Similarities in Clinical and Psychosocial Characteristics of Functional Diarrhea and Irritable Bowel Syndrome With Diarrhea

Singh, Prashant; Lee, Ha‐Neul; Rangan, V. Kasturi; Ballou, Sarah; Lembo, Joseph; Katon, Jesse; McMahon, Courtney; Friedlander, Daniel; Iturrino, Johanna; Nee, Judy; Lembo, Anthony

doi:10.1016/j.cgh.2019.08.020

Cited by 26 publications

(27 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition to the lack of differences in the clinical symptoms, these 2 groups of patients manifested similar scores of anxiety, depression, sleep disturbance, and somatization, leading the investigators to conclude that the 2 entities are in a continuum. 9 In summary, the accumulated evidence in the literature points to the redundancy that has followed the splitting of the main bowel function-related disorders, and argues in favor of a clinicophysiological appraisal, particularly for patients presenting with chronic functional constipation or diarrhea in the absence of alarm symptoms. By the same token, it is relevant to note that there is no current fda-approved drug for chronic functional abdominal pain, and in the future, it is essential to use criteria such as those in Rome III to identify patients with functional abdominal pain, to develop robust patient response outcome endpoints and, thereby, appraise the efficacy of candidate visceral analgesics such as those reviewed elsewhere.…”

Section: Overl Ap and Tr An S Iti On Of Symp Toms And Symp Tom Compmentioning

confidence: 99%

Irritable Bowel Syndrome: Straightening the road from the Rome criteria

Camilleri

2020

Neurogastroenterology Motil

View full text Add to dashboard Cite

The concept of positive diagnosis of irritable bowel syndrome (IBS) based on symptoms kicked off with studies from the University of Bristol; Manning et al identified 4 symptoms that were clearly more common in patients with IBS: abdominal distension as evidenced by tight clothing or visible appearance; pain relief with bowel action; more frequent stools with the onset of pain; and looser stools with the onset of pain. 1 Justification for the development of symptom-based criteria for irritable bowel syndrome is based on the perspectives of several stakeholders: From the patient perspective, effective diagnostic criteria would be expected to improve outcomes by enabling clinicians to diagnose and choose treatments that are likely to be effective. For researchers, accepted criteria would be expected to stratify patient cohorts for research studies. For industry involved in the development of novel approaches to treatment, the availability of effective, evidence-based criteria enables the development of such treatments and convinces regulators and payers that functional gastrointestinal disorders and, specifically, irritable bowel syndrome are real disorders that are amenable to efficacious treatments. A sequence of consensus-based Rome criteria for IBS has been published since 1989 2-5 (Table 1). The fundamental definition based on abdominal pain in association with bowel dysfunction has been consistent. However, 2 major changes occurred in the Rome II and IV criteria. The former change involved "splitting off" of symptoms that were not consistently associated with pain, such as functional, constipation, diarrhea, and bloating. In Rome IV, the main changes have been the exclusion of discomfort (in

show abstract

Section: Overl Ap and Tr An S Iti On Of Symp Toms And Symp Tom Compmentioning

confidence: 99%

Irritable Bowel Syndrome: Straightening the road from the Rome criteria

Camilleri

2020

Neurogastroenterology Motil

View full text Add to dashboard Cite

show abstract

“…Most of these patients reported the presence of pain but did not meet the frequency threshold of having abdominal pain at least 1 day per week. The study by Singh et al 15 is also supportive of this by demonstrating the many shared characteristics between functional diarrhea and IBS-D. Although health care providers consider therapeutic interventions that are based on their proven efficacy for a specific disorder, treatment selection is typically based on the predominant or most bothersome symptoms and/or the associated presumed underlying contributing pathophysiology, whether it is an exaggerated gastrocolic reflex or visceral hypersensitivity, rather than on their specific Rome diagnosis.…”

mentioning

confidence: 90%

“…Whitehead et al 13 and Black et al 14 respectively studied epidemiologic changes for fecal incontinence and IBS when Rome III criteria were compared with Rome IV criteria. Singh et al 15 compared the clinical and psychosocial characteristics between patients with functional diarrhea and those with IBS-D by using Rome IV criteria.…”

