Irritable Bowel Syndrome

Could you clarify the author list of this manuscript? You have included the "Study Group for nonceliac gluten sensitivity" in this list, who are listed on page 2 of the manuscript. Please could you ensure that these individuals are indeed considered as authors? Response: All the people included in the "Study Group for non-celiac gluten sensitivity" gave a significant contribution to this paper. As experts in the field of gluten related disorders, they diagnosed and enrolled patients with celiac disease (CD) and non-celiac gluten sensitivity (NCGS) as well as filled the questionnaires for each patient. Moreover, all of them supervised and approved the paper. Therefore, according to the guidelines of BMC Medicine, they must be regarded as authors of the manuscript. In the revised version of the paper we added this information in the section Author's contribution.

Background: Non-celiac gluten sensitivity (NCGS) is still an undefined syndrome with several unsettled issues despite the increasing awareness of its existence. We carried out a prospective survey on NCGS in Italian centers for the diagnosis of gluten-related disorders, with the aim of defining the clinical picture of this new syndrome and to establish roughly its prevalence compared with celiac disease. Methods: From November 2012 to October 2013, 38 Italian centers (27 adult gastroenterology, 5 internal medicine, 4 pediatrics, and 2 allergy) participated in this prospective survey. A questionnaire was used in order to allow uniform and accurate collection of clinical, biochemical, and instrumental data. Results: In total, 486 patients with suspected NCGS were identified in this 1-year period. The female/male ratio was 5.4 to 1, and the mean age was 38 years (range 3-81). The clinical picture was characterized by combined gastrointestinal (abdominal pain, bloating, diarrhea and/or constipation, nausea, epigastric pain, gastroesophageal reflux, aphthous stomatitis) and systemic manifestations (tiredness, headache, fibromyalgia-like joint/muscle pain, leg or arm numbness, 'foggy mind,' dermatitis or skin rash, depression, anxiety, and anemia). In the large majority of patients, the time lapse between gluten ingestion and the appearance of symptoms varied from a few hours to 1 day. The most frequent associated disorders were irritable bowel syndrome (47%), food intolerance (35%) and IgE-mediated allergy (22%). An associated autoimmune disease was detected in 14% of cases. Regarding family history, 18% of our patients had a relative with celiac disease, but no correlation was found between NCGS and positivity for HLA-DQ2/-DQ8. IgG anti-gliadin antibodies were detected in 25% of the patients tested. Only a proportion of patients underwent duodenal biopsy; for those that did, the biopsies showed normal intestinal mucosa (69%) or mild increase in intraepithelial lymphocytes (31%). The ratio between suspected NCGS and new CD diagnoses, assessed in 28 of the participating centers, was 1.15 to 1. Conclusions: This prospective survey shows that NCGS has a strong correlation with female gender and adult age. Based on our results, the prevalence of NCGS seems to be only slightly higher than that of celiac disease. Please see related article .

Non Celiac Gluten sensitivity (NCGS) was originally described in the 1980s and recently a "re-discovered" disorder characterized by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing food, in subjects that are not affected with either celiac disease (CD) or wheat allergy (WA). Although NCGS frequency is still unclear, epidemiological data have been generated that can help establishing the magnitude of the problem. Clinical studies further defined the identity of NCGS and its implications in human disease. An overlap between the irritable bowel syndrome (IBS) and NCGS has been detected, requiring even more stringent diagnostic criteria. Several studies suggested a relationship between NCGS and neuropsychiatric disorders, particularly autism and schizophrenia. The first case reports of NCGS in children have been described. Lack of biomarkers is still a major limitation of clinical studies, making it difficult to differentiate NCGS from other gluten related disorders. Recent studies raised the possibility that, beside gluten, wheat amylase-trypsin inhibitors and low-fermentable, poorly-absorbed, short-chain carbohydrates can contribute to symptoms (at least those related to IBS) experienced by NCGS patients. In this paper we report the major advances and current trends on NCGS.

Introduction/Objective: Irritable bowel syndrome (IBS) is a bowel disorder characterized by pain accompanying defecation or altered bowel habits, divided into diarrhea-predominant, constipation-predominant, and alternating subtypes, whose pathogenesis is considered to include disordered bowel motility. The hormone ghrelin is a growth hormone secretagogue which furthermore affects gastrointestinal motility. We study the association between its genetic polymorphisms and the risk for IBS. Methods: IBS patients meeting the Rome III criteria and controls similar in age and gender were recruited. Whole blood samples were used for genotyping via polymerase chain reaction and restriction fragment length polymorphism for the polymorphisms rs34911341, rs696217, and rs2075356. Results: Participants included 142 patients and 209 controls. The rs696217 GG genotype frequency was higher in patients (78.87%) compared to controls (55.5%). The rs696217 GT genotype was significantly less frequent among patients than in controls (OR 0.31, 95% CI 0.19-0.52), as was the T allele (OR 0.43, 95% CI 0.28-0.66). No significant differences in genotype distribution were found for the rs34911341 and rs2075356 polymorphisms between patients and controls. The genotype frequencies did not significantly differ between IBS subtype groups for any of the polymorphisms studied. Conclusions: The GG and GT genotypes of the rs696217 polymorphism, as well as the G-allele, demonstrate significant association with IBS susceptibility, while the T allele appears to bear a protective effect. Ghrelin's polymorphisms are plausibly involved in IBS pathogenesis, but do not correlate with any distinct IBS subtype.

Introduction/Objective: Irritable bowel syndrome (IBS) is a bowel disorder characterized by pain accompanying defecation or altered bowel habits, divided into diarrhea-predominant, constipation-predominant, and alternating subtypes, whose pathogenesis is considered to include disordered bowel motility. The hormone ghrelin is a growth hormone secretagogue which furthermore affects gastrointestinal motility. We study the association between its genetic polymorphisms and the risk for IBS. Methods: IBS patients meeting the Rome III criteria and controls similar in age and gender were recruited. Whole blood samples were used for genotyping via polymerase chain reaction and restriction fragment length polymorphism for the polymorphisms rs34911341, rs696217, and rs2075356. Results: Participants included 142 patients and 209 controls. The rs696217 GG genotype frequency was higher in patients (78.87%) compared to controls (55.5%). The rs696217 GT genotype was significantly less frequent amon...

