Background-Both psychological and physiological disturbances have been implicated in the aetiopathogenesis of irritable bowel syndrome (IBS). Aims-To investigate how the psychological factors act, and the involvement of infective and physiological factors. Methods-Consecutive patients hospitalised for gastroenteritis reported life events for the previous 12 months, and past illness experiences on standardised questionnaires. They also completed psychometric questionnaires for anxiety, neuroticism, somatisation, and hypochondriasis. In some patients, rectal biopsy specimens were obtained during the acute illness and at three months postinfection. Results-Ninety four patients completed all questionnaires: 22 patients were diagnosed with IBS after their gastroenteritis (IBS+), and 72 patients returned to normal bowel habits (IBS−). IBS+ patients reported more life events and had higher hypochondriasis scores than IBS− patients. The predictive value of the life event and hypochondriasis measures was highly significant and independent of anxiety, neuroticism, and somatisation scores, which were also elevated in IBS+ patients. Rectal biopsy specimens from 29 patients showed a chronic inflammatory response in both IBS+ and IBS− patients. Three months later, specimens from IBS+ patients continued to show increased chronic inflammatory cell counts but those from IBS− patients had returned to normal levels. IBS+ and IBS− patients exhibited rectal hypersensitivity and hyper-reactivity and rapid colonic transit compared with normal controls, but there were no significant diVerences between IBS+ and IBS− patients for these physiological measurements. Conclusion-Psychological factors most clearly predict the development of IBS symptoms after gastroenteritis but biological mechanisms also contribute towards the expression of symptoms. (Gut 1999;44:400-406)
The effect of a low fat diet (9 MJ) v a high fat diet (19.26 MJ), each consumed separately for four and 14 days, on gastric emptying and mouth to caecum transit time of a high fat test meal and body weight and satiety were examined in groups of 10 and six normal male volunteers. The half time for gastric emptying (tl/2) and the mouth to caecum transit time of a high fat test meal was significantly faster after the high fat diet than the low fat diet when consumed for 14 days (tl/2=98 (80-116) The presence of nutrients, such as glucose'2 and fat,34 in the small intestine exert a powerful inhibitory effect on the rate of gastric emptying, but it is possible that this effect may be modulated by previous dietary history. Gastric emptying of nutrient liquids is delayed in primary anorexia nervosa`8 and after a period of starvation, '" but returns to control values after a two week refeeding programme.7 In contrast, some, but not all, studies have shown an acceleration in the rate of emptying of nutrient liquids" 2 in obese patients. These results suggest that underexposure or overexposure of the small intestinal receptors to nutrients may alter the sensitivity of the mechanisms that regulate gastric emptying. This hypothesis is supported by the observation that the emptying of weak acids from the stomach is faster in subjects with hypochlorhydria" '`than (Table I). The design of the high fat diet was essentially similar to that of the low fat diet except that skimmed milk was replaced with full cream milk and butter and mayonnaise were added, giving an additional 258 g fat and 10-2 MJ. The four day dietary period was composed of one menu which was repeated each day, whereas two slightly different menus were used alternately during the 14 day diets to facilitate compliance by the subjects. The meals were prepared in the hospital and consumed by the subjects under close supervision.Subjects were not allowed to drink alcohol throughout the study periods but were allowed to consume a maximum of three 300 ml glasses of water a day. Daily exercise was recorded and repeated at similar times during their second dietary period.
Symptom scores, stool data, and the transit of a standard, solid meal were measured in 28 patients with irritable bowel syndrome (IBS) during baseline conditions and after five weeks of treatment with placebo and loperamide, given as a flexible dosage regime in the form of a double-blind, cross-over trial. All patients had undergone a comprehensive series of diagnostic investigations and had failed to respond to dietary supplementation with coarse wheat bran (10-30 g daily). Loperamide treatment accelerated gastric emptying, compared with placebo (1.2 +/- 0.1 vs 1.5 +/- 0.1 hr; P less than 0.001) and delayed both small bowel (6.2 +/- 0.3 vs 4.3 +/- 0.3 hr; P less than 0.001) and whole gut transit (56 +/- 5 vs 42 +/- 4 hr; P less than 0.01). Eighteen patients said they felt better taking loperamide compared with placebo and, at follow up, 15 of these patients remained satisfied with the effects of the drug. Most symptoms improved significantly on placebo compared with the baseline period, but three of these [diarrhea (P less than 0.01), urgency (P less than 0.01) and borborygmi (P less than 0.05)] showed a further significant improvement on loperamide. Improvement in diarrhea was not associated with any change in stool weight but was associated with reductions in stool frequency (P less than 0.001), passage of unformed stools (P less than 0.01), and incidence of urgency (P less than 0.001). Urgency was the only symptom that was significantly more common in the success group, compared with the group who did not feel better on loperamide.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.