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Chu H, Zhong Y, Zhao J, Shan Y, Fang X. Unravelling behavioural contributions to IBS risk: evidence from univariate and multivariate Mendelian randomisation. J Glob Health 2025; 15:04112. [PMID: 40214127 PMCID: PMC11987576 DOI: 10.7189/jogh.15.04112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2025] Open
Abstract
Background While numerous studies have investigated the link between behavioural factors and irritable bowel syndrome (IBS), the causal relationships remain unresolved. This study applied Mendelian randomisation (MR) analysis to assess the causal impact of specific behavioural factors on IBS risk. Methods Bidirectional Mendelian randomisation analysis was employed to evaluate the causal relationships between behavioural factors and IBS risk. A genome-wide significance threshold (P < 5e-6) was applied to identify associations between genetic variants and behaviour-related traits, ensuring robust selection of instrumental variables for evaluating potential causal effects. Genetic correlations with IBS were sourced from extensive genome-wide association studies (GWASs). Various statistical methods were applied to estimate the causal effects. Results This study employed both univariate and multivariate Mendelian randomisation analyses to investigate the causal relationships between specific behavioural factors and the risk of irritable bowel syndrome (IBS). The results indicated that body mass index (BMI) (odds ratio (OR) = 1.074; 95% confidence interval (CI) = 1.025-1.125, P = 0.031), insomnia (OR = 1.986; 95% CI = 1.652-2.389, P < 0.001), duration of mobile phone use (OR = 1.120; 95% CI = 1.018-1.232, P = 0.021), and weekly mobile phone usage time in the past three months (OR = 1.148; 95% CI = 1.016-1.298, P = 0.021,) were associated with an increased risk of IBS. In contrast, usual walking speed (OR = 0.756; 95% CI = 0.621-0.920, P < 0.001), non-smoking status (OR = 0.779; 95% CI = 0.645-0.941, P < 0.001), and weekly alcohol consumption (OR = 0.862; 95% CI = 0.743-0.999, P = 0.015) were associated with a reduced risk of IBS. Furthermore, in the multivariate Mendelian randomisation analysis, no statistically significant causal associations were found for BMI, usual walking pace, length of mobile phone use, and smoking status. Weekly mobile phone usage time in the past three months (OR = 1.439; 95% CI = 1.126-1.840, P = 0.0037,) and insomnia (OR = 1.468; 95% CI = 1.076-2.003, P = 0.0156) were identified as risk factors, while weekly alcohol intake (OR = 0.813; 95% CI = 0.677-0.975, P = 0.0257) acted as a protective factor. Conclusions This study identified BMI, insomnia, duration of mobile phone use, and weekly mobile phone usage time in the past three months as risk factors for IBS. In contrast, weekly alcohol consumption, usual walking pace, and non-smoking status were observed as protective factors. Additionally, in multivariable analysis, weekly mobile phone use, insomnia, and weekly alcohol consumption showed a direct influence on IBS risk when considered simultaneously.
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Affiliation(s)
| | | | - Jiayi Zhao
- Department of Gastrointestinal and Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
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Schovsbo SU, Kårhus LL, Bjerregaard AA, Petersen MW, Frostholm L, Fink P, Carstensen TBW, Eplov LF, Benros ME, Brix S, Madsen AL, Linneberg A, Dantoft TM, Jørgensen T. Fluctuation of functional somatic disorders in a population-based cohort. The DanFunD study. PLoS One 2024; 19:e0312031. [PMID: 39413108 PMCID: PMC11482674 DOI: 10.1371/journal.pone.0312031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 09/29/2024] [Indexed: 10/18/2024] Open
Abstract
BACKGROUND Evidence of incidence of functional somatic disorders (FSD) is hampered by unclear delimitations of the conditions and little is known about the possible interchangeability between syndromes. Further, knowledge on remission and persistence of FSD in the general population is limited. We aimed to assess the natural course of various FSD over 5 years in the general population. METHODS A follow-up study (Danish Study of Functional Disorders-DanFunD) was conducted in a random sample of the general population comprising 5,738 participants aged 18-76 years at baseline. Both at baseline and five-year follow-up, participants filled in validated questionnaires on symptoms to delimitate two approaches of FSD, the bodily distress syndrome (BDS) and four functional somatic syndromes (FSS): irritable bowel (IB), chronic fatigue (CF), chronic widespread pain (CWP), and multiple chemical sensitivity (MCS). RESULTS Both BDS and FSS showed a five-year incidence around 11%. Incidence of the individual FSS varied from 0.8% (MCS) to 5.7% (CF). BDS and FSS showed a remission proportion close to 50%. We found a high degree of interchangeability between each FSS varying from 15.0% to 23.4%. CONCLUSION We identified a marked fluctuation pattern of FSD during a five-year period, with a high degree of interchangeability between each FSS. The study stresses the importance of large population-based cohorts with transparent delimitation of FSD in future research to understand these complex conditions.
