Important Note: The following information is provided for your education. It should not be relied upon for personal diagnosis or treatment. If you believe that a particular therapy applies to you or someone you care about, be sure to consult a doctor before trying it.
   

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Previous Irritable Bowel Research: 2002-2006   
The IBS File also contains summaries of past research that has shown promise and may still be standard practice among many physicians. To download earlier research findings on Irritable Bowel, click HERE.
 

Latest Research on
Irritable Bowel Syndrome
     
Pediatrics. 2008 Aug;122(2):e446-51. Epub 2008 Jul 28.
Use of complementary and alternative medicine by pediatric patients with functional and organic gastrointestinal diseases: results from a multicenter survey.
Vlieger AM, Blink M, Tromp E, Benninga MA.
Department of Pediatrics, St Antonius Hospital, PO Box 2500, 3430 EM Nieuwegein, Netherlands. a.vlieger@antonius.net

OBJECTIVES: Many pediatric patients use complementary and alternative medicine, especially when facing a chronic illness for which treatment options are limited. So far, research on the use of complementary and alternative medicine in patients with functional gastrointestinal disease has been scarce. This study was designed to assess complementary and alternative medicine use in children with different gastrointestinal diseases, including functional disorders, to determine which factors predicted complementary and alternative medicine use and to assess the willingness of parents to participate in future studies on complementary and alternative medicine efficacy and safety. PATIENTS AND METHODS: The prevalence of complementary and alternative medicine use was assessed by using a questionnaire for 749 children visiting pediatric gastroenterology clinics of 9 hospitals in the Netherlands. The questionnaire consisted of 35 questions on the child's gastrointestinal disease, medication use, health status, past and future complementary and alternative medicine use, reasons for its use, and the necessity of complementary and alternative medicine research. RESULTS: In this study population, the frequency of complementary and alternative medicine use was 37.6%. A total of 60.3% of this group had used complementary and alternative medicine specifically for their gastrointestinal disease. This specific complementary and alternative medicine use was higher in patients with functional disorders than organic disorders (25.3% vs 17.2%). Adverse effects of allopathic medication, school absenteeism, age <or=11 years, and a low effect of conventional treatment were predictors of specific complementary and alternative medicine use. Almost all (93%) of the parents considered it important that pediatricians initiate complementary and alternative medicine research, and 51% of parents were willing to participate in future complementary and alternative medicine trials. CONCLUSIONS: Almost 40% of parents of pediatric gastroenterology patients are turning to complementary and alternative medicine for their child. Lack of effectiveness of conventional therapy, school absenteeism, and adverse effects of allopathic medication are more important predictors of complementary and alternative medicine use than the type of gastrointestinal disease. Because evidence on most complementary and alternative medicine modalities in children with gastrointestinal disorders is lacking, there is an urgent need for research in this field.

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J Med Chem. 2008 Jul 10;51(13):3684-7. Epub 2008 Jun 17.
Modulation of peripheral serotonin levels by novel tryptophan hydroxylase inhibitors for the potential treatment of functional gastrointestinal disorders.
Shi ZC, Devasagayaraj A, Gu K, Jin H, Marinelli B, Samala L, Scott S, Stouch T, Tunoori A, Wang Y, Zang Y, Zhang C, Kimball SD, Main AJ, Sun W, Yang Q, Nouraldeen A, Yu XQ, Buxton E, Patel S, Nguyen N, Swaffield J, Powell DR, Wilson A, Liu Q.
Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540, USA. zshi@lexpharma.com

The discovery of a novel class of peripheral tryptophan hydroxylase (TPH) inhibitors is described. This class of TPH inhibitors exhibits excellent potency in in vitro biochemical and cell-based assays, and it selectively reduces serotonin levels in the murine intestine after oral administration without affecting levels in the brain. These TPH1 inhibitors may provide novel treatments for gastrointestinal disorders associated with dysregulation of the serotonergic system, such as chemotherapy-induced emesis and irritable bowel syndrome.

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Nippon Rinsho. 2008 Jul;66(7):1385-90.
[The efficacy of probiotics in gastrointestinal disease]
[Article in Japanese]
Kamiya T, Shikano M, Wada T, Sasaki M, Joh T.
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences.

Probiotics are live microbial feed supplement which beneficially affects the host animals by improving its microbial balance. Probiotics have been used in the treatment of bacterial or viral induced acute intestinal infection. In recent years, some clinical studies have shown the therapeutic effects of probiotics in the treatment of chronic inflammatory bowel disease (IBD) or prevention of allergic disease. Evidence exists for therapeutic use of probiotics in acute infectious diarrhea, Clostridium difficile colitis and antibiotic-associated diarrhea. Their exact role in IBD, irritable bowel syndrome and prevention of cancer has not to be determined. This review summarized the data about probiotics in gastrointestinal diseases and examine the mechanisms of action related to their therapeutic effects.

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Am J Gastroenterol. 2008 Jun;103(6):1557-67. Epub 2008 May 29.
Gastrointestinal microbiota in irritable bowel syndrome: their role in its pathogenesis and treatment.
Parkes GC, Brostoff J, Whelan K, Sanderson JD.
Diet and Gastrointestinal Health, Nutritional Sciences Division, King's College London, London, United Kingdom.

Irritable bowel syndrome (IBS) is a chronic disorder characterized by abdominal pain, change in bowel habit, and bloating. It has traditionally been viewed as a disorder of visceral hypersensitivity heavily influenced by stress, and therefore therapeutic strategies to date have largely reflected this. However, more recently, there is good evidence for a role of the gastrointestinal (GI) microbiota in its pathogenesis. Changes in fecal microbiota, the use of probiotics, the phenomenon of postinfectious IBS, and the recognition of an upregulated host immune system response suggest that an interaction between the host and GI microbiota may be important in the pathogenesis of IBS. This article explores the role of the GI microbiota in IBS and how their modification might lead to therapeutic benefit.

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Scand J Prim Health Care. 2008 Jun;26(2):106-10.
Effects of anti-secretory factor (ASF) on irritable bowel syndrome (IBS). A double-blind, randomized study.
Ekesbo R, Nilsson PM, Sjölund K.
Primary Health Care Centre, Dalby, Sweden. rickard.ekesbo@skane.se

OBJECTIVE: To evaluate the role of the endogenous protein anti-secretory factor (ASF) on the symptoms, especially loose stools, in irritable bowel ayndrome (IBS). DESIGN: A diet with specially processed cereals (SPC) known to induce ASF production was used in patients with IBS, in an eight-week randomized, placebo-controlled study. SUBJECTS: Eighty-two patients with IBS were randomized to a diet with either SPC or placebo. MAIN OUTCOME MEASURES: The overall clinical condition and the quality of life were measured by VAS and SF-36 questionnaire, respectively. The plasma levels of ASF were determined in 14 patients with dominating loose stools before and after diet. RESULTS: All patients significantly (p<0.001) improved in IBS-related symptoms irrespective of active or placebo diet. In an active-diet sub-group with diarrhoea (n=11) there was a significant (p<0.05) correlation between the increase of plasma ASF level and the improvement on the VAS. CONCLUSION: Both study groups improved significantly on the VAS but no additive effect was seen for the active treatment. In the sub-group with loose stools, the SPC diet induced ASF plasma levels in IBS patients and was correlated to significant symptom improvement in the individual patient.

