The causes of constipation are extremely complex and are still not fully clear. In addition to secondary factors such as organic diseases and drugs, constipation may also be related to genetics, diet, intestinal flora, age, gender and so on. At present, according to the etiology, chronic constipation is divided into primary constipation and secondary constipation. However, there are significant differences among current clinical guidelines in the clinical classification of primary constipation. Some guidelines classify primary constipation as slow-transit constipation (STC), outlet obstruction constipation (OOC), and mixed constipation; however, some guidelines classify primary constipation as STC, defecation disorder (DD), mixed constipation, and normal-transit constipation (NTC); what's more, some even propose types which are different from the above sub-types. There are also differences in the understanding of the relationship between functional constipation (FC) and primary constipation and the classification of irritable bowel syndrome predominant constipation (IBS-C) among various clinical guidelines. By reviewing domestic and international guidelines and relevant literature on constipation, the following conclusions are drawn: primary constipation can be divided into IBS-C and FC, and FC can be further divided into STC, OOC, and mixed constipation; primary constipation should not be confused with FC, nor should IBS-C be classified as FC.
Humans ; Irritable Bowel Syndrome/complications* ; Constipation/etiology* ; Gastrointestinal Transit

BACKGROUND AND AIMS: Bacterial gastroenteritis seems to be a risk factor of irritable bowel syndrome (IBS). The incidence of post-infectious IBS (PI-IBS) was reported to be in the range of 7-31%, but few studies have reported long term follow-up results. So, we investigated the clinical course and prognosis of PI-IBS three years after shigella infection. METHODS: The subjects were recruited from our previous study, in which we investigated the incidence and risk factors of PI-IBS. We had a questionnaire based on interview with 120 controls and 124 patients who had shigella infection three years ago. Both groups were evaluated for the presence of IBS, functional bowel disorders (FBD) except IBS before, one and three years after the infection, respectively. RESULTS: Ninty-five patients (76.6%) and 105 controls (87.5%) completed the questionnare. In patients group, 7 cases had IBS prior to infection (previous IBS), 12 cases (13.8%) had IBS after 1 year (PI-IBS). Four cases developed IBS newly after 3 years (new IBS). Thirteen cases (14.9%) in patients and 4 cases (4.5%) in controls had IBS over 3 years (OR 3.93: 1.20-12.86). The recovery rate over 3 years were 50.0% (2/4) in previous IBS and 25% (3/12) in PI-IBS. The incidence of PI-IBS after 3 years in previous FBD subjects was 28.6% and was 10.6% in normals (p<0.05). The female gender was a risk factor for FBD. CONCLUSIONS: Bacterial gastroenteritis is a trigger factor of IBS. About a quarter of PI-IBS patients are recovered over 3 years. Previous FBD except IBS is a risk factor after 3 years.
Adult ; Dysentery, Bacillary/*complications ; Female ; Follow-Up Studies ; Humans ; Irritable Bowel Syndrome/*etiology ; Male

OBJECTIVETo explore the risk factors for irritable bowel syndrome (IBS) among school adolescents in China.

METHODA stratified, randomized study by cluster sampling was conducted, which recruited 51,956 students from high and primary schools in Chinese cities. All students were requested to fill in a questionnaire.

RESULT(1) Factors including class (odds ratio 1.12), excessive intake of pepper (odds ratio 1.17), fried (odds ratio 1.08) and starch-based foods (odds ratio 1.06), gastrointestinal tract infection (odds ratio 2.66), abuse of analgesic (odds ratio 1.49), inheritance (odds ratio 1.83), fatigue (odds ratio 1.32) and repression (odds ratio 1.45) were significantly associated with the presence of IBS (P < 0.05). High protein food (odds ratio 0.90) was a protective factor.

CONCLUSIONDifferent food intake, gastrointestinal tract infection, abuse of analgesic, inheritance and psychological factors might be related to development of IBS in the students of the cities involved in this study.

Adolescent ; Child ; China ; epidemiology ; Humans ; Irritable Bowel Syndrome ; epidemiology ; etiology ; Risk Factors ; Sampling Studies ; Students ; Surveys and Questionnaires

OBJECTIVETo compare the incidences of anemia, osteoporosis, and irritable bowel syndrome (IBS) after the application of different endocrine therapies in patients with prostate cancer.

METHODSTotally 125 patients aged 58 to 84 years with biopsy-confirmed local prostate cancer were recruited between September 2008 and September 2010. Of them 52 treated with orchiectomy (castration group) and 73 with luteinizing hormone-releasing hormone analogue (goserelin acetate 3.6mg/month) combined with androgen antagonist (bicalutamide 50mg/d) for at least 12 months (hormone group), but without blood transfusion or erythropoietin. Changes in total testosterone (TT), free testosterone (FT), prostate specific antigen (PSA), hemoglobin (Hb), red blood cell (RBC), hematocrit (Hct), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red blood cell distribution width (RDW), bone mineral density (BMD) and gastrointestinal symptom rating scales (GSRS) were recorded and analyzed before treatment and 12 months after the initiation of treatment.

