A. Agrawal

Clinical trial: the effects of a fermented milk product containing Bifidobacterium lactis DN‐173 010 on abdominal distension and gastrointestinal transit in irritable bowel syndrome with constipation

Background  A sensation of abdominal swelling (bloating) and actual increase in girth (distension) are troublesome features of irritable bowel syndrome (IBS), which is more common in patients with constipation, especially those with delayed transit.

Irritable bowel syndrome: diagnosis and management

Irritable bowel syndrome is often dismissed as just being a nuisance rather than anything more serious, but its symptoms can seriously diminish a patients quality of life. When the disease is better understood and treatment is tailored to the individual patient, it can often be rewarding to manage

Review article: abdominal bloating and distension in functional gastrointestinal disorders – epidemiology and exploration of possible mechanisms

Background  A sensation of abdominal bloating, sometimes accompanied by an increase in girth (distension), is one of the most common and most intrusive features of functional bowel disorders.

Visceral hypersensitivity in endometriosis: a new target for treatment?

Objective In women presenting to gynaecological clinics with lower abdominal pain, the cause is frequently attributed to endometriosis irrespective of whether it is found to be minimal or extensive at laparoscopy. Irritable bowel syndrome (IBS) is also common in this setting, and it was speculated that the visceral hypersensitivity associated with this condition might be amplifying the symptoms of endometriosis. Methods Visceral sensitivity to balloon distension, symptoms and psychological status were assessed following laparoscopy in 20 women with minimal to mild endometriosis, 20 with moderate to severe endometriosis, 20 with laparoscopy negative abdominal pain and 20 asymptomatic women undergoing laparoscopic sterilisation who acted as controls, and compared with 20 women with IBS. Results Compared with controls, patients with minimal to mild and moderate to severe endometriosis had a higher prevalence of symptoms consistent with IBS (0% vs 65% and 50%, respectively, p<0.001) with significantly lower mean pain thresholds (39.5 mm Hg (95% CI 36.0 to 43.0) vs 28.1 mm Hg (95% CI 24.5 to 31.6), p=0.001 and 28.8 mm Hg (95% CI 24.9 to 32.6), p=0.002) not explained by differences in rectal compliance. Patients with laparoscopy negative pain had symptoms and visceral sensitivity similar to patients with IBS. Controls undergoing laparoscopy had normal sensitivity, indicating that the laparoscopic procedure was not inducing hypersensitivity. Conclusion Visceral hypersensitivity is extremely common in endometriosis and could be intensifying the pain. This finding might explain why mildly affected individuals often complain of severe symptoms out of proportion to the extent of their disease. This study has introduced a completely new concept into the understanding of pain in endometriosis and could open up new opportunities for treatment.

Irritable bowel syndrome in the elderly: An overlooked problem?

BACKGROUND In secondary care, irritable bowel syndrome (IBS) is frequently associated with non-colonic symptoms including lethargy, backache and chest pains which can result in inappropriate referral to different specialities with the condition remaining unrecognised. This could also be a problem in the elderly where comorbidity is common, especially as irritable bowel syndrome is usually associated with a younger age group. METHODS A survey of 230 consecutive patients (aged 65-94) attending an elderly care clinic examining referral patterns, irritable bowel syndrome symptoms, duration of disease, non-colonic symptomatology and previous investigation. RESULTS 211 of 230 (92%) patients completed the questionnaire with 46 (22%) having symptoms suggestive of irritable bowel syndrome irrespective of presenting complaint. However despite the exclusion of abdominal pathology the diagnosis was only made in one patient. Symptoms significantly more common in irritable bowel syndrome than non-irritable bowel syndrome patients were constant lethargy (p<0.001), headaches (p=0.01), backache (p=0.02), chest pain (p=0.03), and urinary frequency (p=0.04). Independent predictors of irritable bowel syndrome on logistic regression were bloating (OR 13.3; p<0.001), stool urgency (OR 4.0; p<0.001) and headache (OR 2.3; p=0.01). CONCLUSIONS Irritable bowel syndrome is under-recognised in elderly care despite negative investigation. Making the diagnosis, even in the presence of co-existent disease, could reduce the overall burden of suffering, improve quality of life and prevent repetitive investigations.

Treatment of bloating and distension - role of probiotics

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