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2.
Therap Adv Gastroenterol ; 11: 1756284818768814, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29760783

RESUMO

BACKGROUND: The classification and treatment of patients who do not meet the criteria for a functional gastrointestinal (GI) disorder has not been well established. This study aimed to record the prevalence of minor digestive symptoms (MDSs) in the general population attempting to divide them into symptom clusters as well as trying to assess their impact and the way sufferers cope with them. METHODS: Following face-to-face interviews, a web-based, self-administered questionnaire was designed to capture a range of GI sensations using 34 questions and 12 images depicting abdominal symptoms. A randomly selected sample of 1515 women and 409 men representing the general population in France was studied. Cluster analysis was used to identify groups of respondents with naturally co-occurring symptoms. Data were also collected on other factors such as exacerbating and relieving strategies. RESULTS: MDSs were reported at least every 2 months in 66.5% of women and 47.7% of men. A total of 11 symptom clusters were identified: constipation-like, flatulence, abdominal pressure, abdominal swelling, acid reflux, diarrhoea-like, intestinal heaviness, intestinal pain, gurgling, burning and gastric pain. Despite being minor, these problems had a major impact on vitality and self-image as well as emotional, social and physical well-being. Respondents considered lifestyle, food and disordered function as the main factors responsible for MDSs. Physical measures and dietary modification were the most frequent strategies adopted to obtain relief. CONCLUSIONS: MDSs are common and improved methods of recognition are needed so that better management strategies can be developed for individuals with these symptoms. The definition of symptom clusters may offer one way of achieving this goal.

5.
Neurogastroenterol Motil ; 27(6): 885-98, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25846412

RESUMO

BACKGROUND: Although gas-related symptoms (GRS) are common and intrusive, there are no questionnaires to quantitate this problem. This study aimed to develop an instrument to rectify this gap in our knowledge. METHODS: Concepts were initially identified from the literature and interviews with gastroenterologists. Exploratory one-to-one interviews and focus groups with irritable bowel syndrome (IBS) patients (n = 28) and non-IBS subjects (n = 27) with GRS were conducted in UK, France, and Spain leading to a conceptual framework for the questionnaire. Last, iterative rounds of cognitive debriefing were performed with IBS (n = 16) and non-IBS subjects (n = 14). KEY RESULTS: From the first three steps, nine GRS (bloating, distension, flatulence, odorous flatulence, difficult gas evacuation, stomach rumbling, belching, bad breath, and abdominal movement) were identified although abdominal movement was subsequently excluded. Twelve quality of life domains affected by these symptoms were identified as: Clothing, emotional, physical appearance, diet, daily living, work, social life, physical activity, relationships, sex life, sleep, and cognitive function. A 24-h recall for symptoms and a 7-day recall for impact assessment were supported by the qualitative findings. Cognitive debriefing confirmed the understanding of the instrument. Across the three languages, the instrument was conceptually and linguistically consistent. CONCLUSIONS & INFERENCES: The International Gas Questionnaire is a 2-part instrument, developed rigorously and simultaneously in three languages assessing seven symptoms (17 items) and their impact on 12 domains (26 items) in IBS and general population. It is now undergoing psychometric validation and should provide a unique tool for epidemiological surveys and clinical trials for developing new treatments for these symptoms.


Assuntos
Eructação , Flatulência , Síndrome do Intestino Irritável , Qualidade de Vida , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Grupos Focais , Halitose , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Odorantes , Pesquisa Qualitativa , Inquéritos e Questionários , Adulto Jovem
6.
Aliment Pharmacol Ther ; 41(9): 844-55, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25736234

