Abstract: Ovarian cancer is the second most common gynecologic malignancy in the US and-because more than 70% of women affected are diagnosed with advanced-stage disease-the deadliest. Contrary to what might be expected, screening has not lessened mortality even in high-risk populations. The idea of targeting women having specific symptoms to be screened is relatively recent because of the general belief that symptoms have limited specificity. The authors undertook a case-control study of 149 women with ovarian cancer. An exploratory group served to estimate odds ratios for self-reported symptoms of variable severity, frequency, and duration. The results of logistic regression analysis were used to develop a symptom index, which then was tested in a confirmatory group. The group with ovarian cancer included 55 women with early-stage disease, 88 with late-stage disease, and 6 whose disease stage was not known. Thirty-one of the women with early-stage disease and all but 2 of those with advanced-stage disease had invasive tumors. In the exploratory group, symptoms that were significantly associated with ovarian cancer, when occurring more than 12 days a month and for less than a year, included pelvic/abdominal pain, urinary urgency/frequency, increased abdominal size/bloating, and difficulty eating/feeling full. On logistic regression analysis, pelvic/ abdominal pain, increased abdominal size/bloating, and difficulty eating/feeling full were independently associated with the presence of ovarian cancer. The symptom index was considered to be positive if any of these 6 symptoms occurred more than 12 times a month and had been present for less than 12 months. In the confirmatory group, the symptom index was 56.7% sensitive for early-stage disease and 79.5% sensitive for advanced-stage disease. The index was 90% specific for women older than 50 years of age and 86.7% specific for younger women. When analyzing 1709 women presenting to a primary care clinic, 45 of them (2.6%) tested positive and would have been identified as having symptoms very suggestive of ovarian cancer. The proportions of women less than 50 years of age and those aged 50 and older who tested positive were 3.3% and 1.4%, respectively. The presence of specific symptoms, taking their duration and frequency into account, can help point to women who harbor ovarian cancer. Calculating the symptom index is a relatively simple means of identifying women who should be promptly and thoroughly evaluated.

Abstract: BACKGROUND: IBS is a complex disorder that encompasses a wide profile of symptoms. The symptoms of chronic constipation frequently resemble those of constipation-predominant IBS. Current drug treatments for irritable bowel syndrome (IBS) are of limited value. Many target specific symptoms only. Tegaserod, a 5HT(4) partial agonist, represents a novel mechanism of action in the treatment of IBS and chronic constipation. OBJECTIVES: The objective of this review was to evaluate the efficacy and tolerability of tegaserod for the treatment of IBS and chronic constipation in adults and adolescents aged 12 years and above. SEARCH STRATEGY: MEDLINE 1966-December 2006 and EMBASE 1980 to December 2006 were searched. The text and key words used included "tegaserod", "HTF 919", "irritable bowel", "constipation" and "colonic diseases, functional". The Cochrane Central Register of Controlled Trials, and the Inflammatory Bowel Disease Review Group Specialized Trials Register were also searched. Searches stopped on 15th December 2006. Relevant articles were retrieved, and their reference lists were also reviewed. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials comparing tegaserod with placebo, no treatment or any other intervention (pharmacological or non-pharmacological) in subjects aged 12 years and above with a diagnosis of IBS or chronic constipation, focusing on clinical endpoints were considered for review. DATA COLLECTION AND ANALYSIS: Study inclusion and exclusion, data extraction and quality assessment was undertaken by two authors independently. Meta-analysis was performed where study populations, designs, outcomes, and statistical reporting allowed combination of data in a valid way, using the summary statistics relative risk for dichotomous data and weighted mean difference for continuous data, both with 95% CI. Thirteen short-term placebo-controlled studies fulfilled the inclusion criteria. These were predominantly conducted in women. Ten studies evaluated the efficacy of tegaserod on global gastrointestinal (GI) symptoms in patients with constipation-predominant IBS (C-IBS). One small study evaluated safety in patients with diarrhoea-predominant IBS. Two studies evaluated the effectiveness of tegaserod for the treatment of chronic constipation. MAIN RESULTS: In patients with C-IBS, the relative risk (RR) of being a responder in terms of global relief of GI symptoms during the last 4 weeks of treatment was significantly higher with both tegaserod 12 mg and 4 mg doses compared with placebo. Although the pooled results indicate statistically significant benefit with tegaserod, the a priori minimal clinically important differences set in two of three studies were not reached. The responder rate for this endpoint was also higher when considered for the first 4 weeks of treatment (tegaserod 12 mg only). Tegaserod did not significantly improve the patients' individual symptoms of abdominal pain and discomfort although bowel habit showed a statistically significant improvement with tegaserod 4 mg and there was a non-significant trend in this outcome in favour of tegaserod 12 mg. In patients with chronic constipation, the RR of being a responder in terms of complete spontaneous bowel movements per week with tegaserod 12 mg was 1.54 (95% CI 1.35 to 1.75), WMD for this endpoint compared with placebo 0.6 (95% CI 0.42 to 0.78). Differences between tegaserod and placebo in increases in frequency of bowel movements were small (less than one per week). The proportion of patients with either diagnosis who experienced diarrhea was significantly higher in the tegaserod 12 mg group compared with placebo (RR 2.80, 95% CI 2.13 to 3.68), with a number needed to harm (NNH) of 20. Effects of tegaserod on GI symptoms such as bloating, stool consistency, and straining were not consistent across the studies. AUTHORS' CONCLUSIONS: Tegaserod appears to improve the overall symptomatology of IBS, and the frequency of bowel movements in thos

