Overlap of Irritable Bowel Syndrome and Functional Dyspepsia in the Clinical Setting: Prevalence and Risk Factors

Wulffen, Moritz von; Talley, Nicholas J.; Hammer, Johann; McMaster, Jessica; Rich, Graeme; Shah, Ayesha; Koloski, Natasha A.; Kendall, Bradley J.; Jones, Michael; Holtmann, Gerald

doi:10.1007/s10620-018-5343-6

Cited by 109 publications

(111 citation statements)

References 36 publications

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“…There is emerging evidence for a link between intestinal dysbiosis, including SIBO, and diseases such as IBS, 11 IBD 12 and chronic liver disease 13 . Many patients in these groups are likely to be on a PPI, often for management of unexplained gastrointestinal symptoms or overlapping conditions 36 . This raises the question as to whether PPIs contribute to observed alterations in the gut microbiome in these conditions.…”

Section: Discussionmentioning

confidence: 99%

Duodenal bacterial load as determined by quantitative polymerase chain reaction in asymptomatic controls, functional gastrointestinal disorders and inflammatory bowel disease

Shah

Talley

Koloski

et al. 2020

Aliment Pharmacol Ther

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Summary Background Small intestinal bacterial overgrowth may play a role in gastrointestinal and non‐gastrointestinal diseases. Aims To use quantitative polymerase chain reaction (qPCR) to determine and compare bacterial loads of duodenal biopsies in asymptomatic controls, and patients with functional gastrointestinal disorders (FGIDs) and inflammatory bowel disease (IBD) including ulcerative colitis (UC) and Crohn’s disease (CD). To define effects of gastric acid inhibition on bacterial load, explore links of bacterial load and gastrointestinal symptoms in response to a standardised nutrient challenge and compare bacterial load with glucose breath test results. Methods In 237 patients (63 controls, 84 FGID and 90 IBD), we collected mucosal samples under aseptic conditions during endoscopy extracted and total DNA. Bacterial load metric was calculated utilising qPCR measurements of the bacterial 16S rRNA gene, normalised to human beta‐actin expression. Standard glucose breath test and nutrient challenge test were performed. Results The duodenal microbial load was higher in patients with FGID (0.22 ± 0.03) than controls (0.07 ± 0.05; P = 0.007) and patients with UC (0.01 ± 0.05) or CD (0.02 ± 0.09), (P = 0.0001). While patients treated with proton pump inhibitors (PPI) had significantly higher bacterial loads than non‐users (P < 0.05), this did not explain differences between patient groups and controls. Bacterial load was significantly (r = 0.21, P < 0.016) associated with the symptom response to standardised nutrient challenge test. Methane, but not hydrogen values on glucose breath test were associated with bacterial load measured utilising qPCR. Conclusions Utilising qPCR, a diagnosis of FGID and treatment with PPI were independently associated with increased bacterial loads. Increased bacterial loads are associated with an augmented symptom response to a standardised nutrient challenge.

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Section: Discussionmentioning

confidence: 99%

Duodenal bacterial load as determined by quantitative polymerase chain reaction in asymptomatic controls, functional gastrointestinal disorders and inflammatory bowel disease

Shah

Talley

Koloski

et al. 2020

Aliment Pharmacol Ther

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“…Several studies have clearly demonstrated that a low-FODMAPs diet significantly decreases symptoms in IBS patients (33). The overlap between IBS and dyspepsia is frequent and, in daily clinical settings, the overlap of both of these syndromes has occurred in 64% in patient questionnaires vs. 23% in routine clinical documentations (34). Thus, this overlap appears to be a normal occurrence, rather than an exception.…”

Section: Fodmaps and Functional Dyspepsiamentioning

confidence: 99%

The Role of Diet in Functional Dyspepsia Management

et al. 2020

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Functional dyspepsia is a common functional gastrointestinal disease that is characterized by postprandial fullness, early satiation, epigastric pain, and/or epigastric burning. Eating a meal is a key factor in the occurrence of symptoms during functional dyspepsia, and patients frequently request dietary advice that could relieve these symptoms. Eating behaviors, irregular meal patterns, and moderate-to-fast eating rates are significantly associated with functional dyspepsia. The role of diet is complex; fat ingestion increases the occurrence of symptoms in dyspeptic patients, which might be affected by cognitive factors and palatability. Data concerning the role of carbohydrates are conflicting. Wheat may induce symptoms in patients with nonceliac gluten/wheat sensitivity, and gluten-free diets might be beneficial. Data concerning the role of FODMAPs (Fructo, Oligo, Di-, Monosaccharides, And Polyols) in functional dyspepsia are lacking; however, as there is a frequent overlap between functional dyspepsia and irritable bowel syndrome, a diet that is low in FODMAPs might be useful in relieving some symptoms. Data concerning alcohol are also conflicting. Adherence to a Mediterranean diet seems to be associated with a decrease in dyspepsia symptoms. Finally, data concerning diet modifications are conflicting, and the impact of diet modifications on symptom intensity or frequency has never been reported in randomized prospective studies. Common sense dietary recommendations, such as eating slowly and regularly, as well as decreasing the fat content of meals, can be provided in daily clinical practice.

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“…Applying Rome-criteria in well-controlled trials, the gain over placebo for the available pharmacotherapies is very disappointing and rarely exceeds 10-15% [7,8]. This might be partly explained by the heterogeneity of underlying causes of symptoms (including systemic inflammation [9], sensory or motor dysfunction [10], dietary [11] and psychologic factors [12]), and subsequently there is considerable overlap of categories [13][14][15][16] that is in particular evident in patients with severe disease manifestations [17]. Thus, a variety of factors can -in isolation or collectively -determine the manifestation and severity of GI and concomitant extraintestinal symptoms.…”

Section: Introductionmentioning

confidence: 99%

Use of Evidence-Based Herbal Medicines for Patients with Functional Gastrointestinal Disorders: A Conceptional Framework for Risk-Benefit Assessment and Regulatory Approaches

Holtmann

Schrenk

Madisch

et al. 2019

Dig Dis

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Background: Herbal or complementary medicines are frequently used for the treatment of patients with functional gastrointestinal disorders (FGID). Regulatory requirements for herbal therapies are inconsistent and, in many jurisdictions, herbal therapies are either self-, minimally-or unregulated. Aim: To provide guidance for the appropriate and safe use of herbal medicines in patients with FGID patients with special consideration of the regulatory frameworks. Methods: A PubMed search of the literature was performed; relevant articles were included. Results: Similar to chemically defined therapies herbal medicines can cause adverse events. Thus, a risk-benefit appraisal should be undertaken for these therapies. While there is no disease specific mortality in FGID public and policy makers. However, the frequently chronic or relapsing nature of FGIDs cause disabilities in predominately young people and are a considerable burden to society even though life expectancy is not affected.

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Overlap of Irritable Bowel Syndrome and Functional Dyspepsia in the Clinical Setting: Prevalence and Risk Factors

Cited by 109 publications

References 36 publications

Duodenal bacterial load as determined by quantitative polymerase chain reaction in asymptomatic controls, functional gastrointestinal disorders and inflammatory bowel disease

Duodenal bacterial load as determined by quantitative polymerase chain reaction in asymptomatic controls, functional gastrointestinal disorders and inflammatory bowel disease

The Role of Diet in Functional Dyspepsia Management

Use of Evidence-Based Herbal Medicines for Patients with Functional Gastrointestinal Disorders: A Conceptional Framework for Risk-Benefit Assessment and Regulatory Approaches

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