Introduction

Although urgency and sensation of incomplete evacuation are common symptoms in IBS, their relationship with other symptoms and gut physiology is still unclear.

Aims & Methods

We included IBS patients (Rome II-IV criteria) who participated in pathophysiology and treatment studies. The severity of urgency and sensation of incomplete emptying was graded using individual items of the Gastrointestinal (GI) Symptom Rating Scale-IBS (GSRS-IBS) and dichotomized into low (no to mild symptoms) and high symptom severity (moderate to severe symptoms). We investigated the association between these symptoms and the severity of other GI symptoms (GSRS-IBS), psychological distress (HADS), oro-anal transit time (OATT; radiopaque markers), rectal sensitivity (balloon distensions), and overlapping disorders of gut-brain interactions (DGBI) diagnosed using ROME questionnaire.

Results

We included 1084 patients with IBS (74% females, mean age 38±13 years; 33% IBS-C, 31% IBS-D, 14% IBS-M, and 22% IBS-U). High severity of urgency (55%) and sensation of incomplete evacuation (67%) were both highly prevalent. Among IBS subtypes, high severity of urgency was most prevalent in IBS-D and IBS-M (67 and 68% respectively) and sensation of incomplete emptying in IBS-C and IBS-M (73 and 75%). High severity of urgency was associated with more severe GI symptoms overall, except for constipation and hard stools, where the opposite pattern was seen (Table 1). The largest effect sizes among the GI symptoms were seen for diarrhea and loose stools. In addition, IBS patients with high severity of urgency demonstrated faster transit, rectal hypersensitivity and more severe psychological distress. For sensation of incomplete evacuation, the opposite pattern compared with urgency was seen for diarrheal and constipation symptoms, and with the largest effect sizes for constipation and hard stools. The sensation of incomplete evacuation was associated with slower OATT and more severe psychological distress, but not with rectal sensitivity. With increasing number of overlapping DGBI, there was a gradual increase in the severity of urgency (η²=0.026; p=0.003) and sensation of incomplete evacuation (η²=0.043; p<0.001).
Table 1. Characteristics of IBS patients with high vs low severity of urgency and sensation of incomplete evacuation, respectively.

Conclusion

Urgency and sensation of incomplete evacuation are common in IBS and predominantly associated with bowel habits. These symptoms are associated with transit, rectal hypersensitivity, overlapping DGBI and psychological distress supporting the relevance of gut-brain interactions in the pathophysiology of IBS symptoms.

Introduction

Studies have shown that adults with irritable bowel syndrome (IBS) may be associated with anxiety, mood disorders, chronic headache, and other neuropsychiatric conditions. This growing body of evidence can allude to a possible bidirectional gut-brain connection. While adolescence is the age when both IBS and neuropsychiatric illnesses often first manifest, this population remains under-studied.

Aims & Methods

We aim to assess the association between the presence of irritable bowel syndrome (IBS) and neurologic and psychiatric disorders in a nationwide cohort of adolescents. This cross-sectional study included all adolescents aged 16-21 who underwent mandatory medical evaluations as part of their conscription between 2000-2021. All individuals completed comprehensive medical interviews. Suspected diagnoses prompted referral to board-certified specialists for confirmation and severity grading based on predefined criteria. IBS was diagnosed according to the Rome II-IV criteria by a certified gastroenterologist.
Neurologic disorders included attention-deficit/hyperactivity disorder [ADHD], epilepsy, chronic headache, sleep disorders. Psychiatric disorders included psychotic, personality, general anxiety disorder [GAD], non-combat post-traumatic stress disorder [PTSD], mood, dissociative, and eating disorders. Each diagnosis was classified by severity (mild, moderate, severe). Unadjusted and multivariate-adjusted logistic regression models were fitted to estimate odds ratios (ORs) for associations with IBS. The adjusted models were accounted for age, sex, intelligence score, body mass index (BMI), socioeconomic status (SES), education, country of origin, and any concurrent neuropsychiatric diagnoses.

Results

The study included 1,561,717 adolescents (666,442 [42%] women, mean age 17.4 ± 1.4 years), of whom 7,230 (0.46%) were diagnosed with IBS (4,778 mild; 1,948 moderate; 504 severe). Neurologic disorders were present in 1,661 (23.0%) and 143,348 (9.2%) of those with and without IBS, respectively. The respective numbers of people with psychiatric disorders were 773 (10.7%) and 49,889 (3.2%). In multivariable adjusted models, those with IBS were more likely to have chronic headache (aOR 4.7, 95% CI: 4.4-5.1), GAD (aOR 3.6, 95% CI: 3.2-3.9), eating disorders (aOR 2.6, 95% CI: 1.9-3.5), mood disorders (aOR 2.5, 95% CI: 2.1-3.1), personality disorders (aOR 2.5, 95% CI: 2.1-2.9), and dissociative disorders (aOR 19.1, 95% CI: 12.5-28.9). Patients with severe IBS (n=504) were independently associated with the presence of at least one severe neurologic (aOR 2.9, 95% CI: 1.2-7.1) or psychiatric disorder (aOR 3.8, 95% CI: 2.6-5.4).

