Effects of linseeds on the symptoms of irritable bowel syndrome: a pilot randomised controlled trial

Background: Manipulation of dietary fibre intake represents a longstanding treatment for patients with irritable bowel syndrome (IBS), particularly for those with constipation. Linseeds are often recommended by both clinicians and dietitians as a source of dietary fibre to alleviate symptoms. Recent guidance on the management of irritable bowel syndrome (IBS) advises that linseeds may reduce wind and bloating, although there is limited clinical evidence to support this recommendation. The present pilot study aimed to compare the clinical effectiveness of: (i) whole linseeds versus ground linseeds; (ii) whole linseeds versus no linseeds; and (iii) ground linseeds versus no linseeds in the management of IBS symptoms. Methods: In an open randomised controlled trial, subjects with IBS (n = 40) were allocated to one of three intervention groups: two tablespoons of whole linseeds per day (n = 14), two tablespoons of ground linseeds per day (n = 13) and no linseeds as controls (n = 13). Symptom severity (primary outcome) and bowel habit were assessed before and after a 4‐week intervention and statistical differences between the groups were compared. Results: Thirty‐one subjects completed the present study. Between‐group analysis comparing the improvement in symptom severity did not reach statistical significance for whole linseeds (n = 11) versus ground linseeds (n = 11; P = 0.62), whole linseeds versus controls (n = 9; P = 0.12) and ground linseeds versus controls (P = 0.10). There were no significant changes in stool frequency or stool consistency for any of the groups. Conclusions: Linseeds may be useful in relief of IBS symptoms. Further research is needed to detect clear differences between the effects of whole and ground linseeds.     

Randomized clinical trial: Effect of Lactobacillus plantarum 299 v on symptoms of irritable bowel syndrome

ObjectivesIrritable bowel syndrome (IBS) is a common diagnosis in gastroenterology. Its etiology is unknown and therapeutic options limited. Trials suggest probiotics may be beneficial. The aim of this study was to assess the symptomatic efficacy of Lactobacillus plantarum 299 v (L. plantarum 299 v) for the relief of abdominal pain in patients with IBS fulfilling Rome II criteria.MethodsThis study was conducted in a referral hospital. Trial participants were randomized to receive either two capsules of L. plantarum 299 v at a dosage of 5 × 10⁹ cfu per capsule or placebo daily for 8 wk. Severity of abdominal pain was assessed using a visual analog scale at each visit and a quality-of-life IBS (QoL-IBS) questionnaire was also completed.ResultsThere was no significant difference in abdominal pain relief between the study and placebo groups (P = 0.800). There was also no difference in QoL- IBS scores between the groups (P = 0.687). Both groups had a significant improvement in abdominal pain scores over the study period, from an average of 251.55 to 197.90 (P < 0.0001) indicating a large placebo effect.ConclusionAn 8-wk treatment with L. plantarum 299 v did not provide symptomatic relief, particularly of abdominal pain and bloating, in patients fulfilling the Rome II criteria.     

Cost-effectiveness of internet-based cognitive behavior therapy for irritable bowel syndrome: results from a randomized controlled trial

Background  

Irritable Bowel Syndrome (IBS) is highly prevalent and is associated with a substantial economic burden. Cognitive behavior therapy (CBT) has been shown to be effective in treating IBS. The aim of this study was to evaluate the cost-effectiveness of a new treatment alternative, internet-delivered CBT based on exposure and mindfulness exercises.     

Clinical studies on alleviating the symptoms of irritable bowel syndrome

Irritable bowel syndrome (IBS) is one of the most common diagnoses in gastroenterology, but current therapies are inefficient. Recent clinical trials suggest beneficial effects of certain probiotics in IBS. Because of the heterogeneity of IBS a probiotic combination may be more efficient than a single strain. We screened for optimal strains, and developed a multispecies probiotic combination consisting of L. rhamnosus GG, L. rhamnosus Lc705, P. freudenreichii ssp. shermanii JS and Bifidobacterium breve Bb99. The clinical efficacy of the probiotic combination was evaluated in IBS patients in a randomised, double-blind, placebo-controlled six-month intervention. During six months the subjects received daily either probiotic supplementation or placebo. IBS symptoms were followed by symptom diaries. The probiotic supplementation demonstrated significant value in reducing IBS symptoms. At the end of the study period the total symptom score (abdominal pain + distension + flatulence + rumbling) had reduced with 42% in probiotic group versus 6% for instance anti-inflammatory effects, balancing of the microbiota or motility-related effects induced by the probiotic. The probiotic activity may be enhanced by synergistic effects of the combination that each strain alone would not hold. In conclusion, we found a probiotic combination of LGG and three other strains to be effective in alleviating IBS symptoms.     

