IBS in 2010: advances in pathophysiology, diagnosis and treatment.

IBS is a chronic, fluctuating disorder that continues to be the subject of considerable research. 2010 saw some key advances across all aspects of IBS, including further advances in our understanding of the pathophysiology, diagnosis and treatment of this condition.

Small bowel homing T cells are associated with symptoms and delayed gastric emptying in functional dyspepsia.

Objectives: Immune activation may have an important pathogenic role in the irritable bowel syndrome (IBS). While little is known about immunologic function in functional dyspepsia (FD), we have observed an association between cytokine secretion by peripheral blood mononuclear cells (PBMCs) and symptoms in IBS. Upper gastrointestinal inflammatory diseases are characterized by enhanced small bowel homing α4-, β7-integrin, chemokine receptor 9 (CCR9) positive T lymphocytes.

Neural autoantibody evaluation in functional gastrointestinal disorders: a population-based case-control study.

Background: Our goal is to investigate the serum profile of neural autoantibodies in community-based patients with irritable bowel syndrome (IBS) or functional dyspepsia. The pathogenesis of functional gastrointestinal (GI) disorders, including IBS and dyspepsia, are unknown. Theories range from purely psychological to autoimmune alterations in GI tract neuromuscular function.

An update on irritable bowel syndrome: from diagnosis to emerging therapies.

Purpose Of Review: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder characterized by abdominal discomfort or pain that is accompanied by a disturbance in defecation. Although the exact etiopathogenesis is not completely understood, recent advances in the understanding of the biochemical, physiologic, and biopsychosocial mechanisms of IBS have resulted in exciting new insights as well as therapies. This article will review the recent developments in pathogenesis, diagnosis, and treatment.

Occurrence of and risk factors for complications after endoscopic dilation in eosinophilic esophagitis.

Background: Several small series have suggested an increased risk of complications associated with esophageal dilation in patients with eosinophilic esophagitis (EoE).

Objective: To quantitate the risk and identify risk factors for esophageal complications in dilation in EoE patients.

Design: Retrospective, uncontrolled, single-center study.

Prospective diary evaluation of unexplained abdominal pain and bowel dysfunction: a population-based colonoscopy study.

Introduction: Diagnostic criteria for irritable bowel syndrome (IBS) have not been validated by prospective symptom diary. We investigated the bowel patterns in community subjects with and without non-organic abdominal pain, and compared the symptoms with subjects fulfilling the Rome II criteria (IBS).

Methods: From the Swedish population register, a random sample completed an abdominal symptom questionnaire.

Variation in prevalence, diagnostic criteria, and initial management options for eosinophilic gastrointestinal diseases in the United States.

Objectives: Variation in the prevalence of eosinophilic gastrointestinal diseases in different geographical regions has not been extensively studied. The aim of the present study was to define the regional and national prevalence of eosinophilic gastrointestinal diseases, and differences in practice approaches.

Patients And Methods: We administered a survey electronically to members of the American College of Gastroenterology, the American Academy of Allergy, Asthma, and Immunology, and the North American Society Pediatric Gastroenterology, Hepatology, and Nutrition.

Direct medical costs of constipation from childhood to early adulthood: a population-based birth cohort study.

Background: Although direct medical costs for constipation-related medical visits are thought to be high, to date there have been no studies examining whether longitudinal resource use is persistently elevated in children with constipation. Our aim was to estimate the incremental direct medical costs and types of health care use associated with constipation from childhood to early adulthood.

Methods: A nested case-control study was conducted to evaluate the incremental costs associated with constipation.

5-aminosalicylates prevent relapse of Crohn's disease after surgically induced remission: systematic review and meta-analysis.

Objectives: Evidence from randomized controlled trials (RCTs) for the use of 5-aminosalicylic acid (5-ASA) drugs in Crohn's disease (CD) in remission after a surgical resection is conflicting. We conducted a systematic review and meta-analysis of RCTs to examine this issue.

Methods: MEDLINE, EMBASE, and the Cochrane central register of controlled trials were searched (through April 2010).

Use of tobacco products and gastrointestinal morbidity: an endoscopic population-based study (the Kalixanda study).

The impact of snus (smokeless tobacco or snuff) on gastrointestinal symptoms and pathological findings is largely unknown. The authors aimed to investigate whether the exposure to different forms of tobacco influences upper gastrointestinal symptoms, histology and frequency of Helicobacter pylori infection. A random sample (n = 2,860) of the adult population of two northern Swedish municipalities Kalix and Haparanda (n = 21,610) was surveyed between December 1998 and June 2001 using a validated postal questionnaire assessing gastrointestinal symptoms (response rate 74.

