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Query: UMLS:C0022104 (irritable bowel syndrome)
 8,033 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Recent investigations in patients with irritable bowel syndrome (IBS) undergoing a breath test (BT) with lactulose, have shown inconclusive results on a possible association between IBS and a small intestine bacterial overgrowth (SIBO), as well as on the effective prevalence of SIBO in IBS patients, because of different geographic areas involved and different criteria adopted for the BT positivity. The aim of this study was to estimate the prevalence of SIBO among IBS patients by means a lactulose BT. Between January 2005 and December 2006, all the patients who were sent to our Gastroenterology Unit by general practitioners (GPs) for "functional" gastrointestinal (GI) symptoms, underwent a lactulose BT for diagnosis of SIBO. The test was considered positive if the hydrogen concentrations in the expired air increased more than 20 ppm over basal values within 90 minutes. A total of 127 patients have been selected, 28 males and 99 females, aged between 17 and 76 (mean age: 41.4 years), with an IBS diagnosis based on the Roma II criteria. Fifty-five patients (43%) resulted positive to the lactulose BT. No significant difference was observed between IBS patients with (SIBO+) and without (SIBO-) an intestinal bacteria contamination. In conclusion, our results indicate that SIBO is relatively frequent in IBS patients and that execution of a lactulose BT should be encouraged in all these patients, being the only way to make correct diagnosis of SIBO and establish a valid therapeutic treatment.
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PMID:Small intestine bacterial overgrowth in patients with irritable bowel syndrome. 1870 Jun 92

The relationship between methanogenic flora and hydrogen (H(2)) production is considered to be a possible confounding factor in the interpretation of hydrogen breath tests (H(2)BT). Therefore, the present study was conducted prospectively and included 154 IBS patients (fulfilling Rome II criteria) and 286 age-and-sex-matched apparently healthy controls. Each subject underwent H(2)BT after overnight fasting using 25 g lactose. Methane and H(2) were measured using an SC Microlyser from Quintron, USA, at baseline and every 30 min for a total of 4 h. Subjects with fasting methane concentration <10 ppm were labeled as low methane producers (LMP) and >10 ppm as predominant methane producers (PMP). A rise >20 ppm over base line in hydrogen concentration was taken as +ve hydrogen breath test. IBS and control groups included 66.78% and 67.53% males, respectively. Mean age in the two groups were 48.52 +/- 30.54 years (range 15-68 years) and 45.67 +/- 30.54 years (range 15-78 years), respectively. Hydrogen breath test was +ve in 77/154 (50%) IBS patients and in 142/286 (49.65%) in controls (P > 0.05). It was also observed that the hydrogen breath test was -ve due to PMP in 5/77 (6.49%) of IBS patients and in 29/154 (20.14%) in controls. PMP affected lactose hydrogen breath tests in 6.49-20.14% subjects. This effect is more apparent in apparently healthy subjects as compared to patients with IBS.
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PMID:Effect of predominant methanogenic flora on outcome of lactose hydrogen breath test in controls and irritable bowel syndrome patients of north India. 1900 33

The aim of the study was to assess the expediency of prescription and efficiency of bismuth tri-potassium di-citrate in different therapeutic schemes for the management of irritable bowel syndrome (IBS) dominated by diarrhea. The open prospective study of de-nol efficacy and safety included 30 patients with this disorder allocated to 2 groups. Patients of the main group (n=20) were given 120 mg of de-nol thrice daily in combination with meteospasmyl (a spasmolytic and antifoaming agent). Control patients (n=10) received aluminium phosphate with meteospasmyl (1 capsule thrice daily). Duration of the treatment was 3 weeks. Therapeutic efficiency was assessed from the dynamics of abdominal pain syndrome, stool frequency, properties of faeces, results of their microscopic and microbiological studies, lactulose breath hydrogen test, rectoromanoscopy with rectal mucosal biopsy, and hepatic biochemical test. Before the study, all patients had abdominal pain, diarrhea, meteorism, altered composition of fecal bacteria, their excessive growth in the intestines, and morphological signs of chronic inflammation. Bacterial activity was recorded in 80 and 40% of the patients of the respective groups. By the end of therapy, abdominal pain was eliminated in 90 and 60%, meteorism was absent in 80 and 40%, diarrhea in 75 and 50%, excessive bacterial growth in small intestine in 75 and 30%, changes of fecal microflora persisted in 20 and 70%, histological signs of active mucosal inflammation remained in 40 and 85.7% of the patients of the main and control groups respectively. It is concluded that all patients with irritable bowel syndrome and diarrhea show altered composition of intestinal microflora, morphological signs of moderate chronic inflammation of intestinal mucosa. Most of them have apparent bacterial activity. Treatment with de-nol and spasmolytics for 3 weeks effectively eliminated clinical manifestations of the disease, restored normal composition of intestinal microflora, normalized faeces properties, and resolved active inflammation.
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PMID:[The use of bismuth tripotassium dicitrate (De-Nol), a promising line of pathogenetic therapy for irritated bowel syndrome with diarrhea]. 1906 60

