Research - Irritable Bowel Syndrome / Inflammatory Bowel Disease
Gut microbiota was modulated by moxibustion stimulation in rats with irritable bowel syndrome
Xiaomei Wang† Qin Qi†, Yuanyuan Wang†, Huangan Wu, Xiaoming Jin, Huan Yao, Duiyin Jin, Yanan Liu and Cun Wang
The pathogenesis of irritable bowel syndrome (IBS) is closely related to intestinal dysbacteriosis and can be controlled by moxibustion treatment. However, the mechanism underlying the therapeutic value of moxibustion in IBS treatment remains unknown.
An IBS rat model was established by colorectal distention (CRD) stimulus and mustard oil clyster. Sixty-five male rats were randomly divided into six groups: normal, IBS model, moxibustion, electroacupuncture (EA), Bifid-triple Viable Capsule (BTVC) and Pinaverium Bromide (PB) groups. The moxibustion group was treated with mild moxibustion at the bilateral Tianshu (ST25) and Shangjuxu (ST37) for 10 min/day for 7 days, the EA group was given EA at ST25 and ST37 once daily for 7 days, while the BTVC group and PB groups received Bifid-triple Viable Capsule and Pinaverium Bromide solution (at the proportion of 1:0.018) respectively by gavage once daily for 7 days. After the treatment, abdominal withdrawal reflex (AWR) scores were determined based on CRD stimulus, gut microbiota profiling was conducted by 16S rRNA high-throughput sequencing.
Irritable bowel syndrome model rats had significantly increased AWR scores at all intensities (20, 40, 60 and 80 mmHg) compared with the normal group. Moxibustion treatment significantly reduced AWR scores compared with the IBS model group at all intensities. Across all groups the most abundant phyla were Bacteroidetes and Firmicutes followed by Proteobacteria and Candidatus Saccharibacteria. At genus level IBS model rats had a higher abundance of Prevotella, Bacteroides and Clostridium XI and a lower abundance of Lactobacillusand Clostridium XIVa compared with normal rats. These changes in microbiota profiles could however be reversed by moxibustion treatment. Alpha diversity was decreased in IBS model rats compared with normal rats, yet significantly increased in moxibustion- and PB-treated rats compared with IBS rats.
Our findings suggest that moxibustion treats IBS by modulating the gut microbiota.
Source : Journal Chinese Medicine
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Reduced Symptoms of Post-traumatic Stress Disorder and Irritable Bowel Syndrome Following Mindfulness-Based Stress Reduction Among Veterans
Kaitlin Harding, , Tracy Simpson, , and David J. Kearney
Objectives: Post-traumatic stress disorder (PTSD) and irritable bowel syndrome (IBS) are highly comorbid conditions associated with reduced health-related quality of life. Comorbid prevalence is especially high among veterans, ranging from 23% to 51%, but there is limited research on integrative treatments.
Design: To improve treatment of comorbid PTSD and IBS, this study examined the impact of mindfulness-based stress reduction (MBSR) on symptom reduction and mindfulness skill building among veterans with this comorbidity. We hypothesized that veterans would report reduced trauma-related, gastrointestinal (GI) symptom-specific anxiety (GSA), and depression symptoms and greater mindfulness skills post-treatment. We also hypothesized that veterans who reported lower trauma-related GSA and depression symptoms, and reported greater mindfulness skills and MBSR session attendance would report lower irritable bowel symptoms post-treatment.
Settings/Location: VA (Veterans Administration) Puget Sound Health Care System, Seattle, Washington.
Subjects: Participants were 55 veterans with PTSD and IBS.
Interventions: Veterans participated in an 8-week open trial of MBSR group.
Outcome measures: This study measured the impact of MBSR on PTSD, IBS, GSA, and depression symptoms as well as mindfulness skills.
Results: Veterans reported reduced trauma-related, irritable bowel, GSA, and depression symptoms and greater mindfulness skills immediately post-treatment. Trauma-related and depression symptom reduction were maintained 4 months post-treatment, but irritable bowel and GSA symptoms were nonsignificant. Lower baseline GSA predicted lower irritable bowel symptoms immediately post-treatment. At 4 months post-treatment, 77.50% met PTSD criteria and 40.38% met IBS criteria compared with 100% veteran comorbidity pretreatment.
Conclusions: MBSR holds promise as a transdiagnostic intervention for individuals with comorbid trauma-related, depression, GSA, and irritable bowel symptoms, with maintenance of trauma-related and depression symptom improvement 4 months post-treatment.
