Introduction

It is known that the irregular rhythm of defecation in the form of constipation increases the risk of colorectal cancer by almost 2 times [1-3]. Constipation increases the risk of cardiovascular mortality by 39% - 56% [4 - 6]. Irregular bowel habit increases the risk of obesity, stroke and comorbidity [6 - 8]. However, the effect of irregular bowel habits on the risk of anxiety and depression remains poorly understood.

Aims & Methods

The aim was to screen irregularity of the circadian rhythm of defecation and the occurrence of anxiety and depression in cardiological patients.
We used the method of "Chronoenterography" – weekly monitoring of the regularity of the rhythm of defecation and the study of the level of Anxiety and Depression using a special questionnaire HADS and took into account the level of quality of life (SF-36). 66 patients (38 women and 28 men aged 40-79 years) who were hospitalized for metabolic syndrome in a cardiology clinic were examined.

Results

Irregular Bowel Habit (IBH) occurred in 65% of the examined patients (in 43 out of 66). Regular Bowel Habit (RBH) was detected in 35% of patients (in 23 out of 66). 3 stages of IBH have been identified. The first stage (mild, 5-6 bm/w) occurred in 61% of patients. The second stage (moderate, 3-4 bm/w) – in 30% of patients. The third stage of IBH (severe, 1-2 bm/w) – in 9% of patients. It should be noted that the first two stages of IBH were almost 10 times more common than the third (constipation stage). Anxiety and depression were not detected in patients with RBH. Subclinical anxiety in patients with mild stage of IBH was detected in 12% of cases, in patients with moderate stage of IBH – in 33% of cases, in patients with severe stage of IBH – in 57% of cases. Subclinical depression in patients with mild stage of IBH was diagnosed in 12% of cases, in patients with moderate stage of IBH – in 17% of cases, in patients with severe stage of IBH – in 43% of cases. Consequently, a progressive dependence of the level of anxiety and depression on the stage of severity of IBH was revealed. In patients with a Regular Bowel Habit, an "excellent" quality of life was found in 55% of cases. Among patients with IBH, "Excellent" quality of life was found in 10% of cases. Consequently, the probability of an "Excellent" quality of life in patients with RBH was 5 times higher than in patients with IBH. Patients with IBH have an almost 5-fold increased risk of deterioration in the quality of life.

Conclusion

1. Irregular Bowel Habit was detected in 63% of cardiac patients.
2. Irregular Bowel Habit increases the risk of subclinical anxiety gradually from mild to moderate and severe stages of this habit (12%, 33% and 57%, respectively).
3. Irregular Bowel Habit increases the risk of subclinical depression gradually from mild to moderate and severe stages of this habit (12%, 17% and 43%, respectively).
4. A high level of quality of life in patients with a regular (daily) Bowel Habit was 5 times more common than in patients with an Irregular Bowel Habit.

References

1. Guerin A, et al. Risk of developing colorectal cancer and benign colorectal neoplasm in patients with chronic constipation. Alim. Pharm. Ther. 2014 Jul; 40(1):83-92.
2. Kojima M, et al. Bowel movement frequency and risk of colorectal cancer in a large cohort study of Japanese men and women. Br J Cancer 2004 Apr 5; 90(7): 1397–1401.
3. Watanabe T, at al. Constipation, laxative use and risk of colorectal cancer: The Miyagi Cohort Study. Eur J Cancer 2004 Sep;40(14):2109-15. 4. Honkura K., et al. Defecation frequency and cardiovascular disease mortality in Japan. Atherosclerosis. 2016. N246. P. 251–256.
5. Kubota Y., et al. Bowel Movement Frequency, Laxative Use, and Mortality From Coronary Heart Disease and Stroke Among Japanese Men and Women: JACC Study. J Epidemiol. 2016
May 5; 26(5):242-248.
6. Sundbøll J, et al. Constipation and risk of cardiovascular diseases: a Danish population-based matched cohort study. BMJ Open. 2020 Sep 1;10(9): e037080. 7. Shemerovskii K.A. Irregular Bowel Habit Increases Risk of Obesity. United European Gastroenterology Journal. 2015. № A504. P1223. 8. Shemerovskii K.A., et al. Bradyenteria Syndrome and Comorbidity. United European Gastroenterology Journal, Vol. 10. October, 2022. An international forum for clinical practice and
research in gastroenterology. 2022, P.1081. P1003.

