Year: 2014
Type: dissertation
Abstract: Irritable \nbowel \nsyndrome \n(IBS) \nand \ninflammatory \nbowel \ndisease \n(IBD) \nare \nboth \nchronic \nrelapsing \nintestinal \ndisorders. \nTheir \nsymptom \nprofiles \noverlap \nin \nterms \nof \nabdominal \ndiscomfort \nand \naltered \nbowel \nhabit. \nMeta-‐analysis \nof \npatients \nwith \nIBD \ndemonstrates \nthat \n25-‐46% \nof \nthose \nin \nclinical \nremission \nhave \nsymptoms \ncompatible \nwith \nIBS. \nThese \npatients \nreport \nlower \nquality \nof \nlife \nscores \ncompared \nto \ntheir \nasymptomatic \ncounterparts. \nThere \nis \nuncertainty \nas \nto \nthe \ncause \nof \nthese \nsymptoms, \nand \nconcern \nfor \nthe \ninfluence \nthey \nmay \nexert \non \nclinical \nmanagement. \nThe \nwork \ndescribed \nin \nthis \nthesis \ninvestigated \nthe \nnature \nof \nIBS-‐type \nsymptoms \noccurring \nin \npatients \nwith \nIBD, \nexamined \npotential \ndiagnostic \ntools \nto \ndistinguish \nbetween \nthe \nrespective \nconditions, \nand \nconducted \na \ntherapeutic \ntrial \nfor \nthe \nmanagement \nof \nfunctional \nsymptoms \nin \nthis \nsetting. \nIBS-‐type \nsymptoms \nwere \nobserved \nto \noccur \nmore \ncommonly \nin \nfemale \nIBD \npatients, \nwere \nassociated \nwith \nhigh \nanxiety \nlevels, \nand \noccurred \nin \npatients \nwith \nno \nactive \ninflammation \nas \nconfirmed \nby \na \nnormal \nfaecal \ncalprotectin \nlevel. \nThese \nfindings \nare \ncharacteristic \nof \nirritable \nbowel \nsyndrome, \nand \nsuggest \nthat \nthis \ndisorder \nmay \ncause \npersistent \nsymptoms \nduring \nIBD \nremission. \nTwo \npotential \nbiomarkers \nof \nIBS \nwere \ninvestigated. \nThe \nfirst \nexplored \na \nhypothesis \nthat \nIBS \nmay \nbe \na \nsystemic \ncondition \ncaused \nby \nthe \nabsorption \nof \ntoxic \nmetabolites \nproduced \nby \nthe \nbacterial \nfermentation \nof \ndietary \ncarbohydrates. \nThis \nmechanism \nwould \npotentially \nexplain \nboth \nthe \ngastrointestinal \nand \nthe \nsystemic \nsymptoms \nthat \nare \nobserved \nin \npatients \nwith \nIBS. \nIt \nwas \nproposed \nthat \ntoxic \nmetabolites \nmay \ncovalently \nmodify \nalbumin \nin \npatients \nwith \nIBS, \nhowever \non \ninvestigation \nof \nthis \ntheory \nthere \nwas \nno \nsignificant \ndifference \nobserved \nbetween \nthe \nplasma \nsamples \nof \nIBS \npatients, \nIBD \npatients \nand \nhealthy \ncontrols. \nThe \npresence \nof \nsystemic \nsymptoms \nin \npatients \nwith \nIBS \nand \nIBD \nwas \nassociated \nwith \nhigher \nanxiety \nlevels. \nCognitive \nfunction \nwas \nalso \nassessed \nas \na \npotential \nbiomarker \nof \nIBS \nfollowing \nanecdotal \nreports \nthat \nIBS \npatients \nexperience \nimpaired \nconcentration. \nHowever \nno \nsignificant \ndifference \nbetween \nIBS \npatients, \nIBD \npatients, \nand \nhealthy \ncontrols \nwas \nidentified. \nConcurrent \nmood \ndisorders, \nin \nparticular \ndepression, \nwere \nassociated \nwith \nimpaired \nperformance \nof \nspecific \ntasks \nin \npatients \nwith \nIBD. \nA \nrandomised-‐controlled \ntrial \nof \na \nmindfulness-‐based \npsychological \nintervention \nwas \nperformed \nin \nIBD \npatients \nwith \nIBS-‐type \nsymptoms \nor \nhigh \nperceived \nstress \nlevels. \nSub-‐group \nanalysis \ndemonstrated \na \nsignificant \nimprovement \nin \nquality \nof \nlife \nin \nthe \nintervention \ngroup \nin \nthose \npatients \nwho \nwere \nexperiencing \nIBS-‐type \nsymptoms. \nOverall, \nthese \nfindings \nsupport \nthe \ntheory \nthat \nIBS \ncan \ncause \npersistent \nsymptoms \nin \nIBD \npatients \nwho \nare \nin \nremission. \nHowever, \nuntil \nthe \nmolecular \nmechanisms \nunderlying \nIBS \nare \nidentified \nand \nreliable \nbiomarkers \nare \ndeveloped, \na \nsystematic \ndiagnostic \napproach \nis \nrequired \nto \nevaluate \nthese \npatients. \nIBS-‐type \nsymptoms \nin \nIBD \npatients \nrepresent \na \ntherapeutic \ntarget \nto \nimprove \nquality \nof \nlife \nand \nfurther \ntrials \nof \npsychological \nintervention, \nmedication \nand \ndietary \nmodification \nare \nrequired.
Author: James Berrill
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1525957901