Source : Journal Alternative and Complementary Medicine
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Naturopathic Approaches to Irritable Bowel Syndrome—A Delphi Study
Joshua Z. Goldenberg, ND,1,2 Lesley Ward, PhD,2 Andrew Day, ND,3 and Kieran Cooley, ND2,4
Irritable bowel syndrome (IBS) affects 11% of the population, and up to 50% of patients report using complementary and alternative medicines (CAM) for it. To date, there is no research describing how providers of naturopathic medicine in North America, a well-defined CAM profession, approach IBS.
Methods: A Delphi study was conducted over a 17-month period in 4 rounds with 15 North American naturopathic medicine experts in IBS. Consensus was defined as a median value of 75% or greater agreement with the relevant statement.
Results: Consensus was met with 45 statements describing a ‘‘reasonable naturopathic approach’’ to IBS. These statements covered the domains of general, office visits, tracking progress, testing, interventions, and resources.
Conclusion: These results represent the beginning of an evidence base depicting naturopathic interventions for IBS and should inform future randomized controlled clinical trials in this area. Future research should look to reflect on and revise these guidance consensus statements particularly extending to other stakeholders as well as geographic and regulatory jurisdictions in the naturopathic profession.
Source : Journal Alternative and Complementary Medicine
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Strawberries could help reduce harmful inflammation in the colon
Inflammatory bowel disease (IBD) is a set of painful conditions that can cause severe diarrhea and fatigue. Treatments can include medications and surgery. But now researchers report that a simple dietary intervention could mitigate colonic inflammation and improve gut health. In this case, a strawberry — or rather, less than a cupful of strawberries — a day could help keep the doctor away.
The researchers are presenting their results today at the 256th National Meeting & Exposition of the American Chemical Society (ACS). ACS, the world’s largest scientific society, is holding the meeting here through Thursday. It features more than 10,000 presentations on a wide range of science topics.
“The sedentary lifestyle and dietary habits of many people in this country — high-sugar, high-animal-fat, but low-fiber diets — may promote colonic inflammation and increase the risk of IBD,” says Hang Xiao, Ph.D., who led the study.
In 2015, 3 million adults in the U.S. reported being diagnosed with IBD, according to the U.S. Centers for Disease Control and Prevention. IBD includes both Crohn’s disease, which can infect any part of the gastrointestinal tract, and ulcerative colitis, which is characterized by inflammation of the colon and rectum. People with IBD also have a higher risk of colorectal cancer.
The dietary consumption of fruits and vegetables has been associated with a lowered risk of IBD. To establish an effective and practical approach to decrease colonic inflammation in both IBD patients and the general population, Xiao and his team at the University of Massachusetts Amherst focused on strawberries due to their wide consumption. According to Yanhui Han, a Ph.D. student who conducted the study, most of the previous reports focused on the effects of purified compounds and extracts from strawberries. “But when you only test the purified compounds and extracts, you miss out on a lot of other important components in the berries, such as dietary fiber, as well as phenolic compounds bound to the fibers, that can’t be extracted by solvents,” he says. He adds that it also makes sense to study the effects of whole berries because people mostly consume the whole fruits rather than their extracts.
In their experiment, Han and Xiao used four groups of mice — a group of healthy mice consuming a regular diet, and three groups of mice with IBD consuming a regular diet, a diet with 2.5 percent whole strawberry powder or a diet with 5 percent whole strawberry powder. Xiao says they tried to feed the mice doses of strawberries that would be in line with what a human could reasonably consume.
The researchers found that dietary consumption of whole strawberries at a dose equivalent to as low as three-quarters of a cup of strawberries per day in humans significantly suppressed symptoms like body weight loss and bloody diarrhea in mice with IBD. Strawberry treatments also diminished inflammatory responses in the mice’s colonic tissue.
But decreased inflammation wasn’t the strawberry’s only conferred benefit during this study. Colonic inflammation adversely impacts the composition of microbiota in the gut. With IBD, the abundance of harmful bacteria increases, while levels of beneficial bacteria decrease in the colon. Following the dietary treatments of whole strawberries, the researchers observed a reversal of that unhealthy microbiota composition in the IBD mice. Xiao’s team also obtained experimental data that indicated strawberries might impact abnormal metabolic pathways in the IBD mice, which in turn could lead to the decreased colonic inflammation they observed.
Next, the team will try to validate their findings in IBD patients. While eating three-quarters of a cup of strawberries a day could be beneficial for those looking to enhance their gut health, Xiao advises patients to consult with their doctors before changing their diets. He also suggests avoiding this type of nutritional intervention if one is allergic to the fruit.