Growth hormone to improve short bowel syndrome intestinal autonomy: a pediatric randomized open-label clinical trial

Background: The ability of growth hormone (GH) to promote the weaning‐off of parenteral nutrition (PN) in short bowel syndrome (SBS) is unclear. No randomized controlled study is available in children. This study was undertaken to determine if GH could enhance the weaning off of PN in PN‐dependent children with SBS. Methods: A prospective randomized open‐label multicenter study was performed in 14 patients (mean age, 9 ± 1.4 years) with SBS (average small bowel length, 33 cm) and long‐term PN dependency (8 years) on an unrestricted diet. A standardized PN decrease with and without GH (0.14 mg/kg/d) was conducted. The patients were randomized to either a GH group (4 months of GH) or a control (CTR) group (4 months without GH, followed by 4 months with GH). Blood tests and a nutrition assessment of enteral and parenteral intakes were performed. Groups were compared with the Wilcoxon test. Results: Treatment with GH did not improve the weaning off of PN (decrease in PN caloric intake of 32.5% ± 9.6% in the GH group vs 35.2% ± 8.7% in the CTR group, nonsignificant). In the CTR group, GH treatment induced an additional but not statistically significant decrease of 8.8% ± 12.4% in daily calories. Parenteral needs returned to near basal rates 6 months after GH discontinuation (GH: 77.6% ± 10.6% vs CTR: 73.2% ± 7.4%). Weight decreased slightly in both groups. No biological parameters varied significantly. Conclusions: GH did not improve the weaning off of PN in PN‐dependent children with SBS.     

A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial

BACKGROUND: Although the pathogenesis of acne is currently unknown, recent epidemiologic studies of non-Westernized populations suggest that dietary factors, including the glycemic load, may be involved. OBJECTIVE: The objective was to determine whether a low-glycemic-load diet improves acne lesion counts in young males. DESIGN: Forty-three male acne patients aged 15-25 y were recruited for a 12-wk, parallel design, dietary intervention incorporating investigator-blinded dermatology assessments. The experimental treatment was a low-glycemic-load diet composed of 25% energy from protein and 45% from low-glycemic-index carbohydrates. In contrast, the control situation emphasized carbohydrate-dense foods without reference to the glycemic index. Acne lesion counts and severity were assessed during monthly visits, and insulin sensitivity (using the homeostasis model assessment) was measured at baseline and 12 wk. RESULTS: At 12 wk, mean (+/-SEM) total lesion counts had decreased more (P=0.03) in the low-glycemic-load group (-23.5 +/- 3.9) than in the control group (-12.0 +/- 3.5). The experimental diet also resulted in a greater reduction in weight (-2.9 +/- 0.8 compared with 0.5 +/- 0.3 kg; P<0.001) and body mass index (in kg/m(2); -0.92 +/- 0.25 compared with 0.01 +/- 0.11; P=0.001) and a greater improvement in insulin sensitivity (-0.22 +/- 0.12 compared with 0.47 +/- 0.31; P=0.026) than did the control diet. CONCLUSION: The improvement in acne and insulin sensitivity after a low-glycemic-load diet suggests that nutrition-related lifestyle factors may play a role in the pathogenesis of acne. However, further studies are needed to isolate the independent effects of weight loss and dietary intervention and to further elucidate the underlying pathophysiologic mechanisms.     

Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management

Dietary fructose induces abdominal symptoms in patients with fructose malabsorption, but there are no published guidelines on its dietary management. The objective was to retrospectively evaluate a potentially successful diet therapy in patients with irritable bowel syndrome and fructose malabsorption. Tables detailing the content of fructose and fructans in foods were constructed. A dietary strategy comprising avoidance of foods containing substantial free fructose and short-chain fructans, limitation of the total dietary fructose load, encouragement of foods in which glucose was balanced with fructose, and co-ingestion of free glucose to balance excess free fructose was devised. Sixty-two consecutively referred patients with irritable bowel syndrome and fructose malabsorption on breath hydrogen testing underwent dietary instruction. Dietary adherence and effect on abdominal symptoms were evaluated via telephone interview 2 to 40 months (median 14 months) later. Response to the diet was defined as improvement of all symptoms by at least 5 points on a -10- to 10-point scale. Forty-eight patients (77%) adhered to the diet always or frequently. Forty-six (74%) of all patients responded positively in all abdominal symptoms. Positive response overall was significantly better in those adherent than nonadherent (85% vs 36%; P<0.01), as was improvement in individual symptoms (P<0.01 for all symptoms). This comprehensive fructose malabsorption dietary therapy achieves a high level of sustained adherence and good symptomatic response.     

