmacol Ther. 2014 Feb;39(3):312-21
Publication Type
Article
Date
Feb-2014
Author
A C Ford
P. Bercik
D G Morgan
C. Bolino
M I Pintos-Sanchez
P. Moayyedi
Author Affiliation
Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
Source
Aliment Pharmacol Ther. 2014 Feb;39(3):312-21
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Abdominal Pain - epidemiology - etiology
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Constipation - physiopathology
Cross-Sectional Studies
Diarrhea - epidemiology - etiology
Female
Humans
Irritable Bowel Syndrome - physiopathology
Male
Middle Aged
Ontario - epidemiology
Outpatients
Questionnaires
Risk factors
Sex Factors
Young Adult
Abstract
There is some evidence that, despite attempts to classify them separately, functional bowel disorders are not distinct entities and that such divisions are artificial.
To examine this issue in a large cohort of secondary care patients.
Consecutive, unselected adults with gastrointestinal (GI) symptoms attending out-patient clinics at two hospitals in Hamilton, Ontario were recruited. Demographic data, symptoms and presence of anxiety, depression or somatisation were collected prospectively. We used validated questionnaires, including the Rome III questionnaire, with patients categorised as having irritable bowel syndrome (IBS), functional diarrhoea or chronic idiopathic constipation (CIC). We compared data between these disorders, and measured degree of overlap between them by suspending their mutual exclusivity.
Of 3656 patients providing complete lower GI symptom data, 1551 (42.4%) met criteria for a functional bowel disorder. Diarrhoea-predominant IBS (IBS-D) patients were younger, and more were female, met criteria for anxiety, and reported somatisation-type behaviour, compared with functional diarrhoea. Only loose, mushy or watery stools were more common in functional diarrhoea. When mutual exclusivity was suspended, overlap occurred in 27.6%. Constipation-predominant IBS (IBS-C) patients were younger, and more were female, had never married, reported anxiety type symptoms and exhibited somatisation-type behaviour. One in five CIC patients reported abdominal pain or discomfort. All constipation symptoms were more common in IBS-C. When the mutual exclusivity was suspended, overlap occurred in 18.1%.
There were significant differences in demographics between individuals with functional bowel disorders. Despite this, the Rome III classification system falls short of describing unique entities.
PubMed ID
24308816 View in PubMed
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Cortisol levels in hair are altered in irritable bowel syndrome - A case control study in primary care.

https://arctichealth.org/en/permalink/ahliterature285692
Source
J Psychosom Res. 2017 Feb;93:69-75
Publication Type
Article
Date
Feb-2017
Author
A-K Norlin
S. Walter
E. Theodorsson
V. Tegelstrom
E. Grodzinsky
M P Jones
Å. Faresjö
Source
J Psychosom Res. 2017 Feb;93:69-75
Date
Feb-2017
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Case-Control Studies
Cross-Sectional Studies
Female
Hair - chemistry
Humans
Hydrocortisone - blood
Hypothalamo-Hypophyseal System - physiopathology
Irritable Bowel Syndrome - physiopathology - psychology
Male
Middle Aged
Pituitary-Adrenal System - physiopathology
Primary Health Care
Stress, Psychological - complications - physiopathology - psychology
Sweden
Young Adult
Abstract
Stress is an important component in the pathophysiology of irritable bowel syndrome (IBS). Long term Hypothalamus Pituitary Adrenal (HPA)-axis activity can be studied by measuring hair cortisol concentrations (HCC). Some previous studies have indicated a dysregulated HPA-axis in IBS patients, but cortisol levels in hair have not yet been studied. We investigated whether HCC and self-reported stress differentiate IBS patients from controls.
In a cross-sectional study within 10 Swedish Primary Health Care Centers we compared patients in working age with active IBS to patients without GI complaints. The participants donated hair samples and completed questionnaires including a scale of self-reported perceived stress (PSS). 169 Rome III-fulfilling IBS patients and 316 non-IBS patients were available for final analyses.
IBS patients had significantly lower HCC, median=16.3pg/mg, IQR=26.9pg/mg, compared to non-IBS patients, median=22.8pg/mg, IQR=29.1pg/mg. There was also a difference in the distribution of HCC quintiles between the two groups, with 30.2% IBS patients and 14.2% of non-IBS patients in the lowest quintile of HCC. PSS was higher among IBS patients with a mean (SD) total score of 25.3 (8.0) compared to controls 21.4, (7.5). Quintiles of HCC and PSS stayed significantly but very weakly related to IBS (B=-0.332, Std error=0.146, p
PubMed ID
28107896 View in PubMed
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Faecal microbiota transplantation versus placebo for moderate-to-severe irritable bowel syndrome: a double-blind, randomised, placebo-controlled, parallel-group, single-centre trial.