Source : American Chemical Society
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Effect of TongXie-YaoFang on Cl− and HCO3- Transport in Diarrhea-Predominant Irritable Bowel Syndrome Rats
Xiaofang Lu, Shengsheng Zhang, Cheng Yang, Zhengfang Wang, Luqing Zhao, Zhenyu Wu, and Jing Xie
TongXie-YaoFang (TXYF) can effectively alleviate the symptoms of diarrhea-predominant irritable bowel syndrome (D-IBS) patients. However, the curative mechanism has not been fully clarified. The study was designed to investigate the effect of TXYF on the colonic ion transport induced by serotonin (5-HT) in D-IBS rats. A method of multiple stress (neonatal maternal separation (NMS) combined with restraint stress (RS)) was used to induce the D-IBS model. The model rats were randomly divided into two groups: NMS + RS group and TXYF-formula group, and the normal control (no handling) rats were classified as NH group. In the NMS + RS group, the change of short-circuit current (ΔIsc) induced by 5-HT was lower than that in the NH and TXYF-formula groups. After removing of the extracellular Cl− or HCO3- or basolateral Na+ or blocking the cystic fibrosis transmembrane conductance regulator (CFTR), Na+-K+-2Cl− cotransporter (NKCC), Na+-HCO3- cotransporter, Cl-/HCO3- exchanger, K+ channel, or Na+/K+-ATPase, respectively, there was no difference in 5-HT-induced ΔIsc among the three groups. These data suggest that TXYF can regulate 5-HT-induced Cl− and HCO3- secretion, possibly mediated by the combined action of CFTR, NKCC,
Na+-HCO3- cotransporter, Cl-/HCO3- exchanger, K+ channel, and Na+/K+-ATPase.
Source : Evidence Based Complementary and Alternative Medicine
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Effect of turmeric on colon histology, body weight, ulcer, IL-23, MPO and glutathione in acetic-acid-induced inflammatory bowel disease in rats
- Salim M. A. Bastaki
- Mohammed Majed Al Ahmed,
- Ahmed Al Zaabi,
- Naheed Amir and
- Ernest Adeghate
This study investigates the protective effects of turmeric (Curcuma longa, CL) on acetic acid-induced colitis in rats.
Inflammatory bowel disease (IBD) was induced in male Wistar rats by intra-rectal administration of 1 ml of 4 % acetic acid at 8 cm proximal to the anus for 30 s. Curcuma longa (CL) powder, (1, 10, or 100 mg/kg/day) was administered for either 3 days before or after IBD for 7 days. The body weight, macroscopic and microscopic analysis of the colon of CL-treated IBD rats and that of control rats (no IBD, no CL) were performed on 0 day, 2, 4 and 7th day. Myeloperoxidase (MPO), IL-23 and glutathione levels in control, untreated and treated rats were measured by ELISA.
CL significantly (P < 0.05) improved IBD-induced reduction in mean body weight and mean macroscopic ulcer score. Administration of CL also significantly (P < 0.01) reduced the mean microscopic ulcer score when compared to untreated IBD control. Intake of CL by rats resulted in a significant (P < 0.05) increase in the mean serum glutathione level compared to untreated control. CL reduced both MPO and IL-23 levels in the colonic mucosa of the rat.
CL improved body weight gain, mean macroscopic and microscopic ulcer scores in the colon of rats suffering from acetic acid-induced IBD. CL reduced both MPO and IL-23 in the mucosa of the colon. The increase in the mean serum glutathione level may help in the reduction of oxidative stress associated with IBD.
Source : BMC COmplementary and Alternative Medicine
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Oil of Allay: Peppermint Microcapsules Tame IBS Symptoms
A slow-release formulation of concentrated peppermint oil provides significant relief of the symptoms of irritable bowel syndrome (IBS), researchers have found.
The formulation (IBgard, IM HealthScience) contains purified, coated microbeads of peppermint oil that can pass through the stomach to dissolve slowly in the small intestine. The randomized controlled trial found that patients with IBS who took the peppermint oil reported a 40% decline in bowel symptoms and nearly a 50% decrease in symptom intensity from baseline, according to the researchers.
Peppermint oil, which contains L-menthol, is approved for the treatment of IBS in Europe, where it is used as a first-line therapy for the condition. However, clinicians in the United States have not embraced the substance, nor does it have FDA approval for IBS. The formulation used in the latest study is available over the counter as a “medical food.” Manufacturers of medical foods can make disease claims about their products but do not have to conduct randomized controlled trials to prove those claims.
