J Green

Systematic review: the management of chronic diarrhoea due to bile acid malabsorption

Bile acid malabsorption (BAM) is a common, yet under‐recognised, cause of chronic diarrhoea, with limited guidance available on the appropriate management of patients with BAM.

Symptoms of irritable bowel syndrome in patients with inflammatory bowel disease: examining the role of sub-clinical inflammation and the impact on clinical assessment of disease activity

Symptoms compatible with irritable bowel syndrome (IBS) are frequently present in patients with inflammatory bowel disease (IBD); however, the cause of this phenomenon is unclear.

Quantifying the 'hidden' lactose in drugs used for the treatment of gastrointestinal conditions

Background  Lactose intolerance affects 70% of the world population and may result in abdominal and systemic symptoms. Treatment focuses predominantly on the dietary restriction of food products containing lactose. Lactose is the most common form of excipient used in drug formulations and may be overlooked when advising these patients.

Mindfulness-based therapy for inflammatory bowel disease patients with functional abdominal symptoms or high perceived stress levels

BACKGROUND AND AIMS Psychological interventions are used in patients with inflammatory bowel disease (IBD) but there is uncertainty about who the optimal target population is. Multi-convergent therapy (MCT) is a form of psychotherapy that combines mindfulness meditation with aspects of cognitive behavioural therapy and has been used in the management of irritable bowel syndrome (IBS). This study aimed to assess the feasibility and efficacy of MCT in the management of IBD patients with either functional abdominal symptoms or high perceived stress levels. METHODS Sixty-six IBD patients in clinical remission with either IBS-type symptoms or high perceived stress levels were randomly allocated to a 16-week MCT course or waiting list control group. Patients were followed-up for one year with the Inflammatory Bowel Disease Questionnaire (IBDQ) as the primary outcome measurement. RESULTS A higher mean IBDQ score was observed in the active group compared to controls at the 4-month assessment (167 vs. 156, p=0.081), but this was not statistically significant nor did it reached the predefined clinically significant difference of 20. In patients with IBS-type symptoms at baseline there was a significantly higher mean IBDQ score in the active group compared to controls (161 vs. 145, p=0.021). There was no difference between groups in relapse rate based on faecal calprotectin measurement. CONCLUSIONS IBS-type symptoms in patients with IBD represent a potential therapeutic target to improve quality of life. This study suggests that MCT may be useful in the management of these symptoms but larger studies are required to confirm this. CLINICAL TRIAL REGISTRATION NUMBER NCT01426568.

Association of lactose sensitivity with inflammatory bowel disease - demonstrated by analysis of genetic polymorphism, breath gases and symptoms

Aliment Pharmacol Ther 2011; 34: 735–746

An observational study of cognitive function in patients with irritable bowel syndrome and inflammatory bowel disease

Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are associated with several risk factors for developing cognitive impairment. These include altered cytokine levels, concurrent mood disorders, and the presence of chronic pain. This observational study aimed to explore the cognitive profile of patients with these conditions.

Theological Reflection for the Real World: Time to Think Again

Abstract This article provides an account of part of the preliminary activity undertaken in connection within a project entitled, Theological Reflection for the Real World. Using a loose, reflective empirical methodology, the authors review the reactions and responses of a small group of recently ordained clergy in the Church of England engaged in initial ministerial development to the idea of exploring methods of theological reflection. In the face of a basically negative response to the idea and practice of formal theological reflective methods, the authors consider the implications for theological education. While theological educators put formal theological reflection at the centre of practical theology, it seems possible that many students would give it a very different place. The inference from this is that perhaps methods and practices of theological reflection offered in theological education may need to be radically reconsidered.

Role of a medical student: patient perspectives

Medical students form an important part of the medical team; however, patients may not be fully aware of their role. Identifying students in the clinical setting is difficult because of their similar attire to other health care professionals. This parity may introduce unethical scenarios where patients may be speaking and consenting to individuals whom they do not recognise as students.

Interventions to reduce acute and late adverse gastrointestinal effects of pelvic radiotherapy

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To determine which prophylactic interventions reduce the incidence, severity, or both of adverse gastrointestinal effects among adults receiving radiotherapy to treat primary pelvic cancers.

Lactose content of gastrointestinal drugs; does it matter? authors' reply

SIRS, We thank Dr Guslandi for his comments relating to our recently published paper and agree that the lactose content of medications may not be of clinical relevance for the treatment of all patients with gastrointestinal conditions. We have shown that lactose can cause a range of systemic symptoms, in addition to the well established gut symptoms. The fact that these systemic symptoms are not well known could be a reason for confusion regarding the sensitivity of different individuals to lactose. It is reported that patients with known lactose intolerance (LI) can generally ingest up to 12 g of lactose before reporting symptoms. However, individuals may have a far lower threshold and feel unwell after consuming only very small quantities of the sugar. As a result, we do not advocate the replacement of all drugs used in treatment to ‘lactose-free’ alternatives for every patient. Our paper lists many lactose-free drugs, which may be considered in the treatment of a sub group of patients who appear to be particularly lactose-sensitive. The recent study by Montalto et al. was interesting, but does not contradict the growing evidence that some individuals are sensitive to small amounts of lactose ingested over and above their natural lactose threshold. The lactose content ingested in medications by such a patient could indeed be clinically relevant particularly when added to lactose obtained from other sources in the diet.