Functional gastrointestinal disorders (FGID) are heterogeneous disorders with a variety of clinical manifestations, primarily defined by signs and symptoms rather than a definite underlying cause. Their pathophysiology remains obscure and, although it is expected to differ according to the specific FGID, disruptions in the brain-gut axis are now thought to be a common denominator in their pathogenesis. The hormone ghrelin is an important component of this axis, exerting a wide repertoire of physiological actions, including regulation of gastrointestinal motility and protection of mucosal tissue. Ghrelin's gene shows genetic polymorphism, while its protein product undergoes complex regulation and metabolism in the human body. Numerous studies have studied ghrelin's relation to the emergence of FGIDs, its potential value as an index of disease severity and as a predictive marker for symptom relief during attempted treatment. Despite the mixed results currently available in scientific literature, the plethora of statistically significant findings shows that disruptions in ghrelin genetics and expression are plausibly related to FGID pathogenesis. The aim of this paper is to review current literature studying these associations, in an effort to uncover certain patterns of alterations in both genetics and expression, which could delineate its true contribution to FGID emergence, either as a causative agent or as a pathogenetic intermediate.

The Danish study of Functional Disorders (DanFunD) cohort was initiated to outline the epidemiology of functional somatic syndromes (FSS) and is the first larger coordinated epidemiological study focusing exclusively on FSS. FSS are prevalent in all medical settings and can be defined as syndromes that, after appropriate medical assessment, cannot be explained in terms of a conventional medical or surgical disease. FSS are frequent and the clinical importance varies from vague symptoms to extreme disability. No well-described medical explanations exist for FSS, and how to delimit FSS remains a controversial topic. The specific aims with the cohort were to test delimitations of FSS, estimate prevalence and incidence rates, identify risk factors, delimitate the pathogenic pathways, and explore the consequences of FSS. The study population comprises a random sample of 9,656 men and women aged 18-76 years from the general population examined from 2011 to 2015. The survey comprises scree...

Irritable bowel syndrome (IBS) and bladder pain syndrome/interstitial cystitis (BPS/IC) are comorbid visceral pain disorders seen commonly in women with unknown etiology, limited treatment options and can involve visceral organ cross-sensitization. Calcitonin gene-related peptide (CGRP) is a mediator of nociceptive processing and may serve as a target for therapy. In three rodent models, we employed a monoclonal anti-CGRP F(ab') 2 to investigate the hypothesis that visceral organ cross-sensitization is mediated by abnormal CGRP signaling. Visceral organ cross-sensitization was induced in adult female rats via transurethral infusion of protamine sulfate (PS) into the urinary bladder or infusion into the colon of trinitrobenzene sulfonic acid (TNBS). Colonic sensitivity was assessed via the visceromotor response (VMR) to colorectal distension (CRD). Bladder sensitivity was assessed as the frequency of abdominal withdrawal responses (AWR) to von Frey filaments applied to the suprapubic region. PS-or TNBS-induced changes in colonic and bladder permeability were investigated in vitro via quantification of transepithelial electrical resistance (TEER). Peripheral administration of an anti-CGRP F(ab') 2 inhibited PS-induced visceral pain behaviors and colon hyperpermeability. Similarly, TNBS-induced pain behaviors and colon and bladder hyperpermeability were attenuated by anti-CGRP F(ab') 2 treatment. PS into the bladder or TNBS into the colon significantly increased the VMR to CRD and AWR to suprapubic stimulation and decreased bladder and colon TEER. These findings suggest an important role of peripheral CGRP in visceral nociception and organ cross-sensitization and support the evaluation of CGRP as a therapeutic target for visceral pain in patients with IBS and/or BPS/IC.

Background: Internet-based cognitive behavior therapy (ICBT) has shown promising effects in the treatment of irritable bowel syndrome (IBS). However, to date no study has used a design where participants have been sampled solely from a clinical population. We aimed to investigate the acceptability, effectiveness, and costeffectiveness of ICBT for IBS using a consecutively recruited sample from a gastroenterological clinic. Methods: Sixty-one patients were randomized to 10 weeks of ICBT (n = 30) or a waiting list control (n = 31). The ICBT was guided by an online therapist and emphasized acceptance of symptoms through exposure and mindfulness training. Severity of IBS symptoms was measured with the Gastrointestinal symptom rating scale -IBS version (GSRS-IBS). Patients in both groups were assessed at pre-and post-treatment while only the ICBT group was assessed 12 months after treatment completion. Health economic data were also gathered at all assessment points and analyzed using bootstrap sampling. Results: Fifty of 61 patients (82%) completed the post-treatment assessment and 20 of 30 patients (67%) in the ICBT group were assessed at 12-month follow-up. The ICBT group demonstrated significantly (p < .001) larger improvements on the IBS-related outcome scales than the waiting list group. The between group effect size on GSRS-IBS was Cohen's d = 0.77 (95% CI: 0.19-1.34). Similar effects were noted on measures of quality of life and IBSrelated fear and avoidance behaviors. Improvements in the ICBT group were maintained at 12-month follow-up. The ICBT condition was found to be more cost-effective than the waiting list, with an 87% chance of leading to reduced societal costs combined with clinical effectiveness. The cost-effectiveness was sustained over the 12month period. Conclusions: ICBT proved to be a cost-effective treatment when delivered to a sample recruited from a gastroenterological clinic. However, many of the included patients dropped out of the study and the overall treatment effects were smaller than previous studies with referred and self-referred samples. ICBT may therefore be acceptable and effective for only a subset of clinical patients. Study dropout seemed to be associated with severe symptoms and large impairment. Objective and empirically validated criteria to select which patients to offer ICBT should be developed.

Background: Irritable bowel syndrome (IBS) is a debilitating and costly disorder. Cognitive behavior therapy (CBT) is effective in the treatment of IBS, both when delivered over the internet and in face-to-face settings. CBT consists of different components and little is known about their relative importance. We have in an earlier study showed that inclusion of exposure in the CBT for IBS makes it even more effective. In the present study we wanted to evaluate the economic effects for society of inclusion vs exclusion of exposure in an internet delivered CBT for IBS. We used data from a previous study with 309 participants with IBS. Participants were randomized to internet delivered CBT with (ICBT) or without exposure (ICBT-WE). We compared direct and indirect costs at baseline, after treatment, and 6 months after treatment (primary endpoint; 6MFU). Data was also collected on symptom severity and time spent by therapists and participants. The relative Incremental Cost Effectiveness Ratio (ICER) was calculated for the two treatment conditions and the return on investment (ROI). Results: Results showed that ICBT cost $213.5 (20%) more than ICBT-WE per participant. However, ICBT was associated with larger reductions regarding both costs and symptoms than ICBT-WE at 6MFU. The ICER was -301.69, meaning that for every point improvement on the Gastrointestinal Symptom Rating Scale-IBS version in ICBT, societal costs would be reduced with approximately $300. At a willingness to pay for a case of clinically significant improvement in IBS symptoms of $0, there was an 84% probability of cost-effectiveness. ROI analysis showed that for every $1 invested in ICBT rather than ICBT-WE, the return would be $5.64 six months after treatment. Analyses of posttreatment data showed a similar pattern although cost-savings were smaller. Including exposure in Cognitive Behavior Treatment for IBS is more cost-effective from a societal perspective than not including it, even though it may demand more therapist and patient time in the short term. Trial registration: This study is reported in accordance with the CONSORT statement for non-pharmacological trials . Clinicaltrials.gov registration ID: NCT01529567 (14/02/2013).

