R.W. Stockbrügger

Role of Alimentation in Irritable Bowel Syndrome

Background: Different food items are made responsible for irritable bowel syndrome (IBS) symptoms, but the physiopathology of IBS remains unclear. Aims: During a meeting in Nice, France, experts of the European Working Team of the IBiS Club discussed selected data regarding the relationships between alimentation, food items (including fibers) and IBS symptoms. Methods/Results: Food allergy remains a difficult diagnosis, but medical and general history, presence of general symptoms such as skin rash, and hypersensitivity tests may help in achieving a positive diagnosis. On the other hand, food intolerance is more confusing because of the subjectivity of the relationship between ingestion of certain foods and the appearance of clinical symptoms. Different food items which are commonly implicated in adverse reactions mimicking IBS were found to be stimulants for the gut, suggesting that patients with predominant diarrhea IBS have to be carefully questioned about consumption of different kinds of food (i.e., coffee, alcohol, chewing gum, soft drinks) and not only on lactose ingestion. Gas production is discussed on the basis of retention of intestinal gas as well as on malabsorption of fermentable substrates. The role of a large amount of this kind of substrate reaching the colon is suggested as a potential mechanism of IBS-type symptoms in overeating patients. Regarding the role of fiber in IBS, the expert group concluded that fibers are not inert substances and that they could trigger pain or bloating in some IBS patients. Conclusion: Despite numerous reviews on this subject, it is very difficult to give general dietary advice to IBS patients, but dieteticians may have a positive role in managing such patients.

Quality of life and illness costs in irritable bowel syndrome

Quality of life is reduced in patients with irritable bowel syndrome, and the costs for this disease are substantial to society. During a meeting in London, UK, the IBiS club reviewed the literature on these subjects. Drawbacks and advantages with existing instruments to assess quality of life and costs were discussed and the clinical and scientific relevance of the current knowledge was assessed. A summary from the meeting is presented in this paper.

The Discriminative Value of Patient Characteristics and Dyspeptic Symptoms for Upper Gastrointestinal Endoscopic Findings: A Study on the Clinical Presentation of 1,147 Patients

The discriminative value of patient characteristics and dyspeptic symptoms for upper gastrointestinal endoscopic findings was prospectively assessed in 1,147 patients attending for their first diagnostic endoscopy and who answered paper (n = 431) or computerized (n = 716) questionnaires. The questionnaires provided detailed information concerning present dyspeptic symptoms, with special attention to provoking and/or relieving factors, and smoking and/or drinking habits. In logistic regression models each of a number of specific endoscopic diagnoses was contrasted with normal endoscopy (n = 390), and relevant endoscopic disease (oesophagitis, peptic ulcers, cancers; n = 269) was contrasted with irrelevant and normal endoscopic findings (n = 878). From the regression model a receiver operating characteristic (ROC) curve could be constructed, and the area under the ROC curve (AUC) was calculated to summarize the discriminative power of the regression model. The best discrimination from patients with a normal endoscopy was achieved for patients with gastric (AUC = 0.86) or duodenal (AUC = 0.85) ulcers, followed by patients with hiatus hernia (AUC = 0.78 or oesophagitis (AUC = 0.77). The discriminative performance of the regression models was somewhat less for duodenitis/bulbitis (AUC = 0.75) and endoscopic gastritis (AUC = 0.73). In an open-access endoscopy unit setting, the value of preinvestigation history-taking for the prediction of clinically relevant endoscopic disease was very limited (AUC = 0.63).

Potential Pitfalls in the Differential Diagnosis of Irritable Bowel Syndrome

A. Smouta F. Azpirozb G. Coremansc M. Dapoignyd S. Collinse S. Müller-Lissnerf F. Paceg R. Stockbrüggerh M. Vatni P. Whorwellj aDepartment of Gastroenterology, Academisch Ziekenhuis Utrecht, The Netherlands; bDigestive System Research Unit, Hospital Vall d’Hebron, Barcelona, Spain; cDivision of Gastroenterology, Department of Internal Medicine, University Hospital Gasthuisberg, Leuven, Belgium; dCentre Hospitalier Régional, Clermont-Ferrand, France; eDivision of Gastroenterology, Intestinal Diseases Research Unit, Hamilton, Ont., Canada; fPark-Klinik Weissensee, Berlin, Germany; gGastrointestinal Unit, Ospedale ‘L. Sacco’, Milan, Italy; hDepartment of Gastroenterology/Hepatology, Academisch Ziekenhuis Maastricht, The Netherlands; iMedical Department A, Rikshospitalet, Oslo, Norway, and jDepartment of Medicine, University Hospital of South Manchester, UK

Psychosocial background and intervention in the irritable bowel syndrome

aDepartment of Gastroenterology/Hepatology, University Hospital Maastricht, The Netherlands; bDivision of Gastroenterology, Department of Internal Medicine, University Hospital Gasthuisberg, Leuven, Belgium; cDepartment of Psychiatry, Manchester Royal Infirmary, Manchester, UK; dService de Gastroenterologie, Hôtel-Dieu, Clermont-Ferrand, France; eAbteilung Innere Medizin, Städtisches Krankenhaus Weissensee, Berlin, Germany; fGastrointestinal Unit, Ospedale ‘L. Sacco’, Milan, Italy; gDepartment of Gastroenterology, Academisch Ziekenhuis, Utrecht, The Netherlands; hDepartment of Medicine, University Hospital of South Manchester, Manchester, UK

The rectum: a window to irritable bowel syndrome?

This report summarizes current concepts and information gathered to date about the rectum in the irritable bowel syndrome (IBS) that were presented at the 10th meeting of IBiS Club held in Leuven, Belgium. A working group of experts in the field of IBS discussed whether the rectum or the whole colon is the better site to test in IBS patients and provided suggestions for a number of areas where further advances are required.