The new study, the IBSREST (Irritable Bowel Syndrome Reduction Evaluation and Safety Trial), included 72 men and women with moderate IBS who received either peppermint oil or placebo for four weeks.
After one week, patients taking the peppermint oil reported a statistically significant improvement in total IBS symptoms, which declined by 40% compared with baseline (P<0.0001). Symptom severity also fell, by 49% (P<0.0001), as did mean frequency of symptoms (P<0.0001; Table - click Source below).
The difference between active therapy and placebo also was statistically significant for reduction in total symptoms (P=0.025) and symptom intensity (P=0.028). The oil was well tolerated, and no patient discontinued the study because of problems with the therapy, according to the researchers.
Source : Gastroenterology & Endoscopy News
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The Efficacy of Shugan Jianpi Zhixie Therapy for Diarrhea-Predominant Irritable Bowel Syndrome: A Meta-Analysis of Randomized, Double-Blind, Placebo-Controlled Trials
Ya Xiao , Yanyan Liu , Shaohui Huang , Xiaomin Sun, Yang Tang, Jingru Cheng, Tian Wang, Fei Li, Yuxiang Kuang,
Ren Luo, Xiaoshan Zhao
Background Shugan Jianpi Zhixie therapy (SJZT) has been widely used to treat diarrhea-predominant irritable bowel syndrome (IBS-D), but the results are still controversial. A meta-analysis of randomized, double-blind, placebo-controlled trials was performed to assess the efficacy and tolerability of SJZT for IBS-D.
MethodsThe MEDLINE, EMBASE, Cochrane Library, the China National Knowledge Infrastructure database, the Chinese Biomedical Literature database and the Wanfang database were searched up to June 2014 with no language restrictions. Summary estimates, including 95% confidence intervals (CI), were calculated for global symptom improvement, abdominal pain improvement, and Symptom Severity Scale (BSS) score.
Results Seven trials (N=954) were included. The overall risk of bias assessment was low. SJZT showed significant improvement for global symptom compared to placebo (RR 1.61; 95% CI 1.24, 2.10;P =0.0004; therapeutic gain = 33.0%; number needed to treat (NNT) = 3.0). SJZT was significantly more likely to reduce overall BSS score (SMD –0.67; 95% CI –0.94, –0.40; P < 0.00001) and improve abdominal pain (RR 4.34; 95% CI 2.64, 7.14; P < 0.00001) than placebo. The adverse events of SJZT were no different from those of placebo.
Conclusions This meta-analysis suggests that SJZT is an effective and safe therapy option for patients with IBS-D. However, due to the high clinical heterogeneity and small sample size of the included trials, further standardized preparation, large-scale and rigorously designed trials are needed.
Source : PLOSone
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Cannabis induces a clinical response in patients with Crohn's disease: a prospective placebo-controlled study.
Naftali T1, Bar-Lev Schleider L, Dotan I, Lansky EP, Sklerovsky Benjaminov F, Konikoff FM.
BACKGROUND & AIMS:The marijuana plant Cannabis sativa has been reported to produce beneficial effects for patients with inflammatory bowel diseases, but this has not been investigated in controlled trials. We performed a prospective trial to determine whether cannabis can induce remission in patients with Crohn's disease.
METHODS:We studied 21 patients (mean age, 40 ± 14 y; 13 men) with Crohn's Disease Activity Index (CDAI) scores greater than 200 who did not respond to therapy with steroids, immunomodulators, or anti-tumor necrosis factor-α agents. Patients were assigned randomly to groups given cannabis, twice daily, in the form of cigarettes containing 115 mg of Δ9-tetrahydrocannabinol (THC) or placebo containing cannabis flowers from which the THC had been extracted. Disease activity and laboratory tests were assessed during 8 weeks of treatment and 2 weeks thereafter.
RESULTS:Complete remission (CDAI score, <150) was achieved by 5 of 11 subjects in the cannabis group (45%) and 1 of 10 in the placebo group (10%; P = .43). A clinical response (decrease in CDAI score of >100) was observed in 10 of 11 subjects in the cannabis group (90%; from 330 ± 105 to 152 ± 109) and 4 of 10 in the placebo group (40%; from 373 ± 94 to 306 ± 143; P = .028). Three patients in the cannabis group were weaned from steroid dependency. Subjects receiving cannabis reported improved appetite and sleep, with no significant side effects.
CONCLUSIONS:Although the primary end point of the study (induction of remission) was not achieved, a short course (8 weeks) of THC-rich cannabis produced significant clinical, steroid-free benefits to 10 of 11 patients with active Crohn's disease, compared with placebo, without side effects. Further studies, with larger patient groups and a nonsmoking mode of intake, are warranted
Source : Clin Gastroenterol Hepatol.