Irritable bowel syndrome (IBS) is a frequent gastrointestinal disorder that is difficult to treat. We describe findings from evaluation of a woman (55 years old) with obsessive compulsive disorder, which was treated with bilateral deep brain stimulation in the anterior limb of the internal capsule, and IBS. After the brain stimulation treatment she reported substantial relief of her IBS symptoms. This reduction depended on specific stimulation parameters, was reproducible over time, and was not directly associated with improvements in obsessive compulsive disorder symptoms. These observations indicate a specific effect of deep brain stimulation on IBS. This observation confirms involvement of specific brain structures in the pathophysiology of IBS and shows that symptoms can be reduced through modulation of neuronal activity in the central nervous system. Further studies of the effects of brain stimulation on IBS are required.

The placebo effect has long been recognized as a powerful component in medicine, influencing both clinical practice and research. This paper explores the historical background of placebos, their mechanisms of action, and their role in modern clinical trials. Special attention is given to ethical considerations, with reference to international guidelines that aim to protect patients while ensuring scientific validity. Evidence from pain management, psychiatry, neurology, and other fields highlights the therapeutic potential of the placebo effect when applied under controlled conditions. The discussion also addresses the growing acceptance of placebos in clinical care, emphasizing their role in enhancing patient outcomes when used transparently and ethically.

In this study, we aimed to examine the association between gastrointestinal (GI) symptom presence during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the prevalence of GI symptoms and the development of post-infectious irritable bowel syndrome (PI-IBS). We used data from a prospective cohort and logistic regression to examine the association between GI symptom status during confirmed SARS-CoV-2 infection and prevalence of persistent GI symptoms at ≥45 days. We also report the incidence of PI-IBS following SARS-CoV-2 infection. Of the 1475 participants in this study, 33.8% (n = 499) had GI symptoms during acute infection. Cases with acute GI symptoms had an odds of persisting GI symptoms 4 times higher than cases without acute GI symptoms (odds ratio (OR) 4.29, 95% confidence interval (CI) 2.45-7.53); symptoms lasted on average 8 months following infection. Of those with persisting GI symptoms, 67% sought care for their symptoms and incident PI-IBS occurred in 3.0% (n = 15) of participants. Those with acute GI symptoms after SARS-CoV-2 infection are likely to have similar persistent symptoms 45 days and greater. These data indicate that attention to a potential increase in related healthcare needs is warranted.

In this study, we aimed to examine the association between gastrointestinal (GI) symptom presence during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the prevalence of GI symptoms and the development of post-infectious irritable bowel syndrome (PI-IBS). We used data from a prospective cohort and logistic regression to examine the association between GI symptom status during confirmed SARS-CoV-2 infection and prevalence of persistent GI symptoms at ≥45 days. We also report the incidence of PI-IBS following SARS-CoV-2 infection. Of the 1475 participants in this study, 33.8% (n= 499) had GI symptoms during acute infection. Cases with acute GI symptoms had an odds of persisting GI symptoms 4 times higher than cases without acute GI symptoms (odds ratio (OR) 4.29, 95% confidence interval (CI) 2.45–7.53); symptoms lasted on average 8 months following infection. Of those with persisting GI symptoms, 67% sought care for their symptoms and incident PI-IBS occurr...

Objective: To find out the underlying causes of chronic diarrhea in soldiers and how it differs from general population. Study Design: Prospective comparative study. Place and Duration of Study: Combined Military Hospital (CMH) Multan and Pak Emeritus Military Hospital (PEMH) Rawalpindi, from Dec 2017 to Jan 2020. Methodology: All soldiers in active service, having diarrhea more than 4 weeks in study and non-soldiers of the same age were included in the control group. There were inquired in details about the diarrhea symptoms and investigations carried out accordingly to find out the underlying cause. The two groups were compared to find out any differences. The data were analyzed by SPSS version 22. Results: Seventy one in study and 50 patients in control had their mean ages of 34.61 ± 8.35 and 32.42 ± 10.28 years. Mean duration of symptoms were 18 and 15 months in study and control groups respectively. Irritable Bowel Syndrome (IBS) was more common in both groups i.e. 14 (20%) and...

Akkermansia muciniphila and Faecalibacterium prausnitzii, cohabitants in the intestinal mucosa, are considered members of a healthy microbiota and reduction of both species occurs in several intestinal disorders, including inflammatory bowel disease. Little is known however about a possible link between the reduction in quantity of these species, and in which circumstances this may occur. This study aims to determine the abundances and co-occurrence of the two species in order to elucidate conditions that may compromise their presence in the gut. Loads of A. muciniphila, total F. prausnitzii and its two phylogroup (16S rRNA gene copies) were determined by quantitative polymerase chain reaction in colonic biopsies from 17 healthy controls (H), 23 patients with ulcerative colitis (UC), 31 patients with Crohn's disease (CD), 3 with irritable bowel syndrome (IBS) and 3 with colorectal cancer (CRC). Data were normalized to total bacterial 16S rRNA gene copies in the same sample. Prevalence, relative abundances and correlation analyses were performed according to type of disease and considering relevant clinical characteristics of patients such as IBD location, age of disease onset, CD behavior, current medication and activity status. Co-occurrence of both species was found in 29% of H, 65% of UC and 29% of CD. Lower levels of total F. prausnitzii and phylogroups were found in subjects with CD, compared with H subjects (P ≤ 0.044). In contrast, no differences were found with the regard to A. muciniphila abundance across different disease states, but CD patients with disease onset below 16 years of age featured a marked depletion of this species. In CD patients, correlation between A. muciniphila and total F. prausnitzii (ρ = 0.362, P = 0.045) was observed, and particularly in those with non-stricturing, non-penetrating disease behavior and under moderate immunosuppressants therapy. Altogether, this study revealed that co-occurrence of both species differs between disease status. In addition, IBD patients featured a reduction of F. prausnitzii but similar loads of A. muciniphila when compared to H subjects, with the exception of those with early onset CD. Depletion of A. muciniphila in this subgroup of subjects suggests that it could be a potential biomarker to assist in pediatric CD diagnosis.

