Intestinal Research

Review

Functional disorder

Diagnostic strategy of irritable bowel syndrome: a low- and middle-income country perspective: Amal Arifi Hidayat, Langgeng Agung Waskito, Titong Sugihartono, Hafeza Aftab, Yudith Annisa Ayu Rezkitha, Ratha-korn Vilaichone, Muhammad Miftahussurur; Intest Res 2024;22(3):286-296. Published online March 26, 2024; DOI: https://doi.org/10.5217/ir.2023.00199

Abstract PDF PubReader ePub: Irritable bowel syndrome (IBS) is a highly prevalent gastrointestinal disorder associated with substantial impairment which considerably burdens healthcare systems worldwide. Research on IBS has largely been conducted in high-income countries posing barriers to the application of diagnostic strategies in low- and middle-income countries (LMICs) due to differences in disease characteristics, healthcare resources, and socioeconomic factors. This review discusses the diagnostic issues associated with LMICs. We present a concise overview of the relevant approaches and propose a diagnostic strategy based on the latest evidence. A positive diagnostic strategy that relies on appropriate symptom-based criteria is crucial within the diagnostic framework. A combination of complete blood count, fecal occult blood test, and complete stool test may reliably identify individuals with suspected IBS who are more likely to have organic diseases, thus justifying the necessity for a colonoscopy. Eventually, we developed a diagnostic algorithm based on a limited setting perspective that summarizes the available evidence and may be applied in LMICs.

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Original Articles

Functional bowel disorders

Psychological profiles of irritable bowel syndrome patients with different phenotypes: Michel Bouchoucha, Ghislain Devroede, Noëlle Girault-Lidvan, Maria Hejnar, Florence Mary, Robert Benamouzig; Intest Res 2020;18(4):459-468. Published online October 26, 2020; DOI: https://doi.org/10.5217/ir.2019.09171

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Abnormal psychological profiles are frequently found in patients with functional gastrointestinal disorders (FGIDs). The present study aimed to evaluate the psychological profiles of FGID patients with irritable bowel syndrome (IBS), and IBS phenotypes.
Methods
In 608 FGID patients, including 235 with IBS, have filled a Rome III questionnaire and the French version of the Minnesota Multiphasic Personality Inventory 2. Data analysis was performed using univariate analysis and multivariate logistic regression.
Results
This study shows that IBS patients have abnormal psychological profiles with more significant symptom exaggeration and decreased test defensiveness than non-IBS patients. They have a significantly higher score for all clinical scales. Logistic regression analysis showed in IBS patients a decrease of body mass index (P= 0.002), and test defensiveness score K (P= 0.001) and an increase of Hypochondriasis (P< 0.001) and Masculinity-Femininity scale (P= 0.018). By comparison with non-IBS patients, IBS-constipation, IBS-diarrhea, and mixed IBS patients have increased Hypochondriasis value and Depression score, mixed IBS patients have higher Psychasthenia score and higher Hypomania score. No item was significantly different in the IBS-unspecified group.
Conclusions
This study shows that IBS patients have different psychological profiles than other FGID patients and that psychological characteristics are associated with IBS phenotypes except for patients with unsubtyped IBS.

Citations

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The role of psychological factors in functional gastrointestinal disorders: a systematic review and meta-analysis
Liyanran Yan, Xueli Zhang, Yan Li, Chengjiang Liu, Hua Yang, Chunchun Yang
International Journal of Colorectal Disease.2023;[Epub] CrossRef
An Asian perspective on irritable bowel syndrome
Kee Wook Jung, Seung-Jae Myung
Intestinal Research.2023; 21(2): 189. CrossRef
Limited evidence of moderation of the association between gastrointestinal symptoms and prospective healthcare utilisation by quality of life
David T. McNaughton, Anna Andreasson, Brjánn Ljótsson, Alissa P. Beath, Julia M. Hush, Gunnar Ljunggren, Peter T. Schmidt, Nicholas J. Talley, Lars Agréus, Michael P. Jones
Alimentary Pharmacology & Therapeutics.2022; 55(3): 311. CrossRef
Compositional Changes in the Gut Microbiota of Responders and Non-responders to Probiotic Treatment Among Patients With Diarrhea-predominant Irritable Bowel Syndrome: A Post Hoc Analysis of a Randomized Clinical Trial
Seung Yong Shin, Sein Park, Jung Min Moon, Kisung Kim, Jeong Wook Kim, Jongsik Chun, Tae Hee Lee, Chang Hwan Choi
Journal of Neurogastroenterology and Motility.2022; 28(4): 642. CrossRef
Psychopathological and neuropsychological disorders associated with chronic primary visceral pain: Systematic review
Alejandro Arévalo-Martínez, Juan Manuel Moreno-Manso, María Elena García-Baamonde, Macarena Blázquez-Alonso, Pilar Cantillo-Cordero
Frontiers in Psychology.2022;[Epub] CrossRef
Impact of Psychological Comorbidity on the Prognosis of Irritable Bowel Syndrome
Vivek C. Goodoory, Antonina Mikocka-Walus, Yan Yiannakou, Lesley A. Houghton, Christopher J. Black, Alexander C. Ford
American Journal of Gastroenterology.2021; 116(7): 1485. CrossRef