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Extra Vitamin D May Ease Crohn's Symptoms, Study Finds
Vitamin D supplements may help those with Crohn's disease overcome the fatigue and decreased muscle strength associated with the inflammatory bowel disease, according to new research. Extra vitamin D "was associated with significantly less physical, emotional and general fatigue, greater quality of life and the ability to perform activities of daily living," said Tara Raftery, a research dietitian and doctoral candidate at Trinity College Dublin. She is scheduled to present the findings Saturday at the Digestive Disease Week meeting in Orlando, Fla.
Raftery and her colleagues evaluated 27 patients who had Crohn's in remission. (Even in remission, fatigue and quality of life can be problematic.) The patients were assigned to take either 2,000 IUs (international units) of vitamin D a day or a dummy vitamin for three months.
Before and after the study, the researchers measured hand-grip strength, fatigue, quality of life and blood levels of vitamin D.
"Hand-grip strength is a proxy measure of muscle function," Raftery said. "Muscle function has been known to be reduced in Crohn's disease."
Besides boosting bone growth and remodeling, vitamin D is thought to improve neuromuscular and immune function, reduce inflammation and help with other bodily tasks. Children and adults aged 1 year to 70 are advised to get 600 IUs a day; older adults, 800, according to the U.S. National Institutes of Health (NIH).
Vitamin D is found in fatty fish such as salmon, in smaller amounts in cheese, egg yolks and beef liver, and in fortified foods such as milk.
Sometimes called the sunshine vitamin, vitamin D is also produced when the sun's rays strike the skin.
Crohn's can affect any part of the gastrointestinal tract, but most commonly affects the end of the small bowel and the beginning of the colon. Symptoms vary, but may include persistent diarrhea, rectal bleeding, abdominal cramps, and pain and constipation. About 700,000 Americans are affected, according to the Crohn's & Colitis Foundation of America.
Its cause is not well understood, but Crohn's is thought to involve heredity and environmental factors. Experts believe that in those with Crohn's, the immune system attacks harmless intestinal bacteria, triggering chronic inflammation and, eventually, the disease symptoms.
The daily vitamin D supplement benefitted participants in many ways, Raftery found. "When levels of vitamin D peaked at 30 ng/mL (75 nmol/L) or more [a level considered healthy], muscle function in both the dominant and non-dominant hands were significantly higher than in those who had levels less than 30 ng/mL," she said.
Quality of life improved more for the D-supplement group, too. Using a standard measure to evaluate quality of life, the researchers found those who achieved a healthy blood level of the vitamin scored 24 points higher than those not on supplements. A 20-point difference is considered meaningful from a "real-world" perspective, Raftery said.
Raftery now is testing vitamin D in a larger, year-long study of 130 Crohn's patients.
The study results echo those of other researchers, including John White, professor of physiology at McGill University, Montreal. He said the research findings "show collectively that vitamin D acts in the intestine to stimulate the innate immune system to defend against pathogenic bacteria, and to enhance the barrier function of the intestinal epithelium [the lining of the intestine]."
Other researchers, including Raftery, have also shown vitamin D can help improve muscle strength, he said.
Vitamin D is getting a lot of attention in inflammatory bowel disease treatments, said Dr. Neera Gupta, co-chair of the Crohn's & Colitis Foundation of America's pediatric affairs committee.
More study is needed to determine the benefits of maintaining vitamin D levels higher than currently recommended, she said.
Gupta cautioned those with Crohn's not to self-dose with vitamin D. "Discuss your vitamin D status with your primary gastroenterologist to determine whether or not vitamin D supplementation is indicated in your particular situation," she said.
White said supplements are inexpensive and safer than too much sun exposure. A daily intake of 2,000 IUs is considered safe, he said. The safe upper limit for adults is 4,000 IUs, according to the NIH.
Source : Medline
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Hypnosis Should Be Offered to Patients With IBS, Swedish Research Suggests
Hypnotherapy helps fight IBS symptoms. These are the findings of a thesis from Sahlgrenska Academy, University of Gothenburg, Sweden which proposes implementing this treatment method into the care of severe sufferers of this common disease.
Irritable bowel syndrome, or IBS, is an very common stomach disease that manifests as abdominal pain and discomfort, disturbed bowel movements, abdominal swelling and bloating. Recent studies indicate that 10-15 percent of all Swedes suffer from IBS to varying degrees. Yet researchers still do not know what causes the condition and no effective treatment is available for those suffering from most severe symptoms.
