A Simultaneous Multidisciplinary Evaluation of Irritable Bowel Syndrome in Egyptian Patients: Dietary, Psychiatric, Microbiologic and Autonomic Aspects — Oak Academic Publishing
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A Simultaneous Multidisciplinary Evaluation of Irritable Bowel Syndrome in Egyptian Patients: Dietary, Psychiatric, Microbiologic and Autonomic Aspects
Tropical Medicine Department, Faculty of Medicine, Cairo University, Giza, Egypt
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Tropical Medicine Department, Faculty of Medicine, Cairo University, Giza, Egypt
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Gastrointestinal Endoscopy Unit, Cairo, Egypt
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Psychiatry Department, Faculty of Medicine, Cairo University, Giza, Egypt
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Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Giza, Egypt
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Clinical Neurophysiology Department, Faculty of Medicine, Cairo University, Giza, Egypt
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Tropical Medicine Department, Faculty of Medicine, Cairo University, Giza, Egypt
1 Tropical Medicine Department, Faculty of Medicine, Cairo University, Giza, Egypt
2 Tropical Medicine Department, Faculty of Medicine, Cairo University, Giza, Egypt
3 Gastrointestinal Endoscopy Unit, Cairo, Egypt
4 Psychiatry Department, Faculty of Medicine, Cairo University, Giza, Egypt
5 Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Giza, Egypt
Background and Aim: Irritable bowel syndrome (IBS) is a common medical disorder that may be severe enough to impair the quality of life. This study aimed to assess the role of each of dietary, psychiatric, autonomic, and microbiology background and their interactions in Egyptian patients with IBS. Patients and Methods: Forty adult patients diagnosed with IBS, equally divided into 2 groups the diarrhea predominant and the constipation predominant, were recruited from the Endoscopy Unit. Dietary assessment was done by monthly food frequency questionnaire. Psychiatric assessment was done by both the Eysenck Personality Questionnaire (EPQ) and Hopkins Symptom Checklist (HSCL-90). Microbiologic evaluation was done by faecal cultures and neurophysiologic autonomic evaluation was done via the sympathetic skin response and the parasympathetic R-R interval variation. Another 20 healthy subjects were included as control group. Results: All IBS patients were young, with significant female predominance (P = 0.007), particularly in IBS-C group (20/20; 100%, P = 0.003). Psychologically, abnormal scores of neuroticism, extraversion and criminality, and depression, obsessive compulsion, somatization, sensitivity and anxiety in both IBS groups with particularly extraversion, criminality and depression were significantly higher in constipation subtype. Microbiologically, Bacteroid s were significantly related to IBS, while Klebsiella was significantly deficient without significant difference between its groups. On the contrary, neither diet nor autonomic activity showed any significant relation. Conclusions: IBS is a disorder induced by many factors and affected by several interacting agents, thus revealing controversial results when studied simultaneously.
Drossman, D., Camilleri, M., Mayer, E. and Whitehead, W. (2002) AGA Technical Review on Irritable Bowel Syndrome. Gastroenterology, 123, 2108-2131. https://doi.org/10.1053/gast.2002.37095
Ong, D.K, Mitchell, S.B., Barrett, J.S., Shepherd, S.J., Irving, P.M., Biesiekierski, J.R., Smith, S., Gibson, P.R. and Muir, J.G. (2010) Manipulation of Dietary Short Chain Carbohydrates Alters the Pattern of Gas Production and Genesis of Symptoms in Irritable Bowel Syndrome. Journal of Gastroenterology and Hepatology, 25, 1366-1373. https://doi.org/10.1111/j.1440-1746.2010.06370.x
Staudacher, H.M., Whelan, K., Irving, P.M. and Lomer, M.C.E. (2011) Comparison of Symptom Response Following Advice for a Diet Low in Fermentable Carbohydrates (FOD-MAPs) versus Standard Dietary Advice in Patients with Irritable Bowel Syndrome. Journal of Human Nutrition and Dietetics, 24, 487-495. https://doi.org/10.1111/j.1365-277X.2011.01162.x
Occhipinti, K. and Smith, J.W. (2012) Irritable Bowel Syndrome: A Review and Update. Clinics in Colon and Rectal Surgery, 25, 46-52. https://doi.org/10.1055/s-0032-1301759
Drossman, D.A, Creed, F.H., Olden, K.W., Svedlund, J., Toner, B.B. and Whitehead, W.E. (1999) Psychoscial Aspects of the Functional Gastrointestinal Disorders. Gut, 45, 25-30. https://doi.org/10.1136/gut.45.2008.ii25
Whitehead, W.E. and Crowell, M.D. (1991) Psychologic Considerations in the Irritable Bowel Syndrome. Gastroenterology Clinics of North America, 20, 249-67.