Abstract: Summary Background A sensation of abdominal bloating, sometimes accompanied by an increase in girth (distension), is one of the most common and most intrusive features of functional bowel disorders. Aim To conduct a systematic, evidence-based review of the epidemiology and pathophysiology of abdominal bloating and its relationship to distension. Methods The terms bloating, distension, functional bowel, irritable bowel syndrome, constipation and diarrhoea were searched on MEDLINE up to 2006. References from selected articles and relevant abstracts were also included. Results Approximately 50% of irritable bowel syndrome patients with bloating also experience an increase in abdominal girth and this is more pronounced with constipation than diarrhoea. Bloating appears to be more frequently associated with visceral hypersensitivity, whereas distension is more often related to hyposensitivity and delayed transit. Although there is little evidence for excessive gas as a cause of bloating, gas infusion studies suggest that handling of gas may be impaired in irritable bowel syndrome and there may also be abnormal relaxation of the anterior abdominal musculature in these patients. Conclusions There is unlikely to be a single cause for bloating and distension, which probably have different, but overlapping, pathophysiological mechanisms. Relieving constipation might help distension, but the treatment of bloating may need more complex approaches involving sensory modulation.

Abstract: Summary Objective The relationship between acid and dyspeptic symptoms has not been fully understood. Aim To investigate the type and severity of dyspeptic symptoms induced by direct acid infusion into the stomach of Japanese healthy subjects. Methods This was a multi-centre, cross-over, randomized, double-blind study in 27 healthy subjects (mean age 27). Each fasted subject received two tests with 150 mL of 0.1 mol/L hydrochloric acid infusion (15 mL/min for 10 min) and the same volume of pure water infusion. The type and severity of symptoms were assessed by a 10 cm visual analogue scale administered every 2 min up to 30 min. Results Various symptoms were reported after both acid and water infusions. Most of the symptoms were more severe after acid infusion compared with water infusion (acid vs. water: discomfort 1.8 ± 0.4 vs. 0.5 ± 0.1, pain 0.6 ± 0.3 vs. 0.1 ± 0.1, reflux 1.0 ± 0.3 vs. 0.3 ± 0.1 and satiety 1.1 ± 0.4 vs. 0.2 ± 0.1). The area under curve for dysmotility like symptoms (heavy feeling in the stomach, bloating, nausea or feeling sick, and belching) was significantly higher in acid infusion, and symptoms continued after infusion of the acid. Conclusion Acid induced into stomach induced dysmotility-like predominant dyspeptic symptoms in Japanese healthy control subjects, demonstrating the possible importance of acid in symptom generation.