Introduction

Irritable bowel syndrome (IBS) is considered a disorder of the altered microbiota-gut-brain axis, where gut dysbiosis and impaired central nervous system processing play important roles. The latter, in the form of depression, anxiety, and gastrointestinal-specific anxiety (GSA), frequently coexist and exacerbate IBS. Probiotics might be a promising therapeutic approach to treat IBS and coexisting depression, anxiety, and GSA.

Aims & Methods

The aim of the trial was to compare the impact of standard care combined with multi-strain probiotics with standard care alone on depression, anxiety, and visceral sensitivity in patients with diarrheal IBS (IBS-D). It was a 12-week randomized trial that included 108 patients with IBS-D that were divided into 2 groups: a control group (n = 51) receiving only standard care (diet, peppermint oil) and an experimental group (n = 57) receiving a combination of standard care (diet, peppermint oil) and the study probiotic (based on Lactobacillus, Streptococcus, Bifidobacterium, and Saccharomyces boulardii strains). Patient Health Questionnaire-9 (PHQ-9) and Beck’s Depression Inventory (BDI) were used to assess depression; the Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression; and the Visceral Sensitivity Index (VSI) was used to assess GSA.

Results

Baseline data were not different between the study groups (p> 0.05). After 12 weeks of treatment, PHQ-9, BDI, and anxiety subscale of HADS were not different between the study groups (p> 0.05), while the central tendency of the depression subscale of HADS in the control group was higher (3 (2-4)) than in the experimental group (3 (2-3)), p = 0.046. VSI was higher in the control group (31±5) compared to the experimental group (29±5.7), p = 0.032, after 12 weeks of trial.

Conclusion

In patients with IBS, additional prescribing of a multi-strain probiotic led to a decrease in depression according to HADS, as well as a reduction in GSA and visceral sensitivity assessed by VSI compared to IBS standard care alone.

Introduction

Irritable bowel syndrome (IBS) is a disorder of gut-brain interactions that combines abdominal pain and transit disorders in the Rome IV classification. The severity of IBS varies from patient to patient and is influenced by psychological comorbidities such as anxiety and depression. Alexithymia, also called emotional blindness, is the difficulty in identifying and expressing one's own emotions and feelings or those of others, and is present in 2-20% of healthy subjects. It is frequently found in different types of chronic pain disorders and has also been described in IBS (1). The association between alexithymia and pain intensity varies according to the studies and the type of pain, however. The aim of our study was to assess the prevalence of alexithymia in patients with IBS and to look for links between this trait and both the clinical phenotype of the disorder and the levels of anxiety and depression of the patients.

Aims & Methods

This study was carried out, after approval from a local ethics committee, between January and August 2023 in consecutive patients suffering from IBS according to Rome IV criteria assessed in a multidisciplinary day hospital setting (workup by a neurogastroenterologist, a dietician and a psychologist). Clinical characteristics (age, gender, subtype of IBS, disease duration and severity (IBS-SSS)), levels of anxiety-depression (HADS), quality of life (EQ-5D) and alexithymia (TAS-20, a score composed of 20 questions rated from 1 to 5, maximum score of 100, high-level cutoff >60) were recorded.