Conclusion

In this large nationwide cohort, adolescents with IBS were more likely to have several tested neurologic and psychiatric disorders, compared to those without IBS. Longitudinal studies are needed to explore the directionality and long-term implications of these associations.

Introduction

Irritable bowel syndrome (IBS) has a profound impact on health-related quality of life. Increasing evidence suggests psychological factors have a large impact in the development and course of IBS, and in particular quality of life, with large individual heterogeneity. This observational study aims to investigate the influence of personality traits using the Big Five Inventory (BFI) and examine their associations with abdominal pain, general and gastrointestinal-specific anxiety, and quality of life in patients with IBS.

Aims & Methods

Data from a large observational study in patients with IBS (Rome III criteria) was used, in which patients completed questionnaires with regards to personality traits (BFI-44), symptom severity, general anxiety, GI-specific anxiety, and quality of life. Multivariable regression models and a network correlation analysis were used to determine underlying associations.

Results

194 patients were included for analysis (74.7% female, mean age 51.36 years). There was a positive association of neuroticism to GI-specific anxiety (B 7.234, P = 0.040) and general anxiety (B 0.954, P = 0.040) with a strong negative association to mental quality of life (B – 3.576, P = 0.007). In addition, a strong negative association of agreeableness to mental quality of life was found (B – 4.266, P = 0.001). Although there were no significant associations of personality traits to abdominal pain, positive associations were found regarding general anxiety (B 6.304, p < 0.001) and GI-specific anxiety (B 0.034, P <0.001) of abdominal pain. There were no associations found with regards to the other personality traits openness, conscientiousness or extroversion.

Conclusion

IBS patients with a higher level of neuroticism were more likely to experience higher levels of GI-specific and general anxiety. The trait neuroticism and/or agreeableness was more likely to have a significant lower mental quality of life in IBS. These findings emphasize the contribution of personality traits in the pathophysiology and course of IBS, pleading for a more personalized approach in patient management.

Introduction

Irritable bowel syndrome (IBS) is one of the most prevalent chronic disorders worldwide, with considerable social and economic burden. Gut microbiome impairment is one of the potential pathogenic pathways of IBS, especially in its post-infectious form (PI-IBS).
To date, untargeted therapeutic microbiome modulation (i.e. probiotics, antibiotics, FMT) has achieved conflicting results in patients with dysbiosis-associated chronic disorders, including IBS and PI-IBS,while the inter-individual variability and the plasticity of gut microbiome supports its personalized manipulation.
In this study we performed microbiome-profiling in order to have a precision, microbiome-based approach to PI-IBS.

Aims & Methods

This is a pilot prospective, single-center, case-control study. Our aim was to describe outcomes of targeted microbiome modulation, informed by gut microbiome testing, in patients with PI-IBS referred to our Microbiome clinic, compared with a control group including PI-IBS patients managed at our General Gastroenterology outpatient clinic. PI-IBS was diagnosed according to Rome IV criteria.
Cases included patients treated in our Microbiome Clinic according to their gut microbiome testing. At baseline visit, a commercial stool microbiome testing based on 16S rRNA sequencing was prescribed. After test results, each patient received a personalized treatment to target gut microbial defects. Specifically, in the presence of increased abundance of pathobionts, or overgrowth of non-symbiont taxa, we envisaged their direct suppression by nonabsorbable antibiotics (rifaximin, neomycin-bacitracin, paromomycin) or went for the increase of beneficial taxa to enable microbial competition against them, using pre- or probiotics. In the case of low α-diversity and/or decreased abundance of specific beneficial taxa we prescribed pre- and/or probiotics to upregulate them, depending on the specific defect. When relevant, based on their microbial profile, patients received antibiotics before pre- and/or probiotics.
Controls included patients managed at our General Gastroenterology outpatient clinic who received empirical treatment according to physician’s choice.
All patients were evaluated with the IBS symptom severity scale (IBS-SSS) at baseline and after the end of treatments (±7 days). Response to treatments was defined as decrease in IBS-SSS score ≥50 points.

Results

Overall, 33 patients (13 cases and 20 controls) were enrolled. The two populations were homogeneous in terms of IBS subtypes and baseline IBS-SSS scores. Overall, the type and duration of treatments did not differ significantly between the two groups. Traditional dietary advices for IBS, without specific nutritional counselling, were given in both groups.
All patients in the group of cases (100%) and 11 of 20 patients in the control group (55%) experienced treatment response (decrease in IBS-SSS score ≥ 50 points), with a significant difference between groups (p< 0.0001). The mean IBS-SSS score after treatments was 163 in cases and 231 in controls (p= 0.01). The mean reduction in IBS-SSS score was 167 in cases and 74 in the control group (p= 0.001). Compared with controls, cases experienced significantly lower IBS-SSS subscores after treatments for satisfaction of bowel habits (p= 0.03), bloating (p= 0.04) and quality of life (p= 0.009).

Conclusion

This pilot study represents the first microbiome-based and personalized approach to PI-IBS. Our preliminary findings suggest that targeted microbial modulation, informed by microbiome profiling, might be effective in managing PI-IBS

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Disclosure

None