Abstract: Introduction High-frequency gastric electrical stimulation is a new therapeutic option to improve refractory nausea and vomiting, in gastroparetic patients. Its effects on gastric emptying are, however, inconstant and limited. Therefore, we have hypothesized that high-frequency gastric electrical stimulation could be also effective in patients suffering from refractory vomiting and nausea with normal gastric emptying, and we have compared the symptomatic efficacy of high-frequency gastric electrical stimulation between patients with delayed and normal gastric emptying. Patients and Methods Fifteen patients with chronic, severe and medically resistant nausea and vomiting were included in the study. Gastric emptying was delayed in eight patients (Group 1) and normal in seven patients (Group 2). At inclusion and at 6 months after the start of the stimulation, symptoms (nausea and vomiting, bloating, regurgitations, abdominal pain and appetite) and quality of life were prospectively evaluated using the Gastrointestinal Quality of Life Index score whereas gastric emptying was assessed by scintigraphy and/or octanoic acid breath test. Results Age, sex, symptoms and quality of life were not different at baseline between the two groups. At 6 months, Gastrointestinal Quality of Life Index and nausea/vomiting scores had significantly improved in both groups. Other symptoms (bloating, regurgitations, abdominal pain and appetite) had improved at 6 months in Group 1 but not in Group 2. Six months after the start of stimulation, gastric emptying was normal in 4/8 Group 1 patients and 5/7 Group 2 patients but was not significantly different from that calculated before the implantation of the stimulator. Conclusion Our results suggest that high-frequency gastric electrical stimulation could be an effective therapy for treating chronic, severe vomiting and nausea whether gastric emptying is delayed or not.

Abstract: OBJECTIVES Medications often cause constipation and little data are available concerning treatment interventions. This study was designed to evaluate the safety and efficacy of polyethylene glycol (PEG) 3350 laxative (MiraLax) for relief of constipation from medicines associated with symptoms of constipation. METHODS Study subjects were enrolled who met defined criteria for chronic constipation and were also taking medications that were associated with a reported side effect incidence of more than 3% constipation. Subjects were randomized into a double-blind, parallel, multicenter study where they received 17 g per day of PEG laxative or placebo for 28 days. The primary efficacy variable, "Treatment Success," was defined as relief of ROME II criteria for constipation over the last 7 days of the treatment period. Various secondary measures were also assessed. Daily bowel movement experience, patient perception of efficacy, and safety information were recorded in a diary. Laboratory testing was performed at baseline and at end of study for hematology and blood chemistry, including BUN, calcium, electrolytes, and TSH. RESULTS One hundred patients were enrolled at 4 study centers. Successful treatment according to the primary efficacy variable was seen in 78.3% of PEG and 39.1% of placebo subjects (P < 0.001). Similar results were observed in a subgroup of 28 elderly subjects. Secondary measures of number of bowel movements, complete bowel movements, satisfactory bowel movements, straining at stool and stool consistency also showed statistically significant results in favor of PEG compared with placebo (P < or = 0.01) after the first week of treatment. There were no differences inpatient reported scores for gas, cramping, or bloating between PEG and placebo. No significant differences in laboratory findings or adverse events, including the gastrointestinal category, were observed. Diarrhea and flatulence occurred more frequently with PEG treatment, although they were not individually statistically different from placebo. Similar results were observed when these symptoms were analyzed for differences due to gender, race, or age. CONCLUSIONS PEG laxative is safe and effective for use in treating constipation in patients taking constipating medications.

