A 5Ad Dietary Protocol for Functional Bowel Disorders

Functional bowel disorders (FBDs) affect around 20% of the population worldwide and are associated with reduced quality of life and high healthcare costs. Dietary therapies are frequently implemented to assist with symptom relief in these individuals, however, there are concerns regarding their complexity, restrictiveness, nutritional adequacy, and effectiveness. Thus, to overcome these limitations, a novel approach, the 5Ad Dietary Protocol, was designed and tested for its efficacy in reducing the severity of a range of gastrointestinal symptoms in 22 subjects with FBDs. The protocol was evaluated in a repeated measures MANOVA design (baseline week and intervention week). Measures of stool consistency and frequency were subtyped based on the subject baseline status. Significant improvements were seen in all abdominal symptom measures (p < 0.01). The effect was independent of body mass index (BMI), age, gender, physical activity level, and whether or not the subjects were formally diagnosed with irritable bowel syndrome (IBS) prior to participation. Stool consistency and frequency also improved in the respective contrasting subtypes. The 5Ad Dietary Protocol proved to be a promising universal approach for varying forms and severities of FBDs. The present study paves the way for future research encompassing a longer study duration and the exploration of underlying physiological mechanisms.

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Symptoms compatible with functional bowel disorders are common in patients with quiescent ulcerative colitis and influence the quality of life but not the course of the disease

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284819827689 ◽

2019 ◽

Vol 12 ◽

pp. 175628481982768 ◽

Cited By ~ 5

Author(s):

Georgios Mavroudis ◽

Magnus Simren ◽

Börje Jonefjäll ◽

Lena Öhman ◽

Hans Strid

Keyword(s):

Quality Of Life ◽

Ulcerative Colitis ◽

Psychological Symptoms ◽

Negative Impact ◽

Gastrointestinal Symptoms ◽

Functional Bowel Disorders ◽

Mayo Score ◽

Bowel Disorders ◽

Total Burden

Background: Whether patients with inactive ulcerative colitis (UC) have symptoms compatible with functional bowel disorders (FBDs) other than irritable bowel syndrome (IBS) is unclear. Our aim was to investigate the prevalence and burden of these symptoms and determine impact on the UC course. Methods: We used Mayo score, sigmoidoscopy and calprotectin (f-cal) to define remission in 293 UC patients. Presence of symptoms compatible with FBD, severity of gastrointestinal, extraintestinal and psychological symptoms, stress levels and quality of life (QoL) were measured with validated questionnaires. At 1 year later, remission was determined by modified Mayo score and f-cal in 171 of these patients. They completed the same questionnaires again. Results: A total of 18% of remission patients had symptoms compatible with FBD other than IBS, and 45% subthreshold symptoms compatible with FBD. The total burden of gastrointestinal symptoms in patients with symptoms compatible with FBD was higher than in patients without FBD ( p < 0.001), which had negative impact on QoL ( p = 0.02). These symptoms were not correlated with psychological distress, systemic immune activity or subclinical colonic inflammation and were not a risk factor for UC relapse during follow up. Conclusion: Symptoms compatible with FBD other than IBS are common during UC remission influencing patients’ QoL but not the UC course.

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Evaluation of Walk Across Texas! – a web-based community physical activity program

BMC Public Health ◽

10.1186/s12889-019-7918-3 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Mark D. Faries ◽

Michael L. Lopez ◽

Ethan Faries ◽

Kristen Keenan ◽

Stephen D. Green

Keyword(s):

