- Email: [email protected]
Evaluation of the natural history and role of psychological factors in post-enteritis irritable bowel syndrome
S278
Abstracts
AJG – Vol. 97, No. 9, Suppl., 2002
Type of DM, % cases
Mean age
Sex % M/F
Mean HgA1c
Years DM
UGI Score
LGI score
Type 1 30% Type 2 70%
42 58
46/53 46/54
8.5 7.6
17.7 10.8
6.8 5.4
2.2 2.6
Subjects had the following UGI symptoms at least 1 week/month. N⫽251: Heartburn 39%
Bloating
Appetite2
Early fullness
Stomach pain
Nausea. Vom
29
28
28
24
22
Mean UGI symptom scores ranged from 0 –36 with a mean of 5.8 and LGI scores from 0 to 16 with a mean of 2.5. The most common LGI symptoms included diarrhea (34%), constipation (29%), and abdominal cramping (26%). Nine percent of patients reported occurrence of fecal incontinence at least one week per month. Symptom scores were higher in females (p⬍0.001) and were weakly correlated with BMI, glycosylated hemoglobin and increasing age. No correlation was seen between symptom scores and duration of diabetes or type of diabetes. The only symptom that differed between type 1 and type 2 DM was a slightly higher prevalence of loss of appetite in type 1 subjects (p⫽.01). Conclusions: In our population of patients attending a diabetes clinic: a) several GI symptoms were frequently reported and b) symptoms were associated with female gender, increased HgA1C, obesity and advancing age. Because those GI symptoms can decrease quality of life and could be effectively treated, eliciting GI symptoms should be a routine part of the history when evaluating patients with diabetes. 846 EVALUATION OF THE NATURAL HISTORY AND ROLE OF PSYCHOLOGICAL FACTORS IN POST–ENTERITIS IRRITABLE BOWEL SYNDROME Andrew D. Spears, M.D., Ashok Tuteja, M.D., Susie Frederick, R.N. and Joel S. Levine, M.D.*. Gastroenterology, University of Colorado, Denver, CO; Gastroenterology, University of Colorado, Denver, CO; Gastroenterology, University of Colorado, Denver, CO and Gastroenterology, University of Colorado, Denver, CO. Purpose: To study the natural history of post– enteritis irritable bowel syndrome (IBS) and to evaluate the role of psychological factors in its cause. Methods: We prospectively evaluated patients 18 –75 years with acute infectious enteritis for the development of post– enteritis irritable bowel syndrome (IBS) per modified Rome criteria. Patients with culture positive enteritis reported to the Department of Public Health in the Denver Metro area between June 2001 and June 2002 were eligible to participate in the study. Those patients who expressed interest were administered a standardized IBS questionnaire to assess their baseline symptoms for the 3 months prior to developing enteritis. Those (⫹) for IBS pre–infection were excluded from the study. Those (–) for IBS pre–infection were administered the Patient Health Questionnaire (PHQ) for psychological evaluation. 3 months post–infection all enrolled patients were administered the same standardized IBS questionnaire to determine if they developed IBS. Results: 22 patients expressed interest in the study. 11 of 22 patients were (–) for IBS pre–infection and were enrolled. 11 patients were excluded for the following reasons: age, inability to make telephone contact, or presence of IBS pre–infection. 9 of the 11 patients enrolled did not have evidence of IBS 3 months post–infection. The 2 patients (18%) with IBS symptoms post–infection were also (⫹) for depression on PHQ evaluation. Of the 9 patients who did not develop post– enteritis IBS, none were (⫹) for depression on PHQ evaluation. Conclusions: Our preliminary, small study shows that post– enteritis IBS is seen in 18% (2/11) of patients. This subset of IBS is associated with depression by PHQ evaluation. The results of this study suggest the need for larger sample sizes and longer duration of follow– up to determine the true importance of post– enteritis IBS.