Abstract: Calcium polycarbophil was compared with placebo in 23 patients with irritable bowel syndrome in a six-month, randomized double-blind crossover study. Patients received polycarbophil tablets at a dosage of 6 g/day (twelve 0.5-g tablets) or matching placebo tablets. At study end, among patients expressing a preference, 15 of 21 (71%) chose polycarbophil over placebo for relief of the symptoms of irritable bowel syndrome. Statistically significant differences favouring polycarbophil were found among the following patient subgroups: 15 (79%) of 19 with constipation: all six with alternating diarrhoea and constipation; 13 (87%) of 15 with bloating: and 11 (92%) of 12 with two or more symptoms. Polycarbophil was rated better than placebo in monthly global responses to therapy. Patient diary entries showed statistically significant improvement for ease of passage with polycarbophil. Polycarbophil was rated better than placebo for relief of nausea, pain, and bloating. The data suggest that calcium polycarbophil can benefit irritable bowel syndrome patients with constipation or alternating diarrhoea and constipation and may be particularly useful in patients with bloating as a major complaint.

Abstract: Bloating, abdominal distention, and flatulence represent very frequent complaints in functional disorders but their pathophysiology and treatment are largely unknown. Patients frequently associate these symptoms with excessive intestinal gas and the reduction of gas production may represent an effective strategy. The aim was to evaluate the effect of α-galactosidase administration, in a randomized double-blind placebo-controlled protocol, on intestinal gas production and gas-related symptoms after a challenge test meal in healthy volunteers. Eight healthy volunteers ingested 300 or 1200 GalU of α-galactosidase or placebo during a test meal containing 420 g of cooked beans. Breath hydrogen excretion and occurrence of bloating, abdominal pain, discomfort, flatulence, and diarrhea were measured for 8 hr. The administration of 1200 GalU of α-galactosidase induced a significant reduction of both breath hydrogen excretion and severity of flatulence. A reduction in severity was apparent for all considered symptoms, but both 300 and 1200 GalU induced a significant reduction in the total symptom score. α-Galactosidase reduced gas production following a meal rich in fermentable carbohydrates and may be helpful in patients with gas-related symptoms.

Abstract: Although gastroparesis does not influence gastroesophageal reflux disease (GERD) or antireflux surgery, many patients with GERD will also suffer from gastroparesis-related bloating as a distinct symptom different from GERD-related symptoms. The purpose of this study was to assess whether a pyloroplasty with a fundoplication will improve bloating symptoms in these patients. A prospectively gathered database of all patients undergoing antireflux surgery was reviewed. All patients underwent history, physical examination, upper gastrointestinal endoscopy, esophageal manometry, 24-hour esophageal pH monitoring, and, selectively, contrast upper gastrointestinal radiography. Patients with symptoms of bloating also underwent gastric emptying scintigraphy. All patients completed the GERD-Health Related Quality of Life (HRQL) symptom severity questionnaire. One of the items of this instrument relates to bloating. The item is scored from 0 (asymptomatic) to 5 (incapacitating) based on descriptive anchors. Patients with symptomatic GERD and objective findings by physiologic testing were offered antireflux surgery. Those with delayed gastric emptying (defined as T1/2 > 120 minutes) were also offered a pyloroplasty. Operations performed included a laparoscopic or open Nissen or Toupet fundoplication with a Heineke–Mickulicz pyloroplasty. Postoperatively, patients completed the GERD-HRQL and had a gastric emptying scintigraphy performed. Three-hundred and sixty-nine patients underwent antireflux surgery; of these, 35 patients also had a pyloroplasty. Twenty-eight (80%) of these patients reported significant symptomatic improvement. The median preoperative bloating score improved from 4 to 1 postoperatively (P < 0.05), and the median gastric emptying scintigraphy T1/2 improved from 244 to 112 minutes (P < 0.05). Although gastroparesis may not contribute to symptoms of GERD, it can contribute to symptoms of bloating. Bloating symptoms improved in 80% of patients with the addition of a pyloroplasty. Therefore, addition of pyloroplasty to a fundoplication in patients with gastroparesis-related bloating can improve bloating symptoms.