Physical Activity ◽

Repeated Measures ◽

Leisure Time ◽

Program Assessment ◽

Future Research ◽

Activity Levels ◽

Web Based ◽

Novel Approach ◽

Community Based Programs ◽

Clinically Significant

Abstract Background In response to the chronic disease burden, web- and community-based programs have the potential to address targeted behaviors, such as physical activity (PA), using a novel approach with large audiences. The purpose of this study was to preliminarily evaluate an established team centered, web-based community PA program in Texas. Methods Walk Across Texas! (WAT!) is an eight-week community program delivered through a web-based platform to help people of various ages and abilities establish the habit of regular PA. Teams are challenged to walk a minimum of 832 miles. Changes in self-reported PA (miles/week; days/week) and leisure-time sitting (hours/day) were examined from 11,116 adult participants who participated in the program in 2016. Further analysis determined changes in physical activity (miles/week) between groups of pre-program assessment self-reported physical activity levels (0, 1–2, 3–4, or 5–7 days/week). Statistical analysis included paired-sample t-tests, repeated measures ANOVA and participant descriptors for PA change. Results Overall, mean changes in PA in all variables were statistically significant (p < .001), with the largest, clinically significant changes in submitted miles/week (mean increase of 4.89 ± 20.92). Self-reported PA increased 0.63 ± 2.89 days/week, while leisure-time sitting decreased less than 1 h per day (0.87 ± 1.86 h/day). All sub-groups (inactive, low active, active, high active at pre-program assessment) increased in self-reported miles per week, on average. Both the inactive and low-active groups experienced a statistically significant increase in mileage from week 1 to week 8 (5.48 miles/week or 12,330 steps /week, and 3.91 miles/week or 8797 steps /week, respectively). Conclusions The results provide initial support for the effectiveness of WAT! to initially increase and maintain moderate levels of PA of participants over 8-weeks, even in inactive or low-active participants. Descriptor variables were unable to differentiate between those who increased PA and those who did not. However; the results provide a canvas for future research questions regarding PA enhancement within a team-centered, web-based approach.

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Effect of Combined Live Probiotics Alleviating the Gastrointestinal Symptoms of Functional Bowel Disorders

Gastroenterology Research and Practice ◽

10.1155/2020/4181748 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11

Author(s):

Jin Shi ◽

Feng Gao ◽

Jie Zhang

Keyword(s):

Gut Microbiota ◽

Bowel Preparation ◽

Gastrointestinal Symptoms ◽

Functional Bowel Disorders ◽

Control Groups ◽

Probiotic Supplementation ◽

Positive Rate ◽

Bowel Disorders ◽

Relative Abundances ◽

And Control

Objective. Changes of the gut microbiota are related to the pathogenesis of functional bowel disorders (FBDs), and probiotic supplementation may be an effective treatment option. Therefore, we aimed to investigate the effect of combined live probiotics on the gastrointestinal symptoms of FBDs via altering the gut microbiota. Methods. Patients with the gastrointestinal symptoms of FBDs attending the Outpatient Department, from July to November 2019, were recruited. After the bowel preparation with polyethylene glycol electrolyte powder and colonoscopy, patients with normal result of colonoscopy were randomly divided into the probiotics group and control group. Patients in the probiotics group were prescribed with combined live Bacillus subtilis and Enterococcus faecium enteric-coated capsules for 4 weeks. Small intestinal bacteria overgrowth (SIBO) was measured by lactulose hydrogen breath test, and the microbial DNA was extracted from the fecal samples and the bacteria were classified by 16S rDNA gene amplicon sequencing. Results. Twenty-five patients of each group were recruited, and there was no significant difference between the probiotics and control groups on baseline gastrointestinal symptom rating scale (GSRS), positive rate of SIBO, and relative abundances of the gut microbiota at the phylum level. After 4 weeks of treatment, the values of the probiotics and control groups were as follows: GSRS 1.4±1.4 and 3.6±1.6 and positive rate of SIBO 28.0% and 56.0%, respectively. The median relative abundances of the gut microbiota were 1.01% and 5.03% Actinobacteria and 43.80% and 35.17% Bacteroidetes at the phylum level; 0.76% and 3.29% Bifidobacterium, 0.13% and 0.89% Cillinsella, 0.03% and 0.01% Enterococcus, 0.18% and 0.36% Lachnospiraceae, 0.10% and 0.16% Ruminococcus torques group, 1.31% and 2.44% Blautia, and 0.83% and 2.02% Fusicatenibacter at the genus level (P<0.05), respectively. Conclusion. Combined live probiotic supplementation after the bowel preparation can alter the gut microbiota, decontaminate SIBO, and alleviate the gastrointestinal symptoms of FBDs. This trial is registered with ChiCTR1900026472.