RESUMO

BACKGROUND: Gut-focused hypnotherapy improves the symptoms of irritable bowel syndrome (IBS) with benefits being sustained for many years. Despite this, the technique has not been widely adopted by healthcare systems, possibly due to relatively small numbers in published studies and uncertainty about how it should be provided. AIM: To review the effect of hypnotherapy in a large cohort of refractory IBS patients. METHODS: One thousand IBS patients fulfilling Rome II criteria, mean age 51.6 years (range 17-91 years), 80% female, receiving 12 sessions of hypnotherapy over 3 months, were studied. The primary outcome was a 50 point reduction in the IBS Symptom Severity Score. The fall in scores for Noncolonic Symptoms, Quality of Life and Anxiety or Depression, were secondary outcomes. The Federal Drug Administration's recommended outcome of a 30% or more reduction in abdominal pain was also recorded. RESULTS: Overall, 76% met the primary outcome which was higher in females (females: 80%, males: 62%, P < 0.001) and those with anxiety (anxious: 79%, non-anxious: 71%, P = 0.010). The mean reduction in other scores was: IBS Symptom Severity Score, 129 points (P < 0.001), Noncolonic Symptom Score, 65 (P < 0.001) and Quality of Life Score, 66 (P < 0.001). Sixty-seven per cent reported a 30% or more reduction in abdominal pain scores. Pain days fell from 18 to 9 per month. Patients with anxiety and depression fell from 63% to 34% and 25% to 12% respectively (P < 0.001). Outcome was unaffected by bowel habit subtype. CONCLUSION: These results provide further evidence that gut-focused hypnotherapy is an effective intervention for refractory IBS.


Assuntos
Hipnose/métodos , Síndrome do Intestino Irritável/terapia , Qualidade de Vida , Dor Abdominal/etiologia , Dor Abdominal/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Ansiedade/terapia , Depressão/etiologia , Depressão/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
8.
Aliment Pharmacol Ther ; 40(9): 1094-102, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25175998

RESUMO

BACKGROUND: Cross-cultural, multinational research can advance the field of functional gastrointestinal disorders (FGIDs). Cross-cultural comparative research can make a significant contribution in areas such as epidemiology, genetics, psychosocial modulators, symptom reporting and interpretation, extra-intestinal co-morbidity, diagnosis and treatment, determinants of disease severity, health care utilisation, and health-related quality of life, all issues that can be affected by geographical region, culture, ethnicity and race. AIMS: To identify methodological challenges for cross-cultural, multinational research, and suggest possible solutions. METHODS: This report, which summarises the full report of a working team established by the Rome Foundation that is available on the Internet, reflects an effort by an international committee of FGID clinicians and researchers. It is based on comprehensive literature reviews and expert opinion. RESULTS: Cross-cultural, multinational research is important and feasible, but has barriers to successful implementation. This report contains recommendations for future research relating to study design, subject recruitment, availability of appropriate study instruments, translation and validation of study instruments, documenting confounders, statistical analyses and reporting of results. CONCLUSIONS: Advances in study design and methodology, as well as cross-cultural research competence, have not matched technological advancements. The development of multinational research networks and cross-cultural research collaboration is still in its early stages. This report is intended to be aspirational rather than prescriptive, so we present recommendations, not guidelines. We aim to raise awareness of these issues and to pose higher standards, but not to discourage investigators from doing what is feasible in any particular setting.


Assuntos
Pesquisa Biomédica/normas , Comparação Transcultural , Fundações/normas , Gastroenteropatias/etnologia , Internacionalidade , Relatório de Pesquisa/normas , Pesquisa Biomédica/métodos , Comorbidade , Gastroenteropatias/diagnóstico , Gastroenteropatias/terapia , Humanos , Qualidade de Vida , Cidade de Roma
9.
Proc Nutr Soc ; 73(4): 470-6, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25156472