Results

We included 76 IBS patients (67.1% female; mean age 48.3 ± 16.9 years; BMI 22.1 ± 4.0 kg/m²). The median duration of the disorder was 13 years (IQR 6.7 - 26.4). All subtypes were represented (IBS-D 27.6%, IBS-C 48.7% and IBS-M 17.1%). The majority of patients had a moderate-severe disorder, with a mean IBS-SSS score of 318 ± 107 points (minimal, moderate and severe forms in 1.3%, 34.7% and 58.7% respectively, and remission in 5.3%). Quality of life was impaired, with a median EQ-5D health score of 50 (IQR 35.0-69.5). The HADS-A subscore was 10.8 ± 4.4 points, with 59.7% of patients with definite anxiety (>11), while the HADS-D subscore was 6.2 ± 3.6 points, with 16.4% of patients with definite depression (>11). The total HAD score was 17.0 ± 6.7 points. The severity of IBS was correlated with depression (rho 0.35, p=0.005) and inversely correlated with quality of life (rho -0.28, p=0.02) scores. The mean alexithymia score was 58.7 ± 9.8 points, with 45.4% of patients having a high level of alexithymia (TAS-20 >60). The level of alexithymia was not different between men and women (58.1 ± 9.5 vs 59.8 ± 10.2; p=0.48) and was not influenced by the duration of the disorder (p=0.92). Alexithymia correlated well with anxiety (rho 0.33, p=0.007), depression (rho 0.36, p=0.003) and quality of life (rho -0.31, p=0.016) scores but not with IBS severity (rho 0.17, p=0.18). However, the level of IBS severity was greater in the case of high levels of alexithymia (IBS-SSS of 359.2 ± 73.1 vs 298.4 ± 107.7 points for a TAS-20 > 60 vs ≤ 60; p=0.009).

Conclusion

In this series of patients with moderate-severe IBS and all subtypes, a high level of alexithymia was found in almost one out of two patients. Alexithymia was linked to the level of anxiety-depression and the deterioration in quality of life. Patients with a high level of alexithymia had more severe IBS. The prognostic value of alexithymia for the response to treatments such as hypnotherapy and cognitive behavioural therapies deserves to be evaluated in patients with IBS.

References

(1) Porcelli et al. Alexithymia and gastrointestinal-specific anxiety in moderate to severe irritable bowel syndrome. Comprehensive Psychiatry 2014; 55: 1647-1663.

Introduction

IBS is a a condition which is highly denigratory to patients' quality of life, is often under-diagnosed and is managed through a mixture of diet/lifestyle modifications, treatments and psychological interventions. The following piece of research aims to understand the management patterns and emotional impact of the condition in the IBS population.

Aims & Methods

Surveys were deployed in ten countries (n=1,250 per country, total n=12,500). People were invited to complete the survey if they were aged 18-75, suffering from at least one of the following; constipation, diarrhoea, wind/bloating, abdominal pain, irregular bowel movements or ‘IBS’. With at least one incident in the past month.

Results

9% of the surveyed population reported IBS, with 78% of this group having a diagnosis from a healthcare professional. Key triggers of symptoms were; stress (48%), food allergy/intolerance/sensitivity (20%), poor sleep (19%), infection (18%).
37% used medication, 31% used biotics, 22% diet and home remedies, 18% used supplements. Dissatisfaction with regular treatment were that most treatment options only treat the symptom but not the underlying cause, with females managing their symptoms through diet/lifestyle changes more than males.
The emotional impact in the IBS is very high in prevalence and broad in scope. 71% of IBS sufferers felt worried, anxious or stressed about their symptoms. 62% felt frustrated and fed up. 39% felt embarrassment and negative impact to their confidence. Only 5% were not bothered by their symptoms.

Conclusion

The survey gave insight into management patterns of IBS patients, demonstrating a variety of treatments used. Surprisingly, a high number of IBS patients use biotics despite low quality of evidence. It was evident that IBS is a condition with a high emotional toll. Further qualitative research should delve further into these insights to further understand the patient population.

References

Quantitative U&A 2025- Lower GI - IBS deep dive

Disclosure

This survey was funded by Reckitt. Authors are Reckitt employees.

Introduction

Gastrointestinal functional disorders, including irritable bowel syndrome (IBS), are the gastroenterological disorders with the most frequent epidemiology in the general population. Among university students (medical and nursing), there is an increased prevalence of IBS, so much so that it has repeatedly been called a "global challenge." However, despite this, data in such populations are still scarce and not fully represented in all geographic people considering the wide variability that the epidemiology of IBS encounters moving latitude and longitude. In southern Europe and, in detail, in Italy, data in this regard are lacking.

