Symptomatology of gastrointestinal disease

The skilful analysis of symptoms indicating disorders of the digestive system is an integral part of the practice of internal medicine. Many patients with abdominal symptoms do not have easily defined organic conditions. The traditional skills of taking a careful history and examining the patient thoroughly are invaluable in managing patients who have functional disorders such as ‘irritable bowel’, nonulcer dyspepsia, nonspecific diarrhoea, recurrent abdominal pain, and somatization disorder. The enormous advances in endoscopy, scanning, and other investigative techniques have not made clinical diagnosis less important. Most gastrointestinal disorders are minor self-limited conditions of uncertain cause or are functional in nature, thereby often eluding definition even if extensive diagnostic procedures are (unnecessarily) employed. At the other extreme, the early suspicion of life-threatening disease and prompt referral of patients for investigation depends on clinical judgement.

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Irritable bowel syndrome and biliary tract pathology. Clinical analysis

Medical Council ◽

10.21518/2079-701x-2020-15-28-38 ◽

2020 ◽

pp. 28-38

Author(s):

T. E. Polunina

Keyword(s):

Irritable Bowel Syndrome ◽

Abdominal Pain ◽

Gastrointestinal Tract ◽

Biliary Tract ◽

Emotional Health ◽

Biological Marker ◽

Recurrent Abdominal Pain ◽

Clinical Analysis ◽

Functional Disorders ◽

Irritable Bowel

Irritable bowel syndrome (IBS) – a recurrent functional disorder of the gastrointestinal tract (GIT), the main symptom of which is abdominal pain necessarily associated with a change in intestinal function. IBS is a functional intestinal disorder in which recurrent abdominal pain is associated with a defecation act and a change in the frequency or shape of the stool. The diagnosis of IBS remains exclusively clinical. The difficulty in studying IBS, especially from the perspective of its epidemiology, is that there is still no universal and specific biological marker. Very often patients complain about symptoms typical for several functional disorders, in particular, biliary tract pathology and IBS. The article discusses the multi-component causes and mechanisms of IBS formation, which are also present in other functional gastrointestinal tract diseases. Patients with IBS often have functional disorders of the biliary tract (FDBT) that are not associated with organic pathology. There are no reliable differences in the frequency and nature of FDBT in patients with IBS, depending on its current variant - with constipation or diarrhea prevalence. As a result, the treatment of patients with IBS remains a challenge, and the recurrence of the disease depends on the state of psycho-emotional health, the presence of overlap syndrome in most cases. The article presents the main international criteria for diagnostics of IBS. The main approaches to the treatment of IBS are considered. Good results in the treatment of IBS are observed when using drugs that affect the complex of pathophysiological mechanisms of the disease. This is confirmed in the article by a clinical case study. The prescription of the Sparex drug for pain relief in a patient with IBS and FDBT is justified by the fact that it not only eliminates pain, but also improves the rheological properties of bile, typical for overlap “IBS-FDBT” syndrome.

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Identification of potential biomarkers for abdominal pain in IBS patients by bioinformatics approach

BMC Gastroenterology ◽

10.1186/s12876-021-01626-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhongyuan Lin ◽

Yimin Wang ◽

Shiqing Lin ◽

Decheng Liu ◽

Guohui Mo ◽

...

Keyword(s):

Gene Expression ◽

Irritable Bowel Syndrome ◽

Abdominal Pain ◽

Gastrointestinal Disease ◽

Rectal Mucosa ◽

Interaction Network ◽

Enrichment Analysis ◽

Functional Enrichment ◽

Irritable Bowel ◽

Potential Biomarkers

Abstract Background Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disease characterized by chronic abdominal discomfort and pain. The mechanisms of abdominal pain, as a relevant symptom, in IBS are still unclear. We aimed to explore the key genes and neurobiological changes specially involved in abdominal pain in IBS. Methods Gene expression data (GSE36701) was downloaded from Gene Expression Omnibus database. Fifty-three rectal mucosa samples from 27 irritable bowel syndrome with diarrhea (IBS-D) patients and 40 samples from 21 healthy volunteers as controls were included. Differentially expressed genes (DEGs) between two groups were identified using the GEO2R online tool. Functional enrichment analysis of DEGs was performed on the DAVID database. Then a protein–protein interaction network was constructed and visualized using STRING database and Cytoscape. Results The microarray analysis demonstrated a subset of genes (CCKBR, CCL13, ACPP, BDKRB2, GRPR, SLC1A2, NPFF, P2RX4, TRPA1, CCKBR, TLX2, MRGPRX3, PAX2, CXCR1) specially involved in pain transmission. Among these genes, we identified GRPR, NPFF and TRPA1 genes as potential biomarkers for irritating abdominal pain of IBS patients. Conclusions Overexpression of certain pain-related genes (GRPR, NPFF and TRPA1) may contribute to chronic visceral hypersensitivity, therefore be partly responsible for recurrent abdominal pain or discomfort in IBS patients. Several synapses modification and biological process of psychological distress may be risk factors of IBS.