RESUMO

The aim of this review is to highlight the impact of irritable bowel syndrome (IBS) in those patients who consult the medical profession and examine the therapeutic potential of probiotics in this condition, where there is a strong need for new treatment options. Traditionally, IBS is frequently regarded as a trivial condition which is certainly not life threatening and mainly psychological in origin. However, these preconceptions are misplaced, as in some patients the condition can be devastating with the pain being as severe as that of childbirth coupled with incapacitating bowel dysfunction. In addition, patients suffer from a variety of non-colonic symptoms such as low backache, constant lethargy, nausea and genito-urinary problems, all of which lead to these patients having extremely poor quality of life. Unfortunately, the treatment of IBS is very unsatisfactory with only one new medication being developed for this condition in the last 25 years. It is now recognised that IBS is a multifactorial condition with symptoms being triggered by a variety of factors, some of which appear to be influenced by probiotics, resulting in speculation that they may have therapeutic potential in this condition. There have been over thirty controlled clinical trials of probiotics in IBS with approximately two-thirds of these studies showing evidence of an improvement in symptoms. However, not all probiotics appear to be effective with different symptoms being improved by different strains and some improving symptoms more than others. Consequently, the ideal probiotic for the treatment of IBS has yet to be defined, but the evidence is good enough to encourage further research with the aim of identifying an optimal strain or strains.


Assuntos
Síndrome do Intestino Irritável/terapia , Probióticos/administração & dosagem , Trato Gastrointestinal/microbiologia , Humanos , Microbiota , Qualidade de Vida , Resultado do Tratamento
10.
Neurogastroenterol Motil ; 24(4): 301-4, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22414185

RESUMO

Bloating and distension are common complaints in patients with irritable bowel syndrome of which the cause has remained elusive, although it has been shown that the obvious explanation of excessive gas is unlikely. The recent application of technologies such as the gas challenge technique, abdominal inductance plethysmography, CT scanning, as well as electromyography of the diaphragm and anterior abdominal wall, have allowed the situation to be slowly unraveled. It is now seems probable that the pathophysiology of bloating and distension are subtly different with the former having a sensory component whereas mechanical factors, such as disordered abdominal accommodation, contribute more to the latter.


Assuntos
Abdome/patologia , Síndrome do Intestino Irritável/complicações , Síndrome do Intestino Irritável/fisiopatologia , Abdome/fisiopatologia , Dilatação Patológica/etiologia , Dilatação Patológica/fisiopatologia , Feminino , Humanos , Adulto Jovem
11.
Gut ; 61(3): 367-72, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21868492

RESUMO

OBJECTIVE: In women presenting to gynaecological clinics with lower abdominal pain, the cause is frequently attributed to endometriosis irrespective of whether it is found to be minimal or extensive at laparoscopy. Irritable bowel syndrome (IBS) is also common in this setting, and it was speculated that the visceral hypersensitivity associated with this condition might be amplifying the symptoms of endometriosis. METHODS: Visceral sensitivity to balloon distension, symptoms and psychological status were assessed following laparoscopy in 20 women with minimal to mild endometriosis, 20 with moderate to severe endometriosis, 20 with laparoscopy negative abdominal pain and 20 asymptomatic women undergoing laparoscopic sterilisation who acted as controls, and compared with 20 women with IBS. RESULTS: Compared with controls, patients with minimal to mild and moderate to severe endometriosis had a higher prevalence of symptoms consistent with IBS (0% vs 65% and 50%, respectively, p<0.001) with significantly lower mean pain thresholds (39.5 mm Hg (95% CI 36.0 to 43.0) vs 28.1 mm Hg (95% CI 24.5 to 31.6), p=0.001 and 28.8 mm Hg (95% CI 24.9 to 32.6), p=0.002) not explained by differences in rectal compliance. Patients with laparoscopy negative pain had symptoms and visceral sensitivity similar to patients with IBS. Controls undergoing laparoscopy had normal sensitivity, indicating that the laparoscopic procedure was not inducing hypersensitivity. CONCLUSION: Visceral hypersensitivity is extremely common in endometriosis and could be intensifying the pain. This finding might explain why mildly affected individuals often complain of severe symptoms out of proportion to the extent of their disease. This study has introduced a completely new concept into the understanding of pain in endometriosis and could open up new opportunities for treatment.