Background: Irritable bowel syndrome (IBS) is one of the most frequently diagnosed gastrointestinal (GI) disorders in primary care and gastroenterology practices, despite the fact that many suffer symptoms without knowing their diagnosis or seek for medical consult, so this study aims to explore the prevalence of irritable bowel syndrome (IBS) among Suez Canal university students. Methods: A cross section with multistage cluster probability sample. Using Rome criteria III IBS module, the questionnaire was administrated to Suez Canal university students; a population consisting of (86) students of the faculty of medicine & non-medical (84) students of the faculty of commerce English section with total (170) students of the third batch from both faculties (whose mean age is 20 ± 0.82) years old with total (109) females and (61) males. Results: The prevalence of IBS according to Rome III criteria in Suez Canal University was 22.9%. 23.8% were diseased in the faculty of commerce while 22.1% in faculty of medicine. Females in this study represent 64.1% of the sample, 30.3% of them were diseased, while males represent 35.9% about 9.8% of them were diseased. IBS constipation predominant type was 28.2%, diarrhea predominant type was 15.4%, mixed type was 46.2%, the un-subtyped cases represent 10.3%. Conclusion: Irritable bowel syndrome is a common disease among Suez Canal university students, more common in non medical students than medical ones, can be considered as a female predominant disease. And this

The role of pain-related fear learning and memory processes, conceptually embedded within the fear-avoidance model of chronic pain, is increasingly recognized. The unique biological salience of interoceptive, visceral pain with its cognitive, emotional, and motivational facets fosters associative learning. Conditioned fear is in principle adaptive but may turn maladaptive and contribute to hypervigilance and hyperalgesia in chronic pain. This review summarizes current knowledge on the formation, extinction, and return of painrelated memories with a focus on visceral pain. It provides a conceptual background, describes experimental approaches, and summarizes findings on behavioral and neural mechanisms in healthy humans and patients with chronic pain. Future directions underscore the potential of refining knowledge on the role of associative learning in the pathophysiology and treatment of chronic visceral pain in disorders of gutbrain interactions such as irritable bowel syndrome.

• Mechanisms of brain function and inflammation in IBS-related fatigue are unclear. • A mesocorticolimbic network relevant to fatigue was established and investigated. • In IBS, brain connectivity was decreased, when considering fatigue impact. • High fatigue impact on the lives of IBS patients is related to TNF-α in plasma. • The vulnerability to fatigue in IBS has both central and inflammatory correlates.

• Mechanisms of brain function and inflammation in IBS-related fatigue are unclear. • A mesocorticolimbic network relevant to fatigue was established and investigated. • In IBS, brain connectivity was decreased, when considering fatigue impact. • High fatigue impact on the lives of IBS patients is related to TNF-α in plasma. • The vulnerability to fatigue in IBS has both central and inflammatory correlates.

The role of pain-related fear learning and memory processes, conceptually embedded within the fear-avoidance model of chronic pain, is increasingly recognized. The unique biological salience of interoceptive, visceral pain with its cognitive, emotional, and motivational facets fosters associative learning. Conditioned fear is in principle adaptive but may turn maladaptive and contribute to hypervigilance and hyperalgesia in chronic pain. This review summarizes current knowledge on the formation, extinction, and return of pain-related memories with a focus on visceral pain. It provides a conceptual background, describes experimental approaches, and summarizes findings on behavioral and neural mechanisms in healthy humans and patients with chronic pain. Future directions underscore the potential of refining knowledge on the role of associative learning in the pathophysiology and treatment of chronic visceral pain in disorders of gut–brain interactions such as irritable bowel syndrome.

Visceroception is a complex phenomenon comprising the sensation, interpretation, and integration of sensations along the gut-brain axis, including pain or defecatory urgency. Stress is considered a crucial risk factor for the development and maintenance of disorders of gut-brain signaling, which are characterized by altered visceroception. Although the broad role of stress and stress mediators in disturbed visceroception is widely acknowledged, the putative contribution of chronic stress to variations in normal visceroception remains incompletely understood. We aimed to elucidate the role of chronic stress in shaping different facets of visceroception. From a well-characterized, large sample of healthy men and women (N = 180, 50% female), volunteers presenting with low (n = 57) and elevated (n = 61) perceived chronic stress were identified based on the validated Trier Inventory for Chronic Stress (TICS). Visceral sensitivity together with perceived and recalled intensity and defecatory urgency induced by repeated rectal distensions was experimentally assessed, and compared between low and elevated stress groups. Subgroups were compared regarding state anxiety and salivary cortisol concentrations across experimental phases and with respect to psychological measures. Finally, in the full sample and in chronic stress subgroups, a recall bias in terms of a discrepancy between the perception of experimentally-induced symptoms and their recall was tested. Participants with elevated chronic stress presented with increased state anxiety and higher cortisol concentrations throughout the experimental phases compared to the group with low chronic stress. Group differences in visceral sensitivity were not evident. The elevated stress group perceived significantly higher urgency during the stimulation phase, and recalled substantially higher feelings of urgency induced by rectal distensions, while perceived and recalled intensity were comparable between groups. Volunteers with elevated stress exhibited a recall bias in terms of a higher recall relative to mean perception of urgency, whereas no such bias was observed for the intensity of

Altered neural mechanisms are well-acknowledged in irritable bowel syndrome (IBS), a disorder of brain-gut-communication highly comorbid with anxiety and depression. As a key hub in corticolimbic inhibition, medial prefrontal cortex (mPFC) may be involved in disturbed emotion regulation in IBS. However, aberrant mPFC excitatory and inhibitory neurotransmission potentially contributing to psychological symptoms in IBS remains unknown. Using quantitative magnetic resonance spectroscopy (qMRS), we compared mPFC glutamate + glutamine (Glx) and γ-aminobutyric acid (GABA+) concentrations in 64 women with IBS and 32 age-matched healthy women (HCs) and investigated their association with anxiety and depression in correlational and subgroup analyses. Applying functional magnetic resonance imaging (fMRI), we explored whether altered neurotransmission was paralleled by aberrant mPFC resting-state functional connectivity (FC). IBS patients did not differ from HCs with respect to mPFC GABA+ or G...