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Affiliation(s)
- Signe U. Schovsbo
- Center for Clinical Research and Prevention, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Line L. Kårhus
- Center for Clinical Research and Prevention, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Anne A. Bjerregaard
- Center for Clinical Research and Prevention, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Marie W. Petersen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Lisbeth Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Per Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Tina B. W. Carstensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Lene F. Eplov
- Copenhagen Research Center for Mental Health – CORE, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Michael E. Benros
- Copenhagen Research Center for Mental Health – CORE, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen C, Denmark
| | - Susanne Brix
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Anja L. Madsen
- Center for Clinical Research and Prevention, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen C, Denmark
| | - Thomas M. Dantoft
- Center for Clinical Research and Prevention, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen C, Denmark
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Kulin D, Shah A, Fairlie T, Wong RK, Fang X, Ghoshal UC, Kashyap PC, Mulak A, Lee YY, Talley NJ, Koloski N, Jones MP, Holtmann GJ. The COVID-19 pandemic as a modifier of DGBI symptom severity: A systematic review and meta-analysis. Neurogastroenterol Motil 2024; 36:e14878. [PMID: 39056447 DOI: 10.1111/nmo.14878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/24/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND This SRMA reviewed and assessed the changes in the severity of disorders of gut-brain interaction (DGBI) symptoms during the COVID-19 pandemic, and evaluated factors associated with symptom severity changes. METHODS Electronic databases were searched until February 2024, for articles reporting on changes in symptom severity in DGBI patients during the COVID-19 pandemic. The proportion of DGBI patients who reported a change in their symptom severity were pooled using a random-effects model, and subgroup analyses were conducted to assess the effect of socio-cultural modifiers on symptom severity in DGBI. KEY RESULTS Twelve studies including 3610 DGBI patients found that 31.4% (95% CI, 15.9-52.5) of DGBI patients experienced symptom deterioration, while 24.3% (95% CI, 10.2-47.5) experienced improvement. Countries with high gross domestic product (GDP) had a 43.5% (95% CI, 16.3-75.2) likelihood of symptom deterioration, compared to 9.2% (95% CI, 1.4-42.2) in lower GDP countries. Similarly, countries with low COVID fatality rates had a 60.1% (95% CI, 19.7-90.3) likelihood of symptom deterioration, compared to 18.3% (95% CI, 7.8-36.9) in higher fatality rate countries. Countries with lenient COVID policies had a 58.4% (95% CI, 14.1-92.3) likelihood of symptom deterioration, compared to 19% (95% CI, 8.2-38.1) in countries with stricter policies. Patients in high vaccine hesitancy countries had a 51.4% (95% CI, 19.5-82.2) likelihood of symptom deterioration, compared to 10.6% (95% CI, 2.7-33.4) in low vaccine hesitancy countries. CONCLUSIONS & INFERENCES This meta-analysis reveals that a significantly higher proportion of DGBI patients experienced deterioration of symptoms during the COVID-19 pandemic. Various sociocultural, economic and environmental factors potentially modify the effects of the COVID-19 pandemic on DGBI.
