American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation

Gastroenterology, Journal Year: 2023, Volume and Issue: 164(7), P. 1086 - 1106

Published: May 19, 2023

Language: Английский

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Irritable bowel syndrome: Epidemiology, overlap disorders, pathophysiology and treatment

World Journal of Gastroenterology, Journal Year: 2023, Volume and Issue: 29(26), P. 4120 - 4135

Published: July 6, 2023

Coronavirus disease 2019 (COVID-19) has several extrapulmonary symptoms. Gastrointestinal (GI) symptoms are among the most frequent clinical manifestations of COVID-19, with severe consequences reported in elderly patients. Furthermore, impact COVID-19 on patients pre-existing digestive diseases still needs to be fully elucidated, particularly older population. This review aimed investigate GI tract, liver, and pancreas individuals without previous diseases, a particular focus elderly, highlighting distinctive characteristics observed this Finally, effectiveness adverse events anti-COVID-19 vaccination disorders peculiarities found discussed.

Language: Английский

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Irritable bowel syndrome: treatment based on pathophysiology and biomarkers

Gut, Journal Year: 2022, Volume and Issue: 72(3), P. 590 - 599

Published: Oct. 28, 2022

Objective To appraise the evidence that pathophysiological mechanisms and individualised treatment directed at those provide an alternative approach to of patients with irritable bowel syndrome (IBS). Design A PubMED-based literature review IBS was conducted independently by two authors, any differences perspective or interpretation were resolved following discussion. Results The availability several noninvasive clinical tests can responsible for symptom generation in IBS, including rectal evacuation disorders, abnormal transit, visceral hypersensitivity hypervigilance, bile acid diarrhoea, sugar intolerances, barrier dysfunction, microbiome, immune activation chemicals released latter mechanism. basic molecular contributing these pathophysiologies are increasingly recognised, offering opportunities intervene medications specifically food components, receptors potentially microbiome. Although supporting interventions each mechanism is not same level proof, current state-of-the-art provides opportunity advance practice from based on symptoms individualisation guided pathophysiology clinically identified biomarkers. Conclusion These advances augur well implementation evidence-based actionable biomarkers psychological disturbances.

Language: Английский

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Efficacy of Probiotics in Irritable Bowel Syndrome: Systematic Review and Meta-analysis

Gastroenterology, Journal Year: 2023, Volume and Issue: 165(5), P. 1206 - 1218

Published: Aug. 3, 2023

Some probiotics may be beneficial in irritable bowel syndrome (IBS), but differences species and strains used, as well endpoints reported, have hampered attempts to make specific recommendations which should preferred. We updated our previous meta-analysis examining this issue.

Language: Английский

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AGA Clinical Practice Update on Evaluation and Management of Belching, Abdominal Bloating, and Distention: Expert Review

