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Prescription 2015: Healthier Digestion

May 19, 2015 Written by JP       [Font too small?]

Chronic gastrointestinal symptoms can be caused or worsened by a long list of suspects. Common culprits include food allergies or sensitivities, H. pylori infection, intestinal permeability, microbiome (gut bacteria) imbalance and ulcers. Furthermore, in some instances, the exact cause or contributing factors is not easily identifiable. When this occurs, medications are frequently prescribed based on the specific symptoms that present themselves. Two popular examples include proton pump inhibitors (PPIs) to minimize gastric acid and tricyclic antidepressants to reduce abdominal pain. Physicians who veer towards the integrative side of medicine may also suggest certain dietary changes such avoiding dairy, FODMAPs, grains and/or heavily refined foods. Some doctors will even go so far as to encourage an “elimination diet” to methodically rule out any likely food-based troublemaker.

In addition to dietary influences, the presence of psychological disorders and stress should also be carefully evaluated. At a bare minimum, modern medicine has established that psychological factors can contribute to functional dyspepsia (FD). In fact, recent studies report that implementing stress management techniques, including cognitive behavioral approaches and psychotherapy, improves FD treatment outcomes. And, the connection between the body and mind doesn’t stop there. One fascinating trial found that daily consumption of a fermented, probiotic milk improved both gastrointestinal and psychological symptoms in a group of patients diagnosed with functional GI disorders. Another experiment, appearing in the journal Arquivos de Gastroenterologia, discovered that 4 weeks of acupuncture therapy effectively reduced anxiety, depression and gastrointestinal symptoms in functional dyspepsia patients. Based on these findings, it seems there is a powerful, brain-gut connection in many cases of FD.

When required, functional foods and herbal remedies are worthy of consideration as adjuncts to dietary, mind-body and standard medical care. Current studies haven identified several ingredients which may be particularly beneficial. A two-week trial, published in April 2015, noted that a combination of artichoke and ginger extract assisted those with FD by decreasing feelings of bloating, epigastric fullness, nausea and pain. In other research, thrice-daily administration of anise powder (3 grams after each meal) consistently lessened FD severity over the course of 12 weeks. More evidence is relayed in a scientific review from 2013, which describes the efficacy and safety of Iberogast, a liquid herbal formula which has been shown to relieve FD and IBS or irritable bowel syndrome symptoms. Functional foods containing healthy fats and probiotics are, likewise, promising. This assertion was borne out in an experiment which featured the use of a supplemental food containing extra virgin olive oil and select probiotics – Lactobacillus reuterii, Lactobacillus rhamnosus GG and Saccharomyces boulardii. Study participants who were blindly given this probiotic-enriched oil demonstrated a “significant improvement in dyspeptic symptoms”.

These compelling studies offer additional resources for patients and physicians who are interested in addressing suspected causes and symptoms without necessarily resorting to conventional medications.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 - Therapeutic Strategies for Functional Dyspepsia and Irritable Bowel (link)

Study 2 - The Role of Diet in the Management of Non-Ulcer Dyspepsia … (link)

Study 3 – Effectiveness of Cognitive Behavior Stress Management on Functional(link)

Study 4 - A Randomized Controlled Trial of a 10 Week Group Psychotherapeutic (link)

Study 5 - Continuous Consumption of Fermented Milk Containing Bifidobacterium (link)

Study 6 - Acupuncture Effectiveness as a Complementary Therapy in Functional (link)

Study 7 - Effect of Ginger (Zingiber officinalis) & Artichoke (Cynara cardunculus) (link)

Study 8 - Pimpinella Anisum in the Treatment of Functional Dyspepsia: A Double- (link)

Study 9 - (Iberogast®) A Safe & Effective Standard in the Treatment of Functional (link)

Study 10 - Effect of an Extra-Virgin Olive Oil Enriched with Probiotics or (link)

Functional Dyspepsia (FD) Symptoms

Source: Gastroenterol Res Pract. 2013;2013:351086. (link)

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35 Comments & Updates to “Prescription 2015: Healthier Digestion”

  1. JP Says:

    Update 05/19/15:

    http://onlinelibrary.wiley.com/doi/10.1111/apt.13214/full

    Aliment Pharmacol Ther. 2015 Jun;41(12):1237-45.

    Systematic review with meta-analysis: Saccharomyces boulardii supplementation and eradication of Helicobacter pylori infection.

    BACKGROUND: Unsatisfactory Helicobacter pylori eradication rates and therapy-associated side effects remain a problem.

    AIM: To update our 2010 meta-analysis on the effects of Saccharomyces boulardii as supplementation to a standard eradication regimen on H. pylori eradication rates and therapy-associated side effects.

    METHODS: The Cochrane Library, MEDLINE and EMBASE databases were searched from July 2010 (end date of last search) to February 2015, with no language restrictions, for randomised controlled trials (RCTs); additional references were obtained from reviewed articles. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines.