RESULTSIn the castration group, after 12 months, TT (P=0.0007), FT (P=0.0003), PSA (P=0.0006), Hb (P=0.0001), RBC (P=0.020), Hct (P=0.016), Z-score of lumbar spine (P=0.008), and femoral neck (P=0.004) decreased significantly, and GSRS (P=0.029) increased significantly. In hormone group, after 12 months, TT (P=0.0008), FT (P=0.0006), PSA (P=0.0006), Hb (P=0.0003), RBC (P=0.0001), Hct (P=0.0002), Z-score of lumbar spine (P=0.002), femoral neck (P=0.0002), and RDW (P=0.045) decreased significantly, and GSRS (P=0.010) increased significantly. After 12 months, TT (P=0.004), FT (P=0.012), PSA (P=0.007), Hb (P=0.016), Z-score of lumbar spine (P=0.033), and femoral neck (P=0.015) in hormone group were significantly lower than in the castration group, while GSRS (P=0.027) in hormone group was significantly higher than in the castration group. The incidences of anemia (P=0.006), osteoporosis (P=0.009), and IBS (P=0.022) were significantly different between these two groups. The serum level of testosterone was positively correlated with Hb, RBC, Hct, and BMD in both groups (P=0.039). Negative linear correlations could be seen between serum level of testosterone and GSRS in both groups (P=0.021), and between serum level of testosterone and RDW in medical group only (P=0.044).

CONCLUSIONThe endocrine therapies, particularly maximal androgen blockage, in patients with prostate cancer can be associated with anemia, osteoporosis, and IBS.

Aged ; Aged, 80 and over ; Anemia ; etiology ; Bone Density ; physiology ; Humans ; Incidence ; Irritable Bowel Syndrome ; etiology ; Male ; Middle Aged ; Osteoporosis ; etiology ; Prostatic Neoplasms ; complications ; physiopathology ; therapy ; Quality of Life

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) tract disorder that has heterogeneous clinical presentations such as abdominal pain, diarrhea, constipation, and abdominal distension. It is known that several mechanisms are involved in the pathogenesis of IBS. Probiotics may target one or more pathophysiologic pathways in IBS and may improve the symptoms of IBS. However, the results of studies about probiotics on IBS are controversial. Therefore, the aim of this study was to evaluate the effect of probiotics on GI symptoms and intestinal gas volume changes in patients with IBS. METHODS: Forty patients were randomly allocated to be treated with medilac DS(R) (Bacillus subtilis, Streptococcus faecium) (n=20) or placebo (n=20) in a double-blind, prospective manner. The change in intestinal gas volume and symptom scores after 4-week treatment were evaluated for the efficacy. RESULTS: There was no significant difference in bloating, frequency of gas expulsion, frequency of defecation, and hardness of stool before and after the treatment. However, the severity of abdominal pain and the frequency of abdominal pain decreased significantly in medilac DS(R)group (2.4+/-1.3 cm/day -> 1.6+/-1.6 cm/day, 1.7+/-1.3/day -> 1.0+/-1.0/day) (p=0.044, p=0.038), but not in placebo group (2.1+/-2.0 cm/day -> 1.8+/-2.1 cm/day, 1.3+/-1.2/day -> 1.4+/-1.9/day). In both groups, intestinal gas volume at baseline, after 2-week treatment, and after 4-week treatment did not show significant change. Medilac DS(R)was well tolerated without adverse events. CONCLUSIONS: Medilac DS(R)is a safe and useful probiotic agent for the treatment of abdominal pain in patients with IBS.
Abdominal Pain/etiology/therapy ; Adult ; Bacillus subtilis ; Double-Blind Method ; Enterococcus faecium ; Female ; Humans ; Irritable Bowel Syndrome/*therapy ; Male ; Middle Aged ; Probiotics/*therapeutic use