Irritable bowel syndrome (IBS) is a visceral pain condition with psychological comorbidity. Brain imaging studies in IBS demonstrate altered function in anterior insula (aINS), a key hub for integration of interoceptive, affective, and cognitive processes. However, alterations in aINS excitatory and inhibitory neurotransmission as putative biochemical underpinnings of these functional changes remain elusive. Using quantitative magnetic resonance spectroscopy, we compared women with IBS and healthy women (healthy controls [HC]) with respect to aINS glutamate + glutamine (Glx) and γ-aminobutyric acid (GABA+) concentrations and addressed possible associations with symptoms. Thirty-nine women with IBS and 21 HC underwent quantitative magnetic resonance spectroscopy of bilateral aINS to assess Glx and GABA+ concentrations. Questionnaire data from all participants and prospective symptom-diary data from patients were obtained for regression analyses of neurotransmitter concentrations with...

Changes in brain-gut interactions have been implicated in the pathophysiology of chronic visceral pain in irritable bowel syndrome (IBS). Different mechanisms of sensitization of visceral afferent pathways may contribute to the chronic visceral pain reports and associated brain changes that characterize IBS. They include increased gut permeability and gut associated immune system activation, and an imbalance in descending pain inhibitory and facilitatory mechanisms. In order to study the involvement of these mechanisms, correlations between gut epithelial permeability and live bacterial passage, and structural and functional brain connectivity were measured in women with moderate-to-severe IBS and healthy women. The relationships between gut permeability and functional and anatomical connectivity were significantly altered in IBS compared with the healthy women. IBS participants with lower epithelial permeability reported increased IBS symptoms, which was associated with increased functional and structural connectivity in endogenous pain facilitation regions. The findings suggest that relationships between gut permeability and the brain are significantly altered in IBS and suggest the existence of IBS subtypes based on these interactions.

Visceral pain arising from inner organs differs from somatic pain in crucial aspects, limiting the possibility to transfer knowledge derived from somatic pain research. The neurobiological mechanisms involved in the bidirectional communication between the brain and the gut along the brain-gut axis remain incompletely understood. This review addresses visceral pain from a biopsychological perspective, with an emphasis on psychological aspects and neuroimaging findings. It focuses on the role of stress and other psychological factors involved in the pathophysiology of chronic visceral pain in functional gastrointestinal disorders such as irritable bowel syndrome and summarizes findings on possible sex-related differences. Together, this overview aims to provide insights into a fascinating, interdisciplinary field of research at the interface between biological psychology, neurogastroenterology and the neurosciences.

Increased perception of visceral stimuli is a key feature of Irritable Bowel Syndrome (IBS). While altered resting-state functional connectivity (rsFC) has been also reported in IBS, the relationship between visceral hypersensitivity and aberrant rsFC is unknown. We therefore assessed rsFC within the salience, sensorimotor and default mode networks in patients with and without visceral hypersensitivity and in healthy controls (HCs). An exploratory resting-state functional magnetic resonance imaging study was performed in 41 women with IBS and 20 HCs. Group independent component analysis was used to derive intrinsic brain networks. Rectal thresholds were determined and patients were subdivided into groups with increased (hypersensitive IBS, N = 21) or normal (normosensitive IBS, N = 20) visceral sensitivity. Between-group comparisons of rsFC were carried-out using region-of-interest analyses and peak rsFC values were extracted for correlational analyses. Relative to normosensitive IB...

Being mobile influences not only the type of information people seek but also the ways they attempt to access it. A personal diary may include the person’s experiences, thoughts or feelings. Diaries have made it more convenient to write down the events happening to the author as it happens. In this paper, a diary application was developed for Windows Smartphone. The application was developed using C# programming language on Visual Studio 2014. The user has the ability to write entries, read entries and edit written entries. The diary software was evaluated using a questionnaire completed by twenty (20) users, for user-friendliness, flexibility and accessibility. User responses showed that 16 users (80%) rated the friendliness of the application as excellent or very good. Correspondingly, 17 users (85%) rated the flexibility in navigation while using the application as being either excellent or very good. For accessibility to previous diary entries, 19 users (95%) rated this feature ...

To compare quality of life (QOL) for patients with irritable bowel syndrome (IBS) between the U.S. and Japan, it is indispensable to develop common instruments. The IBS-QOL, which is widely used in Western countries, was translated into Japanese as there has been a lack of Japanese disease-specific QOL measures for IBS. The original 34 items of the IBS-QOL were translated from English into Japanese through two independent forward translations, resolution, back translation, and resolution of differences. Forty nine patients who had GI symptoms but did not have any organic diseases (including 30 IBS patients diagnosed by Rome II criteria) were recruited from Tohoku University Hospital in Sendai, Japan and completed a Japanese version of the IBS-QOL (IBS-QOL-J) concomitant with a Japanese version of the IBS severity index (IBSSI-J) twice within 7-14 days. The IBS-QOL-J demonstrated high internal consistency (Cronbach's alpha; 0.96) and high reproducibility (intraclass correlation coefficient; 0.92, p < 0.001). Convergent analyses confirmed that the overall score of IBS-QOL-J was significantly correlated with overall severity of IBS symptoms on the IBSSI-J (r = -0.36, p = 0.01) and with the individual items on the IBSSI-J that assess interference with life in general (r = -0.47, p = 0.001) and dissatisfaction with bowel habits (r = -0.32, p < 0.05). Eight patients who reported continuous abdominal pain in the past 6 months had significantly lower scores in the IBS-QOL-J than those who did not (53.7 +-12.7 vs. 73.6 +-19.5, p < 0.01). Age, sex, education or marital status did not affect scores on the measure. The IBS-QOL-J is a reliable instrument to assess the disease-specific QOL for IBS. Considering cross-cultural comparison, this measure is likely to be a valuable tool to investigate the QOL in Japanese patients with IBS.

Irritable bowel syndrome (IBS) merupakan penyakit yang mengenai jalur sistem pencernaan di usus besar. Sindrom ini memiliki karakteristik berupa perubahan aktivitas perut dan nyeri perut yang bersifat kronik dan terbagi menjadi beberapa kelompok yaitu predominan gejala diare (IBS-D), gejala konstipasi (IBS-C), kombinasi/alternator (IBS-M), dan unsubtyped (IBS-U) [1]. Selain itu gejala lain juga dapat berupa rasa nyeri perut, kembung, perubahan bentuk tinja dan adanya mukus yang keluar bersama dengan tinja [2]. IBS juga merupakan salah satu penyakit yang paling sering dijumpai Abstrak

Migraine is a recurrent and disabling primary headache disorder that commonly affects a significant proportion of the global population. Recent reports demonstrate an increased frequency of gastrointestinal (GI) disorders in patients with migraine compared with the general population. We review the available literature linking migraine with GI complications and comorbidities.