Gastroenterology, Journal Year: 2023, Volume and Issue: 165(3), P. 791 - 800.e3

Published: July 13, 2023

DescriptionBelching, bloating, and abdominal distention are all highly prevalent gastrointestinal symptoms account for some of the most common reasons patient visits to outpatient gastroenterology practices. These often debilitating, affecting patients' quality life, contributing work absenteeism. Belching bloating differ in their pathophysiology, diagnosis, management, there is limited evidence available various treatments. Therefore, purpose this American Gastroenterological Association (AGA) Clinical Practice Update provide best practice advice based on both controlled trials observational data clinicians covering clinical features, diagnostics, management considerations that include dietary, gut-directed behavioral, drug therapies.MethodsThis Expert Review was commissioned approved by AGA Institute Updates Committee Governing Board timely guidance a topic high importance membership, underwent internal peer review external through standard procedures Gastroenterology. statements were drawn from published literature trials, more robust studies, expert opinion. Because systematic reviews not performed, these do carry formal ratings regarding or strength presented considerations.Best Advice StatementsBest 1Clinical history physical examination findings impedance pH monitoring can help differentiate between gastric supragastric belching.Best 2Treatment options belching may brain–gut behavioral therapies, either separately combination, such as cognitive therapy, diaphragmatic breathing, speech central neuromodulators.Best 3Rome IV criteria should be used diagnose primary distention.Best 4Carbohydrate enzyme deficiencies ruled out with dietary restriction and/or breath testing. In small subset at-risk patients, bowel aspiration glucose- lactulose-based hydrogen testing evaluate intestinal bacterial overgrowth.Best 5Serologic rule celiac disease patients and, if serologies positive, biopsy done confirm diagnosis. A dietitian part multidisciplinary approach care nonceliac gluten sensitivity.Best 6Abdominal imaging upper endoscopy ordered alarm recent worsening symptoms, an abnormal only.Best 7Gastric emptying studies routinely distention, but considered nausea vomiting present. Whole gut motility radiopaque transit unless other additional treatment-refractory lower exist warrant neuromyopathic disorders.Best 8In thought related constipation difficult evacuation, anorectal physiology suggested pelvic floor disorder.Best 9When modifications needed (eg, low–fermentable oligosaccharides, disaccharides, monosaccharides polyols diet), preferably monitor treatment.Best 10Probiotics treat 11Biofeedback therapy effective when disorder identified.Best 12Central neuromodulators antidepressants) reducing visceral hypersensitivity, raising sensation threshold, improving psychological comorbidities.Best 13Medications treating present.Best 14Psychological hypnotherapy, behavior therapies 15Diaphragmatic breathing abdominophrenic dyssynergia. Belching, therapies. This considerations. Best Statements belching. Treatment neuromodulators. Rome distention. Carbohydrate overgrowth. Serologic sensitivity. Abdominal only. Gastric disorders. disorder. When treatment. Probiotics Biofeedback identified. Central comorbidities. Medications Psychological Diaphragmatic describe definition, treatment 3 belching, frequent severe enough impair daily activities, they categorized disorders gut–brain interaction (DGBIs).1Drossman D.A. Functional disorders: history, features IV.Gastroenterology. 2016; 1501282–1279Abstract Full Text PDF PubMed Scopus (1414) Google Scholar The herein evidence-based available, insufficient level 5 provided basis opinion empirically consensus authors. prevalent, possibly life (QOL), productivity, emergency services.2Sperber A.D. Bangdiwala S.I. Drossman et al.Worldwide prevalence burden functional disorders, results Foundation global study.Gastroenterology. 2021; 160: 99-114Abstract (835) Scholar, 3Drossman Li Z. Andruzzi E. al.US householder survey Prevalence, sociodemography, health impact.Dig Dis Sci. 1993; 38: 1569-1580Crossref (1972) 4Peery A.F. Crockett S.D. Murphy C.C. al.Burden cost gastrointestinal, liver, pancreatic diseases United States: update 2018.Gastroenterology. 2019; 156: 254-272Abstract (904) Limited information gastroenterologists find diagnosing managing DGBI we lack because much existing single-centered at times, controversial. Few address pathophysiology risk factors remain suboptimal. Furthermore, overlap DGBIs, mechanisms involve centrally mediated peripheral processes. Review, separate given differing locations, pathways diagnosis defines audible escape air esophagus stomach into pharynx. It referred "excessive belching" it bothersome disrupt patient's usual activities occurs than days per week.5Stanghellini V. Chan F.K. Hasler W.L. al.Gastroduodenal disorders.Gastroenterology. 150: 1380-1392Abstract (913) occur otherwise healthy individuals. also including gastroesophageal reflux (GERD), dyspepsia (FD), gastroparesis (GP), pregnancy, anxiety.6Bredenoord A.J. Weusten B.L. Timmer R. al.Air swallowing, disease.Am J Gastroenterol. 2006; 101: 1721-1726Crossref (59) 7Piessevaux H. De Winter B. Louis al.Dyspeptic general population: factor cluster analysis symptom groupings.Neurogastroenterol Motil. 2009; 21: 378-388Crossref (141) 8Koukias N. Woodland P. Yazaki al.Supragastric belching: association esophageal hypomotility.J Neurogastroenterol 2015; 398-403Crossref (49) has been reported up 50% GERD.9Jeong S.O. Lee J.S. T.H. al.Characteristics symptomatic who exhibit belching.J 27: 231-239Crossref Scholar,10Hemmink G.J. Bredenoord symptoms.Am 104: 1992-1997Crossref (60) Structural causes hiatal paraesophageal hernias post Nissen fundoplication, impaired accommodation lead dyspepsia.11Pauwels A. Boecxstaens Broers C. al.Severely hallmark post-Nissen symptoms.Neurogastroenterol 2017; 29e13063Crossref (14) subdivided stomach. Supragastric 3.4% (GI) commonly associated anxiety.8Koukias population-based study 73,000 adults, overall 1%.2Sperber different aerophagia. With aerophagia, excessive swallowing increases intragastric gas. leads less often, belching.12Hemmink G.J.M. B.L.A.M. al.Aerophagia: demonstrated monitoring.Clin Gastroenterol Hepatol. 