肠易激综合征的发病机制

肠易激综合征 (irritablebowelsyndrome,IBS)是最常见的消化疾病之一。西方国家约 1 5 %～2 0 %的人患有IBS ,我国IBS的发病率具体不详。目前 ,一般认为IBS是一种功能性肠病 ,尚缺乏公认的形态学、生化指标或基因异常的改变 ,但近年的研究逐渐提示IBS的发病机制可能具有其组织或分子生物学的基础。本文就其发病机制进行总结 ,结合我们的研究阐述对本病发病机制的理解。1　肠道运动异常机制IBS病人表现有腹泻、便秘等。近半个世纪以来多数学者认为IBS病人肠道运动具有异常 ,70～90年代许多研究发现IBS结肠或小肠的通过时间与正常人…     

Treating irritable bowel syndrome with a food elimination diet followed by food challenge and probiotics

OBJECTIVE: In Irritable Bowel Syndrome, the gut-associated immune system may be up-regulated resulting in immune complex production, low-grade inflammation, loss of Class I bacteria, and translocation of inflammatory mediators and macromolecules outside of the GI lumen. Since food intolerance may be one of the reasons for this upregulation, our goal was to investigate the role of food intolerance in IBS patients. METHODS: In this open label pilot study, we enrolled 20 patients with IBS by Rome II criteria (15 women, ages 24-81) who had failed standard medical therapies in a tertiary care GI clinic. Baseline serum IgE and IgG food and mold panels, and comprehensive stool analysis (CSA) were performed. Breath-hydrogen testing and IBS Quality-of-Life (QOL) questionnaires were obtained. Patients underwent food elimination diets based on the results of food and mold panels followed by controlled food challenge. Probiotics were also introduced. Repeat testing was performed at 6-months. We followed up with this cohort at 1 year after trial completion to assess the reported intervention and for placebo effect. RESULTS: Baseline abnormalities were identified on serum IgG food and mold panels in 100% of the study subjects with significant improvement after food elimination and rotation diet (p < 0.05). Significant improvements were seen in stool frequency (p < 0.05), pain (p < 0.05), and IBS-QOL scores (p < 0.0001). Imbalances of beneficial flora and dysbiotic flora were identified in 100% of subjects by CSA. There was a trend to improvement of beneficial flora after treatment but no change in dysbiotic flora. The 1-year follow up demonstrated significant continued adherence to the food rotation diet (4.00 +/- 1.45), minimal symptomatic problems with IBS (4.00 +/- 1.17), and perception of control over IBS (4.15 +/- 1.23). The continued use of probiotics was considered less helpful (3.40 +/- 1.60). CONCLUSION: These data demonstrate that identifying and appropriately addressing food sensitivity in IBS patients not previously responding to standard therapy results in a sustained clinical response and impacts on overall well being and quality of life in this challenging entity.     

Clinical audit of the effects of low‐fibre diet on irritable bowel syndrome

Introduction High‐fibre diets are frequently advocated for the treatment of irritable bowel syndrome (IBS) although there is little scientific evidence to support this. Experience of patients on low‐fibre diets suggests that this may be an effective treatment for IBS, warranting investigation. Methods Symptoms were recorded for 204 IBS patients presenting in the gastroenterology clinic. They were then advised on a low‐fibre diet with bulking agents as appropriate. Symptoms were reassessed by postal questionnaire 4 weeks later. Patients who had improved on the diet were advised on the gradual reintroduction of different types of fibre to determine the quantity and type of fibre tolerated by the individual. Results Seventy‐four per cent of questionnaires were returned. A significant improvement (60–100% improvement in overall well‐being) was recorded by 49% of patients. Conclusion This preliminary study suggests that low‐fibre diets may be an effective treatment for some IBS patients and justifies further investigation as a full clinical trial.     