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Prebiotics in irritable bowel syndrome and other functional bowel disorders in adults: a systematic review and meta-analysis of randomized controlled trials

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqy376 ◽

2019 ◽

Vol 109 (4) ◽

pp. 1098-1111 ◽

Cited By ~ 23

Author(s):

Bridgette Wilson ◽

Megan Rossi ◽

Eirini Dimidi ◽

Kevin Whelan

Keyword(s):

Systematic Review ◽

Irritable Bowel Syndrome ◽

Meta Analysis ◽

Gastrointestinal Symptoms ◽

Controlled Trials ◽

Functional Bowel Disorders ◽

Randomized Controlled ◽

Bowel Disorders ◽

Mean Differences ◽

Irritable Bowel

ABSTRACT Background Irritable bowel syndrome (IBS) and other functional bowel disorders (FBDs) are prevalent disorders with altered microbiota. Prebiotics positively augment gut microbiota and may offer therapeutic potential. Objectives The aim of this study was to investigate the effect of prebiotics compared with placebo on global response, gastrointestinal symptoms, quality of life (QoL), and gut microbiota, via systematic review and meta-analysis of randomized controlled trials (RCTs) in adults with IBS and other FBDs. Methods Studies were identified using electronic databases, back-searching reference lists, and hand-searching abstracts. RCTs that compared prebiotics to placebo in adults with IBS or other FBDs were included. Two reviewers independently performed screening, data extraction, and bias assessment. Outcome data were synthesized as ORs, weighted mean differences (WMDs) or standardized mean differences (SMDs) with the use of a random-effects model. Subanalyses were performed for type of FBD and dose, type, and duration of prebiotic. Results Searches identified 2332 records, and 11 RCTs were eligible (729 patients). The numbers responding were 52/97 (54%) for prebiotic and 59/94 (63%) for placebo, with no difference between groups (OR: 0.62; 95% CI: 0.07, 5.69; P = 0.67). Similarly, no differences were found for severity of abdominal pain, bloating and flatulence, and QoL score between prebiotics and placebo. However, flatulence severity was improved by prebiotics at doses ≤6 g/d (SMD: –0.35; 95% CI: –0.71, 0.00; P = 0.05) and by non-inulin-type fructan prebiotics (SMD: –0.34; 95% CI: –0.66, –0.01; P = 0.04), while inulin-type fructans worsened flatulence (SMD: 0.85; 95% CI: 0.23, 1.47; P = 0.007). Prebiotics increased absolute abundance of bifidobacteria (WMD: 1.16 log10 copies of the 16S ribosomal RNA gene; 95% CI: 0.06, 2.26; P = 0.04). No studies were at low risk of bias across all bias categories. Conclusions Prebiotics do not improve gastrointestinal symptoms or QoL in patients with IBS or other FBDs, but they do increase bifidobacteria. Variations in prebiotic type and dose impacted symptom improvement or exacerbation. This review was registered at PROSPERO as CRD42017074072.

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Power of Modified Brown-Forsythe and Mixed-Model Approaches in Split-Plot Designs

Methodology ◽

10.1027/1614-2241/a000124 ◽

2017 ◽

Vol 13 (1) ◽

pp. 9-22 ◽

Cited By ~ 1

Author(s):

Pablo Livacic-Rojas ◽

Guillermo Vallejo ◽

Paula Fernández ◽

Ellián Tuero-Herrero

Keyword(s):

Repeated Measures ◽

Statistical Power ◽

Mixed Model ◽

Covariance Structure ◽

Simulation Method ◽

Future Research ◽

Repeated Measures Design ◽

Fixed And Random Effects ◽

Split Plot ◽

High Level

Abstract. Low precision of the inferences of data analyzed with univariate or multivariate models of the Analysis of Variance (ANOVA) in repeated-measures design is associated to the absence of normality distribution of data, nonspherical covariance structures and free variation of the variance and covariance, the lack of knowledge of the error structure underlying the data, and the wrong choice of covariance structure from different selectors. In this study, levels of statistical power presented the Modified Brown Forsythe (MBF) and two procedures with the Mixed-Model Approaches (the Akaike’s Criterion, the Correctly Identified Model [CIM]) are compared. The data were analyzed using Monte Carlo simulation method with the statistical package SAS 9.2, a split-plot design, and considering six manipulated variables. The results show that the procedures exhibit high statistical power levels for within and interactional effects, and moderate and low levels for the between-groups effects under the different conditions analyzed. For the latter, only the Modified Brown Forsythe shows high level of power mainly for groups with 30 cases and Unstructured (UN) and Autoregressive Heterogeneity (ARH) matrices. For this reason, we recommend using this procedure since it exhibits higher levels of power for all effects and does not require a matrix type that underlies the structure of the data. Future research needs to be done in order to compare the power with corrected selectors using single-level and multilevel designs for fixed and random effects.

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