Aims & Methods

In this cross-sectional observational survey study (VANVITELLI-IBS Study), undergraduate medical and nursing students were enrolled and sent an anonymous questionnaire. The latter was sent only after a careful interview with the gastroenterologists included in the study that excluded red flags of organic gastrointestinal disease. Criteria suggestive for diagnosing IBS according to ROME IV were assessed in the questionnaire. In addition, clinic-demographic variables and variables related to university life (i.e., year of study, being on or off campus, possible receipt of scholarships or being in a delayed time-to-degree condition (i.e., outside prescribed time) were collected. In addition, the "Beck Anxiety Questionnaire Inventory" (BAI) and the "PREDIMED questionnaire" were provided. The former assesses anxiety symptoms, the latter the degree of adherence to the Mediterranean diet.

Results

Two hundred and fifty students were considered for enrolment; however, 89 participants were excluded (39 due to flags of non-functional gastrointestinal disorders and 50 refused to take the questionnaire). In the end, 161 patients were included. Of these, 34/161 met the criteria for IBS according to ROME IV [age 22 (21 - 25.25) years, 17 (50%) males and 17 (50%) females, 22 (65.7%) medical students and 12 (35.3%) nursing students] while 127/161 did not [age 22 (21 - 24) years, 59 (46.5%) males and 68 (53.5%) females, 59 (46.5%) medical students and 68 (53.5%) nursing students]. In addition, students who declared Bristol 1-2 stool in more than 25% of cases and Bristol 6-7 stool in less than 25% were 11/34 (32.35%) compatible with IBS-C. Those who declared an inverse percentage ratio (consistent with IBS-D) were 5/34 (14.7%). The remainder of the students (18/34, 52.9%) had a mixed phenotype (IBS-M). The rate of outside prescribed time was higher in IBS-positive than in IBS-negative (29.4% vs 4.7%, p=0.000168), while on the contrary, for that of perceived scholarship (14.7% vs 33.9%, p=0.035). BAI levels were different between positive and negative IBS [17.5 (10.5 - 40) vs 13 (7 - 20), p=0.002] as were those of PREDIMED score [4 (2.75 - 6) vs 7 (3 - 10), p=0.009]. In binary logistic regression, being outside the prescribed time was associated with a higher likelihood of IBS occurrence (OR: 8.403, p=0.000155); the opposite behaviour was for adherence to the Mediterranean diet (OR: 0.258, p=0.002). No correlations between the PREDIMED score and BAI (τ= - 0.38; p=0.493) and no significant changes in BAI (p=0.205) and PREDIMED (p=0.641) as a function of students' year of enrolment were found. More than half of the sample (61.75%) had moderate-to-severe anxiety levels, and 73.52% of the students adhered poorly to the Mediterranean diet in the IBS group.

Conclusion

This study confirms how IBS, in this setting, is a significant epidemiological problem and campaigns in favour of the Mediterranean diet and proper anxiety management could be helpful.

References

- Oka P, Parr H, Barberio B, Black CJ, Savarino EV, Ford AC. Global prevalence of irritable bowel syndrome according to Rome III or IV criteria: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020 Oct;5(10):908-917.
- Martínez-González MA, García-Arellano A, Toledo E, et al. A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: the PREDIMED trial. PLoS One. 2012;7(8):e43134.
- Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988 Dec;56(6):893–7.
- Yang W, Yang X, Cai X, Zhou Z, Yao H, Song X, Zhao T, Xiong P. The Prevalence of Irritable Bowel Syndrome Among Chinese University Students: A Systematic Review and Meta-Analysis. Front Public Health. 2022 Apr 15;10:864721.
- Elmaliklis IN, Liveri A, Ntelis B, Paraskeva K, Goulis I, Koutelidakis AE. Increased Functional Foods' Consumption and Mediterranean Diet Adherence May Have a Protective Effect in the Appearance of Gastrointestinal Diseases: A Case⁻Control Study. Medicines (Basel). 2019 Apr 9;6(2):50.

Introduction

Irritable bowel syndrome (IBS) is among the most prevalent gastrointestinal conditions. However, its therapeutic management poses challenges, with many current recommendations resting on a low level of evidence.

