Authors: Garcia Rodriguez LA, Ruigomez A, Wallander MA, Johansson S, Olbe L.

Institution: Centro Espanol de Investigacion Farmacoepidemiologica (CEIFE), Madrid, Spain.

Background: We wanted to estimate the incidence of irritable bowel syndrome (IBS) and functional dyspepsia (FD) in the general population, and the detection of colorectal tumor (CRT) and inflammatory bowel disease (IBD) after the diagnosis of IBS and FD.

Results: We found an overall incidence of 10.3 per 1000 person-years for FD and 2.6 per 1000 person-years for IBS. There was a greater prevalence of depression, stress, fatigue, and pain disorders among IBS and FD patients than in the general population. During the 1st year after a diagnosis of IBS the cumulative risk of detecting CRT was close to 1% in IBS patients. After the 1st year the risk of CRT in IBS patients was close to that in the general population. We found a significantly increased risk of detecting IBD among patients initially diagnosed as having IBS (relative risk (RR), 16.3; 95% confidence interval (CI), 6.6-40.7), which was constant during all the follow-up period. No association was found between dyspepsia and CRT, or IBD.

Conclusion: IBS and FD shared some comorbidity features, yet demographics and incidence rates were different. Unlike the detection of colorectal tumor, the excess risk of IBD after an initial diagnosis of IBS was cumulatively increased during all the follow-up period. The continuously increased risk of IBD detection in IBS patients favors a true association between IBS and IBD.

Study link: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10766326&query_hl=9&itool=pubmed_docsum

Authors: Simren M, Axelsson J, Gillberg R, Abrahamsson H, Svedlund J, Bjornsson ES.

Institution: Department of Internal Medicine and Section of Psychiatry, Institute of Clinical Neuroscience, Sahlgrenska University Hospital, Goteborg, Sweden.

Objectives: Quality of life is reduced in inflammatory bowel disease (IBD). Whether or not this is true in IBD patients in long-standing remission is unclear. Symptoms compatible with irritable bowel syndrome (IBS) are common in IBD patients in remission. The importance of psychological factors in this process is a matter of controversy.

Results: The psychological well-being in IBD patients in long-standing remission was similar to that of the general population, despite the presence of more severe GI symptoms. CD patients reported more psychosocial dysfunction, reduced well-being, and GI symptoms than UC patients. Thirty-three percent of UC patients and 57% of CD patients had IBS-like symptoms. The group with IBS-like symptoms (both UC and CD) had higher levels of anxiety and depression and more reduced well-being than those without. Anxiety and reduced vitality were found to be independent predictors for IBS-like symptoms in these patients.

Conclusion: The prevalence of IBS-like symptoms in IBD patients in long-standing remission is two to three times higher than that in the normal population. Psychological factors seem to be of importance in this process. However, as a group IBD patients in remission demonstrate psychological well-being comparable to that of the general population.

Study link: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11866278&query_hl=5&itool=pubmed_docsum

Authors: Pimentel M, Chang M, Chow EJ, Tabibzadeh S, Kirit-Kiriak V, Targan SR, Lin HC.

Institution: GI Motility Program and Inflammatory Bowel Disease Center, Department of Medicine, Cedars-Sinai Medical Center, CSMC Burns and Allen Research Institute, Los Angeles, California 90048, USA.

Objectives: Irritable bowel syndrome, a common gastrointestinal diagnosis, has not been clearly studied in inflammatory bowel disease. Some of the residual symptoms in subjects treated with Crohn's disease and ulcerative colitis are thought to be related to irritable bowel syndrome. The aims of this study were 1) to describe the duration and nature of complaints before the diagnosis of Crohn's disease and ulcerative colitis (prodromal period), and 2) to determine the role of IBS in this prodromal period.

Methods: A total of 66 patients with confirmed inflammatory bowel disease were enrolled in the study. The subjects received a questionnaire to ascertain the nature and duration of symptoms preceding the diagnosis of Crohn's disease or ulcerative colitis, including features described under the Rome criteria for irritable bowel syndrome.

Conclusion: There is a significant prodromal period before the time of diagnosis of Crohn's disease that is not found in ulcerative colitis even after exclusion of subjects with IBS.

