Sleep disorders and gastrointestinal symptoms: chicken, egg or vicious cycle?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75369/1/j.1365-2982.2008.01254.x.pd

Dietary guidelines for irritable bowel syndrome are important for gastroenterologists, dietitians and people with irritable bowel syndrome

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134108/1/jhn12413_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134108/2/jhn12413.pd

American College of Gastroenterology Guideline on the Management of Helicobacter pylori Infection

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73792/1/j.1572-0241.2007.01393.x.pd

Pharmacologic and Complementary and Alternative Medicine Therapies for Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by episodic abdominal pain or discomfort in association with altered bowel habits (diarrhea and/or constipation). Other gastrointestinal symptoms, such as bloating and flatulence, are also common. A variety of factors are believed to play a role in the development of IBS symptoms, including altered bowel motility, visceral hypersensitivity, psychosocial stressors, altered brain-gut interactions, immune activation/low grade inflammation, alterations in the gut microbiome, and genetic factors. In the absence of biomarkers that can distinguish between IBS subgroups on the basis of pathophysiology, treatment of this condition is predicated upon a patient's most bothersome symptoms. In clinical trials, effective therapies have only offered a therapeutic gain over placebos of 7-15%. Evidence based therapies for the global symptoms of constipation predominant IBS (IBS-C) include lubiprostone and tegaserod; evidence based therapies for the global symptoms of diarrhea predominant IBS (IBS-D) include the probiotic Bifidobacter infantis, the nonabsorbable antibiotic rifaximin, and alosetron. Additionally, there is persuasive evidence to suggest that selected antispasmodics and antidepressants are of benefit for the treatment of abdominal pain in IBS patients. Finally, several emerging therapies with novel mechanisms of action are in development. Complementary and alternative medicine therapies including probiotics, herbal therapies and acupuncture are gaining popularity among IBS sufferers, although concerns regarding manufacturing standards and the paucity of high quality efficacy and safety data remain

The utility of diagnostic tests in irritable bowel syndrome patients: a systematic review

The aim of this study was to determine the pretest probability of organic GI disease and the accuracy of diagnostic tests for organic GI disease in patients who meet symptom-based criteria for irritable bowel syndrome (IBS). METHODS : After a comprehensive literature search for studies examining the accuracy of diagnostic tests for organic GI disease among patients who meet symptom-based criteria for IBS, two independent observers qualitatively assessed the methodology of selected studies and extracted data. Data on the pretest probability of organic GI disease in this population and the accuracy of currently recommended diagnostic tests were converted to descriptive tables. RESULTS : Among patients meeting symptom-based criteria for IBS, the pretest probability of inflammatory bowel disease, colorectal cancer, or infectious diarrhea is less than 1%. Currently recommended diagnostic tests rarely identify organic GI disease in patients fulfilling symptom-based criteria for IBS. However, the pretest probability of celiac disease in patients meeting symptom-based criteria for IBS was 10 times higher than the prevalence of celiac disease in the general population. CONCLUSION : There is insufficient evidence to recommend the routine performance of a standardized battery of diagnostic tests in patients who meet symptom-based criteria for IBS. Based upon the increased pretest probability of celiac disease, routine performance of serological tests for celiac disease may be useful in this patient population, though additional study is needed in this area.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72511/1/j.1572-0241.2002.07027.x.pd

Levofloxacin-Based Triple Therapy versus Bismuth-Based Quadruple Therapy for Persistent Helicobacter pylori Infection: A Meta-Analysis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73094/1/j.1572-0241.2006.00637.x.pd

Appropriate timing of the 14 C-urea breath test to establish eradication of Helicobacter pylori infection