Aims & Methods

Our objective is to conduct a systematic review with meta-analysis of randomized, double-blind, placebo-controlled trials to assess the efficacy of antidepressants in treating IBS. ​
Systematic review with meta-analysis performed according to PRISMA guidelines and registered on the PROSPERO platform (CRD42024502427). PubMed, EMBASE, and The Cochrane Library platforms were searched from inception to January 2024. Only randomized, double-blind, placebo-controlled trials, conducted in patients with IBS patients, with a minimum treatment period of 4 weeks, were included. The quality of evidence was assessed using the revised version of the Cochrane tool (RoB 2). A random-effects model was used. Heterogeneity was assessed by the I² statistics. Funnel plots and the Egger test were used to assess publication bias. Statistical analysis was performed using STATA v16.

Results

The search strategy identified 1340 studies, of which 16 were included, totaling 1428 patients. Among these studies, 733 patients were assigned to the antidepressant group and 698 to the placebo group. In the intervention group, 405 (55.3%) patients reported improvement, compared to only 227 (32.5%) patients in the placebo group. The meta-analysis showed that the use of antidepressants in patients with IBS provides a benefit in overall symptom improvement (OR=3.02; 95% CI 2.16-4.2) compared to placebo.
A subgroup analysis of 9 studies, comprising 1008 patients, assessed the efficacy of tricyclic antidepressants (TCAs) in the same setting and revealed similar results (OR=3.39, 95% CI 2.24-5.12), as did the sub-analysis of 6 studies (including 363 patients) evaluating the efficacy of selective serotonin reuptake inhibitors (SSRIs) (OR= OR=2.39, 95% CI 1.14-5.01). The efficacy also extends to patients refractory to first-line measures (6 studies including 713 patients) (OR=2.96, 95% CI 1.67-5.25) and to patients without psychopathology (8 studies including 471 patients) (OR=2.92, 95% CI 1.6-5.31). Concerning symptoms, a sub analysis also confirmed the efficacy of antidepressants specifically both in the improvement of abdominal pain (OR=4.33, 95% CI 2.1-8.93) and in abdominal distension (OR=2.68, 95% CI 1.42-5.04).
Only in the sub-analysis assessing the efficacy of SSRIs and of the improvement of abdominal pain, I² was slightly >60%, indicating substantial heterogeneity, but <75%. Causes of heterogeneity were searched. Publication bias was detected, and potential sources were identified. Sub-analysis without the studies identified as sources of this bias revealed similar results with lower heterogeneity.

Conclusion

Antidepressants, including both TCAs and SSRIs, demonstrate efficacy in patients with IBS, presenting a validated treatment option supported by evidence. Moreover, these medications can be beneficial to patients resistant to initial treatments and those lacking psychopathological symptoms.

References

Drossman DA, Tack J, Ford AC, Szigethy E, Törnblom H, Van Oudenhove L. Neuromodulators for Functional Gastrointestinal Disorders (Disorders of Gut−Brain Interaction): A Rome Foundation Working Team Report. Gastroenterology 2018;154:1140-1171.e1. https://doi.org/10.1053/j.gastro.2017.11.279.
Lacy BE, Pimentel M, Brenner DM, Chey WD, Keefer LA, Long MD, et al. ACG Clinical Guideline: Management of Irritable Bowel Syndrome. Am J Gastroenterol 2021;116:17–44. https://doi.org/10.14309/ajg.0000000000001036.
Lovell RM, Ford AC. Global Prevalence of and Risk Factors for Irritable Bowel Syndrome: A Meta-analysis. Clin Gastroenterol Hepatol 2012;10:712-721.e4. https://doi.org/10.1016/j.cgh.2012.02.029.
Vasant DH, Paine PA, Black CJ, Houghton LA, Everitt HA, Corsetti M, et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut 2021;70:1214–40. https://doi.org/10.1136/gutjnl-2021-324598.

Disclosure

FP received speaker fees from Abbvie, Falk, Ferring, Janssen, Pfizer, Pharmakern, Takeda and Tillotts. The other authors have no conflict of interest.