Abnormalities of GI transit in bloated irritable bowel syndrome: effect of bran on transit and symptoms

Hebden, John M.; Blackshaw, Elaine; D’Amato, Massimo; Perkins, Alan C.; Spiller, Robin C.

doi:10.1111/j.1572-0241.2002.05985.x

Cited by 74 publications

(43 citation statements)

References 23 publications

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“…In GERD, the commonly accepted functional disturbances are a reduction in resting lower esophageal sphincter (LES) pressure [7] and an increase in transient LES relaxation. In the case of IBS, alterations in transit [8][9][10][11] and small bowel motility [12,13] are detectable. In one study, there appears to be common ground whereby resting LES pressure is abnormally low in IBS subjects compared to controls [14].…”

Section: Introductionmentioning

confidence: 99%

Studying the Overlap Between IBS and GERD: A Systematic Review of the Literature

et al. 2006

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Evidence points to a significant overlap between irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD). In this study, we evaluate this overlap by conducting a systematic review of the literature. Six electronic databases from 1966 through January 2005 were screened by multiple search terms to identify all epidmiological evidence linking IBS and GERD. In addition, AGA meeting abstracts for 2003 and 2004 were also screened. All studies were validated by the authors and data extracted according to predefined criteria. As a separate search strategy, studies evaluating the prevalence of IBS and GERD in the general population were sought. These articles were obtained to compare the prevalence of IBS and GERD in the community to the degree of overlap. The search identified 997 original titles with 15 publications that fulfilled our eligibility criteria. Among the 15 studies, 7 determined the GERD maximum mean prevalence in patients already diagnosed with IBS to be 39.3% and the weighted mean 30.3%. The other 7 studies examined the prevalence of IBS in patients already diagnosed with GERD. The maximum mean prevalence of IBS in subjects with known GERD was 48.8% and the weighted mean 60.5%. Based on the prevalence of IBS (12.1%) and GERD (19.4%) in the community, the rate of IBS in the non-GERD community was calculated to be only 5.1%. There is a strong overlap between GERD and IBS that exceeds the individual presence of each condition. In the absence of GERD, IBS is relatively uncommon.

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Section: Introductionmentioning

confidence: 99%

Studying the Overlap Between IBS and GERD: A Systematic Review of the Literature

et al. 2006

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“…Studies investigating soluble fibers (ispaghula, calcium polycarbophil, psyllium) demonstrate more effectiveness in treating C-IBS patients than studies investigating insoluble fibers (corn, wheat bran) [28•]. Insoluble fiber may aggravate abdominal bloating and pain in some cases [29]. A separate meta-analysis identified only five of 13 placebo-controlled trials that reported alleviation of global IBS symptoms and concluded that fiber cannot be recommended except as adjuvant therapy [9••].…”

Section: Constipation-predominantmentioning

confidence: 98%

Current gut-directed therapies for irritable bowel syndrome

Chang¹,

Kelly²,

Lembo³

2006

Curr Treat Options Gastro

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Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that can present with a wide array of symptoms that make treatment difficult. Current therapies are directed at relieving symptoms of abdominal pain or discomfort, bloating, constipation, and diarrhea. Pharmacologic agents used to treat IBS-associated pain include myorelaxants, peppermint oil, and peripherally acting opiates. Dicyclomine and hyoscyamine, the two myorelaxants available in the United States, have not been proven effective in reducing abdominal pain in patients with IBS. The efficacy of peppermint oil is debated, but methodological problems with existing studies preclude definitive judgment. Loperamide is ineffective for relief of abdominal pain. For IBS patients with excessive abdominal bloating, a small number of studies suggest that bacterial eradication with gut-directed antibiotics and bacterial reconstitution with nonpathogenic probiotics may reduce flatulence. For constipation-predominant (C-IBS) symptoms, current treatment options include fiber supplementation, polyethylene glycol, and tegaserod. Soluble fibers (ispaghula, calcium polycarbophil, psyllium) are more effective than insoluble fibers (wheat bran, corn fiber) in alleviating global symptoms and relieving constipation, although fiber in general has marginal benefit in treatment of overall IBS symptoms. Polyethylene glycol increases bowel frequency in chronic constipation, but its overall efficacy against IBS is unclear. Tegaserod, a 5-HT(4) agonist, demonstrates superiority over placebo in improving bowel frequency and stool consistency and alleviating abdominal pain and bloating in women with C-IBS. Overall global symptoms are modestly improved with tegaserod when compared with placebo. Additional agents under investigation for C-IBS include the ClC(2) chloride channel opener lubiprostone, mu-opioid receptor antagonist alvimopan, and 5-HT(4) agonist renzapride. For diarrhea-predominant (D-IBS) symptoms, available therapies include loperamide, alosetron, and clonidine. Alosetron, a 5-HT(3) antagonist, is superior to placebo for reducing bowel frequency, improving stool consistency, and relieving abdominal pain in women with D-IBS. However, alosetron is available under a restricted license because of concerns for ischemic colitis and severe constipation necessitating colectomy. Clonidine may be helpful in alleviating global symptoms for D-IBS patients.

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“…Dietary or commercial bulking agents should be increased gradually to approximately 20 to 25 g/d over several weeks [13]. However, bulking agents often aggravate symptoms of pain and bloating, especially in patients who report bloating as a common symptom [17]. If side effects occur, the dose should be reduced or an agent more resistant to bacterial fermentation, such as methylcellulose or polycarbophil, should be substituted.…”

Section: Bulking Agentsmentioning

confidence: 99%

New approaches to the medical treatment of irritable bowel syndrome

Berrada

Canenguez

Lembo

2003

Curr Gastroenterol Rep

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Irritable bowel syndrome (IBS) is a common disorder with a worldwide distribution; it is characterized by abdominal pain and discomfort associated with an alteration of bowel function. The treatment approach for IBS depends on the patient's presenting symptoms at the time of diagnosis, and treatment is usually directed toward the predominant symptom. In this review we discuss the current approach to the treatment of IBS.

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Abnormalities of GI transit in bloated irritable bowel syndrome: effect of bran on transit and symptoms

Cited by 74 publications

References 23 publications

Studying the Overlap Between IBS and GERD: A Systematic Review of the Literature

Studying the Overlap Between IBS and GERD: A Systematic Review of the Literature

Current gut-directed therapies for irritable bowel syndrome

New approaches to the medical treatment of irritable bowel syndrome

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