Case Control Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2019; 25(7): 837-847
Published online Feb 21, 2019. doi: 10.3748/wjg.v25.i7.837
Nutrient drink test: A promising new tool for irritable bowel syndrome diagnosis
Fermin Estremera-Arevalo, Marta Barcelo, Blanca Serrano, Enrique Rey
Fermin Estremera-Arevalo, Department of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona 31008, Spain
Marta Barcelo, Department of Gastroenterolgy, Hospital Infanta Leonor, Madrid 28031, Spain
Blanca Serrano, Department of Digestive Diseases, Hospital Clinico San Carlos, Madrid 28040, Spain
Enrique Rey, Department of Digestive Diseases, Hospital Clinico San Carlos and Complutense University, Madrid 28040, Spain
Author contributions: Estremera-Arevalo F, Barcelo M, and Rey E designed the project; Estremera-Arevalo F and Serrano B performed the nutrient drink test; Estremera-Arevalo F drafted the manuscript and generated the database; Barcelo M, Serrano B, and Rey E reviewed the manuscript; Rey E performed the statistics.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Hospital Clinico San Carlos.
Informed consent statement: All participants gave informed consent after a careful explanation of the methods and objectives of this study.
Conflict-of-interest statement: None of the authors have conflicts of interest to be declared.
Data sharing statement: Clinical data record, statistical code, and dataset available from the corresponding author at festremera15@gmail.com.
STROBE statement: The guidelines of the STROBE Statement have been adopted.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Fermin Estremera-Arevalo, MD, PhD, Doctor, Staff Physician, Gastroenterologist, Department of Gastroenterology, Complejo Hospitalario de Navarra, Calle Irunlarrea, 3, Pamplona 31008, Spain. festremera15@gmail.com
Telephone: +34-848-422222 Fax: +34-848-422303
Received: October 13, 2018
Peer-review started: October 14, 2018
First decision: November 14, 2018
Revised: January 11, 2019
Accepted: January 26, 2019
Article in press: January 26, 2019
Published online: February 21, 2019
Processing time: 134 Days and 1.2 Hours
Abstract
BACKGROUND

Irritable bowel syndrome (IBS) is a highly prevalent condition. It is diagnosed on the basis of chronic symptoms after the clinical and/or investigative exclusion of organic diseases that can cause similar symptoms. There is no reproducible non-invasive test for the diagnosis of IBS, and this raises diagnostic uncertainty among physicians and hinders acceptance of the diagnosis by patients. Functional gastrointestinal (GI) syndromes often present with overlapping upper and lower GI tract symptoms, now believed to be generated by visceral hypersensitivity. This study examines the possibility that, in IBS, a nutrient drink test (NDT) provokes GI symptoms that allow a positive differentiation of these patients from healthy subjects.

AIM

To evaluate the NDT for the diagnosis of IBS.

METHODS

This prospective case-control study compared the effect of two different nutrient drinks on GI symptoms in 10 IBS patients (patients) and 10 healthy controls (controls). The 500 kcal high nutrient drink and the low nutrient 250 kcal drink were given in randomized order on separate days. Symptoms were assessed just before and at several time points after drink ingestion. Global dyspepsia and abdominal scores were derived from individual symptom data recorded by two questionnaires designed by our group, the upper and the general GI symptom questionnaires, respectively. Psycho-social morbidity and quality of life were also formally assessed. The scores of patients and controls were compared using single factor analysis of variance test.

RESULTS

At baseline, IBS patients compared to controls had significantly higher levels of GI symptoms such as gastro-esophageal reflux (P = 0.05), abdominal pain (P = 0.001), dyspepsia (P = 0.001), diarrhea (P = 0.001), and constipation (P = 0.001) as well as higher psycho-social morbidity and lower quality of life. The very low incidence of GI symptoms reported by control subjects did not differ significantly for the two test drinks. Compared with the low nutrient drink, IBS patients with the high nutrient drink had significantly more dyspeptic symptoms at 30 (P = 0.014), 45 (P = 0.002), 60 (P = 0.001), and 120 min (P = 0.011). Dyspeptic symptoms triggered by the high nutrient drink during the first 120 min gave the best differentiation between healthy controls and patients (area under receiver operating curve of 0.915 at 45 min for the dyspepsia score). Continued symptom monitoring for 24 h did not enhance separation of patients from controls.

CONCLUSION

A high NDT merits further evaluation as a diagnostic tool for IBS.

Keywords: Irritable bowel syndrome; Nutrient drink test; Non-invasive; Dyspepsia; Screening

Core tip: There is no objective non-invasive test for diagnosis of irritable bowel syndrome. This study shows that measurement of early gastrointestinal symptoms provoked by ingestion of a caloric drink is a promising diagnostic tool for this syndrome. This test could allay patient and doctor uncertainty and reduce the use of costly and invasive diagnostic tests.