7: 1127-1129Abstract (40) Note excess moves intestines colon, therefore, flatulence commonly, main manifestation rather alone.6Bredenoord High-resolution manometry, combined monitoring, differentiates spontaneous transient relaxation sphincter followed transport esophagus. clinically Then, (UES) relaxes expelled orally.13Dent J. Holloway R.H. Toouli al.Mechanisms oesophageal incompetence gastrooesophageal reflux.Gut. 1988; 29: 1020-1028Crossref (572) Conversely, enters leading opening UES. clears via peristalsis, stomach6Bredenoord (Figure 1A B). contrast, involves 2 mechanisms—the air-suction method air-injection method.14Kessing B.F. Bredenox Smout A.J.P.M. 2014; 109: 1196-1203Crossref differs aerophagia flows pressure gradient resulting UES relaxation. before influx esophagus, contrast where late event. Unlike flow quickly independent peristalsis (Figures 2A B 3A initiates means elevated pharyngeal pressure. contraction base tongue peristaltic pharynx, wave. latter mechanism akin deliberate burping individuals learned behavior.Figure 3(A) image left shows then (see orange arrow image) belch (thick arrow) acid episode follows (blue < 4.0). (B) Line tracing right swallow seen air.View Large Image Figure ViewerDownload Hi-res Download (PPT) biopsychosocial attend psychosocial triggering factors, anxiety, events, conditioned responses stressors symptoms. Notably, stops during sleep, distraction, speaks.15Karamanolis G. Triantafyllou K. Tsiamoulos al.Effect sleep 24-hour impedance-pH study.J Clin 2010; 44: 332-334Crossref (26) Scholar,16Bredenoord al.Psychological affect frequency aerophagia.Am 2777-2781Crossref (56) provides modulate occurrence which responsive (BGBTs), (CBT). reduce release, thereby wall tension. Surprisingly, children GERD present.17Masui D. Nikaki Sawada al.Belching children: disease.Neurogastroenterol 2022; 34e14194Crossref (4) conditioning later Clinicians first communicate definition establish understanding implement collaborative Impedance helped educate similar biofeedback objectively demonstrating step toward consequence reflux. due episodes typically nonacidic, explain response proton pump inhibitors. Recent activity does respond inhibitor after does.9Jeong strategies, helping become aware symptoms.18Keefer L. Ballou S.K. al.A working team report brain-gut gut-brain interaction.Gastroenterology. 162: 300-315Abstract video: https://romedross.video/3azBfEE) vagal tone, inducing stress response, option addition, improves therapy.19Ong A.M. Chua L.T. Khor C.J. al.Diaphragmatic reduces refractory symptoms.Clin 2018; 16: 407-416.e2Abstract (45) Similarly, CBT exposure, QOL.20Glasinovic Wynter Arguero al.Treatment reflux.Am 113: 539-547Crossref (44) BGBTs, training improve QOL symptoms.21Hurtte Rogers B.D. Richards al.The value psycho-gastroenterological interventions 34e14315Crossref dedicated therapist effectively,22Hemmink Ten Cate al.Speech belching—a pilot study.Neurogastroenterol 22: 24-28.e2–e3Crossref (64) confirmed our experience. We advocate baclofen use alone, prevent those GERD.23Blondeau Rommel al.Baclofen postprandial events rumination belching.Clin 2012; 10: 379-384Abstract (88) Scholar,24Curcic Schwizer Kaufman al.Effects anatomy oesophago-gastric junction proximal volunteers assessed magnetic resonance high-resolution manometry: randomised double-blind study.Aliment Pharmacol Ther. 40: 1230-1240PubMed Finally, distress raise threshold bloating) trigger belching.25Drossman Tack Ford A.C. al.Central (disorders interaction): report.Gastroenterology. 154: 1140-1171Abstract (243) treatment, BGBTs applied combination 4). subjective any region experienced fullness, swelling, trapped gas gaseousness, tightness, described "inflamed" cultures. visible increase girth, "like balloon" being pregnant." conditions have interrelated pathophysiologies, usually coexisting strategies hard separate. define DGBIs recurrent fullness girth least 1 day week active months, onset 6 without predominance pain alteration habits.5Stanghellini category acknowledging patients. large found 3.5% (4.6% women 2.4% men).2Sperber However, (>50%) irritable syndrome (IBS), constipation, FD.26Palsson OS, Simren M, J, al. Bloating distension: inherent characteristics (IBS) (FD)? Poster at: Digestive Disease Week May 21–24, San Diego, CA.Google will isolated diagnoses DGBIs.27Lacy B.E. Cagnemi Vazquez-Roque M. Management chronic distension bloating.Clin 19: 219-231Abstract (47) diagnostic criteria, defined above met, fulfill IBS, diarrhea, FD.5Stanghellini so syndromes occasional allows standardized research guides provider identify undergo treatment.1Drossman Scholar,28Drossman Ruddy Gut Feelings: Disorders Gut-Brain Interaction Patient-Doctor Relationship. Care, 2021Google Given multiple etiologies depend algorithmic presumptive causes, discussed below 5). lactase sucrase), many artificial sweeteners sugar alcohols sorbitol), fructans bloating. They population, undigested sugars osmotic effects colon malabsorption failure digest absorb lactose sucrose.29Misselwitz Butter Verbeke al.Update intolerance: pathogenesis, management.Gut. 68: 2080-2091Crossref (184) Scholar,30Storey Bornet F. al.Gastrointestinal tolerance erythritol xylitol ingested liquid.Eur Nutr. 2007; 61: 349-354Crossref (81) malabsorb carbohydrates get Those hypersensitivity IBS) likely experience thresholds distention.31Wilder-Smith C.H. Materna Wermelinger al.Fructose intolerance testing: relationship disorders.Aliment 2013; 37: 1074-1083Crossref (124) largest cohort specifically IBS subtypes, evaluated date, fructose common—seen 60% patients—and higher (51%), its across major types except (IBS-C).31Wilder-Smith disorders.Alimen

