Irritable Bowel Syndrome

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (30 September 2017) | Viewed by 91834

Special Issue Editor


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Guest Editor
Gastroenterology & Hepatology, VA Boston Healthcare System, Boston University School of Medicine, 650 Albany St, EBRC, Room 508, Boston, MA 02118, USA
Interests: obesity and metabolism; functional bowel disorders, including irritable bowel syndrome; gastrointestinal hormones and receptors; opioid induced constipation; neuroendocrinology and neuroendocrine tumors; gastric acid secretion and acid-related disorders

Special Issue Information

Dear Colleagues,

Functional gastrointestinal disorders (FGID) comprise the most commonly encountered diagnoses in primary care and gastroenterology clinics and regularly present with a range of abnormalities including intestinal dysmotility, visceral hypersensitivity, altered gastrointestinal mucosal immune function, central nervous system dysregulation, and altered gut microbiota. Accordingly, FGID have been recently defined as disorders of Gut–Brain Interaction associated with the concept of a biopsychological model in the field of neurogastroenterology.

The functional bowel disorder irritable bowel syndrome (IBS) in particular represents a highly prevalent chronic FGID in clinical practice characterized by predominant recurring symptoms or signs of altered bowel habits, bloating, distention in association with abdominal pain. Its global prevalence has been estimated to range from 10% to 20% with significant geographic variations, has a higher prevalence noted in women, and younger people below the age of 50 are more likely to be affected. IBS has a highly significant negative impact on quality of life and represents a substantial economic burden due to high utilization of health care resources and its negative socioeconomic impact on productivity in patients with IBS. The diagnosis of IBS (and other FGID) is based mainly on clinical symptom assessment as most recently outlined in the Rome IV criteria. The diagnostic criteria for IBS consist of the presence of recurrent abdominal pain associated with two or more of the following criteria: 1. related to defecation, 2. associated with a change in frequency of stool, and 3. associated with a change in stool form. Based on the predominant stool consistency, IBS can be grouped into four different subtypes: IBS with predominant diarrhea (IBS-D), with predominant constipation (IBS-C), with mixed bowel habits (IBS-M) and unclassified which has an insufficient abnormality of stool consistency to be in the other groups (IBS-U).

The diagnosis of IBS is therefore based primarily on the presence of particular clinical symptoms and the absence of obvious anatomic or physiologic abnormalities during minimal targeted routine diagnostic evaluation. Furthermore, IBS is not considered to be a single disease entity; it is believed to be a multifactorial syndrome of symptoms with differing underlying causes with environmental and hereditary/genetic factors, dysregulation of the bidirectional communication system between the gastrointestinal tract and the brain (brain–gut axis) associated with disruption of cellular immune responses, the gut microbiota, and the gastrointestinal neuroendocrine system.

The crucial foundation for successful management of IBS patients is the development of a trusted patient provider relationship that ultimately can result in improved outcomes. Treatment modalities are directed to alleviate predominant IBS symptoms and may include dietary, non-pharmacological, and targeted pharmacological interventions and also psychological therapy options. The ongoing advance of the fundamental understanding of the gut microbiome and the complexity of the brain–gut axis will undoubtedly uncover further opportunities of additional IBS treatment modalities in the near future.

This special edition on IBS presents several expert reviews on a broad range of important aspects related to the current understanding of the pathophysiology, clinical diagnosis, and management of the functional bowel disorder irritable bowel syndrome.

Dr. H. Christian Weber, MD
Guest Editor

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Keywords

  • Functional Gastrointestinal Disorders (FGID)
  • Irritable Bowel Syndrome (IBS)
  • Gut–Brain Interaction
  • Brain–Gut Axis
  • Central Nervous System (CNS)
  • Enteric Nervous System (ENS)
  • Biopsychosocial Model
  • Rome Criteria
  • Patient Provider Relationship
  • Neurogastroenterology
  • Visceral Hypersensitivity
  • Gut Microbiome
  • Gut Motility Disturbance
  • Gut Mucosal Immune Function
  • Psychological Treatment
  • Quality of Life
  • Healthcare Utilization
  • Pharmacotherapy of IBS

Published Papers (8 papers)