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Affiliation(s)
- Dmitrii Kulin
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Ayesha Shah
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Thomas Fairlie
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Reuben K Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xiucai Fang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Uday C Ghoshal
- Institute of Gastrosciences and Liver Transplantation, Apollo Multispeciality Hospitals, Kolkata, India
| | - Purna C Kashyap
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Agata Mulak
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
- GI Function & Motility Unit, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Nicholas J Talley
- School of Medicine and Public Health, and Hunter Medical Research Institute, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Natasha Koloski
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Michael P Jones
- Macquarie University, School of Psychological Sciences, Sydney, New South Wales, Australia
| | - Gerald J Holtmann
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Adibi P, Ani A, Vaez A, Hadizadeh F, Snieder H, Roohafza H. Multidisciplinary approach to functional somatic syndromes: study protocol for a population-based prospective cohort study. BMJ Open 2022; 12:e048941. [PMID: 35777883 PMCID: PMC9252204 DOI: 10.1136/bmjopen-2021-048941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Isfahan functional disorders (ISFUN) cohort study aims to describe the interplay of genetic and environmental factors in shaping the characteristics of functional somatic syndromes (FSS). This study is primarily intended to investigate the epidemiology, risk factors, course and prognosis of FSSs in a sample of adult Iranian population. The other aim is to develop a new delimitation of FSSs based on an integrated multidisciplinary approach comprising of phenotypic and multiomics data. METHODS AND ANALYSIS ISFUN is a population-based prospective cohort study designed to follow a population of randomly selected seemingly healthy adults (18-65 years) through annual visits during a 4-year observation period. Structured questionnaires are used for data collection and clinical assessment of the participants. Questionnaire-based diagnosis of FSSs are validated in a medical interview. Human DNA genotyping, microbial amplicon sequencing and urine analysis is under progress for genomics, microbiota and metabolomics profiling, respectively. Enrolment began in September 2017, and study completion is expected in 2022. A total number of 1943 participants were initially recruited. ETHICS AND DISSEMINATION Ethical approval for data collection was granted by the National Research Ethics Committee of the Iranian Ministry of Health and Medical Education and the Research Ethics Committee of Isfahan University of Medical Sciences (IR.MUI.REC.1395.1.149). Following the description of the study procedure, we obtained written informed consent from all study participants. Study findings will be disseminated through peer-reviewed publications and presentations at scientific meetings.
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Affiliation(s)
- Peyman Adibi
- Isfahan Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Ani
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Bioinformatics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Vaez
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Bioinformatics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Hadizadeh
- Department of Bioinformatics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hamidreza Roohafza
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Engsbro AL, Begtrup LM, Haastrup P, Storsveen MM, Bytzer P, Kjeldsen J, Schaffalitzky De Muckadell O, Jarbøl DE. A positive diagnostic strategy is safe and saves endoscopies in patients with irritable bowel syndrome: A five-year follow-up of a randomized controlled trial. Neurogastroenterol Motil 2021; 33:e14004. [PMID: 33029843 DOI: 10.1111/nmo.14004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/27/2020] [Accepted: 09/07/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previously, the diagnosis of irritable bowel syndrome (IBS) required exclusion of organic causes by extensive diagnostic testing. Newer guidelines recommend IBS as a positive diagnosis based on symptoms with limited testing. We investigated the long-term safety and impact on use of health resources of a positive diagnostic strategy compared to a strategy of exclusion in patients with symptoms compatible with IBS. METHODS In 2008-2010, primary care patients aged 18-50 years fulfilling the Rome III criteria for IBS without alarm signals were randomized to a positive diagnostic strategy (limited blood tests, n = 150) or a strategy of exclusion (extensive blood tests, fecal samples for intestinal parasites, and sigmoidoscopy with biopsies, n = 152). At five years, hospital-registered diagnoses and use of health resources including lower endoscopies were retrieved from national registries. Participants provided 5-year data on Rome III criteria for IBS, severity of symptoms, and quality of life. KEY RESULTS Baseline mean age was 31.4 (SD 9.1) years; 79% were female. No cases of celiac disease, and gastrointestinal or gynecological cancers were diagnosed within five years. Negligible and comparable numbers were diagnosed with inflammatory bowel disease, benign gynecological conditions, and upper GI conditions in the two groups. The positive diagnosis strategy carried a higher number of lower endoscopies from year 1 to 5 (23 patients versus 13 patients in the exclusion group), but overall saved endoscopies. CONCLUSIONS & INFERENCES A positive diagnosis of IBS was as safe as a diagnosis of exclusion in a five-year perspective and saved lower endoscopies; the study was registered at ClinicalTrials.gov numbers: NCT00659763/NCT01153295.