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) tract disorder that has heterogeneous clinical presentations such as abdominal pain, diarrhea, constipation, and abdominal distension. It is known that several mechanisms are involved in the pathogenesis of IBS. Probiotics may target one or more pathophysiologic pathways in IBS and may improve the symptoms of IBS. However, the results of studies about probiotics on IBS are controversial. Therefore, the aim of this study was to evaluate the effect of probiotics on GI symptoms and intestinal gas volume changes in patients with IBS. METHODS: Forty patients were randomly allocated to be treated with medilac DS(R) (Bacillus subtilis, Streptococcus faecium) (n=20) or placebo (n=20) in a double-blind, prospective manner. The change in intestinal gas volume and symptom scores after 4-week treatment were evaluated for the efficacy. RESULTS: There was no significant difference in bloating, frequency of gas expulsion, frequency of defecation, and hardness of stool before and after the treatment. However, the severity of abdominal pain and the frequency of abdominal pain decreased significantly in medilac DS(R)group (2.4+/-1.3 cm/day -> 1.6+/-1.6 cm/day, 1.7+/-1.3/day -> 1.0+/-1.0/day) (p=0.044, p=0.038), but not in placebo group (2.1+/-2.0 cm/day -> 1.8+/-2.1 cm/day, 1.3+/-1.2/day -> 1.4+/-1.9/day). In both groups, intestinal gas volume at baseline, after 2-week treatment, and after 4-week treatment did not show significant change. Medilac DS(R)was well tolerated without adverse events. CONCLUSIONS: Medilac DS(R)is a safe and useful probiotic agent for the treatment of abdominal pain in patients with IBS.
Abdominal Pain/etiology/therapy ; Adult ; Bacillus subtilis ; Double-Blind Method ; Enterococcus faecium ; Female ; Humans ; Irritable Bowel Syndrome/*therapy ; Male ; Middle Aged ; Probiotics/*therapeutic use

Bile acid diarrhea (BAD) is usually seen in patients with ileal Crohn's disease or ileal resection. However, 25% to 50% of patients with functional diarrhea or diarrhea-predominant irritable bowel syndrome (IBS-D) also have evidence of BAD. It is estimated that 1% of the population may have BAD. The causes of BAD include a deficiency in fibroblast growth factor 19 (FGF-19), a hormone produced in enterocytes that regulates hepatic bile acid (BA) synthesis. Other potential causes include genetic variations that affect the proteins involved in BA enterohepatic circulation and synthesis or in the TGR5 receptor that mediates the actions of BA in colonic secretion and motility. BAs enhance mucosal permeability, induce water and electrolyte secretion, and accelerate colonic transit partly by stimulating propulsive high-amplitude colonic contractions. There is an increased proportion of primary BAs in the stool of patients with IBS-D, and some changes in the fecal microbiome have been described. There are several methods of diagnosing BAD, such as 75selenium homotaurocholic acid test retention, serum C4, FGF-19, and fecal BA measurement; presently, therapeutic trials with BA sequestrants are most commonly used for diagnosis. Management involves the use of BA sequestrants including cholestyramine, colestipol, and colesevelam. FXR agonists such as obeticholic acid constitute a promising new approach to treating BAD.
Anticholesteremic Agents/therapeutic use ; Bile Acids and Salts/*physiology ; Crohn Disease/complications ; Diarrhea/*etiology/pathology/therapy ; Feces/chemistry ; Fibroblast Growth Factors/deficiency ; Gastrointestinal Microbiome ; Humans ; Irritable Bowel Syndrome/complications

BACKGROUND/AIMS: Recent papers have highlighted the role of diet and lifestyle habits in irritable bowel syndrome (IBS), but very few population-based studies have evaluated this association in developing countries. The aim of this study was to evaluate the association between diet and lifestyle habits and IBS. METHODS: A food frequency and lifestyle habits questionnaire was used to record the diet and lifestyle habits of 78 IBS subjects and 79 healthy subjects. Cross-tabulation analysis and logistic regression were used to reveal any association among lifestyle habits, eating habits, food consumption frequency, and other associated conditions. RESULTS: The results from logistic regression analysis indicated that IBS was associated with irregular eating (odds ratio [OR], 3.257), physical inactivity (OR, 3.588), and good quality sleep (OR, 0.132). IBS subjects ate fruit (OR, 3.082) vegetables (OR, 3.778), and legumes (OR, 2.111) and drank tea (OR, 2.221) significantly more frequently than the control subjects. After adjusting for age and sex, irregular eating (OR, 3.963), physical inactivity (OR, 6.297), eating vegetables (OR, 7.904), legumes (OR, 2.674), drinking tea (OR, 3.421) and good quality sleep (OR, 0.054) were independent predictors of IBS. CONCLUSIONS: This study reveals a possible association between diet and lifestyle habits and IBS.
Adult ; Case-Control Studies ; China ; Diet/*adverse effects ; Female ; *Food Habits ; Healthy Volunteers ; Humans ; Irritable Bowel Syndrome/*etiology ; *Life Style ; Logistic Models ; Male ; Middle Aged ; Surveys and Questionnaires