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Functional bowel disorders

Is fecal calprotectin always normal in children with irritable bowel syndrome?: You Jin Choi, Su Jin Jeong; Intest Res 2019;17(4):546-553. Published online September 4, 2019; DOI: https://doi.org/10.5217/ir.2019.00009

Abstract PDF PubReader ePub

Background/Aims
Fecal calprotectin (FC) is a marker of intraluminal intestinal inflammation. Intestinal inflammation may contribute to the pathophysiology of irritable bowel syndrome (IBS). This study evaluated FC levels in children with IBS and differences in FC levels in children stratified by IBS subtype and healthy controls (HCs).
Methods
A total of 157 children with IBS and 56 HCs aged 4–16 years (119 boys, 94 girls, mean age of 9.48 years) were included in this prospective study. Children with IBS were diagnosed using the Rome III criteria and classified into 4 subtypes: IBS with constipation (IBS-C, n=37), IBS with diarrhea (IBS-D, n=54), IBS with alternating constipation and diarrhea (IBS-M, n=49), and IBS unsubtyped (IBS-U, n=17); postinfectious IBS (PI-IBS) was also considered. The FC concentration in stool samples was analyzed using an enzyme-linked immunosorbent assay. All participants answered a questionnaire regarding several demographic and clinical characteristics.
Results
Children with IBS had significantly higher levels of FC than the HCs (88.71 μg/g vs. 17.77 μg/g). Among the 4 IBS subtypes, the FC concentration was highest in children with IBS-D, followed by those with IBS-M, IBS-C, and IBS-U (169.94 μg/g vs. 45.04, 31.22, and 33.52 μg/g, respectively), and these differences were statistically significant. For PI-IBS, 90% of cases were in the IBS-D group.
Conclusions
The FC level was significantly higher in children with IBS than in HCs and differed depending on the IBS subtype, supporting the notion that IBS is a type of low-grade bowel inflammation.

Citations

Citations to this article as recorded by

Markers of Intestinal Permeability and Inflammation in Enterally Fed Children with Cerebral Palsy
Dorota Mickiewicz-Góra, Katarzyna Sznurkowska, Karolina Skonieczna-Żydecka, Arleta Drozd, Anna Borkowska, Maciej Zagierski, Joanna Troch, Agnieszka Szlagatys-Sidorkiewicz
Nutrients.2024; 16(15): 2447. CrossRef
Role of inflammation in pediatric irritable bowel syndrome
Giovanni Di Nardo, Cesare Cremon, Annamaria Staiano, Vincenzo Stanghellini, Osvaldo Borrelli, Caterina Strisciuglio, Claudio Romano, Saverio Mallardo, Elena Scarpato, Giovanni Marasco, Silvia Salvatore, Letizia Zenzeri, Enrico Felici, Licia Pensabene, Sim
Neurogastroenterology & Motility.2023;[Epub] CrossRef
The Role of Bovine Kappa-Casein Glycomacropeptide in Modulating the Microbiome and Inflammatory Responses of Irritable Bowel Syndrome
Yunyao Qu, Si Hong Park, David C. Dallas
Nutrients.2023; 15(18): 3991. CrossRef
Evaluating the Potential of Casein Glycomacropeptide in Adult Irritable Bowel Syndrome Management: A Pilot Study
Yunyao Qu, Si Hong Park, David C. Dallas
Nutrients.2023; 15(19): 4174. CrossRef
Association between body mass index and fecal calprotectin levels in children and adolescents with irritable bowel syndrome
Jun Hwan Kim, Dae Yong Yi, Yoo Min Lee, You Jin Choi, Ju Young Kim, Yong Hee Hong, Ji Young Park, Su Yeong Kim, Na Mi Lee, Sin Weon Yun, Soo Ahn Chae, In Seok Lim, Eung Sang Choi, In Sook Jeong
Medicine.2022; 101(32): e29968. CrossRef
Infantile Colic and the Subsequent Development of the Irritable Bowel Syndrome
Ju Hee Kim, Seung Won Lee, Yoowon Kwon, Eun Kyo Ha, Jaewoo An, Hye Ryeong Cha, Su Jin Jeong, Man Yong Han
Journal of Neurogastroenterology and Motility.2022; 28(4): 618. CrossRef
Irritable bowel syndrome in Indonesian adolescents
Yudianita Kesuma, Rini Sekartini, Ina S. Timan, Agnes Kurniawan, Saptawati Bardosono, Agus Firmansyah, Yvan Vandenplas
Jornal de Pediatria.2021; 97(2): 197. CrossRef
An Update on the Assessment and Management of Pediatric Abdominal Pain
Craig Friesen, Jennifer M Colombo, Amanda Deacy, Jennifer V Schurman
Pediatric Health, Medicine and Therapeutics.2021; Volume 12: 373. CrossRef
Increasing Evidence That Irritable Bowel Syndrome and Functional Gastrointestinal Disorders Have a Microbial Pathogenesis
Caterina Carco, Wayne Young, Richard B. Gearry, Nicholas J. Talley, Warren C. McNabb, Nicole C. Roy
Frontiers in Cellular and Infection Microbiology.2020;[Epub] CrossRef