To evaluate the symptomatology of irritable bowel syndrome (IBS) among health care professionals attending an IBS symposium in a tertiary care university hospital. A questionnaire designed to incorporate Manning and Rome II criteria was distributed among participants of an IBS symposium, most of them were health care professionals. A total of 100 questionnaires were distributed, 41 had symptoms fulfilling criteria of IBS. In these patients male: female ratio was 28:13 with age range 18-68. The predominant symptom was abdominal pain 87.8 % (36/41) which was aggravated post-prandially 72.2% (29/41), relieved following defecation in 87% (35/41) with a sense of incomplete evacuation 85.3% (35/41) and distention after defecation in 80.4% (33/41). Anxiety and depression was present in 80% (33/41) as an extraintestinal symptom. Irritable bowel syndrome is common in health care workers with intestinal and extraintestinal manifestations being equally common.

various anti-inflammatory events. We may therefore propose that interference with epigenetic mechanisms can represent a novel strategy for intervening with pathologies mediated by IgE-activated MCs. However, future studies will be needed to extrapolate the findings to the effects on primary human mast cells. Moreover, such strategies should be adopted with caution, given the possibilities of detrimental side effects associated with global inhibition of DNA demethylation/methylation.

The gut-brain axis is a dynamic, bidirectional communication system connecting the central nervous system with the enteric nervous system. It regulates digestion, cognition, mood, and immune responses and plays an important role in neuropsychiatric and gastrointestinal disorders. Psychobiotics are described as live organisms that interact with the gut-brain axis to improve mental health in the host when consumed in sufficient amounts. This review outlines the mechanism through which psychobiotics will exert their effects, including neurotransmitter modulation (e.g., serotonin, GABA), regulation of the hypothalamicpituitary-adrenal axis, inhibition of neuroinflammation and oxidative stress, restoration of intestinal barrier integrity, and production of neuroactive microbial metabolites such as short-chain fatty acids and tryptophan derivatives. Advances in psychobiotics include engineered microbial strains, targeted delivery systems, personalized therapies, and combination therapies improving mental health. Despite these advances, challenges such as individual differences, regulatory issues, and ethical concerns persist. Continued clinical research is needed to confirm that the psychobiotics are safe and effective for the treatment of psychiatric and neurodevelopmental disorders.

Purpose-Somatization disorder has been described in several comorbid functional syndromes of urological chronic pelvic pain syndrome, such as irritable bowel syndrome. We investigated whether a subset of patients with urological chronic pelvic pain syndrome may have the polysymptomatic, polysyndromic presentation pattern that is common in somatization disorder. Materials and Methods-A total of 70 male and female patients with urological chronic pelvic pain syndrome and 35 age matched controls without the syndrome completed a 59-item symptom checklist to assess the classic polysymptomatic, polysyndromic symptom pattern. The 2 operational tools used were the Perley-Guze derived symptom checklist and the somatic symptom algorithm used for Diagnostic and Statistical Manual, 4th Edition, Text Revision somatization disorder criteria. Results-Female patients with urological chronic pelvic pain syndrome (interstitial cystitis/ bladder pain syndrome) reported significantly more nonpain symptoms and pain symptoms outside the pelvis than control female urology patients (p = 0.0016 and 0.0018, respectively). Female patients with urological chronic pelvic pain syndrome were more likely to endorse a polysymptomatic, polysyndromic symptom pattern than female controls (27% vs 0%, p = 0.0071). In contrast, male patients with urological chronic pelvic pain syndrome (interstitial cystitis/bladder pain syndrome and/or chronic prostatitis/chronic pelvic pain syndrome) did not report more extrapelvic pain than male controls (p = 0.89). Male patients with urological chronic pelvic pain syndrome were not more likely than male controls to have a polysymptomatic, polysyndromic symptom pattern. Conclusions-A subset of female patients with urological chronic pelvic pain syndrome endorses numerous extrapelvic symptoms across multiple organ systems. The checklist may be valuable to assess patients for this polysymptomatic, polysyndromic symptom pattern, which is common in somatization disorder. Recognizing this polysymptomatic, polysyndromic presentation

Faecal microbiota transfer (FMT) consists of the introduction of new microbial communities into the intestine of a patient, with the aim of restoring a disturbed gut microbiota. Even though it is used as a potential treatment for various diseases, it is unknown how the host mucosa responds to FMT. This study aims to investigate the colonic mucosa gene expression response to allogenic (from a donor) or autologous (own) FMT in patients with irritable bowel syndrome (IBS). In a recently conducted randomised, double-blinded, controlled clinical study, 17 IBS patients were treated with FMT by colonoscopy. RNA was isolated from colonic biopsies collected by sigmoidoscopy at baseline, as well as two weeks and eight weeks after FMT. In patients treated with allogenic FMT, predominantly immune response-related gene sets were induced, with the strongest response two weeks after the FMT. In patients treated with autologous FMT, predominantly metabolism-related gene sets were affected. Furthermore, several microbiota genera showed correlations with immune-related gene sets, with different correlations found after allogenic compared to autologous FMT. This study shows that the microbe-host response is influenced by FMT on the mucosal gene expression level, and that there are clear differences in response to allogenic compared to autologous FMT.

INTRODUCTION Dengue is a mosquito-borne viral infection that has become a major global public health concern, with an estimated 390 million infections occurring annually worldwide. [1] While the acute manifestations of dengue are well characterised, there is growing recognition of persistent symptoms that can occur following the acute illness, particularly fatigue. This clinical entity, known as post-dengue fatigue syndrome (PDFS), can significantly impact the quality of life and functionality in a subset of dengue patients. This review aims to synthesise the current evidence on the epidemiology, clinical features, pathophysiology and management of PDFS. EPIDEMIOLOGY The reported incidence of PDFS varies across studies, likely due to differences in study design, populations and case definitions. In a prospective study of hospitalised dengue patients in Singapore, Seet et al. found that 24.4% of patients reported significant fatigue 2 months after acute infection. [2] A study in Sri Lanka observed PDFS in 25% of hospitalised dengue patients. [3]

Blastocystis sp. is among the few enteric parasites with a prevalence that often exceeds 5% in the general population of industrialized countries and can reach 30-60% in developing countries. This parasite is frequently found in people who are immunocompromised (patients with human immunodeficiency virus/acquired immunodeficiency syndrome or cancer) and a higher risk of Blastocystis sp. infection has been found in people with close animal contact. Such prevalence in the human population and the zoonotic potential naturally raise questions about the impact of these parasites on public health and has increased interest in this area. Recent in vitro and in vivo studies have shed new light on the pathogenic power of this parasite, suggesting that Blastocystis sp. infection is associated with a variety of gastrointestinal disorders, may play a significant role in irritable bowel syndrome, and may be linked with cutaneous lesions (urticaria). Despite recent significant advances in the kno...

