The global impact of IBS: time to think about IBS-specific models of care?

Background Colonic mast cells have been proposed to be related to the pathophysiology of irritable bowel syndrome (IBS). Whether mast cell counts are altered in the small intestine, a less‐explored region in patients with IBS is not completely clear. Methods PubMed and EMBASE were searched for case‐control studies on mast cell count/density in the small intestine of patients with IBS vs controls through February 2019. Mast cell counts were separately analyzed in the duodenum, jejunum, and ileum. Data were pooled using the standardized mean difference (SMD) method. When zero was not within the 95% confidence interval (CI), the SMD was considered significant. Key Results Data from 344 patients with IBS and 229 healthy controls from three studies in the duodenum, six in the jejunum, and five in the ileum were pooled in this meta‐analysis. The number of mast cells was significantly higher in the ileum (SMD: 1.78 [95% CI: 0.89, 2.66]) of patients with IBS. Mast cell counts were not significantly different in the duodenum (SMD: 0.81 [‐0.06, 1.67]) or the jejunum (SMD: 0.58 [‐0.03, 1.19]) of patients with IBS vs healthy controls. Conclusions and Inferences Mast cells are increased in the small intestine of IBS vs controls, mainly in the ileum. Future studies should address whether such findings are IBS subtype or gender‐dependent. Methodological variations, single‐center bias, and the limited number of studies included in this meta‐analysis may affect the final results.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mast cells are increased in the small intestinal mucosa of patients with irritable bowel syndrome: A systematic review and meta‐analysis

Robles

Ingles

Myneedu

et al. 2019

“…In addition, there is a lack of follow‐up data for the Dutch population. As implications of IBS on quality of life have shown to vary considerably between different countries, it is of added value to expand earlier findings and investigate the natural history of IBS in a Dutch, well‐characterized population.…”

Section: Introductionmentioning

confidence: 99%

Reduction in IBS symptom severity is not paralleled by improvement in quality of life in patients with irritable bowel syndrome

Weerts

Vork

Mujagic

et al. 2019

Background Irritable bowel syndrome (IBS) is a brain‐gut disorder, of which the natural course varies between patients and is difficult to predict. This study aimed to evaluate symptom evolution over a 5‐year follow‐up period and to identify baseline predictors for symptom severity and quality of life (QoL) at follow‐up. Methods Maastricht IBS cohort participants completed questionnaires upon inclusion regarding demographics and lifestyle, gastrointestinal (GI) symptoms, anxiety and depression, and QoL. The same questionnaires, in addition to others, were completed after 5 years. Rome criteria were confirmed face‐to‐face at initial enrollment and through telephonic interviews at follow‐up. Key Results At a mean follow‐up of 4.7 years, 379 patients were approached of whom 203 (53.7%) responded. Of these, 161 were reached by telephone and analyzed; 49 (30.4%) did not fulfill the Rome III criteria at follow‐up and had lower levels of GI symptoms and GI‐specific anxiety compared to those remaining Rome III‐positive (P < 0.001). However, Rome III‐negative patients had comparable levels of QoL and life satisfaction, comorbid anxiety and depression, work absenteeism, and impaired productivity. No baseline predictors were found for being Rome III‐positive or Rome III‐negative. However, greater age and lower baseline physical QoL predicted lower physical QoL at follow‐up (P < 0.005 and P < 0.01, respectively), while lower baseline mental QoL predicted lower mental QoL at follow‐up (P = 0.005). Additionally, higher anxiety and depression scores at follow‐up were associated with lower QoL and life satisfaction at follow‐up (P < 0.001). Conclusions and Inferences Long‐term QoL and general well‐being might depend on concurrent psychological symptoms, rather than GI symptom improvement.

“…Due to symptom severity and the significant impact on quality of life, IBS may account for 25%‐30% of all primary healthcare visits and causes both work‐related absenteeism and presenteeism . In the UK, it is estimated that IBS accounts for 0.1% of the total National Health Service cost, and in Denmark, the median cost due to absenteeism was $1508 per patient per year in 2013 . Our previous data indicate that the positive effect of SNM for IBS is maintained after at least 3 years, and SNM is estimated to be cost‐effective from a 7‐year perspective .…”

Section: Discussionmentioning

confidence: 98%

“…The prevalence of IBS peaks in the third and fourth decade. Due to symptom severity and the significant impact on quality of life, IBS may account for 25%‐30% of all primary healthcare visits and causes both work‐related absenteeism and presenteeism . In the UK, it is estimated that IBS accounts for 0.1% of the total National Health Service cost, and in Denmark, the median cost due to absenteeism was $1508 per patient per year in 2013 .…”

Section: Discussionmentioning

confidence: 99%

Sacral nerve modulation for irritable bowel syndrome: A randomized, double‐blinded, placebo‐controlled crossover study

Fassov

Lundby

Laurberg

et al. 2019

Background Irritable bowel syndrome (IBS) is among the most common gastrointestinal disorders, and a substantial proportion of patients have an insufficient response to treatment. In a single‐blinded study, sacral nerve modulation (SNM) significantly reduced symptoms of IBS. The aim of the present double‐blinded, randomized, placebo‐controlled study was to evaluate the effect of SNM for IBS. Methods We included patients with diarrhea‐predominant or mixed IBS and a minimum baseline IBS‐specific symptom score of 40 points (Gastrointestinal Symptom Rating Scale‐IBS version). Patients underwent a 6‐week period of SNM. In the first 4 weeks, the patients were randomized 1:1 to have the neurostimulator set subsensory or OFF for 2 weeks and then the opposite for another 2 weeks. Patients and investigators were blinded to settings. In the remaining 2 weeks, the stimulation was set suprasensory. IBS‐specific symptoms and quality of life were assessed with validated questionnaires and bowel diaries. Key Results Twenty‐one patients were randomized and eligible for analysis. The IBS‐specific symptom score was reduced with borderline significance during stimulation (subsensory‐OFF median change −1 (−26, 9), OFF‐subsensory median change 8 (−11, 36); P = 0.0572). Pain was significantly reduced during stimulation (subsensory‐OFF median change −1.5 (−4, 1), OFF‐subsensory median change 1 (−4, 3); P = 0.0188), along with the number of daily bowel movements (subsensory‐OFF median change 0 (−1.8, 0.2), OFF‐subsensory median change 0.2 (−0.5, 1.1); P = 0.0373). The median placebo effect was 14% (0, 55). Conclusion and Inferences Sacral nerve modulation for IBS seems promising but should be considered experimental until larger multicenter studies have been performed.