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Research

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917 KiB  
Article
Inter-Rater Reliability of Provider Interpretations of Irritable Bowel Syndrome Food and Symptom Journals
by Jasmine Zia, Chia-Fang Chung, Kaiyuan Xu, Yi Dong, Jeanette M. Schenk, Kevin Cain, Sean Munson and Margaret M. Heitkemper
J. Clin. Med. 2017, 6(11), 105; https://doi.org/10.3390/jcm6110105 - 4 Nov 2017
Cited by 2 | Viewed by 5328
Abstract
There are currently no standardized methods for identifying trigger food(s) from irritable bowel syndrome (IBS) food and symptom journals. The primary aim of this study was to assess the inter-rater reliability of providers’ interpretations of IBS journals. A second aim was to describe [...] Read more.
There are currently no standardized methods for identifying trigger food(s) from irritable bowel syndrome (IBS) food and symptom journals. The primary aim of this study was to assess the inter-rater reliability of providers’ interpretations of IBS journals. A second aim was to describe whether these interpretations varied for each patient. Eight providers reviewed 17 IBS journals and rated how likely key food groups (fermentable oligo-di-monosaccharides and polyols, high-calorie, gluten, caffeine, high-fiber) were to trigger IBS symptoms for each patient. Agreement of trigger food ratings was calculated using Krippendorff’s α-reliability estimate. Providers were also asked to write down recommendations they would give to each patient. Estimates of agreement of trigger food likelihood ratings were poor (average α = 0.07). Most providers gave similar trigger food likelihood ratings for over half the food groups. Four providers gave the exact same written recommendation(s) (range 3–7) to over half the patients. Inter-rater reliability of provider interpretations of IBS food and symptom journals was poor. Providers favored certain trigger food likelihood ratings and written recommendations. This supports the need for a more standardized method for interpreting these journals and/or more rigorous techniques to accurately identify personalized IBS food triggers. Full article
(This article belongs to the Special Issue Irritable Bowel Syndrome)
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Article
Gender and Weight Influence Quality of Life in Irritable Bowel Syndrome
by LeeAnne B. Sherwin, Onyinyechi M. Ozoji, Christina M. Boulineaux, Paule V. Joseph, Nicolaas H. Fourie, Sarah K. Abey, Xuemin Zhang and Wendy A. Henderson
J. Clin. Med. 2017, 6(11), 103; https://doi.org/10.3390/jcm6110103 - 1 Nov 2017
Cited by 11 | Viewed by 5044
Abstract
Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by abdominal pain and bowel dysfunction in the absence of structural abnormality. Diagnosis can be challenging and often leads to extensive medical tests, non-effective therapeutic modalities, and reduced quality of life (QOL). Identifying [...] Read more.
Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by abdominal pain and bowel dysfunction in the absence of structural abnormality. Diagnosis can be challenging and often leads to extensive medical tests, non-effective therapeutic modalities, and reduced quality of life (QOL). Identifying factors associated with dysfunction have the potential to enhance outcomes. Participants with IBS (n = 41) and healthy volunteers (n = 74) were recruited into this cross-sectional, descriptive, natural history protocol at the National Institute of Health, Clinical Center. Demographic characteristics were self-reported. QOL was assessed with the Irritable Bowel Syndrome Quality of Life (IBS-QOL) questionnaire. Statistical analysis included descriptive statistics, factorial ANOVA, and multiple regression. Individuals with IBS reported lower QOL scores across all QOL-subscales compared to healthy controls. Normal-weight women and overweight men with IBS reported the greatest QOL impairment. Body fat percent had confounding effects on the relationship between IBS and QOL. The disparity between QOL scores in participants with IBS by both gender and weight groups may reflect different social pressures perceived by normal and overweight women and men. These findings enhance the recognition of the disparities in patients with chronic symptoms and thereby lead to personalized assessment and interventions to improve their QOL. Full article
(This article belongs to the Special Issue Irritable Bowel Syndrome)