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Affiliation(s)
- Anne Line Engsbro
- Department of Medicine, Zealand University Hospital, Køge and Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Microbiology, University Hospital Copenhagen Hvidovre, Hvidovre, Denmark
| | - Luise M Begtrup
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, København, Denmark.,Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Peter Haastrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Maria Munch Storsveen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Peter Bytzer
- Department of Medicine, Zealand University Hospital, Køge and Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Kjeldsen
- Department of Medical Gastroenterology S, Odense University Hospital, Odense, Denmark
| | | | - Dorte Ejg Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Flanagan R, Kuo B, Staller K. Utilizing Google Trends to Assess Worldwide Interest in Irritable Bowel Syndrome and Commonly Associated Treatments. Dig Dis Sci 2021; 66:814-822. [PMID: 32361922 DOI: 10.1007/s10620-020-06290-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/18/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Examining the prevalence of irritable bowel syndrome (IBS) across regions has been challenging given significant methodological heterogeneity. AIMS We aimed to perform a uniform assessment of the global burden of IBS using data from Google Trends, a novel, online tool. METHODS Google Trends measures popularity of a search term in a given week compared to popularity of all search terms in that week, calculated as relative search volume (RSV). We compiled data on the popularity of IBS and its treatments across 173 countries between 2014 and 2018. We compared Google Trends popularity for IBS with prior epidemiological prevalence data, while controlling for gross domestic product (GDP) per capita and physician density. RESULTS Of the 173 countries with Google Trends data, 137 countries also had data for GDP per capita and physician density. Worldwide popularity of IBS as a search topic increased from 79 to 89 (13% increase by RSV) over the 5-year period between 2014 and 2018. Country-specific change in IBS RSV ranged from - 35% (Nigeria) to + 64% (Pakistan). There was poor correlation between the Google Trends data and prior epidemiological data (0.08, Pearson correlation, p = 0.64). Popularity of the low-FODMAP diet increased the most among 8 common therapies (RSV 41 to 89, 117% increase). CONCLUSIONS Google Trends is a novel tool that can complement traditional epidemiological methods in gastrointestinal disease. Future research is needed to assess its utility and accuracy as a measure of disease burden across different gastrointestinal diseases.
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Affiliation(s)
- Ryan Flanagan
- Harvard Medical School, Boston, MA, USA.,Division of Gastroenterology, Department of Medicine, Center for Neurointestinal Health, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | - Braden Kuo
- Harvard Medical School, Boston, MA, USA.,Division of Gastroenterology, Department of Medicine, Center for Neurointestinal Health, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | - Kyle Staller
- Harvard Medical School, Boston, MA, USA. .,Division of Gastroenterology, Department of Medicine, Center for Neurointestinal Health, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA.
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Mørk M, Andersen SL, Pedersen IS, Ernst A, Lykkeboe S, Krarup HB. Use of genetic testing for hypolactasia trait in the North Denmark Region. Scand J Gastroenterol 2020; 55:1012-1018. [PMID: 32723192 DOI: 10.1080/00365521.2020.1800079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Lactose intolerance (LI) may be considered in patients with unspecific gastrointestinal symptoms, but there is no clear consensus on when and how to diagnose the disorder. The LCT-13910 CC genotype is associated with acquired primary lactase deficiency (adult-type hypolactasia; ATH). We aimed to describe the number of tests and test results in the North Denmark Region considering patient age, geographical origin and repeated testing. METHODS Retrospective evaluation of the polymerase chain reaction-based LCT-13910 genotype tests registered in the clinical laboratory information system (LABKA II) with data linkage to Danish nationwide registers. RESULTS Between 18 May 2007 and 31 December 2018, a total of 23,560 individuals were tested. There was a sevenfold increase in the number of tests performed during the study period. About 9.8% of the tests performed in 2018 were repeated testing in the same individuals. Overall, 8.8% of tested individuals were younger than 5 years, 90.7% were of Danish origin and 5.5% originated from outside of Europe. The LCT-13910 CC genotype was identified in 13.3% of all tested individuals, in 16.0% of children younger than 5 years, in 6.8% of Danish individuals and in 90.9% originating from outside of Europe. CONCLUSIONS In the North Denmark Region, a marked increase in the use of genetic testing for hypolactasia was observed and repeated testing was frequent. Furthermore, the use of the test and the test results were dependent on patient age and geographical origin. Results inform the debate on when and how to use genetic testing in the diagnosing of LI.