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Praxis (Bern 1994). 2008 Apr 30;97(9):489-94.
[The irritable syndrome--where do we stand?]
[Article in German]
Gschossmann JM.
Klinik und Poliklinik für Gastroenterologie, DMLL, Inselspital, Bern. juergen.gschossmann@insel.ch

Given its high prevalence and the chronic course of disease, the Irritable Bowel Syndrome (IBS) represents an important clinical picture for general practioners. IBS is primarily characterized by chronic recurrent abdominal pain and changes in stool habits which are not explained by pathological findings in routine diagnostic procedures. The etiology of IBS seems to be multifactorial with both intrinsic and extrinsic aspects. Main pathophysiological alterations associated with IBS are changes in gastrointestinal motility and in perception and modulation of visceral pain. The therapeutic options how to treat IBS patients are primarily symptomatic. Given potential adverse effects of causally oriented treatment strategies, the latter ones are yet limited.

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Z Gastroenterol. 2008 Mar;46(3):279-291.
[Nutritional Factors and Nutritional Therapy for Irritable Bowel Syndrome - What is Worthwhile?]
[Article in German]
Wächtershäuser A, Stein JM.
Medizinische Klinik I - ZAFES (Direktor Prof. Dr. S. Zeuzem), Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main.

The prevalence of irritable bowel syndrome (IBS) has increased over the last 50 years in countries where a Western-style diet has been prominent or introduced and 20 - 65 % of patients with irritable bowel syndrome (IBS) attribute their symptoms to something in food that activates an abnormal response. However, data from dietary elimination and re-challenge studies are inconclusive. Although investigations have shown that bran may be helpful in some patients, a complete review of the literature does not reveal conclusive evidence that a high fibre diet therapy is effective in IBS. From the limited reports on probiotics, there appears to be a trend to decreasing symptoms. Despite numerous reviews on this subject, it is very difficult to give general dietary advice to IBS patients, but dietary experts may have a positive role in managing such patients. It is clear that much more prospective research is needed to study both dietary factors and probiotics in these areas.

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Evid Based Complement Alternat Med. 2008 Mar;5(1):41-50.
Mind/Body psychological treatments for irritable bowel syndrome.
Naliboff BD, Fresé MP, Rapgay L.
UCLA Center for Neurovisceral Sciences and Women's Health, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA and Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA, USA.

Currently, the goal of treatment for those with irritable bowel syndrome (IBS) is to improve the quality of life through a reduction in symptoms. While the majority of treatment approaches involve the use of traditional medicine, more and more patients seek out a non-drug approach to managing their symptoms. Current forms of non-drug psychologic or mind/body treatment for IBS include hypnotherapy, cognitive behavioral therapy and brief psychodynamic psychotherapy, all of which have been proven efficacious in clinical trials. We propose that incorporating the constructs of mindfulness and acceptance into a mind/body psychologic treatment of IBS may be of added benefit due to the focus on changing awareness and acceptance of one's own state which is a strong component of traditional and Eastern healing philosophies.

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Ann Pharmacother. 2008 Feb 26 [Epub ahead of print]
Rifaximin Treatment for Symptoms of Irritable Bowel Syndrome (March).
Fumi AL, Trexler K.
Department of Pharmacy, Duke University Hospital, Durham, NC.

OBJECTIVE: To evaluate the role of rifaximin in the treatment of symptoms associated with irritable bowel syndrome (IBS). DATA SOURCES: Clinical literature was accessed through MEDLINE (1990-September 2007) using the terms rifaximin, small intestinal bacterial overgrowth (SIBO), bacterial overgrowth, and irritable bowel syndrome. Additionally, references in publications identified in the search were reviewed for relevant information STUDY SELECTION AND DATA EXTRACTION: All articles published in English identified from the data source were evaluated. Randomized clinical trials in adult populations were included. DATA SYNTHESIS: IBS is a common functional bowel disorder of unknown etiology. Some evidence suggests that symptoms are secondary to bacterial overgrowth in the small intestine. Rifaximin, a nonsystemic antibiotic that targets the gastrointestinal tract, has been evaluated in the treatment of SIBO. Six studies that evaluated rifaximin in either IBS, with or without doc
umented SIBO, or SIBO alone, were reviewed. Significant symptom improvement was reported, and in some cases, correlated with reductions in hydrogen breath tests, suggesting successful treatment of bacterial overgrowth. Data are limited by controversial diagnostic techniques for SIBO, small sample sizes, the unpredictable course of the disorder, and variability in clinical trial methodology that prevents direct comparison. CONCLUSIONS: Rifaximin offers a potential new therapeutic option for patients with refractory IBS. Larger, well-designed trials are necessary to elucidate the role of rifaximin in the treatment of this disorder.

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Aliment Pharmacol Ther. 2008 Feb 14 [Epub ahead of print]
Clinical trial: renzapride therapy for constipation-predominant irritable bowel syndrome—a multicentre, randomised, placebo-controlled, double-blind study in the primary healthcare setting.
George AM, Meyers NL, Hickling RI.
Staploe Medical Centre, Soham, UK.

Aim: To identify an appropriate dose of renzapride (a 5-HT(4) receptor full agonist/5-HT(3) receptor antagonist) to treat abdominal pain/discomfort in patients with IBS-C. Methods: In this randomised, placebo-controlled, phase IIb study in the primary care setting, men and women were randomised to placebo or renzapride (1, 2 or 4 mg/day) for 12 weeks. The primary outcome measure was patient self-assessed relief of abdominal pain/discomfort during Weeks 5-12. Secondary efficacy measures included patients' assessment of their bowel habits, stool consistency, and quality of life. Results: Although there were no statistically significant differences between renzapride and placebo for relief from abdominal pain/discomfort, responder rates in the renzapride treatment groups increased dose-dependently, with the 4 mg/day group being consistently numerically greater than placebo. Importantly, a larger numerical treatment difference versus placebo was observed in women (7.7% and 12.3%, respectively). Statistically significant improvements in bowel movement frequency and stool consistency were observed in the 4 mg/day group relative to placebo. Renzapride was well tolerated at all doses. Conclusions: This study confirms the potent GI prokinetic effects of renzparide. The data also suggested a potentially beneficial effect on abdominal pain/discomfort in women with IBS-C.

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Cochrane Database Syst Rev. 2008 Jan 23;(1):CD003019.
Dietary interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood.
Huertas-Ceballos A, Logan S, Bennett C, Macarthur C.

BACKGROUND: Between 4% and 25% of school-age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. It is unclear whether the diagnosis includes children with different aetiologies for their pain. For the majority no organic cause for their pain can be found on physical examination or investigation. Although most children are likely managed by reassurance and simple measures, a large range of interventions have been recommended. OBJECTIVES: To determine the effectiveness of dietary interventions for recurrent abdominal pain in school-age children. SEARCH STRATEGY: The Cochrane Library (CENTRAL) 2006 (Issue 4), MEDLINE (1966 to Dec 2006), EMBASE (1980 to Dec 2006), CINAHL (1982 to Dec 2007), ERIC (1966 to Dec 2006), PsycINFO (1872 to Dec 2006), LILACS (1982 to Dec 2006), SIGLE (1980 to March 2005), and JICST (1985 to 06/2000) were searched . Where appropriate, search filters were employed. In addition, researchers working in this area were asked to identify relevant studies. SELECTION CRITERIA: Randomised or quasi-randomised studies of any dietary treatment versus placebo or no treatment in school-age children with a diagnosis of RAP or functional gastrointestinal disorder based on the Rome II criteria. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trials for inclusion, assessed quality and extracted data. Where appropriate studies were pooled using a random effects meta-analysis. MAIN RESULTS: Seven trials were included in this review. Two trials, including 83 participants, compared fibre supplements with placebo (Christensen 1982, Feldman 1985), with data from one study reported in two papers (Christensen 1982, Christensen 1986). The pooled odds ratio for improvement in the frequency of abdominal pain was 1.16 (95% CI 0.45-2.87).Two trials, including 90 participants (Lebenthal 1981, Dearlove 1983) compared lactose-containing with lactose-free diets. Neither reported data in a form which could be used in the meta-analysis and the former trial had a loss to follow-up of 45%. We were not able to obtain further data for either trial.Three trials (Bausserman 2005, Gavronska 2007, Young 1997) comparing supplementation with Lactobacillus with placebo met the inclusion criteria but only two (Bausserman 2005, Gavronska 2007), including a total of 168 children, provided analysable data. The pooled odds ratio for improvement of symptoms was 1.17 (95% CI 0.62, 2.21). AUTHORS' CONCLUSIONS: There is a lack of high quality evidence on the effectiveness of dietary interventions. This review provides no evidence that fibre supplements, lactose free diets or lactobacillus supplementation are effective in the management of children with RAP.