https://arctichealth.org/en/permalink/ahliterature295194
Source
Lancet Gastroenterol Hepatol. 2018 01; 3(1):17-24
Publication Type
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Date
01-2018
Author
Peter Holger Johnsen
Frank Hilpüsch
Jorunn Pauline Cavanagh
Ingrid Sande Leikanger
Caroline Kolstad
Per Christian Valle
Rasmus Goll
Author Affiliation
University Hospital of North Norway Harstad, Harstad, Norway; UIT The Arctic University of Norway, Tromsø, Norway. Electronic address: peter.holger.johnsen@unn.no.
Source
Lancet Gastroenterol Hepatol. 2018 01; 3(1):17-24
Date
01-2018
Language
English
Publication Type
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Keywords
Abdominal Pain - etiology
Adult
Double-Blind Method
Fecal Microbiota Transplantation - adverse effects
Female
Humans
Irritable Bowel Syndrome - physiopathology - therapy
Male
Middle Aged
Nausea - etiology
Proof of Concept Study
Vertigo - etiology
Abstract
Irritable bowel syndrome (IBS) is a common condition characterised by abdominal pain, bloating, and poor quality of life. IBS might be caused by a gut dysbiosis. We aimed to compare faecal microbiota transplantation (FMT) with placebo in patients with IBS.
In this double-blind, randomised, placebo-controlled, parallel-group, single-centre study, we enrolled patients with IBS with diarrhoea or with diarrhoea and constipation (excluding dominating constipation) defined by the ROME III criteria, scored as moderate to severe according to the IBS severity scoring system (IBS-SSS; a score of =175). Eligible participants were aged 18-75 years and were recruited locally by general practitioners in northern Norway. We randomly assigned participants (2:1) in blocks of six to active or placebo FMT. Personnel not involved in the clinical performance of the trial generated the randomisation sequence using a randomisation website. Non-study personnel performed the final allocation and standardised the active and placebo transplants to make them identical in appearance and temperature. The faeces were freshly processed, and were used the same day (fresh transplant) or were stored in a freezer for later use (frozen transplant); participants' own faeces served as placebo. A dose of 8 mg loperamide was administered orally 2 h before endoscopy to retain the transplant. The transplant (50-80 g of faeces mixed with 200 mL of isotonic saline and 50 mL of 85% glycerol) was administered by a colonoscope to the caecum. The primary endpoint was symptom relief of more than 75 points assessed by IBS-SSS, 3 months after FMT. The primary analysis was done in the modified intention-to-treat population, excluding participants who did not undergo treatment or who were diagnosed with any other disease by pinch biopsies obtained during the treatment procedure. For the safety analysis, only participants who did not undergo treatment were excluded. The study is registered with ClinicalTrials.gov, number NCT02154867. The trial has been extended with an open-labelled study treating the placebo group with frozen FMT for further exploratory studies.
Between Jan 1, and Oct 30, 2015, we recruited 90 participants and randomly assigned them to active treatment (n=60) or placebo (n=30). Three participants did not undergo FMT and four were excluded after diagnosis of microscopic colitis, leaving 83 for final modified intention-to-treat analysis (55 in the active treatment group and 28 in the placebo group). 36 (65%) of 55 participants receiving active treatment versus 12 (43%) of 28 receiving the placebo showed response at 3 months (p=0·049). One participant had transient nausea and vertigo (active group) and was observed at the hospital for a few hours after the procedure. Two participants had soiling of transplant on their way home from treatment (one in each group) and three experienced self-limiting intermittent abdominal pain (one in the active group and two in the placebo group). No serious adverse events could be attributed to FMT.
FMT induced significant symptom relief in patients with IBS. However, larger multicentre studies are needed to confirm the results.
HelseNord and the Norwegian Centre of Rural Medicine, University of Tromsø.
Notes
CommentIn: Lancet Gastroenterol Hepatol. 2018 Jan;3(1):2-3 PMID 29100844
PubMed ID
29100842 View in PubMed
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Longitudinal Outcomes of GastroIntestinal symptoms in Canada (LOGIC): key factors for an effective patient retention in observational studies.