847 CHANGES IN SYMPTOMS, DISTENTION–STIMULATED COLONIC MOTALITY AND IN FECAL MICROBIOLOGICAL FEATURES AFTER ORAL BACTERIOTHERAPY IN PATIENTS WITH DIARRHEA–PREDOMINAT IBS (D–IBS) OR WITH FUNCTIONAL DIARRHEA (FD) Gabriele Bazzocchi, M.D., Pier F. Almerigi, M.D., Paolo Gionchetti, M.D. and Massimo Campieri, M.D.*. Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy. Purpose: Evidences supporting changes in intestinal microflora as basis for altered gut function in IBS are strongly emerging. Our aim was to evaluate the effect of a preparation containing 300 billions per gram of 8 viable different probiotic bacterial strains (VSL#3, Gatisbourg – USA) on clinical picture and mechanical distention–induced colonic motility in adults with well documented functional origin of diarrhea Methods: Fourty nine pts with D–IBS and 19 with FD according to Rome II° Diagnostic Criteria were evaluated: number and type of stools according to Bristol Stool Form Scale, abdominal pain, bloating/distention and urgency sensations on a 0 –10 non– graduated Visual Analogic Scale (VAS) were measured on a weekly basis. In 15 pts, Motility Index (MI), High Amplitude Propagating Contractions (HAPC) and Painful Threshold (PT) were manometrically measured in the left colon after distentions of the splenic flessure wall by a latex ballon inflations. In 10 of these pts, fecal samples for microbiological analysis and PCR detection of the VSL#3 strains B.infantis and B.breve were taken. Clinical, manometric and microbiological assessment were carried out before and after 20 days of treatment with VSL#3, 3 g/daily. Results: A decrease in evacuation frequency and in VAS score for symptoms occurred in both the groups after treatment. Watery and mushy stool decreased from 91% and 92% to 34% and 42% of weekly defecations in D–IBS and FD respectively (p⬍.001, Wilcoxon signed–rank test). Before treatment colonic distention induced an increase in MI and in HAPC frequency, while no significat changes occurred after VSL#3, as well as an increased balloon air volume eliciting PT. –D– galactosidase activity and concentrations of lactobacilli and bifidobacteria increased significantly after treatment in fecal samples: PCR signals showed that this increase was related to VSL#3 bifidobacteria specific strains presence Conclusions: This was an open, non– controlled trial, but it is the first observation showing clinical improvement related to changes in the composition of fecal bacterial flora, in fecal biochemistry and in colonic motility induced by probiotic administration in pts with well defined functional diarrhea. 848 ALOSETRON IS SAFE AND EFFECTIVE FOR THE LONG TERM TREATMENT OF MEN WITH DIARRHEA– PREDOMINANT IRRITABLE BOWEL SYNDROME (D–IBS) Christine L. Frissora, M.D. and Lucinda A. Harris, M.D.,FACG*. Division of Gastroenterology and Hepatology, The Weill Meical College of Cornell University, New York, NY. Purpose: IBS is a common disease that affects 1 in 5 Americans. IBS impacts negatively on the quality of life (1). Alosetron (LOTRONEX™) is a 5HT3 receptor antagonist that is safe and effective for the treatment of women with D–IBS (2). Clinical trials did not demonstrate statistical significance in men (3). Pharmacotherapy is an essential component of IBS treatment. We report the safety and efficacy of long term alosetron treatment for men with D–IBS. Methods: These male patients met Rome 2 criteria for IBS. Laboratory, microbiology and colonoscopy results were normal. Case 1: PM, a 25 y/o banker, had IBS symptoms of pain, urgency and diarrhea for 5 years. Lifestyle changes and medical therapy had mild impact. PM was frustrated by severe interference with his life. PM was treated with alosetron 1 mg po bd for 1 month and decreased to .5 mg qd as symptoms resolved. “I wish I had more”.
Abstracts
AJG – Vol. 97, No. 9, Suppl., 2002
Type of DM, % cases
Mean age
Sex % M/F
Mean HgA1c
Years DM
UGI Score
LGI score
Type 1 30% Type 2 70%
42 58
46/53 46/54
8.5 7.6
17.7 10.8
6.8 5.4
2.2 2.6
Subjects had the following UGI symptoms at least 1 week/month. N⫽251: Heartburn 39%
Bloating
Appetite2
Early fullness
Stomach pain
Nausea. Vom
29
28
28
24
22
Mean UGI symptom scores ranged from 0 –36 with a mean of 5.8 and LGI scores from 0 to 16 with a mean of 2.5. The most common LGI symptoms included diarrhea (34%), constipation (29%), and abdominal cramping (26%). Nine percent of patients reported occurrence of fecal incontinence at least one week per month. Symptom scores were higher in females (p⬍0.001) and were weakly correlated with BMI, glycosylated hemoglobin and increasing age. No correlation was seen between symptom scores and duration of diabetes or type of diabetes. The only symptom that differed between type 1 and type 2 DM was a slightly higher prevalence of loss of appetite in type 1 subjects (p⫽.01). Conclusions: In our population of patients attending a diabetes clinic: a) several GI symptoms were frequently reported and b) symptoms were associated with female gender, increased HgA1C, obesity and advancing age. Because those GI symptoms can decrease quality of life and could be effectively treated, eliciting GI symptoms should be a routine part of the history when evaluating patients with diabetes. 846 EVALUATION OF THE NATURAL HISTORY AND ROLE OF PSYCHOLOGICAL FACTORS IN POST–ENTERITIS IRRITABLE BOWEL SYNDROME Andrew D. Spears, M.D., Ashok Tuteja, M.D., Susie Frederick, R.N. and Joel S. Levine, M.D.*. Gastroenterology, University of Colorado, Denver, CO; Gastroenterology, University of Colorado, Denver, CO; Gastroenterology, University of Colorado, Denver, CO and Gastroenterology, University of Colorado, Denver, CO. Purpose: To study the natural history of post– enteritis irritable bowel syndrome (IBS) and to evaluate the role of psychological factors in its cause. Methods: We prospectively evaluated patients 18 –75 years with acute infectious enteritis for the development of post– enteritis irritable bowel syndrome (IBS) per modified Rome criteria. Patients with culture positive enteritis reported to the Department of Public Health in the Denver Metro area between June 2001 and June 2002 were eligible to participate in the study. Those patients who expressed interest were administered a standardized IBS questionnaire to assess their baseline symptoms for the 3 months prior to developing enteritis. Those (⫹) for IBS pre–infection were excluded from the study. Those (–) for IBS pre–infection were administered the Patient Health Questionnaire (PHQ) for psychological evaluation. 3 months post–infection all enrolled patients were administered the same standardized IBS questionnaire to determine if they developed IBS. Results: 22 patients expressed interest in the study. 11 of 22 patients were (–) for IBS pre–infection and were enrolled. 11 patients were excluded for the following reasons: age, inability to make telephone contact, or presence of IBS pre–infection. 9 of the 11 patients enrolled did not have evidence of IBS 3 months post–infection. The 2 patients (18%) with IBS symptoms post–infection were also (⫹) for depression on PHQ evaluation. Of the 9 patients who did not develop post– enteritis IBS, none were (⫹) for depression on PHQ evaluation. Conclusions: Our preliminary, small study shows that post– enteritis IBS is seen in 18% (2/11) of patients. This subset of IBS is associated with depression by PHQ evaluation. The results of this study suggest the need for larger sample sizes and longer duration of follow– up to determine the true importance of post– enteritis IBS.
