Irritable bowel syndrome: diagnosis and management

Masuy, Imke; Pannemans, Jasper

doi:10.23736/s1121-421x.19.02640-0

Cited by 31 publications

(25 citation statements)

References 114 publications

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“…277 There is a danger that, in this vacuum, 'alternative' therapies with the least evidence for their efficacy and safety are recommended by physicians or other practitioners, or are sought out by patients. 278 Patients with IBS with severe symptoms are more willing to accept significant medication risks, for example, a mean 1% chance of sudden death in return for a 99% chance of cure of their symptoms with a hypothetical medication. 279 Furthermore, patients are at increased risk of iatrogenic harms, through unnecessary surgery, including hysterectomy, appendicectomy and cholecystectomy, 121 and inappropriate prescribing of opioids.…”

Section: Guidelinesmentioning

confidence: 99%

British Society of Gastroenterology guidelines on the management of irritable bowel syndrome

Vasant

Paine

Black

et al. 2021

Gut

291

334

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Irritable bowel syndrome (IBS) remains one of the most common gastrointestinal disorders seen by clinicians in both primary and secondary care. Since publication of the last British Society of Gastroenterology (BSG) guideline in 2007, substantial advances have been made in understanding its complex pathophysiology, resulting in its re-classification as a disorder of gut-brain interaction, rather than a functional gastrointestinal disorder. Moreover, there has been a considerable amount of new evidence published concerning the diagnosis, investigation and management of IBS. The primary aim of this guideline, commissioned by the BSG, is to review and summarise the current evidence to inform and guide clinical practice, by providing a practical framework for evidence-based management of patients. One of the strengths of this guideline is that the recommendations for treatment are based on evidence derived from a comprehensive search of the medical literature, which was used to inform an update of a series of trial-based and network meta-analyses assessing the efficacy of dietary, pharmacological and psychological therapies in treating IBS. Specific recommendations have been made according to the Grading of Recommendations Assessment, Development and Evaluation system, summarising both the strength of the recommendations and the overall quality of evidence. Finally, this guideline identifies novel treatments that are in development, as well as highlighting areas of unmet need for future research.

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Section: Guidelinesmentioning

confidence: 99%

British Society of Gastroenterology guidelines on the management of irritable bowel syndrome

Vasant

Paine

Black

et al. 2021

Gut

291

334

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“…To determine whether HT-29 cells could uptake IBS-exos, we stained exosomes with PKH67 (Sigma, USA) according to standard protocols as previously reported (2). We then cocultured these labeled exosomes with HT-29 cells.…”

Section: Exosome Uptake Assaymentioning

confidence: 99%

“…Irritable bowel syndrome (IBS) is a multifactorial functional bowel disorder characterized by abdominal pain, diarrhea, and deregulated bowel habits, affecting the quality of life of 9-23% of the general population [1,2]. Intestinal barrier is a physical barrier against luminal inflammatory molecules, and intestinal hyperpermeability results in immune activation and chronic low-grade mucosal inflammation [3,4].…”

Section: Introductionmentioning

confidence: 99%

Serum Exosomes Derived from Irritable Bowel Syndrome Patient Increase Cell Permeability via Regulating miR-148b-5p/RGS2 Signaling in Human Colonic Epithelium Cells

