Search Results for: Trattamento della sindrome dell'intestino irritabile (IBS)

Objectives
To assess the therapeutic effects and safety of Tongxie Yaofang (TXYF) granules vs placebo as an alternative treatment for diarrhoea-predominant irritable bowel syndrome (IBS-D). We hypothesised that TXYF would improve clinical responses among patients with IBS-D.

Design
A randomised, double-blind, placebo-controlled, phase II, superiority trial.

Setting
Outpatients attending the Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China.

Participants
96 eligible participants included men and women ranging from late adolescence to middle adulthood (18–65 years), diagnosed with IBS-D according to the Rome IV criteria. In addition, they were required to have an irritable bowel syndrome symptom severity score (IBS-SSS) of at least 75.

Interventions
TXYF granules (3.7 g) twice daily (taken orally before meals) or placebo for 8 weeks.

Primary and secondary outcomes
The primary outcome was the response rate measured by the change in IBS-SSS compared with baseline at week 8. Secondary outcomes included stool frequency; stool consistency at weeks 4, 8 and 20; and quality of life, anxiety and depression at week 8; and safety was monitored throughout the trial.

Results
The TXYF and placebo groups each comprised 48 participants. The response rate was not significantly different at week 8 between the two groups (the unadjusted treatment effect estimate (intention-to-treat analysis) was 1.12 (95% CI (0.89, 1.41)), p=0.348). Both groups had a high and similar rate of symptom reduction (79.2% (38/48) vs 70.8% (34/48)). There were no statistically significant differences between the two groups on secondary outcomes, although both groups showed substantial improvements. Adverse events in the TXYF and placebo groups were one (sinus arrhythmia) and two (elevated transaminases, weakly positive faecal occult blood), respectively. No serious adverse events occurred.

Conclusions
Despite showing clinically meaningful improvements in IBS-D symptoms and a reasonable safety profile after 8 weeks, no significant differences were observed between the TXYF and placebo groups. This suggests that the severity of IBS-D symptoms in both treatment arms might have decreased over time, regardless of the treatment, and highlights the need to investigate the relationship between IBS-D and patient psychology. Future large-scale, rigorously designed trials with longer treatment and follow-up periods are essential to evaluate the therapeutic effects and safety of TXYF, and to explore the psychological factors.

Trial registration number
ISRCTN12453166.

Many patients with IBD report persisting symptoms, despite resolution of the inflammatory process. Although by definition, a diagnosis of IBS cannot be made, the prevalence of ‘IBS in IBD’ surpasses the rate of IBS in the global population by fivefold. Because IBS-like symptoms are associated with a decreased quality of life and increased healthcare utilisation in IBD, diagnosis and treatment are necessary. In this review, we summarise the current knowledge on IBS-like symptoms in IBD. A pathophysiological common ground is present, which includes genetic susceptibility, environmental triggers, gut microbial dysbiosis, increased intestinal permeability, visceral hypersensitivity and involvement of brain–gut interaction. When symptoms persist after resolution of inflammation, other GI diseases should be excluded based on the chief complaint, considering any possible psychological co-morbidity early in the diagnostic work-up. Subsequent treatment should be initiated that is evidence-based and often multimodal, including classical and non-classical pharmacological agents as well as lifestyle and microbiota-based approaches, spanning the breadth of the gut, brain and its interaction. Treatment goals in this substantial part of the IBD population should be adapted to not only focus on treating the inflammation but taking care of the patient.

A series of papers in Gut recently highlighted genetic variation in the sucrase-isomaltase gene (SI; coding for a brush-border disaccharidase) as a likely causative factor in a subset of patients with irritable bowel syndrome (IBS).1–4 Hypomorphic (dysfunctional) SI variants may thus underlie gastrointestinal symptoms in rare recessive forms of congenital SI deficiency (CSID)5 as well as milder complex (IBS) manifestations,6 across a broad spectrum of genetic SI deficiencies (GSID) that vary in severity and onset of presentation.7 Moreover, SI carrier status has been shown to also affect the response to specific carbohydrate-focused diets, thus providing a rationale for personalising (dietary) therapeutic strategies in IBS.1 8 Together with SI, a number of human Carbohydrate-Active enZymes (hCAZymes, www.cazy.org/e355.html) are involved in the breakdown of polysaccharides during the process of carbohydrate digestion,…

Irritable bowel syndrome (IBS) is a common condition characterized by recurrent abdominal pain associated with a change in stool form or frequency, which may be diarrhea-predominant (IBS-D), constipation-predominant (IBS-C), or marked by mixed bowel habits (IBS-M).1,2 Studies have shown substantial variation in the care of patients with IBS, often including extensive diagnostic testing leading to unnecessary health care expenditures without notable improvements in outcomes. In addition to the impact on quality of life, this leads to a considerable economic burden related to absenteeism and direct medical expenses.

Virus salirebbe al cervello per il nervo vago favorendo malattia

Aideco, ‘il trattamento nasconde insidie se non è eseguito bene’

Aideco, ‘il trattamento nasconde insidie se non è eseguito bene’

With great interest, we read the article by Konings et al,1 in which the authors conducted a combined case–control and cohort study and found that dysphagia, gastroparesis, irritable bowel syndrome (IBS) without diarrhoea and constipation specifically predict subsequent newly onset idiopathic Parkinson’s disease (PD) through comparing patients with PD with matched negative controls and patients with Alzheimer’s disease (AD) and cerebrovascular diseases (CVDs). However, several methodological concerns should be carefully addressed before concluding that those gastrointestinal (GI) syndromes can predict the development of PD. First, reverse causation from the diagnostic delay of neurodegenerative diseases is a big concern,2 3 and not considering it in the analysis might lead to spurious associations (eg, the short-term increased PD risk after Clostridium difficile infection4). Given this diagnostic delay, the temporal relationship between GI syndromes and neurodegenerative disease in Konings et al’s study1…

Background
Colonic motility in constipation can be assessed non-invasively using MRI.

Objective
To compare MRI with high-resolution colonic manometry (HRCM) for predicting treatment response.

Design
Part 1: 44 healthy volunteers (HVs), 43 patients with irritable bowel syndrome with constipation (IBS-C) and 37 with functional constipation (FC) completed stool diaries and questionnaires and underwent oral macrogol (500–1000 mL) challenge. Whole gut transit time (WGTT), segmental colonic volumes (CV), MRI-derived Motility Index and chyme movement by ‘tagging’ were assessed using MRI and time to defecation after macrogol recorded. Left colonic HRCM was recorded before and after a 700 kcal meal. Patients then proceeded to Part 2: a randomised cross-over study of 10-days bisacodyl 10 mg daily versus hyoscine 20 mg three times per day, assessing daily pain and constipation.

Results
Part 1: Total CVs median (range) were significantly greater in IBS-C (776 (595–1033)) and FC (802 (633–951)) vs HV (645 (467–780)), p

Gli esperti:tempi non sono maturi fuori dai centri specializzati

In prevenzione, diagnosi precoce, trattamento e riabilitazione