Study link: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11151877&dopt=Citation

Authors: Sylvie Bradesi, PhD, James A. McRoberts, Ph.D, Peter A. Anton, MD, Emeran A. Mayer, MD

Summary: Both irritable bowel syndrome and inflammatory bowel diseases share symptoms of altered bowel habits associated with abdominal pain or discomfort.

Irritable bowel syndrome has been referred to as a functional bowel disorder, which is diagnosed by a characteristic cluster of symptoms in the absence of detectable structural abnormalities.

Inflammatory bowel disease is a heterogeneous group of disorders characterized by various forms of chronic mucosal and/or transmural inflammation of the intestine. In this review, the authors discuss recent evidence suggesting several potential mechanisms that might play a pathophysiologic role in both syndromes…

Based on recent reports of low-grade mucosal inflammation in subpopulations of patients meeting current diagnostic criteria for irritable bowel syndrome, therapeutic approaches shown to be effective in inflammatory bowel disease, such as probiotics, antibiotics, and antiinflammatory agents, have been suggested as possible therapies for certain patients with irritable bowel syndrome.

Study link: http://www.medscape.com/viewarticle/457

Authors: Bayless TM, Harris ML.

Institution: Johns Hopkins University School of Medicine, Baltimore, Maryland.

Summary: The irritable bowel syndrome accounts for 30 to 50 per cent of patients cared for by gastroenterology practices. Irritable bowel syndrome is more common than inflammatory bowel disease. Therefore, it should not be surprising that some patients with inflammatory bowel disease are initially told that they have irritable bowel syndrome before a diagnosis of inflammatory bowel disease is firmly established.

This article contends that many people have both irritable bowel syndrome and inflammatory bowel disease.

Study link: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=2404178&query_hl=22

Authors: Minderhoud IM, Oldenburg B, Wismeijer JA, van Berge Henegouwen GP, Smout AJ.

Institution: Department of Gastroenterology, University Medical Center Utrecht, Utrecht, The Netherlands. I.M.Minderhoud@azu.nl

Summary: The aim of this study was to assess the prevalence of irritable bowel syndrome-like symptoms in healthy controls and inflammatory bowel disease patients in remission using the Rome II criteria.

Furthermore, the possible relation of irritable bowel syndrome-like symptoms with the quality of life and coping behavior was studied. Seventy-three ulcerative colitis patients in remission, 34 Crohn's disease patients in remission, and 66 healthy controls completed questionnaires on irritable bowel syndrome, quality of life, and coping.

Using the Rome II criteria, irritable bowel syndrome-like symptoms were found in one-third of ulcerative colitis patients and in 42% of Crohn's disease patients in remission. The presence of irritable bowel syndrome-like symptoms impaired the quality of life of patients, while no relation was found between the presence of symptoms and coping strategies.

Study link: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15139501&dopt=Citation

Authors: Premysl Bercik, MD*, Elena F. Verdu, MD, PhD, Stephen M. Collins, MD, FRCP

Institution: Intestinal Disease Research Program and Division of Gastroenterology, McMaster University, 1200 Main Street West, HSC 3N49C, Hamilton, Ontario L8N 3Z5, Canada.

Summary: The authors believe that inflamed bowel disease and at least a subset of irritable bowel syndrome patients exist at two ends of the same spectrum of pathophysiology, which involves immune activation and inflammation.

This is prompted by the observation that IBS symptoms may precede IBD, which reflects gut dysfunction generated by subclinical inflammation. It also has been observed that IBS occurs in patients in remission from IBD. This concept is underpinned by results of basic scientific studies in animal models showing that immune activation and inflammation restricted to the mucosal compartment result in profound changes in neuromuscular function that may persist after recovery of the mucosa.

Emerging evidence shows similarities in genotype between IBD and a subset of IBS patients; polymorphisms of genes that encode cytokine secretion may result in an imbalance of pro- and counter inflammatory signals. This in turn would lead to inefficient down-regulation of inflammatory responses and promote low-grade inflammation.

It is a matter of the severity of inflammation that separates IBD and this IBS subset, and this may reflect additional genetic abnormalities or greater exposure to environmental factors in the case of IBD. This prompts the question as to whether IBD is more common in patients with IBS, and there is some evidence to support this.

Study link: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15862932&dopt=Citation