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Affiliation(s)
- Morten Mørk
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.,Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
| | - Stine Linding Andersen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Biochemistry, Viborg Regional Hospital, Viborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Inge Søkilde Pedersen
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anja Ernst
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
| | - Simon Lykkeboe
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Bygum Krarup
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Abstract
OBJECTIVE To provide normative data for the Low Anterior Resection Syndrome (LARS) score. BACKGROUND The LARS score is a validated and frequently used tool measuring bowel dysfunction after sphincter sparing surgery for rectal cancer. The interpretation of LARS score results has previously been limited by the lack of normative data. METHODS An age and sex-stratified random sample of 3440 citizens from the general population was drawn from the Danish civil registration system (age range 20-89 years, 50% females). A brief questionnaire including the LARS score and health-related items were distributed electronically or by post. RESULTS A total of 1875 (54.5%) responded, 54.0% were females. In the age group 50 to 79 years, relevant for most rectal cancer studies, the response rate was 70.5% (n = 807). In this specific age group, 18.8% of the females and 9.6% of the males had a LARS score ≥30, corresponding to the LARS score category "major LARS" (P = 0.001), and the median (interquartile range) LARS score was 16 (7-26) and 11 (4-22), respectively (P < 0.001). Responders with physical disease had a statistically significant higher risk of a LARS score ≥30, compared with responders without any physical disease (odds ratio 2.2, 95% confidence interval 1.6-2.9, P < 0.001). CONCLUSIONS A LARS score ≥30 (major LARS) is common in the general population, especially in the age group 50 to 79 years. Normative data for the LARS score are now available and can be taken into account when interpreting LARS score results in scientific studies of bowel function after rectal cancer treatment.
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Kavanagh RG, O’Grady J, Carey BW, O’Connor OJ, Maher MM. Review of the role of abdominal imaging in irritable bowel syndrome. World J Radiol 2018; 10:143-149. [PMID: 30568748 PMCID: PMC6288676 DOI: 10.4329/wjr.v10.i11.143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 08/30/2018] [Accepted: 10/09/2018] [Indexed: 02/06/2023] Open
Abstract
The role of radiologic imaging in the investigation of irritable bowel syndrome (IBS) remains a subject of debate and there is some evidence, from recent studies of utilization of imaging in IBS, which focused on associated costs and radiation exposure, that imaging is being used relatively widely in these patients. This review aims to assess current best evidence to accurately define the role of radiologic imaging in IBS patients. Primary and secondary literature searches were performed. Evidence suggests that the lack of "red flag" or alarm features in IBS patients should reassure the clinician that the diagnosis of IBS is correct and United States and United Kingdom guidelines recommend no radiologic imaging for IBS patients if alarm features are not present. In patients presenting with IBS symptoms and alarm features, radiologic testing may be used to exclude an alternative diagnosis and the imaging modality should be chosen based on the most likely alternative diagnosis.