Brandt, L.J., Chey, W.D., Foxx-Orenstein, A.E., Schiller, L.R., Schoenfeld, P.S., Spiegel, B.M., Talley, N.J. and Quigley, E.M.M. (2009) American College of Gastroenterology Task Force on Irritable Bowel Syndrome. An Evidence-Based Position Statement on the Management of Irritable Bowel Syndrome. The American Journal of Gastroenterology, 104, S8-S35. https://doi.org/10.14309/00000434-200901001-00002
Pimentel, M., Chow, E.J. and Lin, H.C. (2000) Eradication of Small Intestinal Bacterial Overgrowth Reduces Symptoms of Irritable Bowel Syndrome. The American Journal of Gastroenterology, 95, 3503-3506.
Bharucha, A.E., Camilleri, M., Low, P.A. and Zinsmeister, A.R. (1993) Autonomic Dysfunction in Gastrointestinal Motility Disorders. Gut, 34, 397-401. https://doi.org/10.1136/gut.34.3.397
Tougas, G. (2000) The Autonomic Nervous System in Functional Bowel Disorders. Gut, 47, iv78-80. https://doi.org/10.1136/gut.47.suppl_4.iv78
Malik, M. (1996) Heart Rate Variability: Standards of Measurement, Physiological Interpretation and Clinical Use. Circulation, 93, 1043-1065.
Arunodaya, G.R. and Taly, A.B. (1995) Sympathetic Skin Response: A Decade Later. Journal of the Neurological Sciences, 129, 81-89. https://doi.org/10.1016/0022-510X(94)00265-P
Salvioli, B., Pellegatta, G., Malacarne, M., Pace, F., Malesci, A., Pagani, M. and Lucini, D. (2015) Autonomic Nervous System Dysregulation in Irritable Bowel Syndrome. Journal of Neurogastroenterology and Motility, 27, 423-430. https://doi.org/10.1111/nmo.12512
Drossman, D.A. (2006) The Functional Gastrointestinal Disorders and the Rome III Process. Gastroenterology, 130, 1377-1390. https://doi.org/10.1053/j.gastro.2006.03.008
Eysenck, H.J and Eysenck, S.B.G. (1975) Manual of the Eysenck Personality Questionnaire. Hodder and Stoughton, London. https://doi.org/10.1037/t05462-000
Derogatis, L., Lipman, R., Reckles, K., Uhlenhuth, E. and Covi, L. (1974) Hopkins Symptom Checklist (HSL). Self-Report Symptom Inventory. Behavioral Science, 19, 1-15. https://doi.org/10.1002/bs.3830190102
Claus, D. and Schondorf, R. (1999) Sympathetic Skin Response. Electroencephalography and Clinical Neurophysiology, 52, 277-282.
Ewing, D.J., Martyn, C.N., Young, R.J. and Clarke, B.F. (1985) The Value of Cardiovascular Autonomic Function Tests: 10 Years Experience in Diabetes. Diabetes Care, 8, 491-498. https://doi.org/10.2337/diacare.8.5.491
Soares, R. (2014) Irritable Bowel Syndrome: A Clinical Review. World Journal of Gastroenterology, 20, 12144-12160. https://doi.org/10.3748/wjg.v20.i34.12144
Talley, N.J. (1999) Irritable Bowel Syndrome: Definition, Diagnosis and Epidemiology. Best Practice & Research Clinical Gastroenterology, 13, 371-384. https://doi.org/10.1053/bega.1999.0033
Spiller, R., Aziz, Q., Creed, F., Emmanuel, A., Houghton, L., Hungin, P., Jones, R., Kumar, D., Rubin, G., Trudgill, N. and Worwell, P. (2007) Guidelines on the Irritable Bowel Syndrome: Mechanisms and Practical Mangament. Gut, 56, 1770-1798. https://doi.org/10.1136/gut.2007.119446
Meleine, M. and Matricon, J. (2014) Gender-Related Differences in Irritable Bowel Syndrome: Potential Mechanisms of Sex Hormones. World Journal Gastroenterology, 20, 6725-6743. https://doi.org/10.3748/wjg.v20.i22.6725
Hattori, T. and Fukudo, S. (2006) Effects of Gender on Irritable Bowel Syndrome. Nihon Rinsho, 64, 1549-1551.
