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

Specific abnormalities of colonic and small bowel motility are identifiable and associated with symptoms in IBS. Characteristic abnormalities in colonic motility include a prolonged increase in 3-cycles/min colonic motor activity after a meal, an exaggerated increase in 3-cycles/min motor activity in response to stressors and CCK, and increased visceral sensitivity and motor activity in response to balloon distention. Symptoms in patients with IBS correlate in some cases with the abnormal gastrocolonic response and with pain induced by distention at various sites in the colon. Small bowel motility abnormalities identified reproducibly in IBS include an increase in daytime jejunal DCCs, an increase in daytime ileal PPCs, and more frequent cycling of daytime MMCs (in diarrhea-predominant IBS only). DCCs and PPCs are strongly associated with symptoms in IBS, and PPCs associated with altered ileocecal transit may be an important mechanism of symptoms in some patients with IBS. Esophageal and gastroduodenal motility abnormalities are inconsistently identified in IBS, and most symptoms in IBS appear to be secondary to small bowel or colonic dysfunction. Because of the paroxysmal nature of these motor abnormalities in IBS, prolonged motility recordings are required to better understand the pathophysiology of this syndrome. Patients with IBS may have altered visceral sensation and changes in afferent reflex mechanisms that modulate GI motility. These patients do not have a generalized increase in pain perception, but may have a distinct sensitivity to visceral afferent stimulation in both gastrointestinal and other viscera. Whether the altered "setpoint" to visceral afferent stimulation in IBS is intrinsic to the smooth muscle of viscera or secondary to CNS and ANS modulation is not known. Many of the symptoms and abnormalities of small bowel and colonic motility in IBS probably result from these changes in afferent sensation and reflex mechanisms. These findings support the concept that IBS is an abnormality of intestinal motility in conjunction with a "sensitive" gut.
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PMID:Motility disorders in the irritable bowel syndrome. 206 53

The irritable bowel syndrome (IBS) is an umbrella for the diagnosis of heterogeneous conditions that are awaiting better identification of specific manometric causes. This article focuses on the concept that future therapy for IBS will rely on identification of subgroups and in turn tailor the specific therapeutic approaches to an appreciation of the pathophysiology and symptom predominance of these subgroups. Future therapies will rely on the following principles: (1) prokinetic agents to coordinate upper gastrointestinal and colonic motility as well as improve the propulsive nature of colonic contractions; (2) gastrointestinal hormone agonists such as erythromycin and antagonists such as sandostatin and cholecystokinin antagonists; (3) spasmolytic therapy incorporating calcium channel blocking and anticholinergic agents; (4) inhibition of ovulatory cycle changes in circulating concentrations of gonadal hormones in women, who tend to dominate the IBS population; (5) incorporation of concepts relating to the role of subtypes of 5-hydroxytryptamine receptors in control of neural and myogenic function; (6) reassessment of food intolerance and sensitivity; and (7) incorporation of concepts relating to psychologic profiles and psychologic treatment approaches. IBS is a rich and fertile area for application of the exciting new pharmacologic advances relating to gastrointestinal smooth-muscle and neural innervation of the gut. Improvement in the understanding and treatment of IBS will be one of the major accomplishments of this decade.
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PMID:New directions in the irritable bowel syndrome. 206 57

The irritable bowel syndrome (IBS) is a familiar problem in the clinic, but as a disease entity it remains ill defined. Much confusion has arisen in the past, because of the inappropriate inclusion within the category of IBS of almost any patient with unexplained abdominal discomfort. Recent work has established that IBS patients can be positively identified by a cluster of specific symptoms. With the use of these criteria, it seems likely that IBS patients suffer from a diffuse motor abnormality of the gut associated with visceral hypersensitivity; although there is no associated psychopathology, a central nervous system component to the disorder is possible. Better insight into IBS promises more effective management.
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PMID:The irritable bowel syndrome. 206 58

This placebo controlled, double-blind, cross-over trial involving 20 patients was conducted to assess the effect of ispaghula husk on the major bowel symptoms and the whole gut transit time in irritable bowel syndrome (IBS) and to determine if changes in these parameters were related to global improvement. All 20 patients were interviewed at the end of the treatment periods and 14 patients kept concurrent daily records. Ispaghula therapy resulted in improvement in global symptoms and satisfying bowel movements (P less than 0.001) but produced no change in abdominal pain or flatulence. There was a correlation between the improvement of well-being and the number of days of satisfying bowel movements (P less than 0.001) but not with the indexes of pain, stool frequency or changes in the transit time. The easing of bowel dissatisfaction appears to be a major reason for the therapeutic success of ispaghula in IBS.
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PMID:Ispaghula therapy in irritable bowel syndrome: improvement in overall well-being is related to reduction in bowel dissatisfaction. 212 22

In this study, gut functioning and the prevalence of functional bowel disorders among a Wellington community sample of 285 apparently healthy people was estimated using a standardised questionnaire. When asked for their opinion of their bowel functioning generally, 37% of respondents were satisfied that it was always normal, 57.2% regarded it as not always normal, and 5.6% felt it was normal less than half the time or not normal at all. However, only 11.6% had actually consulted a physician about a stomach or bowel disorder in the past year. Average bowel frequency was 8.4 movements per week (SD = 3.9) for the total sample. Approximately three quarters of the total sample had experienced diarrhoea at least occasionally, but only 2.5% half the movements or more often. Constipation was reported by 8.1% for half the time or more, and 1.8% for most bowel movements. Abdominal distension was experienced by 7.2% on half of days or more, and 3.6% on most days or daily. Abdominal pain occuring on six or more separate days in the previous year was reported by 26.4% of men and 31.9% of women. Pain not due to organic disorders that was colonic in nature and of the irritable bowel syndrome type was reported by 15.9% of men and 17.2% of women.
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PMID:Functional gastrointestinal symptoms in a Wellington community sample. 239 67

