| 1. |
- Ersryd, Amanda, 1981, et al.
(författare)
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Subtyping the irritable bowel syndrome by predominant bowel habit: Rome II versus Rome III.
- 2007
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Ingår i: Alimentary pharmacology & therapeutics. - : Wiley. - 0269-2813 .- 1365-2036. ; 26:6, s. 953-61
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The agreement between subtyping irritable bowel syndrome (IBS) patients based on Rome II criteria versus Rome III criteria is unknown. AIM: To compare IBS subtyping based on Rome II versus III criteria. METHODS: The Rome II Modular Questionnaire and the Bristol Stool Form Scale (one-week diary cards) were completed by 249 IBS patients. Based on the Rome II criteria, patients were defined as having diarrhoea- or constipation-predominant IBS, or alternating IBS. Based on the Rome III criteria, patients were divided into IBS with constipation, IBS with diarrhoea, mixed IBS or unsubtyped IBS. Agreement between Rome II and Rome III was assessed with kappa statistics. RESULTS: Based on Rome II there were 92 diarrhoea-predominant IBS, 45 constipation-predominant IBS and 112 alternating IBS, and based on Rome III 97 IBS with diarrhoea, 77 IBS with constipation, 16 mixed IBS and 59 unsubtyped IBS. The agreement between Rome II and Rome III subgroups was 46% (kappa = 0.19). Changes from the constipation to the diarrhoea subgroups and vice versa were uncommon (8% of patients). The majority of changes occurred from/to the alternating IBS, mixed IBS and unsubtyped IBS subgroups. CONCLUSION: There is poor agreement between subtyping of IBS patients based on Rome II versus Rome III criteria.
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| 2. |
- Hagstrom, H., et al.
(författare)
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Morbidity, risk of cancer and mortality in 3645 HFE mutations carriers
- 2021
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Ingår i: Liver International. - : Wiley. - 1478-3223 .- 1478-3231. ; 41:3, s. 545-553
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Tidskriftsartikel (refereegranskat)abstract
- Background & Aims Mutations in the HFE gene can lead to hereditary haemochromatosis (HH) and have been suggested to increase the risk of extra-hepatic diseases, especially breast and colorectal cancer. Here we investigated long-term outcomes of Swedish patients with HFE mutations. Methods We identified 3645 patients with a homozygous p.C282Y (62%) or a compound heterozygous p.C282Y/p.H63D (38%) mutation from eight centres in Sweden between 1997 and 2017. These were matched 1:10 by age, sex and county of residence to reference individuals from the general population. We ascertained incident outcomes until the end of 2017 by linkage to national registers. Studied outcomes were HH, cirrhosis, hepatocellular carcinoma (HCC), breast cancer (in women), colorectal cancer, type 1 and 2 diabetes, hypothyroidism, Parkinson's disease and mortality. Cox proportional hazards regression was used to estimate hazard ratios for these outcomes. Results Median age at diagnosis was 52 years, 44% were females. During a mean follow-up of 7.9 years, we found an increased risk for HCC, HH, cirrhosis, type 2 diabetes, osteoarthritis and death. Excess mortality was only seen in men. No increased risk was seen for colorectal or breast cancer. Liver-related outcomes were rare, with a cumulative incidence of HFE mutation carriers in a university hospital setting had an increased risk for mortality in men, along with increased risks of cirrhosis, HCC, diabetes type 2, and osteoarthritis. In general, the absolute risk for adverse outcomes was low and no increased risk for colon or breast cancer was observed.
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| 3. |
- Le Neve, B., et al.
(författare)
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A Combined Nutrient and Lactulose Challenge Test Allows Symptom-Based Clustering of Patients With Irritable Bowel Syndrome
- 2013
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Ingår i: American Journal of Gastroenterology. - : Ovid Technologies (Wolters Kluwer Health). - 0002-9270. ; 108:5, s. 786-795
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of the present pilot study was to evaluate the usefulness of a test meal containing lactulose in the non-invasive assessment of visceral sensitivity in irritable bowel syndrome (IBS), and to identify subsets of IBS patients based on gastrointestinal (GI) symptom generation. METHODS: We included 43 patients with IBS (Rome III) and 29 healthy controls. The fasted subjects were served three test meals consisting of a 400-ml liquid breakfast alone or containing lactulose (15 or 25g) in a double-blind crossover design. Seven GI symptoms, overall digestive comfort, and exhaled H2/CH4 were assessed at baseline and every 15min during 4h after meal intake. Anxiety and depression were assessed only at baseline. A mapping of the seven GI symptoms was done using a Principal Component Analysis (4h mean area under the curve, AUC). Independently, a hierarchical cluster analysis was performed on the same parameters to identify GI symptom-based IBS clusters. RESULTS: All three tests were well tolerated. The 25g lactulose challenge enabled discrimination of IBS from healthy controls according to the symptom response. This challenge also enabled clustering of IBS subjects in two subgroups based mainly on bloating, distension, and discomfort symptoms (2,457 (2,043–2,872), 2,450 (1,910–2,990), 2,602 (2,126–3,079) vs. 537 (383–691), 619 (458–780), 643 (432–854); 4h mean AUC; P<0.0001), overall digestive comfort (1807 (1318–2295) vs. 3350 (2942–3758); 4h mean AUC; P<0.0001), and anxiety at baseline (9.2 (7.0–11.5) vs. 5.5 (4.2–6.9); Hospital Anxiety and Depression scale anxiety mean scores; P=0.003). This clustering was independent of the Rome III subtype and the amount of exhaled H2/CH4. CONCLUSIONS: The lactulose challenge test seems to be a promising tool to assess visceral sensitivity in IBS, and to subgroup IBS patients based on their symptom pattern.