The technological development of modern manufacturing process and its methods has enabled man to exploit all elements of nature, including najs (impurities) and to use them in the manufacturing industry for various forms of production. This new manufacturing method has brought about a change in the process of converting materials which is more complex than the classical methods used in the time of early jurists. This results in so much fear and reluctance among Muslims regarding the use and consumption of products which are produced through transforming substances that are originally najs. The relevant questions here are: whether these najs substances attain purity upon such chemical conversion and are therefore lawful for use or will the substance remain impure and therefore not lawful for consumption and use? Or are there some legal conditions and regulations for using them? Consequently, this research sets out to analyze the legal effect of istihalah (chemical transformation) in ...

Introduction
Rangeland ecosystems cover more than half of the earth's land surface, these ecosystems have high carbon sequestration and cause the formation of about 10% of the total biomass carbon reserves and 30% of soil carbon. Carbon sequestration potential differs according to plant species, habitats, and management methods. Each ecosystem has a certain potential which is determined by utilizing of natural vegetation, climatic conditions, and physical and chemical properties of the soil. Moreover, the amount of carbon in the soil and plants depends on the characteristics of topography, and any change in the elevation and slope of the habitat will affect the amount of organic carbon in the soil and plant cover and carbon sequestration. Therefore, it is important to determine the effects of elevation and slope characteristics, type of vegetation and canopy cover, and soil characteristics on the amount and changes of carbon sequestration. In this study, the carbon sequestration capacity and its relationship with some physical and chemical characteristics of soil, topography, and rangeland habitat have been investigated.

Materials and Methods
Sampling was conducted in six sites in elevation gradient (from 1400 to 3600 m above sea level; rainfall from 350 to 700 mm; the mean temperature varies from -0.24 to 10.1 °C) in the north of Sablan Mountain, Meshginshahr County, Iran, including three sites with the dominant physiognomy of grass-shrublands and three sites with grassland in three elevation levels of less than 2000, 2000-2500 and more than 2500 m above sea level. In each site, soil sampling was conducted at two depths of 0-15 and 15-30 cm. The random-systematic method was used to study vegetation variables. In this way, 10 plots of one m2 (based on the distribution pattern of plants) were established in each of the three transects with a length of 100 m along each transect. After determining the normality of the data and the homogeneity of the variance of the data,  two-way analysis of variance general linear model (GLM) was used for the overall comparison.

Results
The results showed that with the increase in elevation in the two investigated habitats (grassland and grass-shrubland), the carbon sequestration in the soil increased. Moreover, the results indicate that the depth of the soil has a significant effect on the carbon sequestration capacity. Thus the highest amount of soil carbon deposition is in the soil depth of 0-15 cm in the grassland habitat with an elevation of more than 2500 m (70.53 gr cm-2), then the depth of 0-15 cm in the grass-shrub habitat. At an elevation of more than 2500 m (63.98) and a soil depth of 30-15 cm, the grassland habitat is at an elevation of 2000-2500 m (62.73), and its lowest amount belongs to a soil depth of 30-15 cm. The grass-shrub habitat is at an elevation of less than 2000 m. The results of the correlation analysis of carbon sequestration in habitats and different elevation classes indicate a negative relationship with the percentage of sand, acidity, and electrical conductivity of the soil, and a positive correlation with the percentage of clay and silt, the percentage of organic carbon and organic matter, the percentage of carbon, particulate organic matter, soil nitrogen, and total vegetation cover has shown.

Discussion and Conclusion
The distribution of carbon stocks between biomass and soil varies among ecosystems and is influenced by elevation, so that the carbon sequestration potential is more significant in high elevation classes than in lower classes. Based on the estimated carbon values in the studied habitats, it can be concluded that the higher percentage of canopy cover and density preserves more moisture and prevents evaporation, which in turn can affect the amount of cover and density. Therefore, the effect of vegetation in different elevation classes on the amount of changes in soil carbon deposition is confirmed based on the results obtained in this research. Overall, the carbon sequestration potential is different according to habitat and elevation classes; therefore, by better understanding these factors and investigating the management factors that affect the sequestration process, we can take steps towards strengthening carbon sequestration and sustainable management of rangelands.

BACKGROUND: Adolescents with irritable bowel syndrome (IBS) frequently experience interference with everyday activities. Mind-body approaches such as yoga have been recommended as interventions for patients with IBS. Despite promising results among adult samples, there have been limited studies exploring the efficacy of yoga with pediatric patients.OBJECTIVE: To conduct a preliminary randomized study of yoga as treatment for adolescents with IBS.METHODS: Twenty-five adolescents aged 11 to 18 years with IBS were randomly assigned to either a yoga or wait list control group. Before the intervention, both groups completed questionnaires assessing gastrointestinal symptoms, pain, functional disability, coping, anxiety and depression. The yoga intervention consisted of a 1 h instructional session, demonstration and practice, followed by four weeks of daily home practice guided by a video. After four weeks, adolescents repeated the baseline questionnaires. The wait list control group then...

Background: Psychological distresses and stresses are believed to significantly increase the symptoms of irritable bowel syndrome (IBS). In contrast, healthy lifestyle plays an effective role in the prevention and treatment of IBS. The present article investigated the effect of integrating cognitive-behavioral therapy and mindfulness therapy on the lifestyle of patients with IBS in Tehran. Methods: This study was quasi-experimental (pre-test, post-test, and a one-month follow-up design, and a control group). The statistical population herein included all the women with IBS referred to the Gastroenterology Research Center of Shariati Hospital in Tehran in 2020. We selected 30 patients who were willing to participate in the study using convenience sampling and randomly divided them into the control and experimental groups (n=15 per group). The experimental group underwent 12 sessions (90-minute sessions, two days a week) of integrating cognitive-behavioral therapy and mindfulness therapy, yet the control group received no intervention. The research instrument included the Lifestyle Questionnaire (LSQ). Data analysis was carried out using repeated measures ANOVA. Results: The results indicated that integrating cognitive-behavioral therapy and mindfulness therapy effectively improved lifestyles in women with IBS (P<0.001). The mean post-test and follow-up scores of the experimental group were 162.58±30.83 and 166.00±26.61, respectively, which increased compared to the pre-test (110.58±10.02), post-test (107.17±9.52), and follow-up (103.33±7.24) of the control group. Conclusion: Integrating cognitive-behavioral therapy and mindfulness therapy could be recommended as an effective training to improve the lifestyle of women with IBS.