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Functional bowel disorders

Frequency and intensity of gastrointestinal symptoms in exercisers individuals at rest and during physical exercise: an internet-based survey: Claudio Andre Barbosa de Lira, Ricardo Borges Viana, Kaylla Priscilla Mesquista, Douglas de Assis Teles Santos, Mário Hebling Campos, Marília Santos Andrade, Rodrigo Luiz Vancini; Intest Res 2019;17(4):537-545. Published online May 7, 2019; DOI: https://doi.org/10.5217/ir.2018.00162

Abstract PDF PubReader ePub

Background/Aims
Despite the evidence of a modest to high prevalence of gastrointestinal (GI) symptoms in recreational runners and endurance athletes, the frequency and intensity of GI symptoms in exercisers, but nonathletes, individuals from different modalities have been less investigated. Therefore, the present study aimed to assess the prevalence of GI symptoms in individuals that practice moderate or vigorous physical exercise, at rest and during physical exercise training session.
Methods
The sample consisted of 142 exercisers individuals (64 women and 78 men with mean age of 32.9 ± 10.7 years). Out of the 142 participants, 71 reported to perform moderate physical exercise and 71 reported to perform vigorous physical exercise. Participants were assessed by an internet-based questionnaire designed to assess the frequency and intensity (at rest and during physical exercise training session) of 18 GI symptoms.
Results
The GI symptoms most frequently reported by the respondents (during rest and physical exercise training session, respectively) were flatulence (90.8% and 69.7%), abdominal noise (77.5% and 41.5%), and eructation (73.9% and 52.1%). Overall, the frequency and intensity of symptoms were higher (P< 0.050) during rest than physical exercise training session for who perform moderate and vigorous physical exercise.
Conclusions
It can be concluded that GI symptoms in exercisers, but nonathletes, individuals are more prevalent during rest than during physical exercise training session, suggesting that moderate and vigorous physical exercise may act as a regulator of the GI tract.

Citations

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The Frequency and Severity of Gastrointestinal Symptoms in Rugby Players
Sarah Chantler, Ruth Wood-Martin, Adrian Holliday, Glen Davison, Daniel R. Crabtree, Clint Readhead, Ben Jones
International Journal of Sports Medicine.2024; 45(04): 323. CrossRef
Exercise-Induced Gastrointestinal Symptoms in Endurance Sports: A Review of Pathophysiology, Symptoms, and Nutritional Management
Emanuela Ribichini, Giulia Scalese, Alessandra Cesarini, Chiara Mocci, Nadia Pallotta, Carola Severi, Enrico Stefano Corazziari
Dietetics.2023; 2(3): 289. CrossRef
Comparison of physiological and psychobiological acute responses between high intensity functional training and high intensity continuous training
Douglas A.T. Santos, Naiane S. Morais, Ricardo B. Viana, Gustavo C.T. Costa, Marilia S. Andrade, Rodrigo L. Vancini, Katja Weiss, Beat Knechtle, Claudio A.B. de Lira
Sports Medicine and Health Science.2023;[Epub] CrossRef

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163 Download
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3 Crossref

Functional bowel disorders

Evaluation of symptoms and symptom combinations in histamine intolerance: Wolfgang J. Schnedl, Sonja Lackner, Dietmar Enko, Michael Schenk, Sandra J. Holasek, Harald Mangge; Intest Res 2019;17(3):427-433. Published online March 7, 2019; DOI: https://doi.org/10.5217/ir.2018.00152