Abstract: Background: Prebiotic and probiotic therapies are new strategies that are being used to treat different gastrointestinal diseases, such as irritable bowel syndrome, diverticular disease and inflammatory bowel diseases. Aims: Evaluating the effects of a symbiotic preparation on symptoms and colonic transit in patients with irritable bowel syndrome and significant bloating. Methods:We carried out an open-label, prospective, uncontrolled, multicenter trial on 129 patients meeting Rome II criteria for irritable bowel syndrome who did not have lactose malabsorption, abdominal surgery, overt psychiatric disorders and ongoing psychotropic drug therapy or ethanol abuse. For three months, the patients were treated with a symbiotic preparation and were investigated trough questionnaires on symptoms. Data on bloating and abdominal pain were obtained using the McNemar-Bowker’s test, while data on stool frequency were evaluated using the t-test. Results: The administration of a symbiotic preparation to these patients modified the clinical picture and intestinal function, with a significant increase of stool frequency. Conclusions:Our data, although the study had an open design, represent a further analysis of positive symbiotic effects on clinical manifestations and intestinal function in patients with irritable bowel syndrome.

Abstract: Irritable bowel syndrome (IBS) is a common disorder associated with abdominal pain or discomfort and altered bowel habits. The majority of patients describe an insidious onset of symptoms; however, a subset report a fairly precise time of onset following an attack of acute gastroenteritis. Typically, the potential acute infectious symptoms, such as fever and vomiting, resolve after several days, but abdominal discomfort, bloating, and diarrhea persist. Although the underlying mechanism of post-infectious IBS (PI-IBS) has not been established, ongoing inflammation appears to play a role, with an increase in serotonin-containing enterochromaffin cells, T lymphocytes, mast cells, proinflammatory cytokines, and intestinal permeability. Psychiatric comorbidities are less common in PI-IBS, compared with IBS patients in general; however, the prevalence of psychological disorders is still higher compared with that in the general population and is associated with a poorer prognosis. Overall, patients with PI-IBS have a slightly improved prognosis compared with those with IBS without an infectious onset.

Abstract: S Clinical Scenario A 51-year-old self-employed male is referred for further valuation of symptoms of abdominal discomfort and bloating uggestive of irritable bowel syndrome (IBS) that have been resent intermittently for the past 20 years. He had been evalated in the past and was found to be Helicobacter pylori positive y serology. This was eradicated successfully with a course of riple therapy but there was no effect on his symptom complex. e subsequently underwent esophagogastroduodenoscopy, olonoscopy, complete blood count, C-reactive protein levels, nd liver chemistries, all of which were normal. At the time of this evaluation his predominant symptoms re abdominal bloating, a distressing feeling of incomplete ectal evacuation, and left lower-quadrant abdominal pain. He escribes his predominant bowel function as constipation; dirrhea is rare. On more detailed questioning, it becomes clear hat he has a bowel movement every day but stools are “small” nd pellet-like and usually followed by an uncomfortable senation of incomplete evacuation. Further attempts at a bowel ovement are distressingly unsuccessful. However, of greater istress to him is the “constant” sensation of bloating that rogresses through the day and is relieved, to some extent, by assing flatus, when this is possible and socially appropriate. hen severe, bloating exacerbates his right lower-quadrant disomfort. He freely admits to considerable stress in his life, ostly related to his position as the sole owner and CEO of a mall construction firm. Eight weeks ago he received a course of antibiotics for a ental abscess; for 2 weeks thereafter his IBS symptoms were mproved. He read about a relationship between IBS and small ntestinal bacterial overgrowth (SIBO) on the web and seeks dvice on this issue. Physical examination reveals a fit, nonoese, well-nourished male. The abdomen is not distended; no asses are palpable apart from tenderness in the left lower uadrant, rectal examination is normal with no features to uggest an evacuation disorder.

Abstract: Bariatric surgery is the most effective treatment for severe obesity. After surgery, patients may complain of gastrointestinal symptoms but their altered anatomy can make investigations difficult to perform or interpret. In particular, the Roux-en-Y gastric bypass (RYGBP) creates an excluded segment that is not easily accessible. We present a case illustrating some of the difficulties encountered when investigating the RYGBP patient complaining of nonspecific GI symptoms. Options are discussed for examining the excluded segment, and the diagnosis and significance of small intestine bacterial overgrowth in the RYGBP patient is reviewed.