Assuntos
Endometriose/complicações , Hiperalgesia/etiologia , Vísceras/inervação , Adulto , Estudos de Casos e Controles , Dilatação/efeitos adversos , Endometriose/psicologia , Feminino , Humanos , Hiperalgesia/psicologia , Síndrome do Intestino Irritável/complicações , Laparoscopia/efeitos adversos , Pessoa de Meia-Idade , Medição da Dor/métodos , Limiar da Dor , Limiar Sensorial , Adulto Jovem
12.
Dig Dis Sci ; 57(1): 4-8, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21800157

RESUMO

Most patients with irritable bowel syndrome complain of a sensation of an increase in pressure within their abdomen during the course of the day which is called bloating and, in approximately half of these individuals, this symptom is accompanied by an actual increase in abdominal girth, which is referred to as distension. The pathophysiology of these two phenomena is somewhat different and it is now recognised that a whole variety of overlapping mechanisms are involved. Some of these are potentially amenable to treatment by modification of the bacterial flora of the gut and this article reviews the evidence for this.


Assuntos
Gastroenteropatias/microbiologia , Trato Gastrointestinal/microbiologia , Metagenoma/fisiologia , Abdome/microbiologia , Abdome/fisiopatologia , Antibacterianos/uso terapêutico , Dilatação Patológica/tratamento farmacológico , Dilatação Patológica/microbiologia , Dilatação Patológica/fisiopatologia , Gastroenteropatias/tratamento farmacológico , Gastroenteropatias/fisiopatologia , Trato Gastrointestinal/fisiopatologia , Humanos , Síndrome do Intestino Irritável/tratamento farmacológico , Síndrome do Intestino Irritável/microbiologia , Síndrome do Intestino Irritável/fisiopatologia , Probióticos/uso terapêutico
14.
Aliment Pharmacol Ther ; 32(6): 811-20, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20629976

RESUMO

BACKGROUND: Anxiety, depression and nongastrointestinal symptoms are often prominent in irritable bowel syndrome (IBS), but their relative value in patient management has not been quantitatively assessed. We modified the Patient Health Questionnaire 15 (PHQ-15) by excluding three gastrointestinal items to create the PHQ-12 Somatic Symptom (PHQ-12 SS) scale. AIMS: To compare the value of the PHQ-12 SS scale with the Hospital Anxiety and Depression (HAD) scale in predicting symptoms and patient behaviour in IBS and diverticular disease. METHODS: We compared 151 healthy volunteers (HV), 319 IBS patients and 296 patients with diverticular disease (DD), 113 asymptomatic [ASYMPDD] and 173 symptomatic DD (SYMPDD). RESULTS: Patient Health Questionnaire 12 SS scores for IBS and SYMPDD were significantly higher than HV. Receiver-operator curves showed a PHQ-12 SS >6, gave a sensitivity for IBS of 66.4% with a specificity of 94.7% and a positive likelihood ratio (PLR) = 13.2, significantly better than that associated with an HAD anxiety score >7, PLR = 3.0 and depression score >7 PLR = 6.5. PHQ-12 SS correlated strongly with IBS severity scale and GP visits in both IBS and DD. CONCLUSION: The PHQ-12 SS scale is a useful clinical tool which correlates with patient behaviour in both IBS and symptomatic DD.