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Irritable Bowel Syndrome with Constipation

10.2310/gastro.5444 ◽

2015 ◽

Author(s):

Loni Tang ◽

Brooks D. Cash

Keyword(s):

Irritable Bowel Syndrome ◽

Differential Diagnosis ◽

Abdominal Pain ◽

Digital Rectal Examination ◽

Recurrent Abdominal Pain ◽

Differential Diagnoses ◽

Rectal Examination ◽

Stool Form ◽

Alarm Features ◽

Irritable Bowel

Irritable bowel syndrome (IBS) is characterized by recurrent abdominal pain or discomfort that has occurred at least 3 days per month in the 3 months prior to diagnosis. One of the subtypes of this disorder is IBS with constipation (IBS-C), where individuals experience hard or lumpy stools at least 25% of the time and loose or watery stools less than 25% of the time with defecation. This review addresses IBS-C, detailing the epidemiology, etiology, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, and prognosis. A figure shows the Bristol stool form scale. Tables list IBS subtypes, components of digital rectal examination, differential diagnoses for IBS and IBS-C, alarm features, and the American College of Gastroenterology Recommendations. This review contains 1 highly rendered figure, 6 tables, and 71 references.

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Letter To The Editor

PEDIATRICS ◽

10.1542/peds.46.6.970 ◽

1970 ◽

Vol 46 (6) ◽

pp. 970-971

Author(s):

John A. Askin

Keyword(s):

Abdominal Pain ◽

Recurrent Abdominal Pain ◽

Not Given ◽

Letter To The Editor ◽

Symptom Complex ◽

Irritable Bowel ◽

Taking Care

I would like to comment upon the leading article in Pediatrics for May 1970, "Recurrent Abdominal Pain in Childhood," by Robert F. Stone and Giulio J. Barbero. In the attempt by the authors to define the "Symptom Complex Of The Irritable Bowel Complex Syndrome" they have not given sufficient consideration to the possibility of anomaly of the excretory tract being the cause of the recurrent abdominal pain. I think that every one with any experience in taking care of children will agree that recurrent abdominal pain in childhood is a very common problem.

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Irritable bowel syndrome

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0308 ◽

2020 ◽

pp. 2951-2959

Author(s):

Adam D. Farmer ◽

Qasim Aziz

Keyword(s):

Irritable Bowel Syndrome ◽

Abdominal Pain ◽

Recurrent Abdominal Pain ◽

Bowel Habit ◽

Western World ◽

Older Individuals ◽

Butyl Bromide ◽

Rome Iii ◽

Fermentable Carbohydrates ◽

Irritable Bowel

Symptoms suggestive of disturbed lower gastrointestinal function without adequate explanation are very common in adults in the Western world, up to 15% of whom experience such symptoms at any one time, although most do not seek medical advice. The currently used terms are best viewed as an attempt to provide some clinically useful, rather than pathophysiologically accurate, categorization of patients and their symptoms based on disordered gut–brain interactions. Irritable bowel syndrome is defined according to the Rome III criteria as recurrent abdominal pain or discomfort associated with a change in bowel habit for at least 6 months, with symptoms experienced on at least 3 days of at least 3 months. Many subtypes are recognized. Routine haematological and biochemical screening is usually performed on the assumption that it will be normal. Features that raise the suspicion of organic disease and indicate a need for further investigation include the onset of symptoms in middle-aged or older individuals, weight loss, or blood in the stool. Management remains empirical: no single pharmacological agent or group of agents has ever been found to be consistently effective. The principal task of the physician is to provide explanation and reassurance (sometimes supplemented by psychological treatments), but particular symptoms are often treated as follows: (1) constipation—defecation may be eased by supplementary dietary fibre and poorly absorbed fermentable carbohydrates which increase faecal bulk and soften the stool; osmotic laxatives and enemas are used for the severely constipated patient, as well as more novel agents; (2) diarrhoea—attention to diet is often helpful, as are simple antidiarrhoeal agents; and (3) abdominal pain—antispasmodics (e.g. hyoscine butyl bromide) are frequently used, as are antidepressants.

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Recurrent Abdominal Pain in Children: Forerunner to Adult Irritable Bowel Syndrome?

Journal for Specialists in Pediatric Nursing ◽

10.1111/j.1088-145x.2003.00081.x ◽

2003 ◽

Vol 8 (3) ◽

pp. 81-89 ◽

Cited By ~ 19

Author(s):

Monica Jarrett ◽

Margaret Heitkemper ◽

Danita I. Czyzewski ◽

Robert Shulman

Keyword(s):

Irritable Bowel Syndrome ◽

Abdominal Pain ◽

Recurrent Abdominal Pain ◽

Irritable Bowel

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A Double Blind Randomized Clinical Trail: Comparing Lactobacillus plantarum 299v with Placebo in treating irritable bowel syndrome patients

10.21203/rs.2.23376/v1 ◽

2020 ◽

Author(s):

Moeen-ul- haq ◽

Fazl Ullah ◽

Muhammad Kamran Hassan ◽

Ahmad Nawaz Babar ◽

Anwar Ullah

Keyword(s):