Some studies indicate that small intestinal bacterial overgrowth (SIBO), as measured by hydrogen breath tests (HBT), is more prevalent in patients with irritable bowel syndrome (IBS) vs. matched controls without IBS. Although the data are conflicting, this observation has led to the hypothesis that SIBO may be a primary cause of IBS. Yet, it remains unclear whether SIBO is truly fundamental to the pathophysiology of IBS, or is instead a mere epiphenomenon or bystander of something else altogether. We hypothesize that SIBO might be a byproduct of the disproportionate use of proton pump inhibitors (PPIs) in IBS, as follows: (1) IBS patients are more likely than controls to receive PPI therapy; (2) PPI therapy may promote varying forms of SIBO by eliminating gastric acid; and (3) existing studies linking SIBO to IBS have not adjusted for or excluded the use of PPI therapy. When linked together, these premises form the basis for a simple and testable hypothesis: the relationship between SIBO and IBS may be confounded by PPIs. Our article explores these premises, lays out the argument supporting this "PPI hypothesis," discusses potential implications, and outlines next steps to further investigate this possibility.
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PMID:Bacterial overgrowth and irritable bowel syndrome: unifying hypothesis or a spurious consequence of proton pump inhibitors? 1908 51

A hydrogen breath test is a safe, easy-to-perform, 2-to 3-hour outpatient procedure used to identify the presence of small intestine bacterial overgrowth, evaluate carbohydrate maldigestion or malabsorption, and measure intestinal transit time. Breath sample analysis can reveal bacterial overgrowth in the small intestine by the characteristic early rise in breath hydrogen concentration (i.e., an earlier-than-expected rise at approximately 90 minutes when the substrate reaches the colon). Patients with irritable bowel syndrome are often referred for a hydrogen breath test because of symptoms of abdominal bloating, cramping, and diarrhea that are also characteristic of bacterial overgrowth. The elderly are at greater risk for nutritional compromise from untreated small intestine bacterial overgrowth than are younger patients. Treatment often consists of one or more courses of antibiotics. Most patients experience a reduction in symptoms with treatment.
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PMID:Hydrogen breath testing in adults: what is it and why is it performed? 1919 85

OBJECTIVE. Intestinal infection with Giardia lamblia may lead to therapy-resistant, long-lasting post-giardiasis irritable bowel syndrome (IBS). We report two open pilot studies aiming to treat this condition, using either antibiotics or bacterio-therapy. MATERIAL AND METHODS. Twenty-eight patients with persistent abdominal symptoms, following clearance of G. lamblia infection, were investigated. Eighteen received treatment with rifaximin plus metronidazole (8-10 days) whereas 10 received a suspension of live faecal flora, installed into the duodenum during gastro-duodenoscopy. Customary abdominal symptoms and symptoms following a lactulose breath test were quantified by questionnaires. Hydrogen and methane production after lactulose were analysed in expired air and excretion of fat and short-chain fatty acids (SCFAs) was examined in faeces. RESULTS. As compared with pre-treatment values, total customary symptom scores were barely significantly reduced (p = 0.07) after antibiotics, but were highly significantly reduced (p = 0.0009) after bacterio-therapy. However, symptom improvement following bacterio-therapy did not persist 1 year later. Hydrogen breath excretion was slightly reduced after antibiotics, but not after bacterio-therapy. Compared with healthy persons, faecal excretion of fat was significantly increased in Giardia-cured patients. SCFAs were increased in the bacterio-therapy group, and were not influenced by therapy. CONCLUSIONS. Both antibiotics and bacterio-therapy were ineffective with respect to cure of post-giardiasis IBS. High faecal excretion of fat and SCFAs suggests that intestinal malabsorption of fat and carbohydrates may play a role in the IBS-like complaints of these patients.
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PMID:Antibiotic or bacterial therapy in post-giardiasis irritable bowel syndrome. 1982 94

Small intestine bacterial overgrowth (SIBO) is a condition characterised by nutrient malabsorption and excessive bacteria in the small intestine. It typically presents with diarrhea, flatulence and a syndrome of malabsorption (steatorrhea, macrocytic anemia). However, it may be asymptomatic in the eldery. A high index of suspicion is necessary in order to differentiate SIBO from other similar presenting disorders such as coeliac disease, lactose intolerance or the irritable bowel syndrome. A search for predisposing factor is thus necessary. These factors may be anatomical (stenosis, blind loop), or functional (intestinal hypomotility, achlorydria). The hydrogen breath test is the most frequently used diagnostic test although it lacks standardisation. The treatment of SIBO consists of eliminating predisposing factors and broad-spectrum antibiotic therapy.
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PMID:[Small intestine bacterial overgrowth]. 2021 90