The aim of this study was to determine the performance characteristics of the 14 C-urea breath test (UBT) performed 2 wk after the completion of therapy for Helicobacter pylori using a 4 to 6 wk study as the gold standard. METHODS : Patients with active Helicobacter pylori infection at four medical centers received proton pump inhibitor-based triple or quadruple therapy for 10–14 days. Patients underwent the 14 C-UBT 2 and 4–6 wk after the completion of therapy. A positive test was defined as 14 CO 2 excretion of >200 dpm, a negative test as 50 but <200 dpm. Performance characteristics of the 2-wk UBT were calculated using the 4 to 6-wk result as a gold standard. RESULTS : Eighty-five patients were enrolled and 82 patients (mean ± SD age, 62 ± 15 yr; 15 women) completed the protocol. Four patients had equivocal UBT results and were excluded from the analysis. Of the 78 patients, 68 (87%) had a negative 4 to 6-wk UBT. The 2-week UBT yielded a sensitivity of 90% (95% confidence interval 72–100%), specificity of 99% (97–100%), and accuracy of 97% (93–100%). In patients with a persistently positive UBT, 14 CO 2 excretion at 2 wk was significantly lower than at 4–6 wk after therapy ( p = 0.03 ). CONCLUSIONS : A UBT performed 2 wk after therapy yielded results comparable to 4 to 6 wk testing. Further studies to evaluate the optimal time of confirmatory testing in the age of more effective proton pump inhibitor-based triple therapies are warranted.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73434/1/j.1572-0241.2000.02005.x.pd

Tegaserod for Female Patients Suffering From IBS With Mixed Bowel Habits or Constipation: A Randomized Controlled Trial

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73726/1/j.1572-0241.2008.01808.x.pd

Nuances of the psychogastroenterology patient: A predictive model for gastrointestinal quality of life improvement

BackgroundGastrointestinal conditions are multifactorial in nature, and certain patients can benefit greatly from brain–gut psychotherapies delivered by mental health professionals who specialize in psychogastroenterology. This study aimed to identify features associated with improvements in GI‐specific quality of life scores following behavioral health interventions (BHI). The second aim was to create a psychogastroenterology referral care pathway incorporating identified characteristics for greatest benefit from GI‐specific behavioral therapy.MethodsWe performed a prospective observational study of 101 (63 women; median age, 45 years) gastroenterology patients referred for psychogastroenterology consultation at a single center. Patients attended an average of seven sessions with a single GI psychologist where evidence‐based brain–gut psychotherapies were employed. GI‐specific quality of life (IBS‐QOL) and psychological distress (BSI‐18) were assessed before and after BHI. Patients completed self‐reported questionnaires. We performed a multivariable analysis to determine predictors associated with IBS‐QOL score improvement.Key ResultsA total of 53 (52.5%) patients experienced improvement in IBS‐QOL score. Patients with improved IBS‐QOL scores had significantly higher baseline BSI general domain T‐scores (61.9 vs. 56.9, P = 0.002). Female gender (odds ratio [OR], 3.2), pretreatment BSI somatization T‐score ≥63 (OR, 3.7), and a diagnosis of depression (OR, 4.2) were associated with greater odds of IBS‐QOL score improvement following BHI.Conclusions and InferencesWe identified factors associated with response to GI‐specific BHI to aid in optimizing the utilization of psychogastroenterology services and provide referring providers with information to inform treatment recommendations. Female patients with disorders of gut–brain interaction (DGBIs), high somatization, and depression should be considered a priority for brain–gut psychotherapies.Gastrointestinal conditions are multifactorial in nature, and certain patients can benefit greatly from brain–gut psychotherapies delivered by mental health professionals who specialize in psychogastroenterology. Females with disorders of gut–brain interaction, high somatization, and depression should be considered priority for brain–gut psychotherapies. Behavioral health outcomes were not limited to disease; patients with IBD should be routinely considered for referral. Optimizing utilization of GI‐specific behavioral health specialists for the best outcomes can maximize quality of life and disease experience, but also improve value‐based care.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151345/1/nmo13663.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151345/2/nmo13663_am.pd

Safety and patient outcomes with lubiprostone for up to 52 weeks in patients with irritable bowel syndrome with constipation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90244/1/apt4983.pd