Abstract PDF PubReader ePub

Background/Aims
Food intolerance/malabsorption, particularly histamine intolerance (HIT), may cause nonspecific functional gastrointestinal and extraintestinal symptoms. We evaluated gastrointestinal and extraintestinal symptoms in patients with HIT.
Methods
In an analysis of outpatients’ charts we identified 133 patients, who presented with recurring nonspecific functional gastrointestinal, extraintestinal symptoms, and a diamine oxidase value <10 U/mL, indicative of HIT. A standardized anonymous questionnaire with symptoms of HIT based on known symptoms and the 4 histamine receptors including gastrointestinal, cardiovascular, respiratory and skin complaints was developed, and sent by mail to the patients.
Results
In the 62 patients that completed the questionnaire bloating was the most common and most serious symptom. Other commonly reported gastrointestinal symptoms were postprandial fullness, diarrhea, abdominal pain, and constipation. The presence of 2 from a list of 24 symptoms resulted in 276 various symptom combinations. From calculated 2.024 possible combinations of 3 symptoms the patients with HIT presented 1.975 combinations.
Conclusions
The knowledge of this wide variability of symptoms and complex symptom combinations in patients with HIT may help to clinically recognize and diagnose HIT.

Citations

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Yurdagül Zopf, Walburga Dieterich
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Hilario Blasco-Fontecilla, Marcos Bella-Fernández, Ping Wang, Marina Martin-Moratinos, Chao Li
Journal of Clinical Medicine.2024; 13(6): 1659. CrossRef
Histamine intolerance
Martin Fuchs
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Adriana Duelo, Oriol Comas-Basté, Sònia Sánchez-Pérez, M. Teresa Veciana-Nogués, Eva Ruiz-Casares, M. Carmen Vidal-Carou, M. Luz Latorre-Moratalla
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Christoph Jochum
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Yeşim Öztekin
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Xin-Yi Liu, Yan Zhao, Ling-Ling Jin, Yue Pang, Bo Yu
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Maria Carmela Ferrante, Raffaelina Mercogliano
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Increasing Expiratory Hydrogen in Lactose Intolerance Is Associated with Additional Food Intolerance/Malabsorption
Wolfgang J. Schnedl, Nathalie Meier-Allard, Sonja Lackner, Dietmar Enko, Harald Mangge, Sandra J. Holasek
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Armelle Tchoumi Neree, Rodolphe Soret, Lucia Marcocci, Paola Pietrangeli, Nicolas Pilon, Mircea Alexandru Mateescu
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Diamine oxidase supplementation improves symptoms in patients with histamine intolerance
Wolfgang J. Schnedl, Michael Schenk, Sonja Lackner, Dietmar Enko, Harald Mangge, Florian Forster
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Food Intolerances
Caroline J Tuck, Jessica R Biesiekierski, Peter Schmid-Grendelmeier, Daniel Pohl
Nutrients.2019; 11(7): 1684. CrossRef

15,934 View
546 Download
47 Web of Science
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Functional bowel disorders

Is stool frequency associated with the richness and community composition of gut microbiota?: Hye Jung Kwon, Jong Hyun Lim, Dongmin Kang, Sanghyun Lim, Seun Ja Park, Jae Hyun Kim; Intest Res 2019;17(3):419-426. Published online February 7, 2019; DOI: https://doi.org/10.5217/ir.2018.00149

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Recently, a number of studies have reported that the gut microbiota could contribute to human conditions, including obesity, inflammation, cancer development, and behavior. We hypothesized that the composition and distribution of gut microbiota are different according to stool frequency, and attempted to identify the association between gut microbiota and stool frequency.
Methods
We collected fecal samples from healthy individuals divided into 3 groups according to stool frequency: group 1, a small number of defecation (≤2 times/wk); group 2, normal defecation (1 time/day or 1 time/2 day); and group 3, a large number of defecation (≥2–3 times/day). We evaluated the composition and distribution of the gut microbiota in each group via 16S rRNA-based taxonomic profiling of the fecal samples.
Results
Fecal samples were collected from a total of 60 individuals (31 men and 29 women, aged 34.1±5.88 years), and each group comprised 20 individuals. The microbial richness of group 1 was significantly higher than that of group 3 and tended to decrease with increasing number of defecation (P<0.05). The biological community composition was fairly different according to the number of defecation, and Bacteroidetes to Firmicutes ratio was higher in group 1 than in the other groups. Moreover, we found specific strains at the family and genus levels in groups 1 and 3.
Conclusions
Bacteroidetes to Firmicutes ratio and the abundance of Bifidobacterium were different according to the stool frequency, and specific bacteria were identified in the subjects with large and small numbers of defecation, respectively. These findings suggest that stool frequency might be associated with the richness and community composition of the gut microbiota.

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