Heitkemper, M. and Jarrett, M. (2008) Irritable Bowel Syndrome: Does Gender Matter? Journal of Psychosomatic Research, 64, 583-587. https://doi.org/10.1016/j.jpsychores.2008.02.020
Cuomo, R., Andreozzi, P., Zito, F.P., Passananti, V., De Carlo, G. and Sarnelli, G. (2014) Irritable Bowel Syndrome and Food Interaction. World Journal of Gastroenterology, 20, 8837-8845.
Bijkerk, C.J., de Wit, N.J., Muris, J.W.M., Whorwell, P.J., Knottnerus, J.A. and Hoes, A.W. (2009) Soluble or Insoluble Fibre in Irritable Bowel Syndrome in Primary Care? Randomised Placebo Controlled Trial. BMJ, 339, b3154. https://doi.org/10.1136/bmj.b3154
Altobelli, E., Del Negro, V., Angeletti, P. and Latella, G. (2017) Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis. Nutrients, 9, 940. https://doi.org/10.3390/nu9090940
Chakraborti, S.K., Dey, B.K., Ghosh, N., Chaudhury, A.N. and Guha Mazumder, D.N. (1996) Objective Evaluation of Psychological Abnormality in Irritable Bowel Syndrome. Indian Journal of Gastroenterology, 15, 43-45.
Zhang, Q.-E., Wang, F., Geng. Q., Zheng, W., Ng, C.H., Ungvari, G.S., Yuan, Z., Mei, S., Wang, G. and Xiang, Y.-T. (2018) Depressive Symptoms in Patients with Irritable Bowel Syndrome: A Meta-Analysis of Comparative Studies. International Journal of Biological Sciences, 14, 1504-1512. https://doi.org/10.7150/ijbs.25001
Lee, C., Doo, E., Choi, J.M., Jang, S., Ryu, H.-S., Lee, J.Y., Oh, J.H., Park, J.H. and Kim, Y.S., Brain-Gut Axis Research Group of Korean Society of Neurogastroenterology and Motility (2017) The Increased Level of Depression and Anxiety in Irritable Bowel Syndrome Patients Compared with Healthy Controls: Systematic Review and Meta-analysis. Journal of Neurogastroenterology and Motility, 23, 349-362. https://doi.org/10.5056/jnm16220
Geng, Q., Zhang, Q.-E., Wang, F., Zheng, W., Ng, C.H., Ungvari, G.S., Wang, G. and Xiang, Y.-T. (2018) Comparison of Comorbid Depression between Irritable Bowel Syndrome and Inflammatory Bowel Disease: A Meta-Analysis of Comparative Studies. Journal of Affective Disorders, 237, 37-46. https://doi.org/10.1016/j.jad.2018.04.111
de Castro, N.G.R., Miller, V., Carruthers, H.R. and Whorwell, P.J. (2015) Irritable Bowel Syndrome?: A Comparison of Subtypes. Journal of Gastroenterology and Hepatology, 30, 279-285. https://doi.org/10.1111/jgh.12704
Gaylord, S.A., Palsson, O.S., Garland, E.L., Faurot, K.R., Coble, R.S., Mann, J.D., Frey, W., Leniek. K. and Whitehead, W.E. (2011) Mindfulness Training Reduces the Severity of Irritable Bowel Syndrome in Women: Results of a Randomized Controlled Trial. The American Journal of Gastroenterology, 106, 1678-1688. https://doi.org/10.1038/ajg.2011.184
Rodiño-Janeiro, B.K., Vicario, M., Alonso-Cotoner, C., Pascua-García, R. and Santos, J. (2018) A Review of Microbiota and Irritable Bowel Syndrome: Future in Therapies. Advances in Therapy, 35, 289-310. https://doi.org/10.1007/s12325-018-0673-5
Kennedy, P.J., Cryan, J.F., Dinan, T.G. and Clarke, G. (2014) Irritable Bowel Syndrome: A Microbiome-Gut-Brain Axis Disorder? World Journal of Gastroenterology, 20, 14105-14125. https://doi.org/10.3748/wjg.v20.i39.14105
Si, J.-M., Yu, Y.-C., Fan, Y.-J. and Chen, S.-J. (2004) Intestinal Microecology and Quality of Life in Irritable Bowel Syndrome Patients. World Journal of Gastroenterology, 10, 1802-1805. https://doi.org/10.3748/wjg.v10.i12.1802
Mättö, J., Maunuksela, L., Kajander, K., Palva, A., Korpela, R., Kassinen, A. and Saarela, M. (2005) Composition and Temporal Stability of Gastrointestinal Microbiota in Irritable Bowel Syndrome—A Longitudinal Study in IBS and Control Subjects. FEMS Immunology and Medical Microbiology, 43, 213-222. https://doi.org/10.1016/j.femsim.2004.08.009
Brenner, D.M., Moeller, M.J., Chey, W.D. and Schoenfeld, P.S. (2009) The Utility of Probiotics in the Treatment of Irritable Bowel Syndrome: A Systematic Review. The American Journal of Gastroenterology, 104, 1033-1049.
