| 1. |
- Aguilera-Lizarraga, J., et al.
(författare)
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Expression of immune-related genes in rectum and colon descendens of Irritable Bowel Syndrome patients is unrelated to clinical symptoms
- 2019
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Ingår i: Neurogastroenterology and Motility. - : Wiley. - 1350-1925 .- 1365-2982. ; 31:6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Mucosal immune activation has been postulated to play an important role in the pathogenesis of irritable bowel syndrome (IBS). However, data are conflicting and often based on small patient cohorts. Here, we aimed to evaluate the gene expression of a large set of immune-related genes in mucosal biopsies from IBS patients and healthy volunteers (HV). Methods: A total of 171 IBS patients and 127 HV were included in the study. Rectum biopsies were collected from a cohort of 70 HV and 77 IBS patients (Rome III) and colon descendens biopsies from another cohort of 57 HV and 94 IBS patients (Rome II). Gene expression was assessed using OpenArray technology, and validated questionnaires were used to evaluate clinical characteristics (GI symptoms, somatization, anxiety, and depression). Key Results: A subset of IBS patients (33%) with increased immune activation in the colon descendens was identified using multivariate analysis and displayed increased gene expression of IL1B (3-fold change), prostaglandin synthase PTGS2 (2.1-fold change), and the G-protein-coupled receptor MRGPRX2 (10.7-fold change). Clinical characteristics in this subgroup were however similar to the rest of the patient cohort. Analysis of rectal biopsies failed to identify such subgroup of “immuno-active” IBS patients in the other patient cohort. Conclusion: A subset of IBS patients reveals evidence of immune activation in the colon descendens, but not in the rectum; however, gene expression is unrelated to clinical symptoms. To what extent this subgroup might however respond to anti-inflammatory therapy remains to be investigated. © 2019 John Wiley & Sons Ltd
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| 2. |
- Clevers, Egbert, et al.
(författare)
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Relations between food intake, psychological distress, and gastrointestinal symptoms: A diary study
- 2019
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Ingår i: United European Gastroenterology Journal. - : Wiley. - 2050-6406 .- 2050-6414. ; 7:7, s. 965-973
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Tidskriftsartikel (refereegranskat)abstract
- Background: Gastrointestinal symptoms can be triggered by food intake and psychological distress, but individual-level research on food-symptom and stress-symptom associations is scarce. Objective: We aimed to identify associations between food intake, psychological distress and gastrointestinal symptoms, and their implications for personalised clinical management. Methods: Through the mobile phone application mySymptoms, 163 users kept, for a median of five weeks, a diary of food intake, psychological distress and gastrointestinal symptoms. We quantified associations between these on the individual level. The presence of individual-level associations was compared over latent classes of daily symptom patterns. Results: Various gastrointestinal symptoms had demonstrable food-symptom associations (heartburn: 73%, discomfort: 67%, diarrhoea: 57%, bloating: 53%, and gas: 48%). Food-symptom associations for pain in the abdomen (33%) were concentrated in the latent class of individuals with pain in the morning (68%), rather than those with pain in the evening and night (27% and 10%, respectively, p < 0.001). Stress-symptom relations were also found, although only 18% of individuals reported psychological distress. Conclusion: Personal food-symptom and stress-symptom relations can be detected, and may translate into specific daily symptom patterns. A next step will be to let personal food-symptom and stress-symptom relations serve as the basis for personalised clinical management.
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| 3. |
- Clevers, Egbert
(författare)
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Symptom patterns in irritable bowel syndrome
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Who has never had them: symptoms in the abdominal region, such as pain, bloating, constipation, and diarrhoea? These are common symptoms of irritable bowel syndrome (IBS). IBS affects 5-10% of the population, especially females between the age of 16 and 40. The good news is that IBS is a benign disorder: IBS does not increase the risk of cancer, and symptoms are not progressive. The bad news is that impact on quality of life is high due to symptoms in the abdomen as well as elsewhere (e.g. joint pain) and psychological symptoms (e.g. anxiety) or even psychiatric disorders (e.g. anxiety disorders). Specifically, symptom-related anxiety is a predictor of more severe symptoms and worsening quality of life. Why exactly do people have symptoms? In part, symptoms can be explained by lifestyle factors, mainly food and stress. Common food triggers have been described for diarrhoea (confectionery, coffee, spices), flatulence (onions, fruits, bread), bloating (late eating), and pain (late eating, rice, bread). Before we start dieting, however, two important remarks must be made: -Intolerances to food and stress are very person-specific. Person-specific food-symptom and stress-symptom relations may be identified when a patient keeps a diary of food intake, stress, and symptoms. The computer analyses the diary for possible symptom triggers. Exclusion of personal triggers may lead to symptom improvement for a group of patients. -There are many non-lifestyle factors that drive symptoms in IBS. These include the gut bacteria and immune system. Therefore, it is possible that a patient does not benefit from any dietary or psychological therapy. This thesis leads to two research suggestions, both aiming for personalised management of IBS: -Personal symptom triggers. Although we know that the food/symptom diary concept can generate personalised lifestyle advice, we still lack evidence that it actually improves symptoms. Patients who keep a diary and receive personalised lifestyle advice should be followed up to monitor symptom evolution. A great opportunity would be to combine it with smart devices that measure physiologic variables, as these may explain how a trigger leads to symptoms. -Predictors of treatment response. For the patient, finding a good treatment is currently a process of trial and error. There is a need for an evidence-based treatment algorithm, as this makes IBS management more efficient and teaches us about the underlying mechanisms.
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