Abstracts
Lactose Intolerance
Lactose Intolerance
One hundred and one of 427 healthy subjects were defined as lactose maldigesters by the lactose tolerance test with ethanol and 326 were lactose digesters. Irritable bowel syndrome was found in 15% of both the lactose maldigesters and lactose digesters. One-third of the subjects reported intolerance to dairy products containing less than or equal to 20 g of lactose. About half of this third were lactose maldigesters and half were lactose digesters. Characteristics common to both lactose intolerance and irritable bowel syndrome were female sex and abdominal pain in childhood. In the subjects with irritable bowel syndrome, the percentage of lactose maldigesters was the same as in the whole study group, which was 24%. But the number who reported lactose intolerance was higher, at 60% compared to 27%.
Vesa, Tuula H., et al: Role of Irritable Bowel Syndrome in Subjective Lactose Intolerance, American Journal of Clinical Nutrition, 1998;67:710-715.
Stress & Irritable Bowel Syndrome
Stress
Everyday stress can account for the cause of more than half of irritable bowel syndrome cases in Western populations. In 31 irritable bowel syndrome patients, everyday stress and symptomatology showed serial dependence for a statistically significant proportion of sufferers. Therefore, stress management programs may be beneficial in treating irritable bowel syndrome.
Dancey, Christine P., et al: The Relationship Between Daily Stress and Symptoms of Irritable Bowel: A Time-Series Approach, Journal of Psychosomatic Research, 1998;44(5):537-545.
Dieting (Irritable Bowel Syndrome)
Dieting
Young women report symptoms associated with irritable bowel syndrome (IBS), such as pain, bloating, and changes in bowel movements, more often than young men. Young women with eating disorders also report these gastrointestinal symptoms frequently.
Interviewed 301 1st-year college women representing the continuum of dieting severity. Severity of dieting was positively related to frequency of abdominal pain, bloating, diarrhea, and constipation, and that the women who reported 3 or more symptoms regularly scored higher on a scale for dieting severity.
Although this study did not examine the relationship between dieting severity and clinical IBS, findings suggested that dieting is associated with gastrointestinal symptoms in young women.
Krahn D et al., Dieting severity and gastrointestinal symptoms in college women. J Am Coll Health, 1996 Sep, 45:2, 67-71.
Elimination Diet
Elimination Diet
In a significant number of patients affected by the irritable bowel syndrome, an adverse reaction to food is proposed to be a causative factor. A diet that eliminates the offending foods is the obvious treatment for such adverse reactions. Compliance with a dietetic regimen is often poor and sometimes not completely free from risks.
Since the diarrheic type of irritable bowel syndrome seems mainly affected by food intolerance, oral cromolyn sodium was compared with an elimination diet.
Symptoms related to the irritable bowel syndrome improved in 60% of patients treated with elimination diet and in 67% of those treated with oral cromolyn sodium (1,500 mg/day) for 1 month.
Moreover, in both groups clinical results were significantly better in the patients positive to the skin prick test than in the negative ones.
Stefanini GF et al., Oral cromolyn sodium in comparison with elimination diet in the irritable bowel syndrome, diarrheic type. Multicenter study of 428 patients. Scand J Gastroenterol, 1995 Jun, 30:6, 535-41.
Fiber & (Irritable Bowel Syndrome)
Fiber
In recent years, many health claims have been made about dietary and supplemental fiber. However, some reports (e.g., those regarding oat bran) have been controversial.
Fiber has some preventive, or therapeutic benefits, in irritable bowel syndrome, diverticulosis, colorectal cancer, diabetes, and hypercholesterolemia. However, it appears to have no direct benefit in patients with inflammatory bowel disease, gallstones, or obesity.
The United States has one of the lowest per capita intakes of fiber in the world. Therefore, increasing daily fiber intake either through diet or with supplements is recommended for most Americans.
Bennett WG & Cerda JJ: Benefits of dietary fiber. Myth or medicine? Postgrad Med, 1996 Feb, 99:2, 153-6, 166-8, 171-2 passim.
Food Reactions
Food Reactions
The role of allergic reactions in the pathogenesis of inflammatory bowel disease and irritable bowel syndrome has been disputed.
Determined the prevalence of adverse reactions to food in patients with gastrointestinal disease.
Intestinal food allergy could be suspected according to several criteria, such as elevated total IgE, specific IgE against food antigens, eosinophilia, responsiveness to cromoglycate, and clinical signs of atopic disease.