Cimetropium bromide is a new antimuscarinic compound with strong antispasmodic activity. The aim of this study was to evaluate the effects of oral cimetropium bromide on total gut transit time in patients with irritable bowel syndrome. Forty patients, divided according to their initial total gastrointestinal transit times and presenting symptoms, were treated with cimetropium bromide 50 mg t.d.s. or placebo for 1 month according to a double-blind, parallel group design. Before and after treatment all subjects ingested 24 radio-opaque markers. The total intestinal transit time was determined by evaluating the rate of disappearance of markers from plain X-ray films of the abdomen taken every 24 h for 4 days. Pain and bowel habits were also monitored. Seven patients did not complete the study. Cimetropium bromide significantly (P less than 0.01) shortened the whole gut transit time in patients with prolonged transit time (80.8 +/- 4.0 h before vs 60.8 +/- 6.7 h after treatment) and improved the global clinical condition significantly compared with placebo (P = 0.029). In patients with a short total intestinal transit time, cimetropium bromide had no effect on whole gut transit time and did not significantly improve symptoms. The results of this study indicate that oral cimetropium bromide is effective both objectively and subjectively in a subgroup of irritable bowel syndrome patients with constipation.
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PMID:Effects of cimetropium bromide on gastrointestinal transit time in patients with irritable bowel syndrome. 252 Jun 22

Functional digestive disorders have their origin in disturbances of the digestive motility control. This control ensured primarily by the "gut brain", which is able to integrate sensitive information from mucosal receptors and to organize an appropriate motor response from a choice of predetermined "programs". The gut brain is in close relationship with the central nervous system (CNS) which collects in fact most of the information and modulates the sensitive integration and the motor response of the enteric nervous system (ENS). Thus, a perturbation of the CNS, such as stress, may induce a dysfunctioning of the ENS, resulting in motor disturbances and finally functional digestive disorders. In a first study involving fasting healthy volunteers, we showed that stress produces a significant reduction of the intestinal migrating motor complexes (MMC). In a second study, patients with irritable bowel syndrome (IBS) were subjected to stress and compared to patients with inflammatory bowel disease and to healthy controls. All subjects exhibited a decrease of MMC; however, total depletion was observed in numerous IBS patients, together with a characteristic irregular motor activity which was associated with symptoms. Finally, 24-hour recordings of the intestinal motility in these patients showed an entirely normal pattern during sleep and when abnormalities just awakening in association with symptoms. Stress-induced perturbation of the CNS in IBS patients seems to provoke an inappropriate modulation of the motor activity programmed by the ENS, resulting in motor disturbances and finally in the symptoms of the disease.
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PMID:[Motility disorders of the small intestine in functional intestinal disorders]. 252 25

The association between emotion and gastrointestinal dysfunction has been postulated for centuries, and all practicing clinicians have anecdotal experience of the association between stress and irritable bowel syndrome (IBS). However, definite proof of an etiologic link between stress and gut motor dysfunction remains elusive, despite the large number of publications on this topic. A critical appraisal of methodology, use of controls, data interpretation, and significance of findings in the published literature is necessary to assess the present state of knowledge and to develop more meaningful studies in the future. This review attempts to summarize these perspectives.
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PMID:Motility disorders and stress. 268 81

We conducted a survey on functional gut disorders and health care seeking behavior in a large non-patient population of an Italian region (Umbria). 533 subjects were interviewed by means of a specific questionnaire. 44 (8.5%) reported symptoms compatible with the irritable bowel syndrome, 30 (5.8%) had non-colonic pain, 48 (9.2%) chronic constipation, and 20 (3.8%) dyspepsia. It is concluded that in our region there is a relatively high percentage of subjects that do not commonly seek health care, although affected by functional gut disorders.
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PMID:Functional gut disorders and health care seeking behavior in an Italian non-patient population. 276 61

Stress in humans commonly results in gastrointestinal dysfunction, which is characterized by its symptomatology because the etiology is completely unknown. We developed an animal model in which to study the effects of stress on the gastrointestinal tract, and characterized the model as a stressor by evaluating endocrine and analgesic responses to mild restraint. Mild restraint (wrap restraint) elevated plasma levels of adrenocorticotropic hormone and beta-endorphin, and caused analgesia. The different regions of the gastrointestinal tract responded differently to the stress stimulus. Gastric emptying was not affected, small intestinal transit was inhibited, and large intestinal transit was stimulated by stress, and there was an associated increase in fecal excretion. Wrap-restraint stress did not result in the formation of ulcers. There was a strong correlation between stress-induced adrenocorticotropic hormone release and stress-induced intestinal dysfunction over a 24-h period that suggested a circadian influence. However, neither exogenous adrenocorticotropic hormone nor beta-endorphin had any effect on intestinal transit. Furthermore, neither adrenalectomy nor hypophysectomy prevented the response of the intestine to stress, suggesting that neither adrenal nor pituitary-derived factors are responsible for mediating the effects of stress on the gut. We conclude that wrap-restraint stress produces different effects on different regions of the intestine, suggesting that the small and large intestines are independently regulated and can respond differently to different stimuli. There were similarities between the intestinal effects of wrap-restraint stress in rats and intestinal symptoms associated with stress and irritable bowel syndrome in humans. Therefore, wrap restraint may be an appropriate animal model in which to study stress-related intestinal dysfunction. The mechanisms by which stress affects intestinal transit are still unresolved; however, the intestinal effects of stress are not mediated by either pituitary or adrenally derived factors.
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PMID:Stress-induced changes in intestinal transit in the rat: a model for irritable bowel syndrome. 282 44


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