Irritable Bowel Syndrome ◽

Abdominal Pain ◽

Lactobacillus Plantarum ◽

Clinical Symptoms ◽

Gastrointestinal Disease ◽

Treated Group ◽

Significant Difference ◽

Randomized Control ◽

Irritable Bowel ◽

Rectal Emptying

Abstract Irritable bowel syndrome (IBS) is a gastrointestinal disease of intestinal mobility. IBS present with variable clinical symptoms making the treatment difficult. IBS is quiet prevalent around the globe with different frequency. Differences in frequency and gender is due to diet habit. It is less frequent where diary product and vegetable are frequently consumed as compared to those who consumed meat. Lactobacillus plantarum 299v (L. plantarum 299v) is the most widely studied strain in the IBS patients. It is resistant to the actions of intestinal acids and bile, colonizes the human colonic mucosa and is non-pathogenic in nature. The efficacy of Lactobacillus plantarum 299v L is different in different study. The present study was designed to find the efficacy of Lactobacillus plantarum 299v in comparison to placebo in randomized control trial. MethodOne hundred and ninety patients were assessed for eligibility 46 among them were excluded from the study and twenty four declined to participate in the study. One hundred and twenty patient of IBS was grouped in two different groups. The one was treated with Lactobacillus plantarum 299v and the other was treated with placebo. Symptoms of IBS, like abdominal pain, bloating and complete rectal emptying was noted and interpreted among the groups. Results There was no statistically significant difference in relieving abdominal pain, bloating, rectal emptying in Lactobacillus plantarum 299v treated group and placebo treated group. Conclusion This randomized control trail of Lactobacillus plantarum 299v fail to show signicant efficacy in IBS treatment as compared to placebo.

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Fructose and irritable bowel syndrome

Nutrition Research Reviews ◽

10.1017/s0954422420000025 ◽

2020 ◽

Vol 33 (2) ◽

pp. 235-243 ◽

Cited By ~ 1

Author(s):

Chloé Melchior ◽

Véronique Douard ◽

Moïse Coëffier ◽

Guillaume Gourcerol

Keyword(s):

Irritable Bowel Syndrome ◽

Abdominal Pain ◽

Breath Test ◽

Recurrent Abdominal Pain ◽

Fructose Malabsorption ◽

Chronic Disorder ◽

Gi Symptoms ◽

Irritable Bowel ◽

Osmotic Load

AbstractIrritable bowel syndrome (IBS) is a chronic disorder characterised by recurrent abdominal pain or discomfort and transit disturbances with heterogeneous pathophysiological mechanisms. The link between food and gastrointestinal (GI) symptoms is often reported by patients with IBS and the role of fructose has recently been highlighted. Fructose malabsorption can easily be assessed by hydrogen and/or methane breath test in response to 25 g fructose; and its prevalence is about 22 % in patients with IBS. The mechanism of fructose-related symptoms is incompletely understood. Osmotic load, fermentation and visceral hypersensitivity are likely to participate in GI symptoms in the IBS population and may be triggered or worsened by fructose. A low-fructose diet could be integrated in the overall treatment strategy, but its role and implication in the improvement of IBS symptoms should be evaluated. In the present review, we discuss fructose malabsorption in adult patients with IBS and the interest of a low-fructose diet in order to underline the important role of fructose in IBS.

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Adequate Relief as an Endpoint in Clinical Trials in Irritable Bowel Syndrome

Journal of International Medical Research ◽

10.1177/030006059802600203 ◽

1998 ◽

Vol 26 (2) ◽

pp. 76-81 ◽

Cited By ~ 68

Author(s):

AW Mangel ◽

BA Hahn ◽

AT Heath ◽

AR Northcutt ◽

S Kong ◽

...

Keyword(s):

Quality Of Life ◽

Irritable Bowel Syndrome ◽

Abdominal Pain ◽

Bowel Function ◽

Recurrent Abdominal Pain ◽

Response To Therapy ◽

Multiple Parameters ◽

Severity Scores ◽

Irritable Bowel

Irritable bowel syndrome is characterized by recurrent abdominal pain and altered bowel function. In designing studies to evaluate new treatments for this disease, however, it is difficult to select appropriate endpoints to reflect improvement in the range of symptoms of the syndrome. In the present study we evaluated the parameter of adequate relief of abdominal pain and discomfort, as perceived by the patients, as a key endpoint for efficacy in the treatment of patients with irritable bowel syndrome. Abdominal pain and bowel function data were collected daily from 370 patients with the disease during treatment with placebo or a novel potent 5HT3 receptor antagonist. Once every 7 days adequate relief of pain and discomfort was assessed. Quality-of-life data were collected using self-administered questionnaires. The endpoint of adequate relief was significantly ( P < 0.05) correlated with improvement in pain severity scores, percentage of pain-free days, percentage of days with urgency, improvement in stool frequency and consistency, and quality-of-life parameters. Adequate relief of pain and discomfort is significantly correlated with changes in multiple parameters associated with irritable bowel syndrome and can be used as an endpoint for assessing response to therapy in these patients.

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