Stooling Characteristics in Children With Irritable Bowel Syndrome

Weidler, Erica M.; Self, Mariella M.; Czyzewski, Danita I.; Shulman, Robert J.; Chumpitazi, Bruno P.

doi:10.1016/j.cgh.2016.08.021

Cited by 8 publications

(16 citation statements)

References 8 publications

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“…As has been described previously, 31 the number of stools passed per day does not differ between children with IBS and healthy children, similar to our current study, but stools were looser in the IBS group (lower percentage of Bristol Stool Scale 3-5 and higher percentage of 6-7), likely given that approximately 17% of the IBS group was either of the diarrheal or mixed subtype. Similarly, as previously reported, the majority of children with IBS fall into the IBS-Constipation and IBS-Unsubtyped groups (Table 1).…”

Section: Discussionsupporting

confidence: 91%

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Evidence of increased fecal granins in children with irritable bowel syndrome and correlates with symptoms

Shulman

Öhman

Stridsberg

et al. 2018

Neurogastroenterology Motil

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Background Granins have been implicated in the pathophysiology of IBS in adults. We sought to determine if fecal granins are altered in children with IBS and associated with symptoms. Methods Children (7-12 years of age) with IBS and Healthy Controls (HC) kept daily pain and stool diaries for two weeks. Stool samples were analyzed for chromogranins A and B (CgA, CgB) and secretogranins II and III (SgII, SgIII). Children also completed psychological measures to assess anxiety, depression, somatization, and internalizing symptoms. Key Results Fecal CgB and SgIII concentrations were higher in all the boys (IBS plus HC, n=48) than in all the girls (IBS plus HC, n=75) (P=0.02 and P=0.046, respectively). CgA and SgIII were greater in children with IBS (n=52) versus HC (n=69) (P=0.01, P=0.017, respectively). CgB and SgII did not differ between groups. In children with IBS, the number of pain episodes per week and mean daily pain rating correlated positively with all four granins. The number of stools per day correlated positively with CgB and SgII and the percent diarrheal stools (6 or 7 on the Bristol Scale) correlated inversely with all four granins in boys but not in girls. Fecal granins did not correlate with psychological measures. Conclusions & Inferences As measured by fecal granins, there is evidence of neuroimmune activation in children with IBS. Granins are related to abdominal pain symptoms, stooling frequency, and stool form in children with IBS. Sex influences the fecal concentration of CgB and SgIII.

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Section: Discussionsupporting

confidence: 91%

“…27 Using stool form, participants confirmed as IBS then were subtyped as: IBS-C (constipation-predominant); IBS-D (diarrhea-predominant; IBS-M (mixed); or IBS-U (unsubtyped). 31 Stools described as Bristol Stool Form Scale 1 and 2 were deemed constipation, 3-5 normal, and 6-7 as diarrhea.…”

Section: Methodsmentioning

confidence: 99%

Evidence of increased fecal granins in children with irritable bowel syndrome and correlates with symptoms

Shulman

Öhman

Stridsberg

et al. 2018

Neurogastroenterology Motil

Self Cite

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“…The reason for low recruitment number (20 vs 27) may be due to that the study population included children with d-IBS who had on average >18 stools per week. Weidler et al 13 reported that the mean daily stool number in children with d-IBS was 1.01±0.44 compared to healthy children with 0.7±0.30 per day. This represents approximately 7±3 bowel movements per week, far below that of the population recruited for this study.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent study, only modest differences in stool form and frequency were found between children with IBS and healthy children, and childhood IBS subtypes could not be differentiated by stool frequency. 13 However, we enrolled only patients who had stool frequencies averaging 18.7±6.4 per week, a higher number than normal children, and greater than those reported for d-IBS, and hence chose stools frequency as the primary end point. 13 The nonsignificant reduction in stool frequency at the end of treatment in both groups could be related in part to the placebo response observed in FGID treatment trials, that has been attributed in part to the attention given to enrolled patients, including detailed explanation, reassurance, close monitoring, and ready access to the researchers, which may produce a therapeutic effect, a bias leading to an error in estimating the treatment effect.…”

Section: Discussionmentioning

confidence: 99%

“… 13 However, we enrolled only patients who had stool frequencies averaging 18.7±6.4 per week, a higher number than normal children, and greater than those reported for d-IBS, and hence chose stools frequency as the primary end point. 13 The nonsignificant reduction in stool frequency at the end of treatment in both groups could be related in part to the placebo response observed in FGID treatment trials, that has been attributed in part to the attention given to enrolled patients, including detailed explanation, reassurance, close monitoring, and ready access to the researchers, which may produce a therapeutic effect, a bias leading to an error in estimating the treatment effect. 14 In addition, there was slight difference in age and number of male and female participants in each group with the SBI group being slightly older (14.3±3.7 vs 12±3.3 years) and having a higher proportion of male patients (44% vs 33%) which could have biased the results.…”

Section: Discussionmentioning

confidence: 99%

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Serum-derived bovine immunoglobulin for children with diarrhea-predominant irritable bowel syndrome

Arrouk

Herdes

Karpinski

et al. 2018

PHMT

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BackgroundOral serum-derived bovine immunoglobulin (SBI)/protein isolate is a medical food intended to manage chronic diarrhea. It has been shown to improve pain and diarrhea in adults with diarrhea-predominant irritable bowel syndrome (d-IBS).AimTo determine if SBI can improve symptoms in children with d-IBS.MethodsWe performed a randomized, double-blind, placebo-controlled, pilot study (NCT02609529) to evaluate the effectiveness of SBI in children 8–18 years with d-IBS. We recorded stool number, abdominal pain, and stool form in all patients for 1 week and then assigned the patients at a ratio of 2:1 to treatment with SBI 5 g BID or placebo for 3 weeks. The patients and their parents completed the Pediatric Quality of Life Inventory™ for Gastrointestinal Symptoms (PedsQOL) and the Pediatric Functional Disability Index (FDI). In addition, complete blood counts and serum chemistries were recorded at the start and end of treatment to evaluate safety.ResultsFifteen patients (nine SBI, six placebo) completed the study. Both SBI and placebo groups reported nonstatistical reductions in stool frequency per week. The SBI group showed a significant reduction in stool frequency at weeks 1 and 2 but not at the end of treatment. The SBI group also demonstrated statistical improvements in abdominal pain and stool form by 3 weeks. The placebo group did not achieve similar improvements. The overall FDI and PedsQOL scores, as well as PedsQOL subscale scores for pain, discomfort when eating, diarrhea, worry about stomach aches, and communication, improved significantly in the SBI group, but not in the placebo group. No serious adverse events occurred. Serum chemistries and hemograms were normal at baseline and at the end of study in all patients.ConclusionIn this single-center, exploratory pilot study, we demonstrated that 10 g SBI per day was safe in children with d-IBS and improved symptoms. Larger studies, with longer treatment duration, seem warranted based on these initial positive results.

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Fructans Exacerbate Symptoms in a Subset of Children With Irritable Bowel Syndrome

Chumpitazi

McMeans

Vaughan

et al. 2018

Clinical Gastroenterology and Hepatology

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112

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Stooling Characteristics in Children With Irritable Bowel Syndrome

Cited by 8 publications

References 8 publications

Evidence of increased fecal granins in children with irritable bowel syndrome and correlates with symptoms

Evidence of increased fecal granins in children with irritable bowel syndrome and correlates with symptoms

Serum-derived bovine immunoglobulin for children with diarrhea-predominant irritable bowel syndrome

Fructans Exacerbate Symptoms in a Subset of Children With Irritable Bowel Syndrome

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