mentioning

confidence: 99%

“…Patients who met Rome IV criteria had more severe symptoms, which were more likely to interfere with activities of daily living, consistent with findings from prior studies. [7][8][9] Singh et al 15 surveyed 48 consecutive patients with functional diarrhea and 49 consecutive patients with IBS-D in the outpatient Center for Functional Bowel Disorders and GI Motility at Beth Israel Deaconess Medical Center, both groups meeting Rome IV criteria, and found no significant group differences in the proportion of patients reporting abdominal bloating, diarrhea, and various psychosomatic characteristics. As expected, there was a significantly lower proportion of patients with functional diarrhea who reported abdominal pain.…”

mentioning

confidence: 99%

“…The studies conducted by Whitehead et al 13 and Singh et al 15 both provided new information on the epidemiologic and clinical characteristics of these DGBI using Rome IV criteria. The study by Black et al 14 was the largest study yet to explore the impact of changing from Rome III to Rome IV for the diagnosis of IBS, and the results were largely consistent with those reported for a Western patient population.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Benefits and Pitfalls of Change From Rome III to Rome IV Criteria for Irritable Bowel Syndrome and Fecal Incontinence

Lin

Chang

2020

Clinical Gastroenterology and Hepatology

View full text Add to dashboard Cite

Diagnosis and Treatment of Irritable Bowel Syndrome

Camilleri

2021

JAMA

207

135

View full text Add to dashboard Cite

ImportanceThe prevalence of irritable bowel syndrome (IBS) in the United States is between 7% and 16%, most common in women and young people, with annual direct costs estimated at more than $1 billion dollars in the United States. Traditionally, the diagnosis of IBS has been based on the positive identification of symptoms that correlate with several different syndromes associated with disorders such as IBS diarrhea, IBS constipation, functional diarrhea, functional constipation, chronic functional abdominal pain, or bloating. Several peripheral and central mechanisms initiate gastrointestinal motor and sensory dysfunctions leading to IBS symptoms. Those dysfunctions may require evaluation in patients whose symptoms do not respond to first-line treatments.ObservationsValidation studies of consensus symptom-based criteria have identified deficiencies that favor a simpler identification of the predominant symptoms of abdominal pain, bowel dysfunction, and bloating and exclusion of alarm symptoms such as unintentional weight loss, rectal bleeding, or recent change in bowel function. Symptom-based diagnosis of IBS is enhanced with additional history for symptoms of somatoform and psychological disorders and alarm symptoms, physical examination including digital rectal examination, and screening tests to exclude organic disease (by measuring hemoglobin and C-reactive protein concentrations). The initial treatment plan should include patient education, reassurance, and first-line treatments such as fiber and osmotic laxatives for constipation, opioids for diarrhea, antispasmodics for pain and for management of associated psychological disorders. For patients who do not respond to those IBS treatments, testing for specific functional disorders may be required in a minority of patients with IBS. These disorders include rectal evacuation disorder, abnormal colonic transit, and bile acid diarrhea. Their identification is followed by individualized treatment, such as pelvic floor retraining for rectal evacuation disorders, sequestrants for bile acid diarrhea, and secretory agents for constipation, although there is only limited evidence that this individualized management approach is effective.Conclusions and RelevanceAdvances in the identification of specific dysfunctions as causes of individual symptoms in the “IBS spectrum” leads to the potential to enhance the diagnosis and management of symptoms for the majority of patients for whom first-line therapies of IBS and management of comorbid psychological disorders are insufficient.

show abstract

Similarities in Clinical and Psychosocial Characteristics of Functional Diarrhea and Irritable Bowel Syndrome With Diarrhea

Cited by 26 publications

References 27 publications

Irritable Bowel Syndrome: Straightening the road from the Rome criteria

Irritable Bowel Syndrome: Straightening the road from the Rome criteria

Benefits and Pitfalls of Change From Rome III to Rome IV Criteria for Irritable Bowel Syndrome and Fecal Incontinence

Diagnosis and Treatment of Irritable Bowel Syndrome

Contact Info

Product

Resources

About