Bloating and Distension in Irritable Bowel Syndrome: The Role of Gastrointestinal Transit

Agrawal, Anurag K.; Houghton, Lesley A.; Reilly, Brian; Morris, Julie; Whorwell, Peter J.

doi:10.1038/ajg.2009.251

Cited by 87 publications

(63 citation statements)

References 29 publications

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“…The urgent need to defecate and fecal incontinence probably play a major role in the impairment of HRQOL; this improves when the number and consistency of stools is corrected. Bloating is also a symptom that hinders daily life, and many studies have reported a correlation between the production of gas and excessive fermentation that induces slow transit [9]. However, our observational investigation seems to show rather high scores with a mean of 4.5 on a scale of 10.…”

Section: Discussioncontrasting

confidence: 46%

The Effect of Inactivated <i>Lactobacillus</i> LB Fermented Culture Medium on Symptom Severity: Observational Investigation in 297 Patients with Diarrhea-Predominant Irritable Bowel Syndrome

Tarrerias

Costil

Vicari

et al. 2011

Dig Dis

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Introduction: Little is known about the intensity of symptoms of diarrhea-predominant IBS (IBS-D) or the consequences of the disease on patients’ health-related quality of life (HRQOL). This observational investigation assessed the symptoms (abdominal pain, bloating, number of stools per day, and stool consistency), impact on HRQOL, and consequence on anal continence in 297 patients with IBS-D before and after 1 month of probiotic treatment with Lacteol (inactivated Lactobacillus LB plus fermented culture medium). Methods: Functional assessment using a standardized visual analogue scale in order to quantify abdominal pain, bloating, and quality of life before and after 1 month of treatment with 2 capsules/day of Lacteol. The number of symptomatic days per week, number of stools, consistency of stools, secondary fecal incontinence rate, and potential trigger effect of food were quantified. A χ² test was used to compare qualitative data and the variance of quantitative criteria was analyzed. Results: The pain score decreased from 4.46 ± 0.15 on a scale of 0–10 before treatment to 2.8 ± 0.14 after treatment (p < 0.0001). Bloating decreased from 4.49 ± 0.18 to 2.5 ± 0.15 on a scale of 0–10 (p < 0.0001). The HRQOL score, which is inversely correlated with quality of life, decreased from 5.99 ± 0.14 to 3.92 ± 0.16 (p < 0.0001). In this cohort study, the fecal incontinence rate secondary to diarrhea was clearly higher than that of the general population: 18% versus a prevalence of 9–10%, according to different studies. The mean number of stools per week decreased from 17.59 to 12.83 after treatment (p < 0.0001). Before treatment, 54% of patients had watery stools and 46% had smooth stools; at the end of treatment, only 18.5% of patients still had watery stools, and 34% had normal stools. 52% of patients attributed their symptoms to their diet: 34% to vegetables, 29% to fruit, 15% to milk, 15% to fat, 6% to peppers and spices, and 4% to sugar. Conclusion: This observational investigation shed new light on patients with IBS-D, the HRQOL of which is altered by a fecal incontinence rate twice as high as that of the general population. Correlation with diet is confirmed by 1 out of 2 patients reporting poor tolerance of fiber and dairy products. Nutritional management should thus be part of these patients’ treatment. Inactivated Lactobacillus LB plus fermented culture medium is a probiotic drug that has been used by physicians for a long time to treat patients with diarrhea. Strongly concentrated, it has no side effects and seems to help these patients. Due to a strong placebo effect in patients with this pathology, however, a controlled study is necessary to confirm this result.