PURPOSE: Fatigue is the third most common "extraintestinal" complaint of patients with irritable bowel syndrome (IBS), but it is still poorly understood. This study aimed to review characteristics of IBS-associated fatigue and to examine pooled frequency, severity of fatigue, and correlations of related factors with fatigue in IBS via meta-analyses. METHODS: Publications were searched in eight databases from 1995 to 2014. Random effects meta-analyses were applied with standard error, weighted effect size, and correlation-based measure of effect size. RESULTS: Twenty-four studies were included in systematic review. Seventeen studies were used for meta-analyses (2 studies were excluded in the frequency of fatigue analysis due to data unavailability). Using "tiredness" to define fatigue, and Fatigue Impact Scale to assess fatigue were the most frequently used across the studies. Gastrointestinal symptoms, psychological distress, and health-related quality of life were the most common correlates with fatigue. The pooled frequency of fatigue was 54.2% [95% confidence interval (38.5, 69.4)]. Metaregression on the frequency of fatigue showed positive and significant relations with tertiary care settings, female sex, and younger age. There was a negatively moderate relationship between the severity of fatigue and health-related quality of life score (correlation-based measure of effect size: -.378). CONCLUSIONS: Fatigue is prevalent among patients with IBS and commonly co-occurs with other symptoms. This is the first study to fully examine fatigue in IBS, which shed light on the comprehensive management of fatigue in this patient group. Future research is warranted to further explore fatigue-related factors and underlying mechanisms of fatigue in IBS.
Adult ; Age Factors ; Aged ; Fatigue/*etiology/*nursing ; Female ; Humans ; Irritable Bowel Syndrome/*complications/*physiopathology ; Male ; Middle Aged ; Prevalence ; *Quality of Life ; Severity of Illness Index ; Sex Factors ; Stress, Psychological

OBJECTIVETo investigate the correlation between the pathogeneses of diarrhea-pre- dominant irritable bowel syndrome (D-IBS) complicated functional dyspepsia (FD) patients of Gan-stagnation Pi-deficiency Syndrome (GSPDS) and symptoms, psychological states, and gastrointestinal hormones.

METHODSA total of 111 patients with confirmed D-IBS complicated FD of GSPDS were recruited as the treated group by using Rome III standard and Chinese medical syndrome standard. And 30 healthy volunteers were recruited as the control group. The general condition, scoring for digestive symptoms, and the distribution of GSPDS subtype of all subjects were recorded by a questionnaire, and assessed by Symptom Checklist (SCL-90; a software for psychological test developed by Beijing Huicheng Adult Cor- poration). Meanwhile, plasma levels of 5-hydroxytryptamine (5-HT), somatostatin (SS), vasoactive intestinal peptide (VIP), endothelin (ET), interleukin 10 (IL-10), and interleukin 12 (IL-12) were measured in all subjects.

RESULTS(1) The subtype of D-IBS complicated FD of GSPDS was dominant in Pi-qi deficiency type (51/111,45.9%),Pi yang deficiency type (34/111,30.6%), and GSPDS. There was no statistical difference in the scoring of digestive symptoms among the 3 subtypes (P >0.05). (2) Compared with the control group, the anxiety factor score and the total score significantly increased in all three subtypes of D-IBS complicated FD of GSPDS, and the depression score of Pi yang deficiency type and Gan-depression type also significantly increased (P <0.05, P <0.01); the depression score of Gan-depression type was significantly higher than that of the Pi-qi deficiency type (P <0.01). Plasma 5-HT levels were obviously lower in D-IBS complicated FD patients of GSPDS accompanied with anxiety or depression than in those with no obvious psychological abnormalities, and VIP and IL-10 levels were significantly lower than those in the control group (P <0.05). Plasma VIP levels were also obviously lower in D-IBS complicated FD patients of GSPDS accompanied with anxiety or depression than in those with no obvious psychological abnormalities (P <0.01), and SS levels were significantly lower than those in the control group (P <0.05). There was no statistical difference in plasma ET or IL-12 levels in each patient group, when compared with the control group (P >0.05). (3) Compared with the.control group, plasma 5-HT levels significantly increased, plasma VIP and IL-10 levels significantly decreased in ach subtype of D-IBS complicated FD patients of GSPDS (P <0.05, P <0.01), and no significant change of SS, ET, or IL-12 occurred (P >0.05). Besides, plasma 5-HT levels were significantly higher in Gan-depression type than in Pi yang deficiency type, VIP levels were lower in Gan-depression type than in Pi-qi deficiency type (all P <0.05).

CONCLUSIONSGan stagnation and Pi deficiency were dominant in D-IBS complicated FD patients of GSPDS. Psychological abnormalities, increased plasma 5-HT levels, and decreased plasma VIP levels were closely correlated with Gan stagnation subtype, which provided some reference for looking for objective indicators of Chinese medical syndromes in treating D-IBS complicated FD patients of GSPDS.

Adult ; Case-Control Studies ; Diarrhea ; etiology ; Dyspepsia ; blood ; complications ; psychology ; Gastrointestinal Hormones ; blood ; Humans ; Irritable Bowel Syndrome ; blood ; complications ; psychology ; Psychological Tests ; Qi ; Serotonin ; Surveys and Questionnaires ; Yang Deficiency