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Cochrane Database Syst Rev. 2008 Jan 23;(1):CD003017.
Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood.
Huertas-Ceballos A, Logan S, Bennett C, Macarthur C.

BACKGROUND: Between 4% and 25% of school-age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. For the majority no organic cause for their pain can be found on physical examination or investigation and although most children are likely managed by reassurance and simple measures, a large range of interventions have been recommended. OBJECTIVES: To determine the effectiveness of medication for recurrent abdominal pain in school-age children. SEARCH STRATEGY: The Cochrane Library (CENTRAL) 2006 (Issue 4), MEDLINE (1966 to Dec 2006), EMBASE (1980 to Dec 2006), CINAHL (1982 to Dec 2007), ERIC (1966 to Dec 2006), PsycINFO (1872 to Dec 2006), LILACS (1982 to Dec 2006), SIGLE (1980 to March 2005), and JICST (1985 to 06/2000) were searched with appropriate filters SELECTION CRITERIA: Studies on school age children with RAP (Apley or the Rome II criteria for gastrointestinal diseases) allocated by random or quasi-random methods to a drug treatment vs. placebo/ no treatment were included. DATA COLLECTION AND ANALYSIS: References identified by the searches were screened against the inclusion criteria by two independent reviewers. Data was extracted and analysed using RevMan 4.2.10. MAIN RESULTS: Three trials met the inclusion criteria. Symon et al report a cross-over trial comparing pizotifen and placebo in 16 children with "abdominal migraine". Data before cross-over was not available. Results for 14 children showed Mean fewer days in pain of 8.21 (95% CI 2.93, 13.48) while taking the active drug. Kline et al compared peppermint oil capsules with placebo in a randomised trial in 50 children with RAP and IBS. 42 children completed the study. OR for improvement was 3.33 (95% CI 0.93-12.1)See et al compared famotidine with placebo in a randomised cross-over trial in 25 children with RAP and dyspepsia. OR for improvement before cross-over was 11 (95%CI 1.6, 75.5). AUTHORS' CONCLUSIONS: This review provides weak evidence of benefit on medication in children with RAP. The lack of clear evidence of effectiveness for any of the recommended drugs suggests that there is little reason for their use outside of clinical trials. Clinicians may choose to prescribe drugs in children with severe symptoms that have not responded to simple management. However, if using drugs as a "therapeutic trial", clinicians should be aware that, RAP is a fluctuating condition and any "response" may reflect the natural history of the condition or a placebo effect rather than drug efficacy.

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Cochrane Database Syst Rev. 2008 Jan 23;(1):CD003014.
Psychosocial interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood.
Huertas-Ceballos A, Logan S, Bennett C, Macarthur C.

BACKGROUND: Between 4% and 25% of school-age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. For the majority of such children, no organic cause for their pain can be found on physical examination or investigation. Although most children are managed by reassurance and simple measures, a large range of psychosocial interventions including cognitive and behavioural treatments and family therapy have been recommended. OBJECTIVES: To determine the effectiveness of psychosocial interventions for recurrent abdominal pain or IBS in school-age children. SEARCH STRATEGY: The Cochrane Library (CENTRAL) 2006 (Issue 4), MEDLINE (1966 to Dec 2006), EMBASE (1980 to Dec 2006), CINAHL (1982 to Dec 2006), ERIC (1966 to Dec 2006), PsycINFO (1872 to Dec 2006), LILACS (1982 to Dec 2006), SIGLE (1980 to March 2005), and JICST (1985 to 06/2000) were searched with appropriate filters. SELECTION CRITERIA: Any study in which the majority of participants were school-age children fulfilling standard criteria for RAP (Apley or the Rome II criteria for functional gastrointestinal diseases) , randomly allocated to any psychosocial treatment compared to standard care or waiting list, were selected. DATA COLLECTION AND ANALYSIS: References identified by the searches were independently screened against the inclusion criteria by two reviewers. Data were extracted and analysed using RevMan 4.2.10. MAIN RESULTS: Six randomised trials (including a total of 167 participants) of cognitive behavioural interventions were identified, with data reported in ten papers. Five studies reported statistically significant improvements in pain, measured in a variety of ways, in children randomised to receive interventions based on cognitive behavioural therapy compared to children on wait lists or receiving standard medical care (Duarte 2006; Humphreys 1998; Robins 2005; Sanders 1989; Sanders 1994). The remaining trial (Hicks 2003) included a wider group of children with recurrent pain and too few with only RAP to provide interpretable data. AUTHORS' CONCLUSIONS: The included trials were small, with methodological weaknesses and a number failed to give appropriate detail regarding numbers of children assessed. In spite of these methodological weaknesses and the clinical heterogeneity, the consistency and magnitude of the effects reported provides some evidence that cognitive behavioural therapy may be a useful intervention for children with recurrent abdominal pain although most children, particularly in primary care, will improve with reassurance and time.

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Complement Ther Med. 2007 Dec;15(4):255-263. Epub 2007 Feb 20.
Neuroendocrinological effects of acupuncture treatment in patients with irritable bowel syndrome.
Schneider A, Weiland C, Enck P, Joos S, Streitberger K, Maser-Gluth C, Zipfel S, Bagheri S, Herzog W, Friederich HC.
University Medical Hospital Heidelberg, Department of General Practice and Health Services Research, Voßstrasse 2, 69117 Heidelberg, Germany.

OBJECTIVES: Quality of life (QoL) improvement in patients with irritable bowel syndrome (IBS) during acupuncture (AC) treatment seems to be due to a placebo effect. The aim was to explore if acupuncture has some specific influence on the neuroendocrinic and autonomic nervous system (ANS). DESIGN/SETTING: Patients with IBS were randomly assigned to receive either acupuncture (AC) or sham acupuncture (SAC) using the so-called "Streitberger needle". QoL was measured with the functional quality of life diseases quality of life questionnaire (FDDQL) and SF-36. The effect on ANS was evaluated by measuring salivary cortisol and by cardiovascular responses on a tilt table before and after 10 AC treatments. Complete data sets of tilt table and salivary morning cortisol were available for 9 patients in the AC and 12 in SAC group. RESULTS: QoL increased in both groups (p=0.001) with no group differences. Salivary cortisol decreased in all groups (F=10.55; p=0.006). However, the decrease was more pronounced in the AC group (F=4.07; p=0.033) (ANOVA repeated measures model). Heart rate response decreased during orthostatic stress in the AC group while it increased in the SAC group (F=9.234; p=0.005), indicating an increased parasympathetic tone in the AC group. Improvement of pain was positively associated with increased parasympathetic tone in the AC group (F=10.1; p=0.006), but not in the SAC group. CONCLUSIONS: The acupuncture specific physiological effects are in contrast to the unspecific improvement of QoL in both AC and SAC groups. Thus, different mechanisms seem to be involved in placebo and real-acupuncture driven improvements. The specific mechanism of action of acupuncture on the ANS remains unclear and deserves further evaluation.