Review

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8 pages, 1100 KiB  
Review
The Gut-Brain Axis and the Microbiome: Clues to Pathophysiology and Opportunities for Novel Management Strategies in Irritable Bowel Syndrome (IBS)
by Eamonn M.M. Quigley
J. Clin. Med. 2018, 7(1), 6; https://doi.org/10.3390/jcm7010006 - 3 Jan 2018
Cited by 80 | Viewed by 20725
Abstract
Irritable bowel syndrome (IBS) is one of the most common of all medical disorders worldwide and, while for some it represents no more than a nuisance, for others it imposes significant negative impacts on daily life and activities. IBS is a heterogeneous disorder [...] Read more.
Irritable bowel syndrome (IBS) is one of the most common of all medical disorders worldwide and, while for some it represents no more than a nuisance, for others it imposes significant negative impacts on daily life and activities. IBS is a heterogeneous disorder and may well have a number of causes which may lie anywhere from the external environment to the contents of the gut lumen and from the enteric neuromuscular apparatus and the gut immune system to the central nervous system. Consequently, the paradigm of the gut-brain axis, which includes the participation of these various factors, has proven a useful model to assist clinicians and patients alike in understanding the genesis of symptoms in IBS. Now, given the widespread interest in the gut microbiome in health and disease, in general, reports of disordered enteric bacterial communities in IBS, and experimental data to indicate that components of the gut microbiota can influence brain morphology and function, as well as behavior and cognition, this concept has been extended to encompass the microbiota-gut-brain axis. The implications of this novel concept to the assessment and management of IBS will be explored in this review. Full article
(This article belongs to the Special Issue Irritable Bowel Syndrome)
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12 pages, 1190 KiB  
Review
Experimental Models of Irritable Bowel Syndrome and the Role of the Enteric Neurotransmission
by Maria Giuliana Vannucchi and Stefano Evangelista
J. Clin. Med. 2018, 7(1), 4; https://doi.org/10.3390/jcm7010004 - 3 Jan 2018
Cited by 52 | Viewed by 8057
Abstract
Irritable bowel syndrome (IBS) is one of the most common gastrointestinal diseases in humans. It is characterized by visceral pain and/or discomfort, hypersensitivity and abnormal motor responses along with change in gut habits. Although the etio-pathogenesis of IBS is only partially understood, a [...] Read more.
Irritable bowel syndrome (IBS) is one of the most common gastrointestinal diseases in humans. It is characterized by visceral pain and/or discomfort, hypersensitivity and abnormal motor responses along with change in gut habits. Although the etio-pathogenesis of IBS is only partially understood, a main role has been attributed to psychosocial stress of different origin. Animal models such as neonatal maternal separation, water avoidance stress and wrap restraint stress have been developed as psychosocial stressors in the attempt to reproduce the IBS symptomatology and identify the cellular mechanisms responsible for the disease. The study of these models has led to the production of drugs potentially useful for IBS treatment. This review intends to give an overview on the results obtained with the animal models; to emphasize the role of the enteric nervous system in IBS appearance and evolution and as a possible target of drug therapies. Full article
(This article belongs to the Special Issue Irritable Bowel Syndrome)
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10 pages, 200 KiB  
Review
Irritable Bowel Syndrome: Patient-Provider Interaction and Patient Education
by Albena Halpert
J. Clin. Med. 2018, 7(1), 3; https://doi.org/10.3390/jcm7010003 - 2 Jan 2018
Cited by 37 | Viewed by 7216
Abstract
The Patient-Provider (P-P) relationship is the foundation of medical practice. The quality of this relationship is essential, particularly for the management of chronic illness such as Irritable Bowel Syndrome (IBS), since it correlates with disease improvement. A significant aspect of fostering the P-P [...] Read more.
The Patient-Provider (P-P) relationship is the foundation of medical practice. The quality of this relationship is essential, particularly for the management of chronic illness such as Irritable Bowel Syndrome (IBS), since it correlates with disease improvement. A significant aspect of fostering the P-P relationship is providing effective patient-centered education about IBS. An effective education empowers the patients to achieve the main therapeutic goals: to reduce symptoms and improve quality of life. Method: A literature search of PubMed was conducted using the terms “Irritable Bowel syndrome”, “Patient Physician Relationship”, “Patient Provider Relationship”, and “Patient Physician interaction”. Preference was given to articles with a clearly defined methodology and those with control groups if applicable/appropriate. This article provides a review of the literature on Patient-Provider interaction and patient education as it relates to IBS and provides practical recommendations on how to optimize this important relationship. Full article
(This article belongs to the Special Issue Irritable Bowel Syndrome)
212 KiB  
Review
Adenosine A2B Receptors: An Optional Target for the Management of Irritable Bowel Syndrome with Diarrhea?