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Affiliation(s)
- Richard G Kavanagh
- Department of Radiology, Cork University Hospital, Cork T12 DC4A, Ireland
| | - John O’Grady
- Department of Gastroenterology, Cork University Hospital, Cork T12 DC4A, Ireland
- APC Microbiome Ireland, University College Cork, Cork T12 DC4A, Ireland
| | - Brian W Carey
- Department of Radiology, Cork University Hospital, Cork T12 DC4A, Ireland
| | - Owen J O’Connor
- Department of Radiology, Cork University Hospital, Cork T12 DC4A, Ireland
- APC Microbiome Ireland, University College Cork, Cork T12 DC4A, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, Cork T12 DC4A, Ireland
- APC Microbiome Ireland, University College Cork, Cork T12 DC4A, Ireland
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Krogsgaard LR, Engsbro AL, Bytzer P. Antibiotics: a risk factor for irritable bowel syndrome in a population-based cohort. Scand J Gastroenterol 2018; 53:1027-1030. [PMID: 30189148 DOI: 10.1080/00365521.2018.1500638] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Use of antibiotics affects the composition of the gut microbiome. The microbiome is thought to play a role in development of irritable bowel syndrome (IBS), but antibiotics as a possible risk factor for IBS has not been clarified. We aimed to explore if antibiotics is a risk factor for IBS by investigating use of antibiotics and development of IBS in a cohort from the Danish background population. MATERIALS AND METHODS An internet-based web panel representative of the Danish background population was invited to participate in a survey regarding the epidemiology of IBS in 2010, 2011 and 2013. A questionnaire based on the Rome III criteria for IBS were answered at all three occasions. In 2013, a question regarding use of antibiotics in the past year was included. RESULTS In 2013, use of antibiotics was reported by 22.4% (624/2781) of the population. A higher proportion of individuals with IBS reported use of antibiotics compared with asymptomatic controls [29.0% (155/534) vs. 17.9% (212/1,184), p < .01]. For asymptomatic respondents in 2010 and 2011 (n = 1004), the relative risk of IBS in 2013 related with use of antibiotics was 1.9 [95% confidence interval (CI): 1.1-3.1]. Adjusting for sex by logistic regression, development of IBS was predicted by use of antibiotics with an odds ratio of 1.8 (95% CI: 1.0-3.2). CONCLUSIONS Antibiotics is a risk factor for IBS in asymptomatic individuals. Possible mechanisms should be investigated in future studies.
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Affiliation(s)
| | - Anne Line Engsbro
- b Department of Clinical Microbiology , Hvidovre University Hospital , Hvidovre , Denmark
| | - Peter Bytzer
- a Department of Medicine , Zealand University Hospital , Køge , Denmark.,c Department of Clinical Medicine , University of Copenhagen , Copenhagen , Denmark
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Characteristics of the bacterial microbiome in association with common intestinal parasites in irritable bowel syndrome. Clin Transl Gastroenterol 2018; 9:161. [PMID: 29915224 PMCID: PMC6006308 DOI: 10.1038/s41424-018-0027-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/23/2018] [Accepted: 04/09/2018] [Indexed: 12/19/2022] Open
Abstract
Objective A low prevalence of intestinal parasites has been identified in individuals with irritable bowel syndrome (IBS), but potential associations with alterations in the bacterial microbiome remain largely unexplored. We aimed to investigate the relationship between parasites and bacteria in individuals with IBS in order to identify potential trans-kingdom microbial characteristics. Design Stool samples were collected from the Danish background population classified into IBS (n = 119), unspecific gastrointestinal (GI) symptoms (n = 114), and asymptomatic controls (n = 186) based on the Rome III criteria for IBS. Bacterial (16S) and eukaryotic (18S) ribosomal DNA was sequenced, and 18S data were merged with data from conventional parasite laboratory tests. The bacterial microbiome was analyzed according to symptom group and parasite colonization status. Results Bacterial richness and diversity were similar for IBS and controls but higher in those with unspecific GI symptoms. A higher abundance of Bacteroides and a lower abundance of Faecalibacterium were detected in individuals with IBS and unspecific GI symptoms compared with controls. Principal component analyses indicated differences in bacterial composition related to parasite colonization rather than symptom group. Parasites were detected at the lowest frequency in the IBS group (39%) and in samples dominated by Bacteroides. Higher bacterial richness and diversity were found in parasite-positive samples from controls and those with unspecific GI symptoms but not in individuals with IBS. Conclusion Parasite colonization, rather than bacterial composition, differed between individuals with IBS and healthy controls. Parasite colonization was associated to a rich and diverse bacterial microbiome; however, this association was altered in IBS.