Infection as a cause of irritable bowel syndrome

The normal response to infection, such as vomiting and diarrhoea, is protective and beneficial. However, in about 10% of patients these protective changes persist and may contribute to the development of post-infective irritable bowel syndrome, which may persist for many years. New insights into the pathogenesis of this condition suggest novel, effective ways of treatment.     

Family practitioners' attitudes and knowledge about irritable bowel syndrome: effect of a trial of physician education

BACKGROUND: Primary physicians care for most patients with irritable bowel syndrome (IBS), but data on their attitudes and knowledge about the disorder are limited to research in the UK. OBJECTIVE: The purpose of the present study was to assess US family practitioners' attitudes and knowledge about IBS and determine the effect of a single education class on these measures. METHODS: In a large health maintenance organization (HMO), a baseline group of family practitioners twice completed a questionnaire on attitudes and knowledge about IBS, 3 months apart. A class group completed it pre-class, immediately post-class and 3 months post-class. RESULT: Thirty-five physicians ranked IBS among five chronic, painful syndromes as highest in difficulty satisfying patients, tied with headache for highest in difficulty in practice strategy decision, second in time required, and fourth in diagnostic confidence and satisfaction in caring for patients. IBS and heartburn had widely separated rankings in all five attitudes. The correct answer rate on seven of 13 knowledge questions was <50%, and a majority did not identify the Rome II symptom criteria as typical and lacked other important knowledge. Of the 30 class physicians, the knowledge scores (mean +/- SD; maximum possible, 13) of 29 increased from 5.59 +/- 1.84 pre-class to 10.21 +/- 1.76 immediately post-class (P < 0.0001); 3 months later, the scores were lower (8.93 +/- 0.36) than post-class (P < 0.0001), but still higher than pre-class (P < 0.0001). Their attitude rankings were nearly identical pre-class and 3 months later (P > 0.05). In the 19 baseline physicians, IBS attitude rankings and knowledge scores did not change significantly over 3 months (P > 0.05). CONCLUSION: These US family practitioners had attitudes about IBS patients and lacked knowledge that could interfere with patient care. A single class improved short-term knowledge but had little effect on attitudes about IBS.     

The irritable bowel: a pathological or a psychological syndrome?

The irritable bowel syndrome is discussed together with some of its theories, methods of investigation and various treatment regimens. Eight case histories are reported. In each patient, symptoms appeared to be precipitated by situations interpreted by that patient as stressful. A programme of prospective desensitization using hypnosis is described. Where symptoms of depression were additionally present, antidepressant medication was prescribed. This was subsequently phased out as and when indicated. Where patients had been taking antidiarrhoeal or antispasmodic drugs, various stool bulking agents or benzodiazepines, these were also slowly discontinued as treatment progressed. Cases were followed up from 3 months to 12 years. In 2 cases recurrence of symptoms was again successfully treated. There was no recurrence of any of the bowel symptoms in any other patient. The results support the view that the irritable bowel syndrome is psychogenic in origin.     

Sources of fibre in the diet of irritable bowel patients prescribed a high-fibre diet

Seventy-two patients (27 male and 45 female) with irritable bowel syndrome were prescribed a high-fibre diet. They were given a diet sheet and variable amounts of individual dietetic counselling. After 6 months they kept a 7-day weighed food inventory. Median (mean) intake of dietary fibre was 19.5 (21.6)g, 57% of which was provided by cereal sources, mainly breads and breakfast cereals. Patients also frequently ate low-fibre and energy-dense foods. Average fibre intakes were greater at the evening (main) meal of the day. However, the largest intakes by individuals were at breakfast and the lunch (snack) meal, which suggests that dietary advice should put emphasis on the consumption of high-fibre breakfast cereals and wholemeal bread at these two meals.     

Genetic background of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a functional disorder which affects the 20% of the population. The exact origin is unknown. IBS is the result of interaction of genes and environmental factors. Familial aggregation and higher concordance rate of monozygotic twins compared to dizygotic twins provide evidence for the importance of genetic factors in the pathogenesis of IBS. Interest has focused on genetic variants of serotonin transporter and receptors, because of their role in gut motility, visceral sensitivity, immune processes and mood. Firm conclusions about the role of serotonin system, as well as other neuroreceptors, G-proteins, cytokine polymorphisms in the pathogenesis of IBS cannot be made.