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| 4. |
- Posserud, Iris, 1978, et al.
(författare)
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Altered visceral perceptual and neuroendocrine response in patients with irritable bowel syndrome during mental stress.
- 2004
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Ingår i: Gut. - : BMJ. - 0017-5749. ; 53:8, s. 1102-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: Stress often worsens the symptoms of irritable bowel syndrome (IBS). We hypothesised that this might be explained by altered neuroendocrine and visceral sensory responses to stress in IBS patients.Subjects and METHODS: Eighteen IBS patients and 22 control subjects were assessed using rectal balloon distensions before, during, and after mental stress. Ten controls and nine patients were studied in supplementary sessions. Rectal sensitivity (thresholds and intensity-visual analogue scale (VAS)) and perceived stress and arousal (VAS) were determined. Plasma levels of corticotropin releasing factor (CRF), adrenocorticotropic hormone (ACTH), cortisol, noradrenaline, and adrenaline were analysed at baseline, immediately after stress, and after the last distension. Heart rate was recorded continuously. RESULTS: Thresholds were increased during stress in control subjects (p<0.01) but not in IBS patients. Both groups showed lower thresholds after stress (p<0.05). Repeated distensions without stress did not affect thresholds. Both groups showed increased heart rate (p<0.001) and VAS ratings for stress and arousal (p<0.05) during stress. Patients demonstrated higher ratings for stress but lower for arousal than controls. Basal CRF levels were lower in patients (p<0.05) and increased significantly during stress in patients (p<0.01) but not in controls. Patients also responded with higher levels of ACTH during stress (p<0.05) and had higher basal levels of noradrenaline than controls (p<0.01). Controls, but not patients, showed increased levels of adrenaline and noradrenaline in response to stress (p<0.05). CONCLUSIONS: Stress induced exaggeration of the neuroendocrine response and visceral perceptual alterations during and after stress may explain some of the stress related gastrointestinal symptoms in IBS.
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| 5. |
- Posserud, Iris, 1978, et al.
(författare)
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Functional findings in irritable bowel syndrome.
- 2006
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Ingår i: World journal of gastroenterology : WJG. - 1007-9327. ; 12:18, s. 2830-8
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Forskningsöversikt (refereegranskat)abstract
- The pathophysiology of IBS is complex and still incompletely known. Both central and peripheral factors, including psychosocial factors, abnormal GI motility and secretion, and visceral hypersensitivity, are thought to contribute to the symptoms of IBS. Several studies have demonstrated altered GI motor function in IBS patients and the pattern differs between IBS subgroups based on the predominant bowel pattern. Few studies have so far addressed GI secretion in IBS, but there are some evidence supporting altered secretion in the small intestine of IBS patients. Visceral hypersensitivity is currently considered to be perhaps the most important pathophysiological factor in IBS. Importantly, several external and internal factors can modulate visceral sensitivity, as well as GI motility, and enhanced responsiveness within the GI tract to for instance stress and nutrients has been demonstrated in IBS patients. Today IBS is viewed upon as a disorder of dysregulation of the so-called brain-gut axis, involving abnormal function in the enteric, autonomic and/or central nervous systems, with peripheral alterations probably dominating in some patients and disturbed central processing of signals from the periphery in others.
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| 6. |
- Posserud, Iris, 1978, et al.
(författare)
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Hypervigilance in irritable bowel syndrome compared with organic gastrointestinal disease.
