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
ARTICLE HIGHLIGHTS
Research background

Irritable bowel syndrome (IBS) is highly prevalent worldwide. It is among the most common causes for gastroenterologist consultation and a significant economic burden in healthcare systems. The diagnosis of IBS is made when the symptom pattern fulfills Rome Criteria and underlying organic pathology is ruled out by tests that usually require invasive procedures, such as endoscopy or imaging examinations with radiation. Patients often conclude that their physician does not know what disease they are suffering from. Physicians are often tentative in their diagnosis of IBS and unsure how many investigations they should order to exclude other possible causes of their patient’s symptoms. The lack of a specific diagnostic test for IBS is an important gap in the physician’s toolkit. The symptom provocation caused by a nutrient drink test (NDT) has been used as a tool for the diagnosis of a very similar syndrome - functional dyspepsia (FD), whose symptoms usually overlap with IBS. In both IBS and FD, there is an abnormally heightened level of gut sensations, which is known as “visceral hypersensitivity”. The use of a NDT for diagnosis of IBS has not been previously evaluated.

Research motivation

This study focused on the design of a simple, inexpensive, and non-invasive diagnostic tool for IBS. The study tested whether prolongation of symptom recording beyond the 3 h-4 h of the provocative drink would improve diagnostic outcomes. The existence of a validated, simple test for IBS could reduce the use of invasive tests and exposure to X-rays in IBS patients.

Research objectives

The main objective was to determine whether the symptoms triggered by a highly caloric drink can differentiate IBS patients from healthy controls.

Research methods

After ingestion of the high and low nutrient drinks, given on separate days, subjects were screened for gut symptoms face-to-face every 5 min for the first 2 h and by telephone until 24 h after drink ingestion.

Research results

This study has shown consistent provocation of symptoms during the first 2 h after a high nutrient drink in IBS patients, an effect not seen in the healthy subjects. Continuation of symptom monitoring up to 24 h after the drink did not enhance diagnostic outcomes.

Research conclusions

Our data show that the NDT is a promising non-invasive test for IBS diagnosis and provide guidance for simplification of the test procedure.

Research perspectives

More studies are needed since the patients enrolled in this project were especially severely affected and so not representative of the entire spectrum of IBS. The major priority for future research is a large-scale investigation of the diagnostic performance of the NDT in less severely symptomatic IBS patients, compared with patients with abdominal symptoms arising from structural (organic) disorders of the gut.