847 CHANGES IN SYMPTOMS, DISTENTION–STIMULATED COLONIC MOTALITY AND IN FECAL MICROBIOLOGICAL FEATURES AFTER ORAL BACTERIOTHERAPY IN PATIENTS WITH DIARRHEA–PREDOMINAT IBS (D–IBS) OR WITH FUNCTIONAL DIARRHEA (FD) Gabriele Bazzocchi, M.D., Pier F. Almerigi, M.D., Paolo Gionchetti, M.D. and Massimo Campieri, M.D.*. Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy. Purpose: Evidences supporting changes in intestinal microflora as basis for altered gut function in IBS are strongly emerging. Our aim was to evaluate the effect of a preparation containing 300 billions per gram of 8 viable different probiotic bacterial strains (VSL#3, Gatisbourg – USA) on clinical picture and mechanical distention–induced colonic motility in adults with well documented functional origin of diarrhea Methods: Fourty nine pts with D–IBS and 19 with FD according to Rome II° Diagnostic Criteria were evaluated: number and type of stools according to Bristol Stool Form Scale, abdominal pain, bloating/distention and urgency sensations on a 0 –10 non– graduated Visual Analogic Scale (VAS) were measured on a weekly basis. In 15 pts, Motility Index (MI), High Amplitude Propagating Contractions (HAPC) and Painful Threshold (PT) were manometrically measured in the left colon after distentions of the splenic flessure wall by a latex ballon inflations. In 10 of these pts, fecal samples for microbiological analysis and PCR detection of the VSL#3 strains B.infantis and B.breve were taken. Clinical, manometric and microbiological assessment were carried out before and after 20 days of treatment with VSL#3, 3 g/daily. Results: A decrease in evacuation frequency and in VAS score for symptoms occurred in both the groups after treatment. Watery and mushy stool decreased from 91% and 92% to 34% and 42% of weekly defecations in D–IBS and FD respectively (p⬍.001, Wilcoxon signed–rank test). Before treatment colonic distention induced an increase in MI and in HAPC frequency, while no significat changes occurred after VSL#3, as well as an increased balloon air volume eliciting PT. –D– galactosidase activity and concentrations of lactobacilli and bifidobacteria increased significantly after treatment in fecal samples: PCR signals showed that this increase was related to VSL#3 bifidobacteria specific strains presence Conclusions: This was an open, non– controlled trial, but it is the first observation showing clinical improvement related to changes in the composition of fecal bacterial flora, in fecal biochemistry and in colonic motility induced by probiotic administration in pts with well defined functional diarrhea. 848 ALOSETRON IS SAFE AND EFFECTIVE FOR THE LONG TERM TREATMENT OF MEN WITH DIARRHEA– PREDOMINANT IRRITABLE BOWEL SYNDROME (D–IBS) Christine L. Frissora, M.D. and Lucinda A. Harris, M.D.,FACG*. Division of Gastroenterology and Hepatology, The Weill Meical College of Cornell University, New York, NY. Purpose: IBS is a common disease that affects 1 in 5 Americans. IBS impacts negatively on the quality of life (1). Alosetron (LOTRONEX™) is a 5HT3 receptor antagonist that is safe and effective for the treatment of women with D–IBS (2). Clinical trials did not demonstrate statistical significance in men (3). Pharmacotherapy is an essential component of IBS treatment. We report the safety and efficacy of long term alosetron treatment for men with D–IBS. Methods: These male patients met Rome 2 criteria for IBS. Laboratory, microbiology and colonoscopy results were normal. Case 1: PM, a 25 y/o banker, had IBS symptoms of pain, urgency and diarrhea for 5 years. Lifestyle changes and medical therapy had mild impact. PM was frustrated by severe interference with his life. PM was treated with alosetron 1 mg po bd for 1 month and decreased to .5 mg qd as symptoms resolved. “I wish I had more”.