Studies at Sahlgrenska Academy, University of Gothenburg, show that psychological treatment using hypnosis may offer effective, lasting relief. The studies are part of a thesis which concludes that hypnotherapy should be used in clinical care of patients with severe IBS.
"We have four different studies showing that hypnotherapy helps treat IBS, even when the treatment is not provided by highly specialized hypnotherapy centers. The treatment improves gastrointestinal symptoms and quality of life, and patient satisfaction is very high. The method also makes efficient use of health care resources," says Perjohan Lindfors, doctoral student at Sahlgrenska Academy, University of Gothenburg.
Source : ScienceDaily
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Mind-body education helps irritable bowel syndrome
Patients who go through a mind-body educational course are better able to manage irritable bowel syndrome (IBS), according to a new study.
The benefits of the course were modest, about as large as what are typically seen from taking medications, said Dr. Emeran Mayer, the senior author of the study and a professor at the University of California, Los Angeles, School of Medicine.
The program doesn't work for everybody, said Mayer, but for others "it changed their lives."
The researchers couldn't describe exactly how patients' lives were changed, but those in the study reported having somewhat less severe symptoms and a higher quality of life after they went through the program.
Irritable bowel syndrome is a collection of symptoms, including stomach pain and diarrhea, that don't have a known inflammatory component like inflammatory bowel disease.
According to Mayer's study, published in Alimentary Pharmacology and Therapeutics, up to 15 percent of people experience IBS.
Although fiber supplements, antidiarrheal drugs and antidepressants can be used to ease some of the symptoms of IBS, there is no cure.
Some studies have found success with talk therapy, meditation and hypnosis (see Reuters Health reports of November 1, 2011 reut.rs/uOYJ8l, June 29, 2011 reut.rs/kbJOwu, and May 4, 2010 reut.rs/h2R0Ac).
In the current study, Mayer and his colleagues developed a group education program, in which patients attended two-hour sessions once a week for five weeks. The discussions centered on the role of the brain in regulating digestion, how responses to stressful events can affect IBS, and strategies to better manage symptoms.
The researchers compared the symptoms, quality of life, and mental health between 34 people who went through the course to 35 patients who were told they were on a wait list.
By the end of the sessions, patients reported that the severity of their symptoms dropped from about 10 down to about 8 on a 20-point scale. And three months after the program ended, these patients reported that the severity of their symptoms was at about 7.
In comparison, the wait-listed group reported that their symptoms went from about 13 to about 11 at the end of five weeks, and down to about 10 three months later.
The researchers could not describe just what these changes mean in day-to-day terms.
Similarly, the quality of life for patients in the education group rose from about 67 to nearly 76 on a 100-point scale by the end of the sessions, whereas the quality of life reported by the wait-listed group had a small drop from about 64 to about 62.
Patients in the mind-body course also showed some signs of better coping skills. For instance, people were less likely make the worst out of a given situation if they had gone through the sessions.
The findings are "part of larger set of data that says that the brain seems to be really important in the brain-gut interactions as they relate to IBS symptoms," said Jeffrey Lackner, a professor at the State University of New York at Buffalo who was not involved in the study.
Lackner said it's not entirely clear yet how meaningful the improvements on these measures will be to people's everyday lives. He said that future research should explore just how much, in a practical way, patients' lives change.
The changes seen after the educational program are not huge, Mayer said, but they would be noticeable to the patients. "I would prefer to see much larger changes," he told Reuters Health.
Dr. Arnold Wald, a professor of medicine at the University of Wisconsin who was not involved in the study, said he's not surprised to see that the program made some difference to people's illness.
He explained that one of the premises of the mind-body approach to treating IBS "is that the mind and the body are linked, physically, neurologically, as well as emotionally, and that things that affect the mind can affect the gut and vice versa. So if you can do something to alleviate mind stressors, you can improve body functions."
"Instead of when symptoms happen to them, saying, 'I'm going to have the worst abdominal pain of my life and I'm not going to make it to this meeting,'...they can say, 'I know about stress, I can rationally implement specific steps" to reduce it, Mayer said.
But whether such treatments will reach large numbers of people is unclear. Lackner said there are few therapists in the U.S. who focus on IBS.
Mayer's group is developing online programs to help make his approach more accessible.
Source : Reuters Health via: bit.ly/U8hjKn Alimentary Pharmacology and Therapeutics, online December 3, 2012.