Abstract: There are few studies supporting the effective and safe use of laxatives for constipation. This study examined the short-term efficacy and safety of sodium picosulphate in patients with chronic constipation. Patients with a history of chronic constipation for at least 3 months were randomised to receive 7 mg sodium picosulphate or placebo for three consecutive nights. Patients recorded stool frequency and consistency, straining, bloating, and pain at baseline and during treatment. Vital signs, haematocrit, serum creatinine and electrolytes were monitored. Primary end-point for efficacy was the occurrence of a response to treatment, defined as improvement in stool frequency and occurrence of straining. All 57 randomised patients (sodium picosulphate n = 29, placebo n = 28; mean age 54.8 and 54.1 years) completed the study. Sodium picosulphate produced a treatment response (improved stool frequency and straining) in 82.8% compared with 50% in the placebo group (p = 0.010) and reduced bloating more often than placebo. There were no serious adverse events and one patient with diarrhoea and another with abdominal pain in each treatment group. There were no cardiovascular effects, changes in serum haematocrit, creatinine or electrolytes in either group. This study confirmed that sodium picosulphate is an effective, well-tolerated and safe laxative in the acute treatment of constipation.

Abstract: While assessing the methylphosphonothioic acid S-(2-(bis(1-methylethyl)amino)ethyl)O-ethyl ester (VX) induced respiratory toxicity and evaluating therapeutics against lung injury, we observed that the animals were experiencing abnormal swelling in the abdominal area. Nerve agent has been known to increase salivary, nasal and gastrointestinal secretion and cause diarrhea. This study was initiated to investigate the effect of VX on the gastrointestinal tract (GI) since abdominal pathology may affect breathing and contribute to the on going respiratory toxicity. The mid-abdominal diameter and the size of the lower left abdomen was measured before and after 27.3 mg/m3 VX exposure by microinstillation and at 30 min intervals up to 2 h post-VX exposure. Both VX and saline exposed animals exhibited a decrease in circumference of the upper abdomen, although the decrease was slightly higher in VX-exposed animals up to 1 h. The waist diameter increased slightly in VX-exposed animals from 60 to 90 min post-VX exposure but was similar to saline controls. The lower left abdomen near to the cecum, 6 cm below and 2cm to the right of the end of the sternum, showed an increase in size at 30-60 min that was significantly increased at 90-120 min post-VX exposure. In addition, VX-exposed animals showed loose fecal matter compared to controls. Necropsy at 24h showed an increased small intestine twisting motility in VX-exposed animals. Body tissue AChE assay showed high inhibition in the esophagus and intestine in VX-exposed animals indicating that a significant amount of the agent is localized to the GI following microinstillation exposure. These results suggest that microinstillatipn inhalation VX exposure induces gastrointestinal disturbances similar to that of irritable bowel syndrome and bloating.

Abstract: BACKGROUND AND OBJECTIVE: Abdominal pain is generally believed to be a symptom of intra-abdominal disease. When no pathological findings are evident, abdominal pain is considered functional. Abdominal pain, however, may also originate in the abdominal wall. METHODS: Consecutive patients with unexplained abdominal pain were enrolled in a prospective observational study in a gastroenterologic clinic during a period of three years. The following criteria were tested: Can abdominal pain be elicited by physical movement? Is the source of pain localized to a circumscribed site in the abdominal wall? Can pain be provoked by digital palpation in this area and does pain increase when the abdominal muscles are tensed? RESULTS: Clinical examination of 55 patients revealed small painful pits in the abdominal wall with varying intensity of pain when the abdominal muscles were contracted: in 39 patients the painful area was located in the semilunar line, in seven patients the pain originated in the linea alba between xiphoid and umbilicus, in five cases the painful spots were situated within the rectus muscle, and in four patients the pain was localized along the costal arch. Of the 39 patients with pain in the semilunar line, 16 had a BMI > 30, 12 presented with anxiety and depression, and 10 reported bloating and straining during defecation. Pain in the rectus muscle was associated with exercise. The patients with pain in the linea alba and at the costal arch suffered from obesity, anxiety or depression. CONCLUSIONS: These findings suggest that repeated forceful contractions of the abdominal wall muscles during exercise and straining, as well as chronic inflation of the abdominal wall by fat pads and by bloating, may cause strain and pain in the abdominal wall at sites predestined by anatomy. Symptom-specific anxiety may be a consequence of chronic unexplained abdominal pain. A novel classification of abdominal wall pain is proposed. The correct diagnosis will avoid repeated and costly investigations and relieve the patient's anxiety.