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12
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Poulsen CH, Eplov LF, Hjorthøj C, Hastrup LH, Eliasen M, Dantoft TM, Schröder A, Jørgensen T. Irritable bowel symptoms, use of healthcare, costs, sickness and disability pension benefits: A long-term population-based study. Scand J Public Health 2018; 47:867-875. [PMID: 29762084 DOI: 10.1177/1403494818776168] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objectives: Irritable bowel syndrome (IBS) is associated with increased healthcare use and work absenteeism. We aimed to investigate long-term use of healthcare services and social benefits across IBS symptom groups. Additionally, we estimated excess healthcare costs. Methods: A longitudinal population-based study comprising two 5-year follow-up studies: The Danish part of the Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (Dan-MONICA) 1 (1982-1987) and Inter99 (1999-2004) recruited from the western part of Copenhagen County. The total study population (n = 7278) was divided into symptom groups according to degree of IBS definition fulfillment at baseline and/or 5-year follow-up and was followed until 31 December 2013 in Danish central registries. Poisson regression was used for the analyses adjusting for age, sex, length of education, comorbidity, cohort membership and mental vulnerability. Results: IBS symptom groups compared to no IBS symptoms were associated with an increased number of contacts with primary and secondary healthcare, as well as weeks on sickness and disability benefits. Accounting for mental vulnerability decreased the estimates and all but two associations between IBS symptom groups and outcomes remained statistically significant. The two associations that became insignificant were contacts with psychiatric hospitals and weeks on disability pension. The excess unadjusted healthcare costs for IBS were 680 Euros per year and the overall association between symptom groups and total healthcare costs were statistically significant. Conclusions: IBS symptoms influence the long-term use and costs of healthcare, as well as the use of social benefits in the general population. Mental vulnerability explained some, but not all, of the use of healthcare and social benefits.
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Affiliation(s)
- Chalotte H Poulsen
- Research Centre for Prevention and Health, Capital Region of Denmark, Denmark.,Copenhagen University Hospital, Mental Health Centre Copenhagen, Denmark
| | - Lene F Eplov
- Copenhagen University Hospital, Mental Health Centre Copenhagen, Denmark
| | - Carsten Hjorthøj
- Copenhagen University Hospital, Mental Health Centre Copenhagen, Denmark
| | | | - Marie Eliasen
- Research Centre for Prevention and Health, Capital Region of Denmark, Denmark
| | - Thomas M Dantoft
- Research Centre for Prevention and Health, Capital Region of Denmark, Denmark
| | - Andreas Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - Torben Jørgensen
- Research Centre for Prevention and Health, Capital Region of Denmark, Denmark.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,The Faculty of Medicine, Aalborg University, Denmark
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Mansouri A, Rarani MA, Fallahi M, Alvandi I. Irritable bowel syndrome is concentrated in people with higher educations in Iran: an inequality analysis. Epidemiol Health 2017; 39:e2017005. [PMID: 28171714 PMCID: PMC5434229 DOI: 10.4178/epih.e2017005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 02/01/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Like any other health-related disorder, irritable bowel syndrome (IBS) has a differential distribution with respect to socioeconomic factors. This study aimed to estimate and decompose educational inequalities in the prevalence of IBS. METHODS Sampling was performed using a multi-stage random cluster sampling approach. The data of 1,850 residents of Kish Island aged 15 years or older were included, and the determinants of IBS were identified using a generalized estimating equation regression model. The concentration index of educational inequality in cases of IBS was estimated and decomposed as the specific inequality index. RESULTS The prevalence of IBS in this study was 21.57% (95% confidence interval [CI], 19.69 to 23.44%). The concentration index of IBS was 0.20 (95% CI, 0.14 to 0.26). A multivariable regression model revealed that age, sex, level of education, marital status, anxiety, and poor general health were significant determinants of IBS. In the decomposition analysis, level of education (89.91%), age (−11.99%), and marital status (9.11%) were the three main contributors to IBS inequality. Anxiety and poor general health were the next two contributors to IBS inequality, and were responsible for more than 12% of the total observed inequality. CONCLUSIONS The main contributors of IBS inequality were education level, age, and marital status. Given the high percentage of anxious individuals among highly educated, young, single, and divorced people, we can conclude that all contributors to IBS inequality may be partially influenced by psychological factors. Therefore, programs that promote the development of mental health to alleviate the abovementioned inequality in this population are highly warranted.
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Affiliation(s)
- Asieh Mansouri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Amini Rarani
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Iman Alvandi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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