Objective: to obtain a histological comparison of tertiary dentin after indirect pulp capping procedures using calcium hydroxide or MTA in teeth with deep carious lesions, regarding its morphological characteristics and degree of inflammation induced in the dental pulp. We used 60 third molars with occlusal caries lesions from 30 patients of 17-26 years of age. Class I and II deep cavities were prepared and randomly restored with calcium hydroxide or MTA and glass ionomer cement. The histologic specimens were obtained at 2-4-6 weeks and the evaluation was done by the same person in a double blind manner.The results showed statistical significant differences between these capping materials regarding the formation rate and morphology of tertiary dentin induced by indirect pulp capping procedures. Conclusion: the success of this therapy is conditioned by the use of dental materials that contain or can deliver calcium hydroxide, completed with a final restoration without marginal leakag...

Background: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by altered bowel habits and abdominal pain in the absence of a recognizable structural anomaly. The pathogenesis of IBS has been associated with inflammation and the expression of pro-inflammatory chemokines, such as CCL2 and CCL16. Our study aimed to investigate the relationship between the serum levels of CCL2 and CCL16 and IBS. Additionally, we examined how serum levels of these chemokines relate to IBS subtypes. Methods: Patients with IBS diagnosed according to the Rome III criteria participated in this study (n= 96). Healthy individuals with no history of allergic, autoimmune, chronic or active gastrointestinal infectious diseases were used as controls (n= 44). The serum levels of CCL2 and CCL16 was measured via enzyme-linked immunosorbent assay (ELISA). Results: A significant decrease in the serum levels of CCL16 and CCL2 was observed in the patients with IBS. Additionally, the serum levels of CCL16 in IBS patients with diarrhea (D-IBS) was significantly higher than those with the mixed IBS (M-IBS) subtype. Conclusion: The significant increase in the serum levels of CCL-16 in patients with D-IBS compared to patients with M-IBS suggests that CCL-16 may be used as an immunological biomarker to differentiate between these two subtypes.

Aim: Association studies of serotonin transporter gene SLC6A4 I/S polymorphism and irritable bowel syndrome (IBS) have shown inconsistent and contradictory results among different populations. In the present study, meta-analysis was performed to evaluate the association between SLC6A4 I/S polymorphism and IBS susceptibility. Methodology: Systemic assessment was performed for the published studies based on the association of SLC6A4 I/S polymorphism and IBS risk from PubMed (Medline), EMBASE search. A meta-analysis was done to appraise the said association. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for allele contrast, homozygous, heterozygous, dominant and recessive genetic model. A total of twelve studies comprising 2068 IBS cases and 2076 controls were included in this meta-analysis. Overall, no significant results were obtained for S allele carrier (S vs. I: p=0.488; OR=1.073, 95% CI=0.879 to 1.311) Co-dominant (SS vs. II; p=0.587; OR=1.112, 95% CI=0.758 to 1.631), (IS vs. II; p=0.361; OR=0.878, 95% CI=0.665 to 1.160). Similarly, dominant (SS+IS vs. II: p=0.853; OR=0.974, 95% CI=0.736 to 1.288) and recessive (SS vs. II +IS: p=0.267; OR=1.172, 95% CI=0.886 to 1.522) genetic models did not demonstrate risk. In the subgroup population based analysis, reduced risks were found in American (IS vs. II: p=0.009; OR=0.685, 95% CI=0.516 to 0.908) and Asian (SS+IS vs. II; p=0.001; OR=0.116, 95% CI=0.068 to 0.197) population. However, no risk was observed in European population. This investigation clearly demonstrates that SLC6A4 (Ins/Del) polymorphism is associated with reduced risk of IBS in American and Asian population. However, future well-designed studies with stratified case control and biological characterization will be needed to validate this finding.

Chronic symptoms such as epigastric pain, bloating and early
satiety are the main features of functional dyspepsia (FD). Even though
the Low-FODMAP diet is beneficial for IBS, more research is needed
to determine its effects on FD. The purpose of this review was to find
out how helpful the Low-FODMAP diet is for people with FD. A
search was made in well-known databases (PubMed, web of science,
Cochrane Library, Google Scholar) to find randomized controlled trials
(RCTs) and observational studies published between 2020 and 2025.
Studies that looked at the difference between Low-FODMAP diet
and either control dietary advice or placebo in people with FD were
included. Analysis of pooled data was performed and effect size was
calculated using a random-effects model. The degree of heterogeneity
was tabulated using the I² statistic and funnel plotting and Egger’s test
were carried out to check for publication bias. From the total number of
studies investigated, ten were used for the review since they mirrored
the criteria. The combined analysis showed that following the LowFODMAP diet led to fewer symptoms in the gut and a better quality of
life for people with FD (r = 0.29, 95% CI: -0.03 to 0.57). The diet may
noticeably enhance psychological outcomes, and reductions in anxiety
and depression were found in several studies. Ongoing research is,
however, complicated by the presence of significant heterogeneity
(I² = 94.5%) among studies. The intervention would hence indicate
variability in treatment outcomes. This gives credence to the LowFODMAP diet as a good intervention for gastrointestinal symptoms
in FD and is likely to promote psychological well-being. Although the
heterogeneity was observed, overall results encourage such a diet for
this specific: management of FD. More studies should be conducted
to standardize protocols, determine their long-term effects, and better
understand the psychological implications of the diet.

There is debate about how best to measure patient-reported outcomes (PROs) in irritable bowel syndrome (IBS). We pooled data to measure the psychometric properties of IBS end points, including binary responses (eg, "adequate relief") and 50% improvement in symptom severity. METHODS: We pooled data from 12 IBS drug trials involving 10,066 participants. We tested the properties of binary response and 50% improvement end points, including the impact of baseline severity on performance, and measured construct validity using clinical anchors. RESULTS: There were 9044 evaluable subjects (age, 44 years; 85% female; 58% IBS constipation-prominent [IBS-C]; 31% IBS diarrhea-prominent [IBS-D]). Using the binary end point, the proportion responding in the mild, moderate, and severe groups was 42%, 40%, and 38%, respectively (P ϭ .0008). There was no effect of baseline severity on binary response (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.99 -1.0; P ϭ .07). The proportions reaching 50% improvement in pain were 45%, 41%, and 41%, respectively; there was a small, yet significant, impact of baseline severity (OR, 1.04; 95% CI, 1.03-1.05; P Ͻ .0001) that did not meet clinical relevance criteria. Both end points revealed strong construct validity and detected "minimally clinically important differences" in symptoms. Both provided better discriminant spread in IBS-D than IBS-C. CONCLUSIONS: Both the traditional binary and 50% improvement end points are equivalent in their psychometric properties. Neither is impacted by baseline severity, and both demonstrate excellent construct validity. They are optimized for the IBS-D population but also appear valid in IBS-C.