Irritable Bowel Syndrome A functional or an organic condition? Ferrara, September 27 th, 2014...
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Irritable Bowel Syndrome A functional or an organic condition? Ferrara, September 27 th , 2014 Reinhold W. Stockbrugger Em. Prof. Gastroenterology and Hepatology, University Maastricht/NL Contract Prof. Internal Medicine, University Ferrara/I Editor European Journal of Gastroenterology & Hepatology [email protected]
Irritable Bowel Syndrome A functional or an organic condition? Ferrara, September 27 th, 2014 Reinhold W. Stockbrugger Em. Prof. Gastroenterology and Hepatology,
Irritable Bowel Syndrome A functional or an organic condition?
Ferrara, September 27 th, 2014 Reinhold W. Stockbrugger Em. Prof.
Gastroenterology and Hepatology, University Maastricht/NL Contract
Prof. Internal Medicine, University Ferrara/I Editor European
Journal of Gastroenterology & Hepatology
[email protected]
Slide 2
What is a functional condition? ? I do not function ? ? It
functions me ? ? Am I healthy ? ? Sick leave for functional
disorders ? ? Do I need a psychologist ? ? Or a pension ? ? Why has
the doctor said that that (s)he cannot help me? I think (s)he does
not function !!!
Slide 3
RS: body + soul? Fortunately much more! My parents (or the lack
of them) The alcohol The politics The bugs My boss The weather The
fast and slow food The sex The money The music The diabetes The
sports The future and the anxiety
IBS Epidemiology In Northern Greece Katsinelos et al. Eur J
Gastroenterol Hepatol 2009; 21: 183-9 Setting: Primary Care, 2004 -
2007 N= 2397 (f: 70.6%; mean age 46.1 years) IBS in 15.7% (D-IBS
36.5%; C-IBS 44.2%; M-IBS 19.3%) IBS patients more likely to be:
female from urban areas
Slide 7
Slide 8
IBS Epidemiology In Asia Gwee et al. J Gastroenterol Hepatol
2009; 24: 1601-7 Early studies: prevalence
IBS Clinical presentation and diagnosis To consider (depending
on history, physical and mental examination, basic lab, and
environment): -Postinfectious IBS (onset!) -Lactose intolerance
-Other nutritional causes (fructose, BMI) -Chronic parasitic
infection -Inflammatory Bowel Disease -Early childhood trauma
-Psychosocial stress/events (chronic > acute)
IBS Clinical presentation and diagnosis Useful: - Comorbidity
(fibromyalgia; dyspepsia; dysuria; etc) - Assessment anxiety and
depression (HADS) - Assessment Health-Related Quality of Life
(HRQoL)
Slide 24
Relation between concurrent anxiety and/or depression and SF-36
Mean score SF-36 subscales
Slide 25
IBS Treatment Is there a standard treatment for IBS? NO (and
YES)
Slide 26
Slide 27
IBS Treatment, some progress (1) Bijkerk et al. BMJ 2009; 339:
b3154 Soluble or insoluble fibre in irritable bowel syndrome in
primary care? Randomised placebo controlled trial Setting: General
practice, Netherlands N= 275 Treatment: psyllium 10 g or bran 10 g
or placebo 10 g Outcome: psyllium better than both alternatives,
with the best symptom reduction after 3 months
Slide 28
IBS Treatment, some progress (2) Simren et al. Aliment
Pharmacol Ther 2010; 31: 217-27 Clinical trial: the effects of a
fermented milk containing three probiotic bacteria in patients with
irritable bowel syndrome, a randomized, double-blind, controlled
trial Setting: outpatientN= 74 Probiotic: 2 lactobacilli, 1
bifidobacter, in acidified milk Duration: 8 weeks; weekly
assessment Response: probiotic 38%, placebo 27% (n.s.); probiotics
better in the initial 2 weeks
Slide 29
The last meta-analysis Am J Gastroenterol. 2014 Jul 29. doi:
10.1038/ajg.2014.202. [Epub ahead of print] Efficacy of Prebiotics,
Probiotics, and Synbiotics in Irritable Bowel Syndrome and Chronic
Idiopathic Constipation: Systematic Review and Meta-analysis. Ford
AC1, Quigley EM2, Lacy BE3, Lembo AJ4, Saito YA5, Schiller LR6,
Soffer EE7, Spiegel BM8, Moayyedi P9
Slide 30
Postinfectious IBS Outcome (1) Good hope: Jung et al. J Clin
Gastroenterol 2009; 43: 534-40 The clinical course of
postinfectious irritable bowel syndrome: a five-year follow-up
study Setting: Hospital personnel; 5 years after Shigella infection
outbreak N= 119 (Shigella exposed 60; controls 59) Follow-up at 1,
3, 5 years
Slide 31
Postinfectious IBS Outcome (2) IBS after infection (in %)
TimeShigella +Shigella 1 year13,81.1s. 3 years14.94.5s. 5
years20.812.2n.s.
Slide 32
IBS Future needs (1) At short term: -Knowledge about causes and
natural history -Capacity to apply a bio-psycho-social model to
diagnosis, therapy and follow-up (SPECT) -Patient-orientated
healthcare organisation -More public information about functional
gastrointestinal disorders and their comorbidity
Slide 33
IBS Future needs (2) At longer term, individualised care:
-Markers for the pathogenetic contribution of Central and
Peripheral Nervous System, gut flora and immune system, as well as
for the psycho-social risks factors -Drugs and clinical techniques
that can interfere at central, intermediate and/or peripheral
levels