A series of in vitro experiments was arranged to assess effects of different concentrations of H(2)O(2) contained in bacterial cultures on apoptosis and necrosis of HT-29 line cells representing human gut epithelium. On the basis of cytofluorimetric assays it was possible to demonstrate that supernatant of the Lactobacillus strain producing hydrogen peroxide (L. delbrueckii CU/22) was able to induce both apoptosis and necrosis in human epithelial culture cells HT-29. Both effects were more prominent than those visible under influence of supernatant of the non-H(2)O(2)-producing Lactobacillus strain or chemically pure H(2)O(2) at the same concentration used as a control. In the light of this study and also other reports on damaging effects of hydrogen peroxide and superoxide radicals of bacterial origin on colonic cells, commensal bacteria of the human gut producing H(2)O(2) may be involved in pathomechanisms of IBD by perpetuating the inflammatory reaction and increasing apoptosis and necrosis. There is a promise that probiotic preparations containing Lactobacillus bacteria will be successful as adjunct therapy of IBD and it is, therefore, postulated to make a very careful selection of the Lactobacillus strains as candidates for probiotics indicated to ameliorate the course of IBD, before starting clinical trials.
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PMID:Effect of hydrogen peroxide of bacterial origin on apoptosis and necrosis of gut mucosa epithelial cells as a possible pathomechanism of inflammatory bowel disease and cancer. 2022 52

Irritable bowel syndrome(IBS) is a very common functional gastrointestinal disorder characterized by abdominal discomfort, bloating, and disturbed defecation. Patients with IBS have a tendency to visit physicians more frequently than those without IBS, thus annual economic consequences of IBS in the Western countries are substantial. Therefore, guidelines for the diagnosis and treatment of IBS patients have been designed to give a favored effect on the Department of Gastroenterology's overall performance. A variety of criteria have been developed to identify a combination of symptoms to diagnose IBS, including Manning and Rome I, II, and III criteria. Overall, Manning's criteria had a pooled sensitivity and specificity, 78% and 72%, respectively. In addition, the Rome I criteria had a sensitivity and specificity, 71% and 85%, respectively. However, none described the accuracy of Rome II and III yet. Alarm features such as rectal bleeding and nocturnal pain offer little discriminative value in separating patients with IBS from those with organic diseases. Even though anemia and weight loss have poor sensitivity for organic diseases, they offer very good specificity. Since specific biomarker of IBS is not yet available, diagnostic tests are frequently performed to exclude organic diseases. However, the accuracy of diagnostic tests is disappointing. CBC, chemistry, thyroid function test, stool exam, ultrasonography, hydrogen breath test, erythrocyte sedimentation rate, and C-reactive protein have all very limited accuracy in discriminating IBS from organic diseases. This systemic review is targeted to establish the strategy of IBS treatment, which is very necessary for the current clinical practice.
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PMID:[Diagnosis of irritable bowel syndrome: a systematic review]. 2069 90

The pathophysiology of bloating is largely unknown, and many mechanisms have been proposed. An alteration of intestinal gas production may have a role in a subgroup of patients, but available data are conflicting. We have previously shown that hypersensitivity to colonic fermentation is associated with severe bloating in a subgroup of patients with low intestinal gas production. Accordingly, we evaluated whether modification of intestinal gas production improves bloating severity according to the presence of visceral hypersensitivity to colonic fermentation. Twenty-four IBS-C patients with severe bloating underwent intestinal gas production measurement by hydrogen breath test after lactulose, and a recto-sigmoid barostat test in order to evaluate sensitivity thresholds in a basal condition and after induction of colonic fermentation. The subjects were then randomly assigned to receive either rifaximin or placebo according to a double-blind, randomized, cross-over trial. Rifaximin induced an improvement of symptom severity. A post hoc analysis according to the presence of hypersensitivity to colonic fermentation shows that rifaximin induces a significant improvement in symptom severity only in normosensitive, hyperproducer patients. Modulation of colonic flora, in order to reduce fermentation, does not interfere with bloating severity in patients with visceral hypersensitivity, thus suggesting that in this subgroup of subjects gas production is not crucial for the onset of bloating.
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PMID:Colonic hypersensitivity is a major determinant of the efficacy of bloating treatment in constipation-predominant irritable bowel syndrome. 2116 99


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