Abstract. General gastrointestinal dysmotility occurs in patients with irritable bowel syndrome (IBS). Ghrelin seems to play an important role in regulating gastrointestinal motility. The present study was undertaken, therefore, to establish the possible role of ghrelin in the pathophysiology of IBS. Thirty-seven patients with IBS (19 had IBS-constipation and 18 IBS-diarrhoea) were included in this study. Ten healthy volunteers served as controls. After overnight fast, blood samples were drawn from patients and controls, and a gastroduodenal endoscopy was performed. Biopsies were taken from oxyntic mucosa and duodenum. Ghrelin cell density was determined by computer image analysis after immunohistochemical staining of the tissues. Total and active ghrelin were detected in tissue extracts and plasma by commercially available RIA and ELISA Kits. The density of ghrelinimmunoreactive cells in the oxyntic mucosa was significantly lower in IBS-constipation and significantly higher in IBSdiarrhoea patients than healthy controls (P<0.0001 and <0.0001, respectively). There was no statistical difference in total or active ghrelin between IBS patients and controls, regarding tissue extracts or plasma. In order to compensate for the increase and decrease in the ghrelin cell density, the synthesis and release of ghrelin may be decreased and increased in IBS-diarrhoea and IBS-constipation patients, respectively. It has been speculated that this compensatory mechanism may be subjected from time to time to fatigue with the subsequent increased and decreased synthesis and release of ghrelin in IBS-diarrhoea and IBS-constipation with a subsequent intermittent diarrhoea or constipation seen in these patients, respectively.

Effects of a health program comprising reassurance and patient education, diet management, administration of probiotics and regular exercise on symptoms and quality of life in patients with IBS were investigated.A total of 143 patients (95% women and 5% men), with an average age of 32 years (range, 18-58 years), were included in the study. Ninety-six of these patients had diarrhea and 47 had constipation as the predominant symptom. The patients went through a program combining reassurance and IBS education, guidance in diet management, intake of probiotics, and regular exercise. The patients were asked to complete the Birmingham IBS symptom score questionnaire, the SF-36 questionnaire and the IBS-quality of life (IBS-QoL) questionnaire before starting the program and three, six, 12 and 24 months after completing the program.The total score of symptoms, as well as all the 3 dimensions (pain, diarrhea and constipation), were diminished significantly at all observation times after completing the program. The total score of quality of life, as assessed by the SF-36 questionnaire and by the IBS-QoL questionnaire, was significantly improved at all observation times after completing the program. This improvement included all health concepts of the SF-36 and all the domains of the IBS-QoL except physical and mental role limitations, food avoidance and sexual relations. There was no statistical difference between patients with IBS with diarrhea-or constipation-predominant symptoms.Combining reassurance and patient education, diet management, probiotics administration and regular exercise in a health program improves symptoms and quality of life in patients with IBS.