Abstract: Functional gastrointestinal disorders are the most common problem in gastroenterological practice. They are defined by chronic abdominal symptom complexes that occur in the absence of underlying structural abnormalities. The pathogenesis of these disorders is heterogeneous and involves behavioral, infective, and inflammatory components. Common symptoms are abdominal pain, diarrhea, constipation, and bloating. Mechanisms underlying these symptoms include alterations in gastrointestinal motility, visceral perception, altered epithelial function, and disturbances in fermentation activity by gut commensal bacteria.

Abstract: Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder characterized by abdominal pain and/or discomfort together with abnormal bowel habits. The pathophysiology is complex and incompletely understood. Potential important factors are altered brain-gut interactions, visceral hypersensitivity, psychosocial factors, disturbed GI motility, inflammatory changes, and bacterial overgrowth. Our aim was to investigate some of the different pathophysiological factors in IBS. Altered rectal perception was found in 62% of IBS patients. These subjects more frequently reported moderate or severe abdominal pain, bloating, diarrhea, satiety, and anxiety. Symptoms of abdominal pain and bloating were associated with altered rectal perception in a multivariate analysis. Moderate or severe symptoms overall were also associated with female gender and anxiety. Stress decreased visceral sensory thresholds in controls, probably due to distraction. In IBS patients, sensory thresholds remained stable during stress, indicating a disability to suppress signals from the bowel during stress in these patients. Compared with controls, IBS patients had altered neuroendocrine hormones both in the basal state and in response to stress. In an experimental setting, investigation of memory and attention showed that compared with patients with organic GI disease, IBS patients were faster at identifying words, especially words representing GI symptoms and negative affects. There were no group differences regarding levels of anxiety or depression, but in IBS patients these levels were correlated with memory processing of GI words. Small intestinal bacterial overgrowth investigated with proximal jejunal cultures, was present in 4% of IBS subjects, which was not different from healthy controls. However, mildly elevated counts of bacteria were more common in IBS patients than in controls. Patients with bacterial overgrowth tended to have fewer phase IIIs, and enteric dysmotility was twice as common in these subjects. There was no relation between mildly elevated counts of bacteria and small bowel motility. Conclusions: The pathophysiology of IBS is complex and multifactorial. Altered visceral perception is associated with symptom severity, and stress induces an altered visceral and neuroendocrine response in IBS patients, which could explain why stress is sometimes associated with the onset and worsening of symptoms. IBS patients seem to be hypervigilant regarding GI symptoms through memory processing connected to psychological state. Small intestinal bacterial overgrowth is not common in IBS, but of uncertain relevance, a proportion of IBS patients have elevated counts of bacteria in the proximal jejunum.

Abstract: The current treatment options that are available for patients with severe chronic constipation are unsatisfactory. Long-term high dose laxative therapy produces significant morbidity in some, with ongoing bloating and abdominal pain. In refractory cases subtotal colectomy has become increasingly popular. However this is a major abdominal procedure with all the normal associated risks. Less invasive procedures for the treatment of constipation are being sought. However, improved therapies can only stem from a better understanding of the phenomena underlying severe constipation. Colonic propagating pressure wave sequences (PSs) are responsible for discrete movements of content and are vital for normal defaecation. Deficiencies in PS frequency, amplitude and extent of propagation are all implicated in severe defaecatory dysfunction. Mechanisms that can normalise these aberrant motor patterns may help rectify the problem. Recently the novel therapy of sacral nerve stimulation (SNS) has been utilized for the treatment of severe constipation. The results from a limited number of studies are encoura- ging, with improved stool frequency commonly reported. However, little is known of the effects of SNS upon colonic motor patterns. Colonic manometry provides the ideal test-bed to examine this phenomenon. Additionally colonic manometry can be used as a measurement tool to evaluate a range of stimulus parameters and determine those that give the optimal colonic response.

