Evidence-based clinical practice guidelines for irritable bowel syndrome

Fukudo, Shin; Kaneko, Hiroshi; Akiho, Hirotada; Inamori, Masahiko; Endo, Yuka; Okumura, Toshikatsu; Kanazawa, Motoyori; Kamiya, Tetsuro; Sato, Ken; Chiba, Tetsuhiro; Furuta, K.; Yamato, Shigeru; Arakawa, Tetsuo; Fujiyama, Yoshihide; Azuma, Takeshi; Fujimoto, Kazuma; Mine, Tetsuya; Miura, Soichiro; Kinoshita, Yoshikazu; Sugano, Kentaro; Shimosegawa, Tooru

doi:10.1007/s00535-014-1017-0

Cited by 129 publications

(125 citation statements)

References 161 publications

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“…Disruption of duodenal and intestinal permeability has been reported in some cases of FD and IBS [76][77][78][79][80]. An interesting finding was that a fecal supernatant from either diarrhea-predominant or constipation-predominant IBS increased intestinal permeability [81][82][83][84], which shows that soluble mediators are involved in the increased permeability.…”

Section: Irritable Bowel Syndrome (Ibs)mentioning

confidence: 84%

Gastrointestinal mucosal barrier function and diseases

2016

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The gastrointestinal mucosal barrier plays an essential role in the separation of the inside of the body from the outside environment. Tight junctions (TJs) are the most important component for construction of a constitutive barrier of epithelial cells, and they regulate the permeability of the barrier by tightly sealing the cell-cell junctions. TJ proteins are represented by claudins, occludin, junctional adhesion molecules, and scaffold protein zonula occludens. Among these TJ proteins, claudins are the major components of TJs and are responsible for the barrier and the polarity of the epithelial cells. Gastrointestinal diseases including reflux esophagitis, inflammatory bowel disease, functional gastrointestinal disorders, and cancers may be regulated by these molecules, and disruption of their functions leads to chronic inflammatory conditions and chronic or progressive disease. Therefore, regulation of the barrier function of epithelial cells by regulating the expression and localization of TJ proteins is a potential new target for the treatment of these diseases. Treatment strategies for these diseases might thus be largely altered if symptom generation and/or immune dysfunction could be regulated through improvement of mucosal barrier function. Since TJ proteins may also modify tumor infiltration and metastasis, other important goals include finding a good TJ biomarker of cancer progression and patient prognosis, and developing TJ protein-targeted therapies that can modify patient prognosis. This review summarizes current understanding of gastrointestinal barrier function, TJ protein expression, and the mechanisms underlying epithelial barrier dysregulation in gastrointestinal diseases.

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Section: Irritable Bowel Syndrome (Ibs)mentioning

confidence: 84%

Gastrointestinal mucosal barrier function and diseases

2016

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“…5-HT acts on the 5-HT 3 receptors on the parasympathetic ganglia to cause smooth muscle contraction and increased intestinal secretion by stimulating nerve terminal acetylcholine release [5]. 5-HT 3 receptor antagonists inhibit the activation of 5-HT 3 receptors on the mucosal processes of the intrinsic and extrinsic primary afferent neurons and attenuate motor and secretory reflex activity while decreasing the depolarization of extrinsic sensory neurons that transmit signals to the brain, thereby inhibiting the sensory signals leading to abdominal pain and discomfort and are likely directly or indirectly related to the pathophysiology of IBS [6]. This has been exploited therapeutically in patients with IBS-D in whom 5-HT 3 receptor antagonists improve gastrointestinal (GI) symptoms, reducing stool frequency, urgency, and abdominal discomfort while increasing stool consistency [7].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of 5-Hydroxytryptamine 3 Receptor Antagonists in Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Zheng¹,