by Teita Asano and Mitsuko Takenaga
J. Clin. Med. 2017, 6(11), 104; https://doi.org/10.3390/jcm6110104 - 3 Nov 2017
Cited by 10 | Viewed by 3918
Abstract
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder, with the characteristic symptoms of chronic abdominal pain and altered bowel habits (diarrhea, constipation, or both). IBS is a highly prevalent condition, which negatively affects quality of life and is a significant burden on [...] Read more.
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder, with the characteristic symptoms of chronic abdominal pain and altered bowel habits (diarrhea, constipation, or both). IBS is a highly prevalent condition, which negatively affects quality of life and is a significant burden on global healthcare costs. Although many pharmacological medicines have been proposed to treat IBS, including those targeting receptors, channels, and chemical mediators related to visceral hypersensitivity, successful pharmacotherapy for the disease has not been established. Visceral hypersensitivity plays an important role in IBS pathogenesis. Immune activation is observed in diarrhea-predominant patients with IBS and contributes to the development of visceral hypersensitivity. Adenosine is a chemical mediator that regulates many physiological processes, including inflammation and nociception. Among its receptors, the adenosine A2B receptor regulates intestinal secretion, motor function, and the immune response. We recently demonstrated that the adenosine A2B receptor is involved in visceral hypersensitivity in animal models of IBS. In this review, we discuss the possibility of the adenosine A2B receptor as a novel therapeutic target for IBS. Full article
(This article belongs to the Special Issue Irritable Bowel Syndrome)
553 KiB  
Review
Pharmacotherapy for Irritable Bowel Syndrome
by Michael Camilleri and Alexander C. Ford
J. Clin. Med. 2017, 6(11), 101; https://doi.org/10.3390/jcm6110101 - 27 Oct 2017
Cited by 39 | Viewed by 15612
Abstract
Irritable bowel syndrome (IBS) is a disorder of the brain-gut axis; the pathophysiological mechanisms include altered colonic motility, bile acid metabolism, neurohormonal regulation, immune dysfunction, alterations in the epithelial barrier and secretory properties of the gut. This article reviews the mechanisms, efficacy, and [...] Read more.
Irritable bowel syndrome (IBS) is a disorder of the brain-gut axis; the pathophysiological mechanisms include altered colonic motility, bile acid metabolism, neurohormonal regulation, immune dysfunction, alterations in the epithelial barrier and secretory properties of the gut. This article reviews the mechanisms, efficacy, and safety of current pharmacotherapy, and medications that are in phase III trials for the treatment of IBS. There remains a significant unmet need for effective treatments—particularly for the pain component of IBS—although the introduction of drugs directed at secretion, motility and a non-absorbable antibiotic provide options for the bowel dysfunction in IBS. Full article
(This article belongs to the Special Issue Irritable Bowel Syndrome)
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178 KiB  
Review
Rome Criteria and a Diagnostic Approach to Irritable Bowel Syndrome
by Brian E. Lacy and Nihal K. Patel
J. Clin. Med. 2017, 6(11), 99; https://doi.org/10.3390/jcm6110099 - 26 Oct 2017
Cited by 288 | Viewed by 24787
Abstract
Functional gastrointestinal disorders (FGIDs) account for at least 40% of all referrals to gastroenterologists. Of the 33 recognized adult FGIDs, irritable bowel syndrome (IBS) is the most prevalent, with a worldwide prevalence estimated at 12%. IBS is an important health care concern as [...] Read more.
Functional gastrointestinal disorders (FGIDs) account for at least 40% of all referrals to gastroenterologists. Of the 33 recognized adult FGIDs, irritable bowel syndrome (IBS) is the most prevalent, with a worldwide prevalence estimated at 12%. IBS is an important health care concern as it greatly affects patients’ quality of life and imposes a significant economic burden to the health care system. Cardinal symptoms of IBS include abdominal pain and altered bowel habits. The absence of abdominal pain makes the diagnosis of IBS untenable. The diagnosis of IBS can be made by performing a careful review of the patient’s symptoms, taking a thoughtful history (e.g., diet, medication, medical, surgical, and psychological history), evaluating the patient for the presence of warning signs (e.g., “red flags” of anemia, hematochezia, unintentional weight loss, or a family history of colorectal cancer or inflammatory bowel disease), performing a guided physical examination, and using the Rome IV criteria. The Rome criteria were developed by a panel of international experts in the field of functional gastrointestinal disorders. Although initially developed to guide researchers, these criteria have undergone several revisions with the intent of making them clinically useful and relevant. This monograph provides a brief overview on the development of the Rome criteria, discusses the utility of the Rome IV criteria, and reviews how the criteria can be applied clinically to diagnose IBS. In addition, a diagnostic strategy for the cost-effective diagnosis of IBS will be reviewed. Full article
(This article belongs to the Special Issue Irritable Bowel Syndrome)
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