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Psychiatr Danub. 2007 Dec;19(4):327-31.
[Psychotherapy in somatic diseases--for example gastrointestinal disorders]
[Article in German]
Moser G.
Universitätsklinik für Innere Medizin III, Währinger Gürtel 18-20, 1090 Wien, Austria. gabriele.moser@univie.ac.at

The functional gastrointestinal disorders (FGID) are the most frequent clinical conditions seen in practice. Up to 60% of these patients is also suffering from psychosocial problems. Therefore it is important to define the patient's complaints in terms of a biopsychosocial disorder, to acknowledge the relevance of the psychosocial aspects and to provide an integrated psychosomatic treatment or a psychotherapy if indicated. Most of the research on psychotherapy in FGID to date has focused on the irritable bowel syndrome and different methods of treatments were studied (e.g., cognitive-behavioral therapy, dynamic psychotherapy, hypnotherapy, and relaxation). Randomised controlled studies have shown that psychotherapy is superior to conventional medical therapy. Hypnotherapy is successful not only for irritable bowel syndrome but also for functional dyspepsia. Predictors of a positive response to psychological treatment generally are: (1) awareness that stress exacerbates their bowel symptoms, (2) at least mild anxiety or depression, (3) the predominant bowel symptom is abdominal pain or diarrhea and not constipation, (4) the abdominal pain waxes and wanes in response to eating, defecation, or stress rather than being constant pain, and 5) the symptoms are of relatively short duration. Benefits persist over years, and in the long run, clinic visits and health care costs can be reduced.

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Nurs Res. 2007 Nov-Dec;56(6):399-406.
Daily stress and gastrointestinal symptoms in women with irritable bowel syndrome.
Hertig VL, Cain KC, Jarrett ME, Burr RL, Heitkemper MM.
Department of Biobehavioral Nursing & Health Systems, University of Washington, Seattle, WA 98195, USA. vhertig@u.washington.edu

BACKGROUND: Stress has been implicated as contributing to the initiation and exacerbation of bowel and discomfort symptoms in patients with irritable bowel syndrome (IBS). OBJECTIVE: To examine the relationships of daily self-reported stress to gastrointestinal (GI) and psychological distress symptoms both across women and within woman in a comparison group of women without IBS and among subgroups of women with IBS. METHODS: Women with IBS (n = 181; age = 18-49 years) who were divided into subgroups based on bowel pattern (constipation, n = 52; diarrhea, n = 67; alternating, n = 62) were compared to a group of women without IBS (n = 48). Self-report stress measures; abdominal (abdominal pain, bloating, and intestinal gas), bowel pattern (constipation, diarrhea), and intestinal gas; and psychological (anxiety and depression) distress symptoms were obtained daily over 1 month. Across-women and within-woman analyses were used. RESULTS: There were significant across-women correlations among mean daily stress, psychological distress, and GI symptoms in the total IBS group and the IBS bowel pattern subgroups. The across-women relationships between daily stress and GI symptoms were diminished when anxiety and depression were controlled in the analyses. Within-woman analyses showed little evidence of relationship between day-to-day variations in stress and day-to-day variations in GI symptoms; however, stress was strongly related to anxiety and depression. DISCUSSION: Gastrointestinal symptom distress is associated with self-reported stress in women with IBS. Psychological distress moderates the effects of stress on GI symptoms. The IBS treatment protocols that incorporate strategies that decrease stress and psychological distress are likely to reduce GI symptoms.

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Med Klin (Munich). 2007 Nov 15;102(11):888-92.
[Treatment of irritable bowel syndrome with Escherichia coli strain Nissle 1917 (EcN): a retrospective survey]
[Article in German]
Plassmann D, Schulte-Witte H.
Praxis für Innere Medizin/Gastroenterologie, Münsterstrasse 18 (Cassiusbastei), 53111, Bonn, Germany. info@gastroenterologie-bonn.de

BACKGROUND AND PURPOSE: In many patients with irritable bowel syndrome (IBS), one symptom is predominant (e.g., diarrhea, constipation, meteorism, or alternating stool consistency). For IBS therapy, probiotic drugs such as Mutaflor (active ingredient: Escherichia coli strain Nissle 1917 [EcN]) are also being used. A systematic survey on the efficacy and safety of EcN in different IBS subgroups is still missing. PATIENTS AND METHODS: In a gastroenterologic outpatient practice, results of 150 IBS patients treated with EcN were evaluated retrospectively. Most IBS patients enrolled belonged to the subgroups "diarrhea", "meteorism", and "alternating stool consistency". RESULTS: Regarding the diarrhea subgroup, not only a statistically significant improvement in stool frequency was observed, but also a marked improvement in concomitant symptoms such as abnormal urge, flatulence, and abdominal fullness. These complaints improved under EcN therapy in the other IBS subgroups as well, so that efficacy was assessed as "good to very good" in 73.4% of all cases. Tolerance to treatment was "good to very good" in 97.9% of the cases. CONCLUSION: The results point to the possibility of EcN being a therapeutic option for patients of various IBS subgroups which is almost free of side effects.

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Curr Gastroenterol Rep. 2007 Oct;9(5):393-400.
The role of probiotics in management of irritable bowel syndrome.
Borowiec AM, Fedorak RN.
Division of Gastroenterology, University of Alberta, Zeidler Ledcor Centre, 130 University Campus, Edmonton, AB T6G 2X8, Canada. richard.fedorak@ualberta.ca.

Irritable bowel syndrome (IBS) affects a significant proportion of the North American population; however, the etiology and pathophysiology of this disease remain poorly understood, and treatment is focused on symptom management. Over the years, research has revealed that the bacterial flora in the human gut interact with the bowel in a complex and dynamic relationship and may be responsible for the induction and progression of some of the pathophysiologic aspects of IBS. Probiotics are nonpathogenic bacteria that benefit the host, and the roles they can play in the bacterio-gut relationship provide hope of a safe treatment that would allow for modulation of IBS disease states. Probiotic treatment for IBS has undergone significant exploration, yet the exact therapeutic effects and doses of these beneficial bacteria remain unclear due to the conflicting nature of available evidence. This review discusses the evidence from randomized controlled trials on probiotic treatment of IBS and presents the current understanding of the mechanisms of action of probiotics as they apply to IBS and provides a plausible explanation for the variability in evidence documented by the various trials under review.

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Aliment Pharmacol Ther. 2007 Oct 31 [Epub ahead of print]
Clinical trial: dextofisopam in the treatment of patients with diarrhea-predominant or alternating irritable bowel syndrome.
Leventer SM, Raudibaugh K, Frissora CL, Kassem N, Keogh JC, Phillips J, Mangel AW.
Vela Pharmaceuticals Inc., Ewing, NJ, USA.