Assuntos
Ansiedade/etiologia , Depressão/etiologia , Síndrome do Intestino Irritável/fisiopatologia , Adulto , Idoso , Ansiedade/psicologia , Depressão/psicologia , Feminino , Humanos , Síndrome do Intestino Irritável/complicações , Síndrome do Intestino Irritável/psicologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Encaminhamento e Consulta , Índice de Gravidade de Doença , Inquéritos e Questionários
15.
Aliment Pharmacol Ther ; 31(1): 131-42, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19744134

RESUMO

BACKGROUND: We have been using a medical artist to record and paint the images patients have of their irritable bowel syndrome (IBS) and have hypothesized that the reaction to such images might differ in health and IBS, which could have practical implications for future research. AIM: To examine reactivity to images in health and IBS. METHODS: Twelve paintings of IBS were shown to 70 patients to determine the four most evocative images. The spontaneous response to these images and four 'non-IBS painful' and four neutral paintings was assessed in another 100 IBS patients and 100 controls. The prompted reaction in terms of whether an image evoked the notion of pain, bloating or discomfort and to what degree was also recorded. RESULTS: Four images depicting bloating and pain scored the highest. These IBS images triggered significantly different reactivity between patients and controls in terms of their spontaneous and prompted responses. Even 'non-IBS painful' and neutral images resulted in exaggerated and frequently significantly different responses in patients than in controls. CONCLUSIONS: Visual hypersensitivity appears to be another manifestation of the tendency of IBS patients to react adversely to a variety of endogenous and exogenous stimuli. Identifying how individuals relate to different images might also give useful insights into understanding gastrointestinal symptoms.


Assuntos
Adaptação Psicológica/fisiologia , Síndrome do Intestino Irritável/psicologia , Medição da Dor/psicologia , Pinturas/psicologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Síndrome do Intestino Irritável/diagnóstico , Medicina nas Artes , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Inquéritos e Questionários , Adulto Jovem
16.
Aliment Pharmacol Ther ; 30(9): 919-29, 2009 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-19691669

RESUMO

BACKGROUND: Symptomatology and physiology differ between men and women and across the menstrual cycle in irritable bowel syndrome (IBS). Ovarian hormones influence 5-hydroxytryptamine (5-HT), an amine known to play a role in gut motor-sensory function. AIM: To assess the effects of gender and menstrual status on platelet-depleted plasma (PDP) 5-HT concentration in IBS patients with diarrhoea (IBS-D) patients compared with healthy volunteers (HV). METHODS: Platelet-depleted plasma 5-HT concentrations were assessed under fasting and fed conditions in 73 IBS-D patients (aged 18-58 years; 18 men) and 64 HV (aged 18-50 years; 24 men). Women were divided into those with low or high progesterone/oestrogen (P/O) levels. RESULTS: Irritable bowel syndrome patients with diarrhoea had higher PDP 5-HT concentrations than HV under fasting (P = 0.002) and fed (P = 0.049) conditions. This was particularly related to IBS-D men having higher PDP 5-HT concentrations than healthy controls (P = 0.002). Moreover, PDP 5-HT concentrations in IBS-D women with low P/O levels were similar to healthy controls. CONCLUSIONS: Similar to IBS-D women with high P/O levels, IBS-D men also have raised PDP 5-HT concentrations. 5-HT concentration normalizes at menses in IBS-D women, suggesting a shift in the mechanisms responsible for abnormal 5-HT signalling in these patients.


Assuntos
Plaquetas/metabolismo , Diarreia/fisiopatologia , Síndrome do Intestino Irritável/fisiopatologia , Ciclo Menstrual/fisiologia , Serotonina/metabolismo , Adolescente , Adulto , Estudos de Casos e Controles , Diarreia/complicações , Ingestão de Alimentos/fisiologia , Estrogênios/metabolismo , Jejum/fisiologia , Feminino , Humanos , Síndrome do Intestino Irritável/complicações , Masculino , Pessoa de Meia-Idade , Progesterona/metabolismo , Fatores Sexuais , Transdução de Sinais/fisiologia , Adulto Jovem
17.
BMJ ; 339: b3154, 2009 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-19713235