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Section: Discussioncontrasting

confidence: 46%

The Effect of Inactivated <i>Lactobacillus</i> LB Fermented Culture Medium on Symptom Severity: Observational Investigation in 297 Patients with Diarrhea-Predominant Irritable Bowel Syndrome

Tarrerias

Costil

Vicari

et al. 2011

Dig Dis

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“…After evaluating for alarm conditions and failure of empiric therapy, motility testing is often rec ommended, which has traditionally been focused on the specific region of the GI tract consistent with the chief complaint [Abell et al 2008;Rao, 2009;Sarosiek et al 2010]. However, studies show a significant overlap between functional motility disorders of the upper and lower GI tract, for example, patients with slow transit constipa tion were found to have delayed gastric emptying and abnormal functioning of the esophageal body and sphincters [Hasler, 2007;Agrawal et al 2009]. A comprehensive assessment of upper and lower GI motility can provide critical objective data to aid in diagnosis and the planning of opti mal therapeutic and feeding strategies.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of regional and whole gut motility using the wireless motility capsule: relevance in clinical practice

Tran

Brun

Kuo

2012

Therap Adv Gastroenterol

101

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Abstract:The wireless motility capsule (WMC) is an ambulatory noninvasive and nonradioactive diagnostic sensor that continuously samples intraluminal pH, temperature, and pressure as it moves through the gastrointestinal (GI) tract. This review summarizes the data obtained in clinical trials with the WMC and discusses its role in clinical practice. The United States Food and Drug Administration has approved the SmartPill GI monitoring system for the evaluation of gastric emptying time in patients with suspected gastroparesis, the evaluation of colonic transit time in patients with suspected chronic constipation, and for the characterization of pressure profiles from the antrum and duodenum. Clinical studies have shown that WMC-measured GI transit times can distinguish patients with motility abnormalities similarly to conventional testing. However, the WMC offers the advantage of providing a full GI-tract profile, enabling the detection of multiregional GI transit abnormalities in patients with suspected upper or lower GI dysmotility. The WMC also characterizes pressure profiles of the GI tract and impaired pressure profile limits are reported for the antrum and duodenum. In comparison with manometry, interpretations of pressure measurements obtained by the WMC are limited by an inability to detect a peristaltic pressure wave front, and further investigation is required to develop clinical applications. Clinical studies with the WMC indicated that it should be considered for the evaluation of regional and whole gut transit time in patients with suspected upper or lower dysmotility, particularly if there are concerns about multiregional dysmotility.

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“…Les impériosités et l'incontinence anale participent certainement à l'altération de la qualité de vie qui s'améliore lorsque l'on corrige le nombre de selles et leur consistance. Les ballonnements font aussi partie des symptômes qui gênent la vie courante ; beaucoup d'études relient la production de gaz à l'excès de fermentation et donc à un transit lent [9] or notre observatoire semble au contraire montrer des scores assez élevés, en moyenne à 45 sur une échelle de 100. Cela ne signifie pas nécessairement une hyper fermentation mais peut-être une hypersensibilité digestive à la présence de ces gaz dans le colon puisqu'il est montré que les IBS diarrhéiques ont plus souvent, une hypersensibilité colique au barostat [10].…”

Section: Discussionunclassified

Effet de Lactobacillus LB inactivés et Milieu de Culture Fermenté sur la sévérité des symptômes : Observatoire sur 297 patients IBS diarrhéiques

Tarrerias¹,

Costil²,

Vicari³

et al. 2012

Hegel

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Bloating and Distension in Irritable Bowel Syndrome: The Role of Gastrointestinal Transit

Abstract: IBS-C patients with delayed transit show greater abdominal distension than do those with normal transit. Therefore, drugs that accelerate transit may be expected to alleviate this troublesome problem.

Cited by 87 publications

References 29 publications

The Effect of Inactivated <i>Lactobacillus</i> LB Fermented Culture Medium on Symptom Severity: Observational Investigation in 297 Patients with Diarrhea-Predominant Irritable Bowel Syndrome

The Effect of Inactivated <i>Lactobacillus</i> LB Fermented Culture Medium on Symptom Severity: Observational Investigation in 297 Patients with Diarrhea-Predominant Irritable Bowel Syndrome

Evaluation of regional and whole gut motility using the wireless motility capsule: relevance in clinical practice

Effet de Lactobacillus LB inactivés et Milieu de Culture Fermenté sur la sévérité des symptômes : Observatoire sur 297 patients IBS diarrhéiques

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