Background: Dextofisopam modulates stimulated activity in animal models of stress, altered bowel motility, and visceral hypersensitivity. Aim: This double-blind, placebo-controlled study evaluated the effects of dextofisopam in men and women with diarrhea-predominant or alternating IBS (d-IBS or a-IBS). Methods: Patients were randomly assigned to receive dextofisopam 200 mg BID or placebo for 12 weeks. The prospectively defined primary endpoint was number of months of adequate overall relief of IBS symptoms. Bowel function was assessed primarily via stool frequency and consistency. Results: Of 140 enrolled patients, 66 received dextofisopam and 74 placebo, 73% of the patients were women, and 78% had d-IBS. Dextofisopam was superior to placebo on the primary endpoint (p=0.033). In d-IBS patients treated with dextofisopam, both men and women had improved stool consistency, but stool frequency was reduced only in women. Benefit diminished over time on the primary endpoint but persisted on frequency and consistency. Dextofisopam and placebo had similar rates and types of adverse events, with more events of worsening abdominal pain with dextofisopam (12% vs. 4%) and more headaches with placebo (12% vs. 5%). Constipation was rare. Conclusions: Dextofisopam should be further evaluated as a new treatment for men and women with d-IBS and a-IBS.

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Aliment Pharmacol Ther. 2007 Aug 15;26(4):605-15.
Effect of long-term treatment with octreotide on rectal sensitivity in patients with non-constipated irritable bowel syndrome.
Klooker TK, Kuiken SD, Lei A, Boeckxstaens GE.
Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands.

Background Acute administration of octreotide reduces visceral perception and therefore has been suggested as potential treatment for irritable bowel syndrome. Whether prolonged treatment with octreotide also reduces visceral sensitivity and improves gastrointestinal symptoms remains, however, unknown. Aim To investigate the effect of a slow release preparation of octreotide on rectal sensitivity and symptoms in irritable bowel syndrome patients. Methods Forty-six non-constipated irritable bowel syndrome patients (52% female, 19-63 years) participated. Before and after 8 weeks of treatment with octreotide (Sandostatin LAR 20 mg i.m.) or placebo, patients underwent a barostat study to assess the rectal sensitivity. During a 2-week run-in period and treatment, abdominal pain, defecation frequency, consistency and symptom relief were scored weekly. Results Octreotide, but not placebo, significantly increased the threshold for first sensation. Thresholds for urge to defecate and discomfort/pain and rectal compliance were not altered by either treatment. Octreotide improved stool consistency compared with placebo (loose stools after eight weeks: octreotide: 52%, placebo: 81%, P < 0.05). In contrast, abdominal pain and defecation frequency were not affected. Conclusions Although the threshold of first rectal sensation increased and stool consistency improved, long-term treatment with octreotide, at least at the current dose used, has no visceral analgesic effect and fails to improve irritable bowel syndrome symptoms.

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Neurogastroenterol Motil. 2007 Aug;19(8):630-7.
A meta-analysis of the placebo response in complementary and alternative medicine trials of irritable bowel syndrome.
Dorn SD, Kaptchuk TJ, Park JB, Nguyen LT, Canenguez K, Nam BH, Woods KB, Conboy LA, Stason WB, Lembo AJ.
Brigham and Women's Hospital, Boston, MA, USA.

Among patients with irritable bowel syndrome (IBS) enrolled in clinical trials of conventional medical therapy, the placebo response rate is high. IBS patients also frequently use complementary and alternative medicine (CAM), which may act through an 'enhanced placebo effect'. The purpose of this study was to estimate the magnitude of the placebo response rate in CAM trials for IBS and to identify factors that influence this response. We performed a systematic review and meta-analysis of randomized, placebo-controlled clinical trials of CAM therapies for IBS identified from MEDLINE/EMBASE/PsychLIT databases from 1970 to 2006. Placebo and active treatment response rates for global symptom improvement were assessed. Nineteen studies met the inclusion criteria. The pooled estimate of the placebo response rate was 42.6% (95% confidence interval, 38.0-46.5%). Significant heterogeneity existed across trials (range 15.0-72.2%, P < 0.00001). Higher placebo response rates correlated with a longer duration of treatment (r = 0.455, P = 0.05) and a greater number of office visits (r = 0.633, P = 0.03). Among IBS patients in CAM trials, the placebo response rate is high. That this rate is similar in magnitude to that seen in conventional medicine trials suggests that the placebo response is independent of the type of therapy used and that it is not particularly 'enhanced' in CAM trials.

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Aliment Pharmacol Ther. 2007 Aug 1;26(3):475-86.
Effect of a fermented milk containing Bifidobacterium animalis DN-173 010 on the health-related quality of life and symptoms in irritable bowel syndrome in adults in primary care: a multicentre, randomized, double-blind, controlled trial.
Guyonnet D, Chassany O, Ducrotte P, Picard C, Mouret M, Mercier CH, Matuchansky C.
Danone Research, Route Départementale 128, 91767 Palaiseau, France.

Background Health-related quality of life (HRQoL) has been rarely evaluated as a primary endpoint in the assessment of the effect of probiotics on the irritable bowel syndrome (IBS). Aim To study the effects of fermented milk containing Bifidobacterium animalis DN-173 010 and yoghurt strains on the IBS in a multicentre, double-blind, controlled trial. Methods A total of 274 primary care adults with constipation-predominant IBS (Rome II) were randomized to consume for 6 weeks either the test fermented milk or a heat-treated yoghurt (control). HRQoL and digestive symptoms were assessed after 3 and 6 weeks on an intention-to-treat population of 267 subjects. Results The HRQoL discomfort score, the primary endpoint, improved (P < 0.001) in both groups at weeks 3 and 6. The responder rate for the HRQoL discomfort score was higher (65.2 vs. 47.7%, P < 0.005), as was the decrease in bloating score [0.56 +/- (s.d.)1.01 vs. 0.31 +/- 0.87, P = 0.03], at week 3 in the test vs. the control group. In those subjects with <3 stools/week, stool frequency increased (P < 0.001) over 6 weeks in the test vs. control group. Conclusions This study suggests a beneficial effect of a probiotic food on discomfort HRQoL score and bloating in constipation-predominant IBS, and on stool frequency in subjects with <3 stools/week.

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World J Gastroenterol. 2007 Jul 7;13(25):3425-9.
Placebo responses in patients with gastrointestinal disorders.
Musial F, Klosterhalfen S, Enck P.
Department of Internal Medicine, Integrative and Complementary Medicine, Kliniken Essen-Mitte, Knappschafts-Krankenhaus, Am Deimelsberg 34a, Essen 45276, Germany. f.musial@kliniken-essen-mitte.de.

Over the last several years there has been a growing interest in placebo, not only as an inert control in clinical trials, but also in the placebo effect as a group effect as well as a reaction in individual subjects. Methodological factors such as regression to the mean and natural history of the disease play a role in the evaluation of a possible placebo effect. In this report, we discuss several factors including Pavlovian conditioning, beliefs outcome, expectations, and other factors as potential mediators of the placebo response. Placebo effects are common in gastrointestinal diseases and there seems to be no clear difference between placebo effects in functional gastrointestinal diseases (functional dyspepsia and irritable bowel syndrome) and organic gastrointestinal disease (duodenal ulcer and inflammatory bowel disease).

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World J Gastroenterol. 2007 Jul 7;13(25):3417-3424.
Acupuncture treatment in gastrointestinal diseases: A systematic review.
Schneider A, Streitberger K, Joos S.
Department of General Practice and Health Services Research, University Medical Hospital Heidelberg, Voßstrasse 2, Heidelberg 69120, Germany. antonius.schneider@med.uni-heidelberg.de.

