Symptom pattern following a meal challenge test in patients with irritable bowel syndrome and healthy controls

Abstract

Background: Patients with irritable bowel syndrome (IBS) often complain of worsening of symptoms after meal intake. Meal challenge tests have previously been used to study symptoms and pathophysiology in functional dyspepsia. Objective: The objective of this article is to evaluate differences in gastrointestinal (GI) symptom response to a standardized meal test in IBS compared to healthy controls. Methods: We included 67 patients with IBS and 16 healthy controls. After an overnight fast the subjects were served breakfast (540 kcal; 36% fat, 15% proteins, 49% carbohydrates; 8.9 g fiber). They completed visual analog scales assessing severity of six GI symptoms (abdominal pain, bloating, discomfort, nausea, gas, fullness) before breakfast and every 30 minutes up to 240 minutes after breakfast. The patients also completed a questionnaire (IBS-SSS) to assess IBS symptom severity during the preceding week. The course of symptom scores over time was analyzed using mixed models. Results: The meal was well tolerated and all subjects completed the test period. In patients, significant effects of time (initial increase to a maximum, followed by a return to baseline) were found for fullness, bloating, nausea and discomfort (all p values < 0.01 for linear, quadratic and third-order effect of time). In IBS patients, an independent significant association between IBS-SSS scores and all postprandial symptoms, except for nausea, was found (all p < 0.01). In controls, a significant linear, quadratic and third-order effect of time (all p < 0.0001) was found for fullness only. The difference in time course for bloating and discomfort between IBS patients and controls was confirmed when comparing the groups directly (significant time-by-group interaction effects, all p < 0.05), but not for nausea. On average, IBS patients scored significantly higher than controls on all symptoms, except for nausea (significant main effects of group, all p < 0.05). Conclusions: A standardized meal test seems to be a promising tool to study the symptom pattern in IBS and potentially to follow the effect of interventions.

Irritable bowel syndrome

“…Food ingestion is one of the most commonly reported factors that results in the exacerbation of symptoms among patients with IBS 163,164 . Postprandial symptoms per se and fear of their occurrence (anticipatory anxiety) contribute profoundly to reduced QOL in IBS 128 .…”

Diaphragmatic breathing for rumination syndrome: efficacy and mechanisms of action

“…However, the experimental design, which allowed patients to choose the meal and provided a reasonable amount of time for the symptoms to occur, was perhaps more representative of their daily routine and thereby reliably provoked typical rumination symptoms in all patients. The mean caloric intake was estimated to be 466 kcal, which is comparable to standard meals used previously to study postprandial symptoms in rumination and patients with other functional gut disorders . In addition, neither the participant nor physician was blinded, nor was a control group of asymptomatic individuals studied.…”

TummyTrials

“…IBS is a useful domain for understanding the potential for self-experimentation because patients struggle to manage their condition, particular triggers are highly individualized [52,67], symptoms tend to be experienced within a short time window of consuming the trigger food [34,61,67], and the current identification process is lengthy, tedious, and frustrating [28]. We aim to improve both process and outcome, aiding IBS patients in effectively determining whether a particular food is a trigger while minimizing impact on their daily life.…”