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Why Peppermint May Relieve IBS
Often, abdominal pain occurs in Irritable Bowel Syndrome (IBS). This is because the sensory nerves from the gut are hypersensitive to mechanical stimulation. Peppermint produces a cooling sensation and is known to provide relief from symptoms of IBS. The current study that was conducted on mice found that icilin, a cooling agent, reduced the sensitivity of the sensory nerve fibers from the gut. This might explain the mechanism by which peppermint and certain herbal remedies help to reduce abdominal pain. Drugs that modify the presence and activity of the transient receptor potential ion channel melastatin subtype 8 (TRPM8) channels in the gut wall may facilitate ushering new therapies for treating IBS in the future.
One of the prominent symptoms of IBS is abdominal pain, caused due to distension of the gut. Colon, which is a part of the gut, becomes sensitive to mechanical pressure. The pain is caused by the nerves connecting the colon and spinal column. Administration of peppermint reduces the severity of the abdominal pain in patients with IBS, but the exact mechanism of this action of peppermint is not known. TRPM8 channels are specific sites located in the sensory nerves of colon and spinal ganglia that respond to cool temperature and cooling sensation producing agents like peppermint. This study is aimed at characterizing the presence and functions of TRPM8 channels in mice colon. It identifies a role for TRPM8 in modulating the signals of visceral events.
- A retrograde tracer, which is a chemical used to label pathways in the nerves, was injected in the colon of the mice. These mice were then killed for dissociate ganglia cell culture (a culture of a large nerve cell, especially one of those of the spinal ganglia).
- From the dorsal root ganglion (DRG) present in the spinal column neurons, which were labeled with tracer, the percentage of the neurons in the whole DRG was worked out.
- In another part of the study, four DRGs were removed four days after injections of fluorescent dye into the colon, and the neurons were then cultured in the laboratory.
- Further, the colon was opened and the nerve fibers were dissected. The electric activity in these fibers was recorded by applying three mechanical stimuli of probing, mucosal stroking, and circular stretch.
- TRPM8 levels were measured before and after applying icilin, a cooling agent, and provoking agents like capsaicin and mustard oil.
- The results showed that 7-9% neurons in the DRG of the spinal canal were retrogradely labeled from tracer injected in the gut wall.
- Single-fiber recordings of nerve fibers showed that 24% fibers reacted directly to the cooling agent icilin.
- It was found that the nerve fiber response to chemical capsaicin, a noxious agent, was reduced when icilin was applied and electric activity in fibers was tested again.
- Mustard oil increased the nerve fiber responses to mechanical stress. This response was also found to be reduced after the application of icilin.
In IBS, abdominal pain is felt due to hypersensitivity of the gut nerves. This study explains why peppermint and certain herbal remedies reduce the symptoms of IBS. This study provides evidence for the TRPM8 expression in colonic afferent neurons. The intestinal nerve fiber and their connections in the spinal canal were identified by special tracers. The expression of TRPM8 channels that are involved in conducting sensory stimuli of cooling and altering the properties of mechanoreceptive colonic afferent endings were also studied. It was found that the application of cooling agents like icilin reduces the sensitivity of nerve fibers of the colon to mechanical stimulation. Peppermint and some herbal medicines also produce a cooling sensation and these agents might act and reduce the sensitivity of gut nerve fibers.
Study Abstract : A novel role for TRPM8 in visceral afferent function.
Source : fyi Living
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Mind/Body Psychological Treatments for Irritable Bowel Syndrome
Bruce D. Naliboff,1,2,3 Michael P. Fresé,1,2,3 and Lobsang Rapgay2
1UCLA Center for Neurovisceral Sciences and Women's Health, VAGLAHS, Bldg. 115, Rm. 223, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA
2Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
3Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA, USA
Currently, the goal of treatment for those with irritable bowel syndrome (IBS) is to improve the quality of life through a reduction in symptoms. While the majority of treatment approaches involve the use of traditional medicine, more and more patients seek out a non-drug approach to managing their symptoms. Current forms of non-drug psychologic or mind/body treatment for IBS include hypnotherapy, cognitive behavioral therapy and brief psychodynamic psychotherapy, all of which have been proven efficacious in clinical trials. We propose that incorporating the constructs of mindfulness and acceptance into a mind/body psychologic treatment of IBS may be of added benefit due to the focus on changing awareness and acceptance of one's own state which is a strong component of traditional and Eastern healing philosophies.