In 3%, the diagnosis could be confirmed by endoscopic allergen provocation and/or elimination diet and rechallenge.
Data suggest that allergic reactions to food antigens may be a causative factor in a subgroup of patients with inflammatory and functional gastrointestinal disease.
Bischoff SC et al., Prevalence of adverse reactions to food in patients with gastrointestinal disease. Allergy, 1996 Nov, 51:11, 811-8.
Gluten-free Diet
Gluten-free Diet
The majority of patients with celiac sprue experience diarrhea before diagnosis. There have been no studies of the prevalence, or causes, of chronic diarrhea in these patients after treatment with a gluten-free diet.
Patients with celiac sprue (59 women and 19 men, total n = 78) treated with a gluten-free diet for at least 12 months were surveyed about their bowel habits. Those with chronic diarrhea, defined as passage of loose stools 3 or more times per week for 6 months, underwent an extensive diagnostic evaluation to determine its cause.
62 of the 78 patients (79%) experienced diarrhea before treatment, and 13 (17%) had chronic diarrhea (of lesser severity) after treatment.
After treatment of celiac sprue with a gluten-free diet, chronic diarrhea persists in a substantial percentage of patients. Although ongoing gluten ingestion is one possible cause, other causes may be more frequent. Therefore, diagnostic investigation of diarrhea in celiac sprue after treatment seems warranted.
Fine KD et al., The prevalence and causes of chronic diarrhea in patients with celiac sprue treated with a gluten-free diet. Gastroenterology, 1997 Jun, 112:6, 1830-8.
Hypothyroidism (IBS)
Hypothyroidism
This is a case report regarding the role of "thyroid" function in bowel disorders. After finding elevated TSH levels in two patients with functional "bowel disease" in which the symptoms were eliminated with thyroid replacement, the authors did a controlled trial of 46 consecutive patients with functional bowel disease over a two year "period" and found four more patients with previously undiagnosed "hypothyroidism". All had normal upper "gastrointestinal" series or endoscopy, "barium" enema or colonoscopy and ultrasound of the "pancreas" or "gallbladder". Symptoms improved with thyroid supplementation.
"Hypothyroidism and Functional Bowel Disease", The American Journal of Medicine, March 1990;88:312.
Lactose Malabsorption (1) [Italy]
Lactose Malabsorption (1) [Italy]
Lactose malabsorption may induce abdominal symptoms indistinguishable from those of the irritable bowel syndrome (IBS), however the exact relationship between the two conditions and the optimal differential diagnostic workup are still to be defined.
Lactose malabsorption was diagnosed in 68% of the patient group.
A test for diagnosing lactose malabsorption should always be included in the diagnostic workup for IBS and a long-term lactose-free regimen recommended if the test is positive.
Vernia P et al., Lactose malabsorption and irritable bowel syndrome. Effect of a long-term lactose-free diet. Ital J Gastroenterol, 1995 Apr, 27:3, 117-21.
Lactose Malabsorption (2) (Netherlands)
Lactose Malabsorption (2) [Netherlands]
The prevalence of lactose malabsorption (LM) in the Caucasian population of northern Europe is estimated to be low. Irritable bowel syndrome (IBS) is a very common diagnosis, and its symptoms are nearly identical to those of LM.
LM was detected in 17 out of 70 (24%) IBS patients, in comparison with 2 out of 35 (5.7%) controls.
The mean symptom score of the LM positive group showed a marked decrease after 6 weeks of dietary therapy.
A substantial number of IBS patients showed a clinically unrecognized lactose malabsorption, which could not be discriminated by symptoms and dietary history, and which can be treated with a lactose-restricted diet. Therefore LM has to be excluded before the diagnosis IBS is made.
B”hmer CJ & Tuynman HA The clinical relevance of lactose malabsorption in irritable bowel syndrome. Eur J Gastroenterol Hepatol, 1996 Oct, 8:10, 1013-6.
Necrolytic Migratory Erythema (NME)
Necrolytic Migratory Erythema (NME]
Necrolytic migratory "erythema" (NME) is a cutaneous reaction pattern with specific histopathologic features that is typically associated with a functioning "pancreatic" islet "cell" "neoplasm" such as a glucagonoma.
Any patient with NME should be evaluated for glucagonoma and small bowel disease that may be associated with malabsorption and "malnutrition".
Necrolytic migratory erythema: a report of three cases. Thorisdottir-K; Camisa-C; Tomecki-KJ; Bergfeld-WF. J-Am-Acad-Dermatol. 1994 Feb; 30(2 Pt 2): 324-9.
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