- 2009
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Ingår i: Journal of psychosomatic research. - : Elsevier BV. - 1879-1360 .- 0022-3999. ; 66:5, s. 399-405
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Irritable bowel syndrome (IBS) patients are suggested to selectively attend to gastrointestinal (GI) sensations compared with healthy controls. However, it remains unclear whether there are differences between IBS and other chronic GI disorders. We aimed to evaluate the presence of hypervigilance towards the GI tract in IBS compared with patients with organic GI diseases. METHODS: We included 36 IBS patients and 40 age- and gender-matched patients with organic GI disease. They completed the Hospital Anxiety and Depression Scale (HADS) and underwent three tests: (1) word association-write down as many words as possible representing signs of disease; (2) word recognition (tachistoscope)-four categories of words (positive affects, non-GI symptoms, GI symptoms, negative affects) displayed for increasing time until identified; (3) word recollection-memorize words (10 GI symptoms, 10 positive affects, 10 negative affects). RESULTS: The word-association task did not show group differences. IBS patients were significantly faster than organic GI patients at recognizing words representing GI symptoms (21 vs. 26 ms; P=.04) and negative affects (27 vs. 34 ms; P=.03), but also tended to be faster at recognizing positive affects (24 vs. 29 ms; P=.08) and non-GI symptoms (22 vs. 27 ms; P=.2). Both groups remembered a similar number of words, but IBS patients tended to recall more incorrect GI words than organic patients (1.3 vs. 1.0; P=.06). There were no group differences in HADS scores. CONCLUSION: Compared to patients with organic GI disease, IBS patients seem to be hypervigilant for information regarding GI sensations and maybe also negative information.
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| 7. |
- Posserud, Iris, 1978
(författare)
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Peripheral and central factors in the pathophysiology of irritable bowel syndrome
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder characterized by abdominal pain and/or discomfort together with abnormal bowel habits. The pathophysiology is complex and incompletely understood. Potential important factors are altered brain-gut interactions, visceral hypersensitivity, psychosocial factors, disturbed GI motility, inflammatory changes, and bacterial overgrowth. Our aim was to investigate some of the different pathophysiological factors in IBS. Altered rectal perception was found in 62% of IBS patients. These subjects more frequently reported moderate or severe abdominal pain, bloating, diarrhea, satiety, and anxiety. Symptoms of abdominal pain and bloating were associated with altered rectal perception in a multivariate analysis. Moderate or severe symptoms overall were also associated with female gender and anxiety. Stress decreased visceral sensory thresholds in controls, probably due to distraction. In IBS patients, sensory thresholds remained stable during stress, indicating a disability to suppress signals from the bowel during stress in these patients. Compared with controls, IBS patients had altered neuroendocrine hormones both in the basal state and in response to stress. In an experimental setting, investigation of memory and attention showed that compared with patients with organic GI disease, IBS patients were faster at identifying words, especially words representing GI symptoms and negative affects. There were no group differences regarding levels of anxiety or depression, but in IBS patients these levels were correlated with memory processing of GI words. Small intestinal bacterial overgrowth investigated with proximal jejunal cultures, was present in 4% of IBS subjects, which was not different from healthy controls. However, mildly elevated counts of bacteria were more common in IBS patients than in controls. Patients with bacterial overgrowth tended to have fewer phase IIIs, and enteric dysmotility was twice as common in these subjects. There was no relation between mildly elevated counts of bacteria and small bowel motility. Conclusions: The pathophysiology of IBS is complex and multifactorial. Altered visceral perception is associated with symptom severity, and stress induces an altered visceral and neuroendocrine response in IBS patients, which could explain why stress is sometimes associated with the onset and worsening of symptoms. IBS patients seem to be hypervigilant regarding GI symptoms through memory processing connected to psychological state. Small intestinal bacterial overgrowth is not common in IBS, but of uncertain relevance, a proportion of IBS patients have elevated counts of bacteria in the proximal jejunum.
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| 8. |
- Posserud, Iris, 1978, et al.
(författare)
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Small intestinal bacterial overgrowth in patients with irritable bowel syndrome.
- 2007
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Ingår i: Gut. - : BMJ. - 0017-5749. ; 56:6, s. 802-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Small intestinal bacterial overgrowth (SIBO) has been proposed to be common in irritable bowel syndrome (IBS), with altered small-bowel motility as a possible predisposing factor. AIM: To assess the prevalence of SIBO, by culture of small-bowel aspirate, and its correlation to symptoms and motility in IBS. METHODS: 162 patients with IBS who underwent small-bowel manometry and culture of jejunal aspirate were included. Cultures from 26 healthy subjects served as controls. Two definitions of altered flora were used: the standard definition of SIBO (>/=10(5) colonic bacteria/ml), and mildly increased counts of small-bowel bacteria (>/=95th centile in controls). RESULTS: SIBO (as per standard definition) was found in 4% of both patients and controls. Signs of enteric dysmotility were seen in 86% of patients with SIBO and in 39% of patients without SIBO (p = 0.02). Patients with SIBO had fewer phase III activities (activity fronts) than patients without SIBO (p = 0.08), but otherwise no differences in motility parameters were seen. Mildly increased bacterial counts (>/=5x10(3)/ml) were more common in patients with IBS than in controls (43% vs 12%; p = 0.002), but this was unrelated to small intestinal motility. No correlation between bacterial alterations and symptom pattern was observed. CONCLUSIONS: The data do not support an important role for SIBO according to commonly used clinical definitions, in IBS. However, mildly increased counts of small-bowel bacteria seem to be more common in IBS, and needs further investigation. Motility alterations could not reliably predict altered small-bowel bacterial flora.
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