The purpose of this work was to assess the evidence for effectiveness of acupuncture (AC) treatment in gastrointestinal diseases. A systematic review of the Medline-cited literature for clinical trials was performed up to May 2006. Controlled trials assessing acupuncture point stimulation for patients with gastrointestinal diseases were considered for inclusion. The search identified 18 relevant trials meeting the inclusion criteria. Two irritable bowel syndrome (IBS) trials, 1 Crohn's disease and 1 colitis ulcerosa trial had a robust random controlled trial (RCT) design. In regard to other gastrointestinal disorders, study quality was poor. In all trials, quality of life (QoL) improved significantly independently from the kind of acupuncture, real or sham. Real AC was significantly superior to sham acupuncture with regard to disease activity scores in the Crohn and Colitis trials. Efficacy of acupuncture related to QoL in IBS may be explained by unspecific effects. This is the same for QoL in inflammatory bowel diseases (IBD), whereas specific acupuncture effects may be found in clinical scores. Further trials for IBDs and in particular for all other gastrointestinal disorders would be necessary to evaluate the efficacy of acupuncture treatment. However, it must be discussed on what terms patients benefit when this harmless and obviously powerful therapy with regard to QoL is demystified by further placebo controlled trials.

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Dig Liver Dis. 2007 Jul 20; [Epub ahead of print]
Effect of gluten-free diet and co-morbidity of irritable bowel syndrome-type symptoms on health-related quality of life in adult coeliac patients.
Usai P, Manca R, Cuomo R, Lai MA, Boi MF.
Gastroenterology Unit, University of Cagliari, S.S. 554 Bivio per Sestu, 09042 Monserrato (CA), Italy.

BACKGROUND: Both coeliac disease and irritable bowel syndrome show impaired health-related quality of life, however, the impact of irritable bowel syndrome-type symptoms on health-related quality of life in coeliac disease is unclear. AIM: To evaluate the effect of gluten-free diet adherence and irritable bowel syndrome-type symptoms co-morbidity on health-related quality of life in adult coeliac disease patients. PATIENTS AND METHODS: A total of 1130 adults were enrolled in the study comprising 1001 controls from the general population and 129 diagnosed coeliac disease patients from the University Clinic in Cagliari. Irritable bowel syndrome-type symptoms and health-related quality of life were assessed using the Rome II and the SF-36 questionnaires, respectively. RESULTS: Irritable bowel syndrome-type symptoms prevalence in controls was 10.1% (102/1001) and 55% (71/129) in the coeliac disease patients. Irritable bowel syndrome-type symptom controls and coeliac disease patients both presented significantly lower health-related quality of life (p</=0.05) compared to healthy controls. Strict diet coeliac disease patients, compared to partial diet patients, showed significantly (p</=0.05) better scores in all domains, except physical functioning, physical-role and bodily pain. The lowest scores were found in partial diet coeliac disease patients with irritable bowel syndrome-type symptoms. CONCLUSIONS: The present results confirm the burden of irritable bowel syndrome-type symptoms and coeliac disease on health-related quality of life. Moreover, these data show that health-related quality of life in coeliac disease is impaired by poor compliance and by co-morbidity with irritable bowel syndrome-type symptoms.

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Ther Umsch. 2007 Apr;64(4):205-10.
[Irritable bowel syndrome]
[Article in German]
Truninger K.
Klinik und Poliklinik für Gastroenterologie, Universitátsspital, Bern. kaspar.truninger@insel.ch

Irritable bowel syndrome (IBS) is one of the most frequent functional gastrointestinal disorders. The main symptoms are abdominal pain associated with a change in bowel habit. Headache and psychiatric disorders such as mood or anxiety disorders are often associated with IBS. Genetic predisposition, sensomotoric dysfunction, altered enteric inflammation and immune activation and disturbance of the brain-gut interaction are the most important pathogenetic factors. The diagnosis requires the new symptom-based Rome-III-criteria. Diagnostic testing primarily depends on the patients complaints, clinical and laboratory features and is then guided by the patient's age, symptom's severity and duration, alarm symptoms, psychosocial factors, and the family history for tumors. Treatment of IBS is based on an individualized evaluation and depends on disease severity, predominant symptoms and associated disorders. Treatment options include lifestyle modifications, drug therapy aimed at predominant symptoms and various forms of psychological treatments.

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Best Pract Res Clin Gastroenterol. 2007;21(4):689-707.
Irritable bowel syndrome and bloating.
Hasler WL.
Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, MI, USA.

Gaseous symptoms in irritable bowel syndrome (IBS) including eructation, flatulence, and bloating occur as a consequence of excess gas production, altered gas transit, abnormal perception of normal amounts of gas within the gastrointestinal tract, or dysfunctional somatic muscle activity in the abdominal wall. Because of the prominence of gaseous complaints in IBS, recent investigations have focussed on new insights into pathogenesis and novel therapies of bloating. The evaluation of the IBS patient with unexplained gas and bloating relies on careful exclusion of organic disease with further characterisation of the underlying condition with directed functional testing. Treatment of gaseous symptomatology in IBS should be targeted to pathophysiologic defects whenever possible. Available therapies include lifestyle alterations, dietary modifications, enzyme preparations, adsorbents and agents which reduce surface tension, treatments that alter gut flora, and drugs that modulate gut transit.

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Ther Umsch. 2007 Mar;64(3):161-9.
[Pre- and probiotics.]
[Article in German]
Meier R, Lochs H.
Medizinische Universitatsklinik, Abteilung fur Gastroenterologie, Hepatologie und Ernahrung, Kantonsspital, Liestal.

Nowadays, the regular consumption of pre- and probiotics is recommended to provide various positive health benefits. The in vitro and in vivo demonstrated actions on the intestinal microflora, the mucosal barrier and the immunological system are very interesting to propose beneficial health effects, but the scientific proof in humans is not demonstrated yet. Pre- and probiotics are very active in the intestinal tract (mainly in the colon) by maintaining a healthy gut microflora and influencing metabolic, trophic and protective mechanism. Prebiotics stimulates the growth of apathogen bacteria and increase the short chain fatty acid concentration by fermentation. Short chain fatty acids are necessary substrates for a healthy gut. Probiotics inhibit the growth of pathogen bacteria, reduce the translocation of bacteria and toxins and modulate the intestinal immune system. For some specific clinical diseases (ulcerative colitis, pouchitis, diarrhoea) a therapeutic and prophylactic effect with pre- and probiotics was shown. In the near future more indications for pre- and probiotics (used as a single strain or as in a combination) will be added. Promising results are already shown in irritable bowel syndrome, prevention of antibiotic induced diarrhoea, in surgical and in intensive care patients. Future studies should focus to determine the characteristics of a healthy gut and the evaluation of specific health benefits by well-designed, controlled human studies of adequate duration.

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Neurogastroenterol Motil. 2007 Mar;19(3):166-72.
Probiotics and irritable bowel syndrome: a rationale for their use and an assessment of the evidence to date.
Quigley EM, Flourie B.
Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland.

Probiotics, defined as live organisms that, when ingested in adequate amounts, exert a health benefit on the host, have been used for almost a century in the management of a variety of medical disorders, usually on the basis of little evidence. Advances in our understanding of the gut flora and of its relationship to the host, together with progress in microbiology, molecular biology and clinical research have identified important biological properties for probiotics and demonstrated efficacy in a number of gastrointestinal disorders. The clear delineation of a post-infective variety of irritable bowel syndrome (IBS), as well as the description, in a number of studies, of evidence of low-grade inflammation and immune activation in IBS, suggest a role for a dysfunctional relationship between the indigenous flora and the host in IBS and, accordingly, provide a clear rationale for the use of probiotics in this disorder. Other modes of action, including bacterial displacement and alterations in luminal contents, are also plausible. While clinical evidence of efficacy is now beginning to emerge, a review of available trials emphasises the importance of clear definition of strain selection, dose and viability. This is evidently an area of great potential in IBS and deserves further study at all levels.