Yu²,

Lin³

2017

Gastroenterology

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AimWe assessed the efficacy and safety of 5-hydroxytryptamine (5-HT 3 ) receptor antagonists in adults with non-constipated irritable bowel syndrome (IBS) or diarrhea-predominant IBS (IBS-D). MethodsWe searched PubMed, MEDLINE, EMBASE, and the Cochrane Controlled Trials Register for randomized controlled trials (RCTs) involving adults with non-constipated IBS or IBS-D that compared 5-HT 3 receptor antagonists with placebo or other conventional treatment. Dichotomous symptom data were pooled to obtain the relative risk (RR) and 95% confidence intervals (CIs) for improving global IBS symptoms, abdominal pain and abnormal bowel habits, or stool consistency symptoms after therapy, and adverse events, including constipation. Meta-analysis was performed with Mantel Haenszel method using Revman 5.3 software. ResultsWe included 21 RCTs; 16 were high quality (Jadad score ! 4). The pooled RR of global IBS symptoms improved by 5-HT 3 receptor antagonists versus placebo or mebeverine was 1.56 (95% CI: 1.43-1.71); alosetron, ramosetron, and cilansetron had similar treatment effects. The pooled RR of abdominal pain relieved by 5-HT 3 receptor antagonists versus placebo was 1.33 (95% CI: 1.26-1.39). The pooled RR showed that 5-HT 3 receptor antagonists improved abnormal bowel habits or stool consistency symptoms (RR = 1.63, 95% CI: 1.33, 1.99). The pooled RR of adverse events following 5-HT 3 receptor antagonist treatment was 1.15 (95% CI: 1.08, 1.22). Subgroup analysis indicated that alosetron had a high rate of adverse effects (RR = 1.16, 95% CI: 1.08, 1.25); adverse events following ramosetron treatment were not statistically significantly different. ConclusionsRamosetron, cilansetron, ondansetron, and alosetron are effective for treating non-constipated IBS and IBS-D. Our systematic review found rare serious adverse events.

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“…22 Patients showing manifestations of this disorder who report to a physician have a higher percentage of comorbid psychological disturbances than patients who do not look for medical help. 15 The chronic and recurrent character of this disease may predispose patients to additional psychiatric disorders.…”

Section: Discussionmentioning

confidence: 99%

Psychiatric Co-morbidity in Patients With Irritable Bowel Syndrome at a Tertiary Care Center in Northern India

Kawoos

Wani

Kadla

et al. 2017

J Neurogastroenterol Motil

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Background/AimsIrritable bowel syndrome (IBS) is a chronic psycho-physiological disorder. It is considered to be the most common functional gastrointestinal disorder, and about 50-90% of IBS patients have associated psychiatric co-morbidity. We aimed to study psychiatric co-morbidities in patients with IBS visiting a tertiary care center. MethodsThis was a cross-sectional case-control study conducted over a duration of one and a half years from January 2014 to July 2015. Patients were selected from the out-patient department of gastroenterology. About 160 patients with IBS who fulfilled the inclusion criteria and who gave written informed consent were selected as study cases. The healthy attendants of cases were selected as controls. A total of 200 controls were selected. Rome-III criteria were used to diagnose IBS. For diagnosing psychiatric disorders, we used the Mini International Neuropsychiatric Interview Schedule Plus. ResultsMean age of our cases and controls was 39.7 ± 11.4 and 37.7 ± 9.6 years, respectively. Females outnumbered males in our cases as well as their controls by a ratio of 2:1 approximately. Psychiatric disorders were seen in 84.4% of IBS patients as compared to 41.5% in controls. Major psychiatric disorders seen in our patients were generalized anxiety disorders (30.0%) and depression (28.0%). ConclusionsThe majority of patients with IBS who present to a tertiary care center have co-morbid psychiatric disorders. We need to screen these patients for such co-morbidities and develop a holistic approach for better outcome in such cases.

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Evidence-based clinical practice guidelines for irritable bowel syndrome

Cited by 129 publications

References 161 publications

Gastrointestinal mucosal barrier function and diseases

Gastrointestinal mucosal barrier function and diseases

Efficacy and Safety of 5-Hydroxytryptamine 3 Receptor Antagonists in Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Psychiatric Co-morbidity in Patients With Irritable Bowel Syndrome at a Tertiary Care Center in Northern India

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