Source : eCAM 2008;5(1)41–50 doi:10.1093/ecam/nem046
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ROLE OF PROBIOTICS IN THE TREATMENT OF IRRITABLE BOWEL SYNDROME: POTENTIAL MECHANISMS AND CURRENT CLINICAL EVIDENCE
Viola Andresen and Daniel C. Baumgart
Department of Medicine, Division of Hepatology & Gastroenterology, Charité Medical School – Virchow Hospital, Humboldt-University of Berlin, Germany
Irritable bowel syndrome (IBS) is a highly prevalent functional gastrointestinal disorder affecting 3 to 15 % of the general population. It is characterized by unexplained abdominal pain, discomfort, and bloating in association with altered bowel
habits. The pathophysiology of IBS is not well understood, but most likely involves multiple causes. IBS has been associated
with abnormal gastrointestinal motor function, visceral hypersensitivity, psychosocial factors, autonomic dysfunction,
and inflammation. In a subgroup of patients, IBS develops after an acute bacterial infection of the bowel. Increased numbers of
inflammatory cells, such as mast cells and lymphocytes in the colonic mucosa of IBS patients suggest an ongoing state of
inflammation in these patients. Probiotics have been shown to have a beneficial effect in acute infectious diarrhea and
inflammatory bowel disease and thus could presumably be of potential benefit in postinfectious IBS. Another rationale for
using probiotics in IBS is their potential to influence fermentation processes and diminish gas production by changing
the colonic flora. Even though evidence from controlled clinical trials supporting a beneficial role of probiotics in the treatment
of IBS is still limited, improvement of different IBS symptoms and normalization of inflammatory cytokine levels have been
demonstrated. Small sample sizes and the use of different probiotic preparations complicate the interpretation and comparison
between different studies. While preliminary results are encouraging, the exact mechanism of action and their clinical
efficacy of Probiotics in ISB need to be studied in well designed experiments and larger randomized, controlled trials.
Source : International Journal of Probiotics and Prebiotics Vol. 1, pp. 11-18,
Link to Full Article
Meta-analysis of probiotics for the treatment of irritable bowel syndrome.
McFarland LV, Dublin S.
Department of Health Services Research and Development, VA Puget Sound Health Care System, Seattle WA 98101, United States.
Irritable bowel syndrome (IBS) is a chronic condition affecting 3%-25% of the general population. As no curative treatment is available, therapy is aimed at reducing symptoms, often with little success. Because alteration of the normal intestinal microflora has been observed in IBS, probiotics (beneficial microbes taken to improve health) may be useful in reducing symptoms. This paper systematically reviews randomized, controlled, blinded trials of probiotics for the treatment of IBS and synthesizes data on efficacy across trials of adequate quality. PubMed, Medline, Google Scholar, NIH registry of clinical trials, metaRegister, and the Cochrane Central Register of Controlled Trials were searched from 1982-2007. We also conducted secondary searches of reference lists, reviews, commentaries, relevant articles on associated diseases, books and meeting abstracts. Twenty trials with 23 probiotic treatment arms and a total of 1404 subjects met inclusion criteria. Probiotic use was associated with improvement in global IBS symptoms compared to placebo [pooled relative risk (RR pooled) 0.77, 95% confidence interval (95% CI) 0.62-0.94]. Probiotics were also associated with less abdominal pain compared to placebo [RR pooled = 0.78 (0.69-0.88)]. Too few studies reported data on other IBS symptoms or on specific probiotic strains to allow estimation of a pooled RR. While our analyses suggest that probiotic use may be associated with improvement in IBS symptoms compared to placebo, these results should be interpreted with caution, given the methodological limitations of contributing studies. Probiotics warrant further study as a potential therapy for IBS.
Source : World Journal of Gastroenterology
Link to Full Article
Efficacy of probiotics in irritable bowel syndrome: a meta-analysis of randomized, controlled trials.
Nikfar S, Rahimi R, Rahimi F, Derakhshani S, Abdollahi M.
Drug Selecting Committee, Food and Drug Organization, Food & Drug Laboratory Research Center, Ministry of Health & Medical Education, Tehran, Iran.
PURPOSE: This study was designed to evaluate whether probiotics improve symptoms in patients with irritable bowel syndrome.
METHODS: PubMed, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were searched for studies that investigated the efficacy of probiotics in the management of irritable bowel syndrome. Clinical improvement was the key outcome of interest. Data were searched within the time period of 1966 through September 2007.
RESULTS: Eight randomized, placebo-controlled, clinical trials met our criteria and were included in the analysis. Pooling of eight trials for the outcome of clinical improvement yielded a significant relative risk of 1.22 (95 percent confidence interval, 1.07-1.4; P = 0.0042).
CONCLUSIONS: Probiotics may improve symptoms of irritable bowel syndrome and can be used as supplement to standard therapy.
Source : Dis Colon Rectum. 2008 Dec;51(12):1775-80.
Link to Abstract
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