RESUMO

OBJECTIVE: To determine the effectiveness of increasing the dietary content of soluble fibre (psyllium) or insoluble fibre (bran) in patients with irritable bowel syndrome. DESIGN: Randomised controlled trial. SETTING: General practice. PARTICIPANTS: 275 patients aged 18-65 years with irritable bowel syndrome. INTERVENTIONS: 12 weeks of treatment with 10 g psyllium (n=85), 10 g bran (n=97), or 10 g placebo (rice flour) (n=93). MAIN OUTCOME MEASURES: The primary end point was adequate symptom relief during at least two weeks in the previous month, analysed after one, two, and three months of treatment to assess both short term and sustained effectiveness. Secondary end points included irritable bowel syndrome symptom severity score, severity of abdominal pain, and irritable bowel syndrome quality of life scale. RESULTS: The proportion of responders was significantly greater in the psyllium group than in the placebo group during the first month (57% v 35%; relative risk 1.60, 95% confidence interval 1.13 to 2.26) and the second month of treatment (59% v 41%; 1.44, 1.02 to 2.06). Bran was more effective than placebo during the third month of treatment only (57% v 32%; 1.70, 1.12 to 2.57), but this was not statistically significant in the worst case analysis (1.45, 0.97 to 2.16). After three months of treatment, symptom severity in the psyllium group was reduced by 90 points, compared with 49 points in the placebo group (P=0.03) and 58 points in the bran group (P=0.61 versus placebo). No differences were found with respect to quality of life. Fifty four (64%) of the patients allocated to psyllium, 54 (56%) in the bran group, and 56 (60%) in the placebo group completed the three month treatment period. Early dropout was most common in the bran group; the main reason was that the symptoms of irritable bowel syndrome worsened. CONCLUSIONS: Psyllium offers benefits in patients with irritable bowel syndrome in primary care. TRIAL REGISTRATION: Clinical trials NCT00189033.


Assuntos
Fibras na Dieta/administração & dosagem , Síndrome do Intestino Irritável/dietoterapia , Plantago , Dor Abdominal/etiologia , Dor Abdominal/prevenção & controle , Adolescente , Adulto , Idoso , Medicina de Família e Comunidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
18.
Dig Liver Dis ; 41(10): 721-4, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19411198

RESUMO

BACKGROUND: In secondary care, irritable bowel syndrome (IBS) is frequently associated with non-colonic symptoms including lethargy, backache and chest pains which can result in inappropriate referral to different specialities with the condition remaining unrecognised. This could also be a problem in the elderly where comorbidity is common, especially as irritable bowel syndrome is usually associated with a younger age group. METHODS: A survey of 230 consecutive patients (aged 65-94) attending an elderly care clinic examining referral patterns, irritable bowel syndrome symptoms, duration of disease, non-colonic symptomatology and previous investigation. RESULTS: 211 of 230 (92%) patients completed the questionnaire with 46 (22%) having symptoms suggestive of irritable bowel syndrome irrespective of presenting complaint. However despite the exclusion of abdominal pathology the diagnosis was only made in one patient. Symptoms significantly more common in irritable bowel syndrome than non-irritable bowel syndrome patients were constant lethargy (p<0.001), headaches (p=0.01), backache (p=0.02), chest pain (p=0.03), and urinary frequency (p=0.04). Independent predictors of irritable bowel syndrome on logistic regression were bloating (OR 13.3; p<0.001), stool urgency (OR 4.0; p<0.001) and headache (OR 2.3; p=0.01). CONCLUSIONS: Irritable bowel syndrome is under-recognised in elderly care despite negative investigation. Making the diagnosis, even in the presence of co-existent disease, could reduce the overall burden of suffering, improve quality of life and prevent repetitive investigations.