Xing

Xue

et al. 2021

Gastroenterology Research and Practice

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Aim. Irritable bowel syndrome (IBS) is a multifactorial functional bowel disorder characterized by disruption of the intestinal barrier. Circulating exosomal microRNAs (miRNAs) are involved in regulating epithelial barrier function, and upregulation of miR-148b-5p has been detected in IBS. However, whether exosomal miR-148-5p is involved in the IBS pathogenesis remains unclear. This study was aimed at investigating the relationship of exosomal miR-148-5p with colonic epithelial permeability. Methods. Exosomes were isolated from the serum of IBS patients and healthy controls. HT-29 cells were cultured with the IBS-derived serum exosomes (IBS-exo). Exosome uptake assay was used to evaluate whether the IBS-exo could be absorbed by HT-29 cells. FITC-Dextran flux and transepithelial/endothelial electrical resistance were measured to evaluate epithelial permeability. A luciferase reporter assay was used to determine whether the regulator of G protein signaling- (RGS-) 2 is a target gene of miR-148b-5p. Results. miR-148b-5p was obviously elevated in the IBS-exo compared to the control-exo. Upregulation of miR-148b-5p was observed in the HT-29 cells cultured with IBS-exo. Exposure to IBS-exo increased cell permeability and decreased RGS2 expression. The IBS-exo-induced alterations were obviously reversed by interfering with the miR-148b-5p expression. Mimicking the IBS-exo treatment, miR-148b-5p overexpression increased cell permeability and downregulated RGS2 expression, which were abrogated by overexpressing RGS2. The luciferase reporter assay revealed that RGS2 was a direct target of miR-148b-5p. Conclusions. Serum-derived exosomes from IBS patients increase colonic epithelial permeability via miR-148b-5p/RGS2 signaling.

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“…32 The currently available pharmacological treatments still have some limitations, resulting in many patients with refractory IBS seeking help through complementary medicine. 33 However, when considering refractory IBS treatment, the symptoms should be highly addressed to maintain optimal results and enhance the QOL of individuals. Patients with IBS, especially refractory IBS, have more severe psychosomatic disorders.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of acupuncture in refractory irritable bowel syndrome: study protocol for a randomised controlled trial

et al. 2021

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IntroductionIrritable bowel syndrome (IBS) is a common chronic functional gastrointestinal disorder that presents with abdominal pain/discomfort and altered bowel patterns. IBS has multiple potential causes for which conventional medicines have had limited success, resulting in a significant number of patients who do not sensitively respond to pharmacotherapy for a period of 12 months and who develop a continuing symptom profile (described as refractory IBS) and seek help through (non)pharmacological treatments. The aim of this study is to investigate the efficacy and safety of acupuncture therapy for refractory IBS on the basis of conventional treatments.Methods and analysisA total of 170 eligible patients who meet the Rome IV criteria for refractory IBS will be randomly allocated to receive acupuncture or sham acupuncture. Each patient will receive 12 sessions of acupuncture over 4 weeks and a 4-week follow-up. The primary outcome will be the IBS Symptom Severity Score. Secondary outcomes will include the proportion of participants experiencing adequate relief of global IBS symptoms, the weekly frequency of defecation, the stool properties assessed by the Bristol Grading Scale, the Work and Social Adjustment Scale, the IBS-Quality of Life score, and the Self-Rating Depression Scale and Self-Rating Anxiety Scale anxiety and depression scores. Outcome measures will be collected at baseline, 2 and 4 weeks of the intervention, and 6 and 8 weeks after the intervention. Categorical variables will be compared with Fisher’s exact test or the Wilcoxon rank-sum test, and continuous variables will be compared using Student’s t-test or the Wilcoxon rank-sum test.Ethics and disseminationThe entire project has been approved by the ethics committees of Beijing University of Chinese Medicine (2020BZYLL0507) and Sichuan Province Regional Institution for Conducting Research on Traditional Chinese Medicine (2020KL-025). The outcomes of the trial will be disseminated through peer-reviewed publications.Trial registration numberNCT04276961.

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Irritable bowel syndrome: diagnosis and management

Cited by 31 publications

References 114 publications

British Society of Gastroenterology guidelines on the management of irritable bowel syndrome

British Society of Gastroenterology guidelines on the management of irritable bowel syndrome

Serum Exosomes Derived from Irritable Bowel Syndrome Patient Increase Cell Permeability via Regulating miR-148b-5p/RGS2 Signaling in Human Colonic Epithelium Cells

Efficacy of acupuncture in refractory irritable bowel syndrome: study protocol for a randomised controlled trial

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