Abstract: Irritable bowel syndrome (IBS) is a common diagnosis in gastroenterology with patients usually subgrouped under the Rome clinical criteria according to their bowel pattern. Although an individual may be classified as diarrhea-predominant IBS or constipation-predominant IBS, patients often resist this subgrouping by saying that they have both constipation and diarrhea. Regardless of their predominant bowel complaint, 92% of IBS patients share the symptom of bloating. Bloating secondary to abnormal bacterial fermentation is a feature of small intestinal bacterial overgrowth (SIBO). The role for an antibiotic-sensitive mechanism in IBS such as SIBO is supported by 2 double-blind, randomized, placebo-controlled trial showing: (1) a 75% improvement in global bowel symptoms when bacterial overgrowth was successfully treated with a nonabsorbable antibiotic and (2) a sustained improvement of symptoms for a period of 10 weeks after the treatment with a small bowel-targeting antibiotic. Although diarrhea is a well-known symptom in SIBO, constipation may also be a consequence of altered host-gut microbial relationship through the action of the bacterial gas methane on intestinal motility. In addition to bloating and bowel symptoms, a number of extraintestinal complaints are common in patients with IBS, including psychologic changes such as anxiety. Animal data would suggest that anxiety may also be a consequence of altered host-gut microbial relationship. In this review, we will discuss the role of gut bacteria in the gastrointestinal and extraintestinal presentations of IBS.

Abstract: A method of treatment for intestinal gas bloating, microscopic colitis, traveler's diarrhea and inflammatory bowel disease, said method comprising ingesting an effective quantity of a composition comprising colloidal bismuth subcitrate to eliminate gastrointestinal discomfort.

Abstract: Chronic constipation is a common condition that affects more American adults than hypertension, migraine, diabetes, asthma, and coronary heart disease. It is associated with bothersome symptoms such as straining, gas, bloating, infrequent bowel movements, incomplete evacuation, and abdominal distention and/or discomfort. Chronic constipation also imposes a significant economic burden and has a negative impact on health-related quality of life. This article reviews the definition, diagnostic criteria, etiology, and epidemiology of chronic constipation, in addition to its impact on healthcare costs, resource utilization, and quality of life. It also addresses several treatment options, including lifestyle modifications, fiber supplementation, and the prescription medications that are approved for the treatment

Abstract: SUMMARY Treatment of patients with irritable bowel syndrome (IBS) should be individualised on the basis of patient’s symptoms and needs. The management of IBS starts with its safe diagnosis based on the patient’s symptoms and a limited work-up for exclusion of organic diseases. The physician should always try to establish a good therapeutic relationship with the patient, explain the benign nature of IBS, and clarify potential triggering factors for IBS exacerbations. Dietary and lifestyle changes may help a very small number of IBS patients with mild symptoms, while highfiber diets or supplements are recommended only for patients with severe constipation. Loperamide is the drug of choice for episodes of diarrhea and/or urgency, while smooth muscle relaxants may be used for IBS exacerbations with abdominal pain, bloating and/or distention. Antidepressants are currently used for the treatment of diarrhea- or abdominal pain-predominant IBS patients who are refractory to other forms of drug therapy, while psychological therapies may help refractory IBS cases, but their availability is rather limited, their cost high, and their efficacy unproven. In the future, novel agents, which have resulted from the better understanding of IBS pathophysiology, may prove to be more effective and safe therapeutic options for our IBS patients. Key words: Irritable bowel syndrome, diet, fiber, loperamide, smooth muscle relaxants, antidepressants