Assuntos
Síndrome do Intestino Irritável/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Dor nas Costas/epidemiologia , Dor no Peito/epidemiologia , Comorbidade , Inglaterra/epidemiologia , Feminino , Cefaleia/epidemiologia , Inquéritos Epidemiológicos , Humanos , Síndrome do Intestino Irritável/diagnóstico , Letargia/epidemiologia , Masculino , Pacientes Ambulatoriais/estatística & dados numéricos , Prevalência
19.
Aliment Pharmacol Ther ; 29(1): 104-14, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18801055

RESUMO

BACKGROUND: A sensation of abdominal swelling (bloating) and actual increase in girth (distension) are troublesome features of irritable bowel syndrome (IBS), which is more common in patients with constipation, especially those with delayed transit. AIM: To establish whether a fermented dairy product containing Bifidobacterium lactis DN-173 010 reduces distension in association with acceleration of gastrointestinal transit and improvement of symptoms in IBS with constipation. METHODS: A single centre, randomized, double-blind, controlled, parallel group study in which patients consumed the test product or control product for 4 weeks. Distension, orocaecal and colonic transit and IBS symptoms were assessed on an intention-to-treat population of 34 patients. RESULTS: Compared with control product, the test product resulted in a significant reduction in the percentage change in maximal distension [median difference - 39%, 95% CI (-78, -5); P = 0.02] and a trend towards reduced mean distension during the day [-1.52 cm (-3.33, 0.39); P = 0.096]. An acceleration of orocaecal [-1.2 h (-2.3,0); P = 0.049] as well as colonic [-12.2 h (-22.8, -1.6); P = 0.026] transit was observed and overall symptom severity [-0.5 (-1.0, -0.05); P = 0.032] also improved. CONCLUSIONS: This probiotic resulted in improvements in objectively measured abdominal girth and gastrointestinal transit, as well as reduced symptomatology. These data support the concept that accelerating transit is a useful strategy for treating distension.


Assuntos
Bifidobacterium , Constipação Intestinal/dietoterapia , Produtos Fermentados do Leite , Dilatação Patológica/dietoterapia , Síndrome do Intestino Irritável/dietoterapia , Probióticos/uso terapêutico , Adulto , Idoso , Análise de Variância , Constipação Intestinal/complicações , Constipação Intestinal/fisiopatologia , Dilatação Patológica/complicações , Método Duplo-Cego , Feminino , Trânsito Gastrointestinal/fisiologia , Humanos , Síndrome do Intestino Irritável/complicações , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
20.
Aliment Pharmacol Ther ; 27(1): 2-10, 2008 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-17931344

RESUMO

BACKGROUND: A sensation of abdominal bloating, sometimes accompanied by an increase in girth (distension), is one of the most common and most intrusive features of functional bowel disorders. AIM: To conduct a systematic, evidence-based review of the epidemiology and pathophysiology of abdominal bloating and its relationship to distension. METHODS: The terms bloating, distension, functional bowel, irritable bowel syndrome, constipation and diarrhoea were searched on MEDLINE up to 2006. References from selected articles and relevant abstracts were also included. RESULTS: Approximately 50% of irritable bowel syndrome patients with bloating also experience an increase in abdominal girth and this is more pronounced with constipation than diarrhoea. Bloating appears to be more frequently associated with visceral hypersensitivity, whereas distension is more often related to hyposensitivity and delayed transit. Although there is little evidence for excessive gas as a cause of bloating, gas infusion studies suggest that handling of gas may be impaired in irritable bowel syndrome and there may also be abnormal relaxation of the anterior abdominal musculature in these patients. CONCLUSIONS: There is unlikely to be a single cause for bloating and distension, which probably have different, but overlapping, pathophysiological mechanisms. Relieving constipation might help distension, but the treatment of bloating may need more complex approaches involving sensory modulation.


Assuntos
Abdome/fisiopatologia , Dilatação Gástrica/etiologia , Síndrome do Intestino Irritável/fisiopatologia , Sensação/fisiologia , Constipação Intestinal/fisiopatologia , Diagnóstico Diferencial , Diarreia/fisiopatologia , Gases , Dilatação Gástrica/epidemiologia , Dilatação Gástrica/fisiopatologia , Dilatação Gástrica/terapia , Humanos , Obesidade/fisiopatologia
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