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Pharmacotherapy. 2007 Feb;27(2):267-77.
Tegaserod for constipation-predominant irritable bowel syndrome.
Kale-Pradhan PB, Wilhelm SM.
1 Department of Pharmacy Practice, Wayne State University, Detroit, Michigan; Department of Pharmacy, St. John Hospital and Medical Center, Detroit, Michigan.

Tegaserod, a selective and partial agonist at the 5-hydroxytryptamine (5-HT [serotonin]) receptor subtype 4 (5-HT(4)), is the only United States Food and Drug Administration-approved drug for the treatment of constipation-predominant irritable bowel syndrome (IBS) in women. The drug's stimulation of 5-HT(4) receptors on intestinal enterocytes increases peristaltic activity and fluid secretion into the gut lumen, facilitating stool passage. In addition, affinity of tegaserod for 5-HT(4) receptors modulates visceral sensitivity, which helps alleviate abdominal pain associated with constipation-predominant IBS. The drug's pharmacokinetic and pharmacodynamic parameters do not differ significantly with age or sex. Tegaserod safely and effectively relieves overall gastrointestinal symptoms and abdominal discomfort and normalizes bowel habits in patients with constipation-predominant IBS. It is associated with few drug interactions. In clinical studies, tegaserod was well tolerated, and its adverse-effect profile was similar to that of placebo. Severe diarrhea, as well as abdominal pain, flatulence, headache, and nausea, were the most commonly reported events. Patients who experience severe diarrhea should discontinue the drug. With the data available, tegaserod remains an option for patients with constipation-predominant IBS.

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Chin J Dig Dis. 2007;8(1):2-7.
Bacterial flora in irritable bowel syndrome: role in pathophysiology, implications for management.
Quigley EM.
Alimentary Pharmabiotic Center, University College Cork, Cork, IRELAND.

Irritable bowel syndrome (IBS) may, in part at least, result from a dysfunctional interaction between the indigenous flora and the intestinal mucosa which, in turn, leads to immune activation in the colonic mucosa. Some propose a role for bacterial overgrowth as a common causative factor in the pathogenesis of symptoms in IBS; other evidence points to more subtle qualitative changes in the colonic flora; both hypotheses remain to be confirmed but the likelihood that bacterial overgrowth will prove to be a major factor in IBS now seems remote. Nevertheless, short-term therapy with either antibiotics or probiotics does seem to reduce symptoms among IBS patients. It seems most likely that the benefits of antibiotic therapy are mediated through subtle and, perhaps, localized, quantitative and/or qualitative changes in the colonic flora. How probiotics exert their effects remain to be defined but an anti-inflammatory effect seems likely. While this approach to the management of IBS is in its infancy, it is evident that manipulation of the flora, whether through the administration of antibiotics or probiotics, deserves further attention in IBS.

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Inflamm Bowel Dis. 2007 Jan;13(1):91-6.
Treatment of irritable bowel syndrome in outpatients with inflammatory bowel disease using a food and beverage intolerance, food and beverage avoidance diet.
Macdermott RP.
Inflammatory Bowel Diseases Center, The Albert M. Yunich MD Professor of Medicine, Division of Gastroenterology, Albany Medical College, Albany, New York.

Irritable bowel syndrome (IBS) in the outpatient with chronic inflammatory bowel disease (IBD) is a difficult but important challenge to recognize and treat. It is very helpful to have effective treatment approaches for IBS that are practical and use minimal medications. Because of the underlying chronic inflammation in IBD, IBS symptoms occur with increased frequency and severity, secondary to increased hypersensitivity to foods and beverages that stimulate the gastrointestinal tract. This paper discusses how to treat IBS in the IBD outpatient, with emphasis on using a food and beverage intolerance, avoidance diet. The adverse effects of many foods and beverages are amount dependent and can be delayed, additive, and cumulative. The specific types of foods and beverages that can induce IBS symptoms include milk and milk containing products; caffeine containing products; alcoholic beverages; fruits; fruit juices; spices; seasonings; diet beverages; diet foods; diet candies; diet gum; fast foods; condiments; fried foods; fatty foods; multigrain breads; sourdough breads; bagels; salads; salad dressings; vegetables; beans; red meats; gravies; spaghetti sauce; stews; nuts; popcorn; high fiber; and cookies, crackers, pretzels, cakes, and pies. The types of foods and beverages that are better tolerated include water; rice; plain pasta or noodles; baked or broiled potatoes; white breads; plain fish, chicken, turkey, or ham; eggs; dry cereals; soy or rice based products; peas; applesauce; cantaloupe; watermelon; fruit cocktail; margarine; jams; jellies; and peanut butter. Handouts that were developed based upon what worsens or helps IBS symptoms in patients are included to help patients learn which foods and beverages to avoid and which are better tolerated.(Inflamm Bowel Dis 2007;13:91-96).

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Clin Drug Investig. 2007;27(1):15-33.
Irritable bowel syndrome.
Spinelli A.
Department of Gastroenterology and Digestive Endoscopy, Policlinico di Monza, Monza, Italy.

Irritable bowel syndrome (IBS) is a disease of unclear, complex pathophysiology characterised by abdominal pain and discomfort and altered bowel activity. It affects an estimated 10-15% of individuals worldwide and has a large impact on quality of life (QOL) and both direct and indirect healthcare costs. Symptoms of IBS are usually triggered by disruption of gastrointestinal (GI) function secondary to infection, dietary factors, lifestyle changes or psychological stress.While most currently available pharmacological treatments of IBS focus on symptomatic treatment of the syndrome, agents that attempt to address the pathophysiology of the disease, in particular the role of serotonin, have received much attention in recent years. However, there is growing concern that sero- tonergic agents as a class may be associated with rare, but serious, episodes of ischaemic colitis, with several cases of this complication having been reported in association with use of serotonergic agents that have reached the market. Thus, there remains an important need for safe and effective agents that treat the symptoms of IBS.Otilonium bromide, a spasmolytic agent, has been widely used worldwide and has been found to be effective and safe for managing abdominal pain. Clinical trials indicate that it improves baseline abdominal pain and distension, and is particularly effective in reducing diarrhoea. Combining otilonium bromide with benzodiazepines, such as diazepam, may improve the efficacy of the agent with respect to GI symptoms, while also treating underlying anxiety disorders. More research is required to confirm the efficacy and mechanisms of action associated with this combination therapy in IBS. Safety data from clinical trials and postmarketing sources indicate that otilonium bromide is well tolerated, with a safety profile comparable to placebo in clinical trials and only two reported cases of adverse reactions (urticaria) among 10-year postmarketing data. This article reviews the pathophysiology and treatment of IBS with a particular focus on the role of otilonium bromide in the management of this condition.

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Pain Res Manag. 2006 Winter;11(4):217-23.
A randomized trial of yoga for adolescents with irritable bowel syndrome.
Kuttner L, Chambers CT, Hardial J, Israel DM, Jacobson K, Evans K.
University of British Columbia, Vancouver, Canada.