Lee, B.J., Bak and Y.-T. (2011) Irritable Bowel Syndrome, Gut Microbiota and Probiotics. Journal of Neurogastroenterology and Motility, 17, 252-266. https://doi.org/10.5056/jnm.2011.17.3.252
Jarrett, M.E., Burr, R.L., Cain, K.C., Rothermel, J.D., Landis, C.A. and Heitkemper, M.M. (2008) Autonomic Nervous System Function During Sleep Among Women with Irritable Bowel Syndrome. Digestive Diseases and Sciences, 53, 694-703. https://doi.org/10.1007/s10620-007-9943-9
Ng, C., Malcolm, A., Hansen, R. and Kellow, J. (2007) Feeding and Colonic Distension Provoke Altered Autonomic Responses in Irritable Bowel Syndrome. Scandinavian Journal of Gastroenterology, 42, 441–446. https://doi.org/10.1080/00365520600965749
Robert, J.J.T., Orr, W.C. and Elsenbruch, S. (2004) Modulation of Sleep Quality and Autonomic Functioning by Symptoms of Depression in Women with Irritable Bowel Syndrome. Digestive Diseases and Sciences, 49, 1250-1258. https://doi.org/10.1023/B:DDAS.0000037820.54069.6c
Heitkemper, M., Jarrett, M., Cain, K.C., Burr, R., Levy, R., Feld, A. and Hertig, V. (2001) Autonomic Nervous System Function in Women with Irritable Bowel Syndrome. Digestive Diseases and Sciences, 46, 1276-1284. https://doi.org/10.1023/A:1010671514618
Elsenbruch, S., Lovallo, W.R. and Orr, W.C. (2001) Psychological and Physiological Responses to Postprandial Mental Stress in Women with the Irritable Bowel Syndrome. Psychosomatic Medicine, 63, 805-813. https://doi.org/10.1097/00006842-200109000-00014
Park H-J. (2008). Heart Rate Variability as a Measure of Disease State in Irritable Bowel Syndrome. Asian Nursing Research, 2, 5-16. https://doi.org/10.1016/S1976-1317(08)60024-9
Dobrek, L., Friediger, J., Furgała, A. and Thor, P.J. (2006) Autonomic Nervous System Activity in IBS Patients Estimated by Heart Rate Variability (HRV). Przeglad Lekarski, 63, 743-747.
Mazurak, N., Seredyuk, N., Sauer, H., Teufel, M. and Enck, P. (2012) Heart Rate Variability in the Irritable Bowel Syndrome: A Review of the Literature. Neurogastroenterology and Motility, 24, 206-216. https://doi.org/10.1111/j.1365-2982.2011.01866.x
Rajilić-Stojanović, M., Jonkers, D.M., Salonen, A., Hanevik, K., Raes, J., Jalanka, J., de Vos, W.M., Manichanh, C., Golic, N., Enck, P., Philippou, E., Iraqi, F.A., Clarke, G., Spiller, R.C. and Penders, J. (2015) Intestinal Microbiota And Diet in IBS: Causes, Consequences, or Epiphenomena? The American Journal of Gastroenterology, 110, 278-287. https://doi.org/10.1038/ajg.2014.427
Harper, A., Naghibi, M. and Garcha D. (2018) The Role of Bacteria, Probiotics and Diet in Irritable Bowel Syndrome. Foods, 7, 13. https://doi.org/10.3390/foods7020013