Association between clinical manifestations of complicated and uncomplicated peptic ulcer and visceral sensory dysfunction.

Background And Aims: Peptic ulcer disease (PUD) usually manifests as either dyspepsia or less commonly with complications such as bleeding. Patients with bleeding ulcers are often asymptomatic until the bleeding occurs. A lack of dyspeptic symptoms might be explained by impaired visceral sensory function.

Current and emerging therapies in irritable bowel syndrome: from pathophysiology to treatment.

Irritable bowel syndrome is a common functional gastrointestinal disorder with characteristic symptoms of abdominal pain/discomfort with a concurrent disturbance in defecation. It accounts for a significant healthcare burden, and symptoms may be debilitating for some patients. Traditional symptom-based therapies have been found to be ineffective in the treatment of the entire syndrome complex, and do not modify the natural history of the disorder.

Gastroesophageal reflux disease and sleep disorders: evidence for a causal link and therapeutic implications.

Gastroesophageal reflux disease (GERD) and sleep disturbances are both common health problems. There is a significant association between disturbed sleep and GERD, and this may be bidirectional. Sleep disorders may induce gastrointestinal (GI) disturbances, while GI symptoms also may provoke or worsen sleep derangements.

Shortening a survey and using alternative forms of prenotification: impact on response rate and quality.

Background: Evidence suggests that survey response rates are decreasing and that the level of survey response can be influenced by questionnaire length and the use of pre-notification. The goal of the present investigation was determine the effect of questionnaire length and pre-notification type (letter vs. postcard) on measures of survey quality, including response rates, response times (days to return the survey), and item nonresponse.

A shift in the clinical spectrum of eosinophilic gastroenteritis toward the mucosal disease type.

Background & Aims: Eosinophilic gastroenteritis (EG) is a rare disorder characterized by eosinophilic infiltration of the gastrointestinal (GI) tract. Despite the increasing prevalence of eosinophilic GI disorders, the epidemiology of EG has not been well studied. We evaluated the clinical spectrum of EG.

Detection of celiac disease and lymphocytic enteropathy by parallel serology and histopathology in a population-based study.

Background & Aims: Although serologic analysis is used in diagnosis of celiac disease, histopathology is considered most reliable. We performed a prospective study to determine the clinical, pathologic, and serologic spectrum of celiac disease in a general population (Kalixanda study).

Methods: A random sample of an adult general population (n = 1000) was analyzed by upper endoscopy, duodenal biopsy, and serologic analysis of tissue transglutaminase (tTg) levels; endomysial antibody (EMA) levels were analyzed in samples that were tTg+.

Irritable bowel syndrome and chronic pelvic pain: a population-based study.

Background: Women with irritable bowel syndrome (IBS) frequently report chronic pelvic pain, however, it is still unanswered whether these are truly separate entities. IBS negatively impacts on quality of life, but the impact of IBS on sexual function is not clear.

Goals: We aimed to (1) describe the impact of IBS on sexual function, and (2) evaluate the association between pelvic pain and IBS, and in particular identify if there are unique characteristics of the overlap group.

Functional dyspepsia impacts absenteeism and direct and indirect costs.

Background & Aims: Functional dyspepsia (FD) is a common morbid condition but data are limited on the direct and indirect costs for employees with FD or on its impact on productivity. Few data on absenteeism and no objective information are available. This study aimed to assess the impact of FD on costs and effects on absenteeism and work output (productivity).

Familial aggregation of irritable bowel syndrome: a family case-control study.

Objectives: Irritable bowel syndrome (IBS) clusters in families, but previous studies documented family history only from patients. We have shown that patient-relative agreement on IBS status is poor. Thus, we conducted a family case-control study with direct survey of symptoms from family members to better quantitate the aggregation of IBS in families.

Assessment of normal bowel habits in the general adult population: the Popcol study.

Objective: Defining normal stool habit is important when evaluating diarrhoea or constipation, but common confounders such as irritable bowel syndrome (IBS) or the intake of medications with gastrointestinal side effects have not been considered in earlier population based studies defining what is normal. We hypothesized that the exclusion of subjects with common confounders would help to better understand what are "normal bowel habits". We aimed to prospectively study bowel habits in a carefully studied random sample of the general population.