BACKGROUND: Adolescents with irritable bowel syndrome (IBS) frequently experience interference with everyday activities. Mind-body approaches such as yoga have been recommended as interventions for patients with IBS. Despite promising results among adult samples, there have been limited studies exploring the efficacy of yoga with pediatric patients. OBJECTIVE: To conduct a preliminary randomized study of yoga as treatment for adolescents with IBS. METHODS: Twenty-five adolescents aged 11 to 18 years with IBS were randomly assigned to either a yoga or wait list control group. Before the intervention, both groups completed questionnaires assessing gastrointestinal symptoms, pain, functional disability, coping, anxiety and depression. The yoga intervention consisted of a 1 h instructional session, demonstration and practice, followed by four weeks of daily home practice guided by a video. After four weeks, adolescents repeated the baseline questionnaires. The wait list control group then received the yoga intervention and four weeks later completed an additional set of questionnaires. RESULTS: Adolescents in the yoga group reported lower levels of functional disability, less use of emotion-focused avoidance and lower anxiety following the intervention than adolescents in the control group. When the pre- and postintervention data for the two groups were combined, adolescents had significantly lower scores for gastrointestinal symptoms and emotion-focused avoidance following the yoga intervention. Adolescents found the yoga to be helpful and indicated they would continue to use it to manage their IBS. CONCLUSIONS: Yoga holds promise as an intervention for adolescents with IBS.

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Intern Med J. 2006 Nov;36(11):724-8.
Irritable bowel syndrome.
Talley NJ.
Mayo Clinic College of Medicine, Dyspepsia Center, Clinical Enteric Neuroscience Translational and Epidemiological Research Program, Rochester, Minnesota 55905, USA. talley.nicholas@mayo.edu

Free full text at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17040359

Conceptually, the irritable bowel syndrome (IBS) has been considered a brain-gut functional disorder, but this paradigm is under serious challenge. There is increasing evidence that organic disease of the gastrointestinal tract can be identified in subsets of patients who fulfil the Rome criteria for IBS. Evidence for subtle inflammatory bowel disease, serotonin dysregulation, bacterial overgrowth and central dysregulation continue to accumulate. The underlying causes of IBS remain to be adequately identified, but postinfectious IBS is a clear-cut entity. Furthermore, a genetic contribution to IBS also seems likely. Diagnosis continues to be based on the symptom profile and the absence of alarm features. A heightened awareness of coeliac disease masquerading as IBS is becoming accepted. Management remains largely based on symptomatic rather than on disease-modifying therapy, but this is likely to change in the near future. Here, recent advances in the pathophysiology and management of IBS are considered.

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Cochrane Database Syst Rev. 2006 Oct 18;(4):CD005111.
Acupuncture for treatment of irritable bowel syndrome.
Lim B, Manheimer E, Lao L, Ziea E, Wisniewski J, Liu J, Berman B.
University of Maryland School of Medicine, Center for Integrative Medicine, Kernan Hospital Mansion, 2200 Kernan Drive, Baltimore, Maryland 21207-6697, USA.

BACKGROUND: Irritable bowel syndrome (IBS), a disorder of altered bowel habits associated with abdominal pain or discomfort. The pain, discomfort, and impairment from IBS often lead to healthcare medical consultation (Talley 1997) and workplace absenteeism, and associated economic costs (Leong 2003). A recent randomized controlled trial shows variable results but no clear evidence in support of acupuncture as an effective treatment for IBS (Fireman 2001). OBJECTIVES: The objective of this systematic review is to determine whether acupuncture is more effective than no treatment, more effective than 'sham' (placebo) acupuncture, and as effective as other interventions used to treat irritable bowel syndrome. Adverse events associated with acupuncture were also assessed. SEARCH STRATEGY: The following electronic bibliographic databases were searched irrespective of language, date of publication, and publication status: MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library, EMBASE, the Chinese Biomedical Database, the Cumulative Index to Nursing and Allied Health (CINAHL), and the Allied and Complementary Medicine Database (AMED). References in relevant reviews and RCTs were screened by hand. The last date for searching for studies was 7 February 2006. SELECTION CRITERIA: Published reports of randomized controlled trials (RCTs) and quasi-randomised trials of acupuncture therapy for IBS. DATA COLLECTION AND ANALYSIS: All eligible records identified were dually evaluated for eligibility and dually abstracted. Methodological quality was assessed using the Jadad scale and the Linde Internal Validity Scale. Data from individual trials were combined for meta-analysis when the interventions were sufficiently similar. Heterogeneity was assessed using the I squared statistic. MAIN RESULTS: Six trials were included. The proportion of responders, as assessed by either the global symptom score or the patient-determined treatment success rate, did not show a significant difference between the acupuncture and the sham acupuncture group with a pooled relative risk of 1.28 (95% CI 0.83 to 1.98; n=109). Acupuncture treatment was also not significantly more effective than sham acupuncture for overall general well-being, individual symptoms (e.g., abdominal pain, defecation difficulties, diarrhea, and bloating), the number of improved patients assessed by blinded clinician, or the EuroQol score. For two of the studies without a sham control, acupuncture was more effective than control treatment for the improvement of symptoms: acupuncture versus herbal medication with a RR of 1.14(95% CI 1.00 to 1.31; n=132); acupuncture plus psychotherapy versus psychotherapy alone with a RR of 1.20 (95% CI 1.03 to 1.39; n=100). When the effect of ear acupuncture treatment was compared to an unclearly specified combination of one or more of the drugs diazepam, perphenazine or domperidone, the difference was not statistically significant with a RR of 1.49(95% CI 0.94 to 2.34; n=48). AUTHORS' CONCLUSIONS: Most of the trials included in this review were of poor quality and were heterogeneous in terms of interventions, controls, and outcomes measured. With the exception of one outcome in common between two trials, data were not combined. Therefore, it is still inconclusive whether acupuncture is more effective than sham acupuncture or other interventions for treating IBS.

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Acta Biomed Ateneo Parmense. 2006 Aug;77(2):85-9.
Role of gut microflora and probiotic effects in the irritable bowel syndrome.
Fanigliulo L, Comparato G, Aragona G, Cavallaro L, Iori V, Maino M, Cavestro GM, Soliani P, Sianesi M, Franze A, Di Mario F.
Chair of Gastroenterology, Department of Clinical Sciences, University of Parma , Italy.

BACKGROUND: Even though the cause of irritable bowel sindrome (IBS) is not yet known, alterations of the intestinal microflora may be important in its pathogenesis. AIM: To evaluate the efficacy of rifaximine alone or in association with the probiotic strain of Bifidobacterium longum W11 in reducing symptoms in patients with IBS. METHODS: We performed a monocentric, prospective, randomized open trial including 70 patients randomized in to two groups: Group A (41 patients) receiving rifaximin 200 (2 cp bid for ten days in a month) followed by a formulation of the probiotic strain of Bifidobacterium longum W11(one granulated suspension for 6 days on alternate weeks ) and Group B (29 patients) receiving only rifaximin 200 (2 cp bid for ten days in a month). The clinical evaluation was performed at admission and after 2-months, taking into account the method of visual analogous. RESULTS: At the 2-month follow-up, Group A patients reported a greater improvement of symptoms compared to patients in group B (p = 0.010) even if the physician's opinion at T1 did not confirm these results (p = 0.07). CONCLUSION: The increased colonisation by Bifi-dobacterium longum W11, after the cyclic administration of rifaximin, which eradicates the bacterial overgrowth of the small intestine, may reduce symptoms, especially those related to bowel habit and stool frequency in patients with IBS. The abnormalities observed in the colonic flora of IBS suggest, in fact, that a probiotic approach will ultimately be justified.
  
Previous Irritable Bowel Research: 2002-2006   
The IBS File also contains summaries of past research that has shown promise and may still be standard practice among many physicians. To download earlier research findings on Irritable Bowel, click HERE.
 

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