https://arctichealth.org/en/permalink/ahliterature152867
Source
Can J Clin Pharmacol. 2009;16(1):e140-50
Publication Type
Article
Date
2009
Author
R. Balshaw
S. Khorasheh
M. Barbeau
S. Kelly
S. Flynn
O. Heisel
C R McBurney
Author Affiliation
Syreon Corporation, Vancouver, Canada.
Source
Can J Clin Pharmacol. 2009;16(1):e140-50
Date
2009
Language
English
Publication Type
Article
Keywords
Canada
Clinical Trials as Topic
Efficiency
Female
Health Services - utilization
Humans
Irritable Bowel Syndrome - physiopathology - therapy
Longitudinal Studies
Male
Patient Dropouts
Patient Participation - methods
Patient Satisfaction - statistics & numerical data
Patient Selection
Quality of Life
Questionnaires
Reminder Systems
Reproducibility of Results
Research Subjects
Severity of Illness Index
Abstract
Longitudinal Outcomes of GastroIntestinal symptoms in Canada (LOGIC) is an ongoing study on irritable bowel syndrome (IBS) treatment patterns and health outcomes in routine Canadian clinical practice. Advancements in understanding IBS, a chronic multifaceted GI disorder, may be possible through methodical observational studies. The objective of this paper is to describe site recruitment techniques and extensive subject follow-up methodology used to facilitate a high return rate of questionnaires from this population-based study of subjects with IBS.
Invitation letters along with protocol synopses and preliminary site assessment questionnaires were faxed to potential sites across Canada. There were 1,556 subjects enrolled in this study from general practitioner sites (GP) and specialist sites (SP) in Canada. Subjects were compensated for the return of questionnaires reporting symptoms, quality of life, productivity, healthcare and resource utilization at baseline, Month 1, 3, 6, 9, and 12. Upon the return of questionnaires, subjects received thank you cards which included a reminder of the next questionnaire's due date. If subject questionnaires were not received within 2 weeks after the due date, the subjects received a reminder letter in the mail.
The methodology in the LOGIC study allowed for a high patient questionnaire return rate (89%) through extensive subject reminders and follow-up. Subject participation throughout the study was not found to be linked to study site size or type (GP or SP).
Questionnaire based observational studies may benefit from focusing resources on increasing questionnaire return rates to effectively maintain data reliability and also reduce non-response bias.
PubMed ID
19182307 View in PubMed
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Patients' experiences of living with irritable bowel syndrome.

https://arctichealth.org/en/permalink/ahliterature150572
Source
J Adv Nurs. 2009 Aug;65(8):1676-85
Publication Type
Article
Date
Aug-2009
Author
Marit Rønnevig
Per Olav Vandvik
Ingegerd Bergbom
Author Affiliation
Faculty of Nursing, Oslo College University, Oslo, Norway. Marit.ronnevig@su.hio.no
Source
J Adv Nurs. 2009 Aug;65(8):1676-85
Date
Aug-2009
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Attitude to Health
Female
Health status
Humans
Irritable Bowel Syndrome - physiopathology - psychology
Male
Middle Aged
Norway - epidemiology
Qualitative Research
Quality of Life - psychology
Taboo
Abstract
This paper is a report of a study conducted to describe people's experiences, and meanings of these, while living with irritable bowel syndrome.
Irritable bowel syndrome is characterized by abdominal pain, diarrhoea and/or constipation, distension and bloating. Such symptoms are stigmatized in western societies. Patients may experience negative attitudes from healthcare personnel, and they can feel helpless and frustrated trying to control symptoms.
A qualitative, hermeneutic approach was used. Open-ended interviews were conducted during 2005-2006 with 13 patients currently diagnosed with irritable bowel syndrome. The interview setting was a rural healthcare centre or the person's home. An interpretive analysis of the data was performed.
Four interwoven themes were identified in the data: Living with unpredictability, represented by the subthemes 'not being in control', 'not being able to trust' and 'invasion of privacy'; preserving dignity, described by 'living with sacrifice', 'taking command' and 'fulfilling obligations'; 'reconciling struggle'; and 'living with comorbidity'.
The unpredictability and taboos of irritable bowel syndrome made these people suffer, feel constrained and dependent. Dignity was preserved both by sacrifices and taking command. Healthcare personnel should allow patients to talk about their suffering and discomfort to decrease their experience of suffering. Our study contributes to a more nuanced understanding of life with this unpleasant companion, the suffering it creates and the threats to dignity and health.
PubMed ID
19493148 View in PubMed
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