Language: Английский

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Effect of Brain-gut Behavioral Treatments on Abdominal Pain in Irritable Bowel Syndrome: Systematic Review and Network Meta-analysis.

Gastroenterology, Journal Year: 2024, Volume and Issue: 167(5), P. 934 - 943.e5

Published: May 20, 2024

BGBT brain-gut behavioral treatment CBT cognitive therapy CI confidence interval DGBI disorder of gut-brain interaction FDA Food and Drug Administration IBS irritable bowel syndrome IBS-C with constipation IBS-D diarrhea IBS-M mixed stool pattern RCT randomized controlled

Language: Английский

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NHE3 inhibitor tenapanor maintains intestinal barrier function, decreases visceral hypersensitivity, and attenuates TRPV1 signaling in colonic sensory neurons

AJP Gastrointestinal and Liver Physiology, Journal Year: 2024, Volume and Issue: 326(5), P. G543 - G554

Published: Jan. 22, 2024

A series of nonclinical experiments support the theory that tenapanor inhibits IBS-C-related pain by strengthening intestinal barrier. Tenapanor treatment reduced visceral motor responses to nonsensitized levels in two rat models hypersensitivity and capsaicin sensitized colonic nociceptive dorsal root ganglia neurons. Intestinal permeability human colon monolayer cultures found attenuates increases induced either inflammatory cytokines or fecal supernatants from patients with IBS-C.

Language: Английский

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Microbiota modulation in disorders of gut-brain interaction

Digestive and Liver Disease, Journal Year: 2024, Volume and Issue: 56(12), P. 1971 - 1979

Published: May 20, 2024

Language: Английский

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An evidence-based update on the diagnosis and management of irritable bowel syndrome

Expert Review of Gastroenterology & Hepatology, Journal Year: 2025, Volume and Issue: unknown, P. 1 - 16

Published: Jan. 21, 2025

Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction affecting 5% the population. The cardinal symptoms are abdominal pain and altered stool form or frequency. Diagnosis management IBS. We searched literature for diagnostic accuracy studies, randomized controlled trials, meta-analyses. A positive diagnosis IBS, alongside testing to exclude celiac disease, recommended. Exhaustive investigation has low yield. Patients should be offered traditional dietary advice. If response incomplete, specialist dietetic guidance considered. Probiotics may beneficial, but quality evidence poor. First-line treatment constipation with laxatives, secretagogues used where these ineffective. Anti-diarrheal drugs first-line diarrhea, second-line including 5-hydroxytryptamine-3 antagonists, eluxadoline, rifaximin, available. antispasmodics, neuromodulators prescribed second-line. Low-dose tricyclic antidepressants, such as amitriptyline, preferred. Brain-gut behavioral therapies effective have efficacy in patients refractory standard therapies. Despite substantial advances, there remains scope improvement terms both Reinforcement strategies condition novel paradigms required.

Language: Английский

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Efficacy of gut–brain neuromodulators in irritable bowel syndrome: an updated systematic review and meta-analysis

˜The œLancet. Gastroenterology & hepatology, Journal Year: 2025, Volume and Issue: unknown

Published: April 1, 2025

Language: Английский

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