    RESULTS: Eleven RCTs (2200 participants, among them 330 children) met the inclusion criteria. Of the 853 patients in the S. boulardii group, 679 (80%, 95% CI 77-82) experienced eradication compared with 608 of the 855 patients (71%, 95% CI 68-74) in the control group [relative risk (RR) 1.11, 95% confidence interval (CI) 1.06-1.17; moderate quality evidence]. S. boulardii compared with control reduced the risk of overall H. pylori therapy-related adverse effects (RR 0.44, 95% CI 0.31-0.64; moderate quality evidence), particularly of diarrhoea (RR 0.51, 95% CI 0.42-0.62; high quality evidence) and nausea [RR 0.6, 95% CI 0.44-0.83 (moderate quality of evidence)].

    CONCLUSIONS: In the populations studied, the effectiveness of standard triple therapy was unsatisfactory. The addition of S. boulardii significantly increased the eradication rate, but it was still below the desired level of success. Saccharomyces boulardii significantly decreased some therapy-related side effects.

    Be well!

    JP

  2. JP Says:

    Update 05/19/15:

    http://www.explorejournal.com/article/S1550-8307%2815%2900033-6/abstract

    Explore (NY). 2015 May-Jun;11(3):199-207.

    Efficacy and safety of jollab to treat functional dyspepsia: a randomized placebo-controlled clinical trial.

    BACKGROUND: Functional dyspepsia (FD) is a common gastrointestinal disease that is highly prevalent worldwide. Because of its heterogeneous pathophysiology, treatment options for FD can be difficult to choose; in this context, complementary and alternative medicine modalities have been suggested as promising options.

    AIM: To evaluate the efficacy of a traditional Persian medicine, jollab, in reducing patients’ FD symptoms.

    METHODS: In a double-blind randomized clinical trial, 160 patients with a diagnosis of FD were enrolled and treated with either jollab or placebo (15ml, t.i.d., four weeks, orally). The outcomes reported were changes in symptom frequency and severity as recorded in patients’ diaries and evaluated with the Short Form of the Leeds Dyspepsia Questionnaire (SF-LDQ), and physical examination.

    RESULTS: The response rate was higher in the treatment group (78%) than in the placebo group (31%) according to per-protocol sample analysis (P < .001). Symptoms of FD disappeared significantly more frequently, and the rate of concomitant synthetic drug consumption was significantly lower, in the jollab group compared to the placebo group at the end of the trial. Mean total symptom frequency and severity according to the SF-LDQ score was 1.55 ± 2.78 in the treatment group versus 5.61 ± 3.80 in the placebo group at the last follow-up time point (P < .001). A promising safety profile for jollab was observed throughout the trial.

    CONCLUSIONS: In patients with FD, jollab appeared to be more effective than the placebo. Complementary and alternative therapies such as the use of this traditional medicinal substance may be beneficial in relieving symptoms of dyspepsia.

    Be well!

    JP

  3. JP Says:

    Update 05/19/15:

    http://www.hindawi.com/journals/ecam/2014/832523/

    Evid Based Complement Alternat Med. 2014;2014:832523.

    An alternative to current therapies of functional dyspepsia: self-administrated transcutaneous electroacupuncture improves dyspeptic symptoms.

    Functional dyspepsia is of high prevalence with little treatment options. The aim of this study was to develop a new treatment method using self-management transcutaneous electroacupuncture (TEA) for functional dyspepsia (FD). Twenty-eight patients with FD were enrolled and underwent a crossover clinical trial with 2-week TEA at ST36 and PC6 and 2-week sham-TEA at nonacupuncture sham-points. Questionnaires were used to assess symptoms of dyspepsia and quality of life. Physiological testing included gastric emptying and electrogastrography. It was found that (1) TEA but not sham-TEA significantly improved dyspeptic symptoms and 4 domains in quality of life; improvement was also noted in self-rated anxiety and depression scores; (2) gastric emptying was significantly and substantially increased with 2-week TEA but not sham-TEA; and (3) gastric accommodation was also improved with TEA but not sham-TEA, reflected as increased ingested nutrient volumes at the levels of satiety and maximum tolerance. These findings suggest a therapeutic potential of self-administrated TEA method for functional dyspepsia, possibly attributed to improvement in gastric motility.

    Be well!

    JP

  4. JP Says:

    Update 05/19/15:

    http://www.minervamedica.it/en/journals/gastroenterologica-dietologica/article.php?cod=R08Y2014N04A0263

    Minerva Gastroenterol Dietol. 2014 Dec;60(4):263-8.

    Benefit of supplements in functional dyspepsia after treatment of Helicobacter pylori.

    AIM: Functional dyspepsia, though benign, leads to deterioration of the quality of life and high costs for healthcare systems. The optimal therapy for functional dyspepsia is still to be defined because of its multifactorial pathogenesis. In an open multicentric study of patients with functional dyspepsia, we prospectively evaluated the benefit of treatment with a food supplement composed of sodium alginate, carbonate calcium, pineapple, papaya, ginger, α-galactosidase and fennel (Perdiges, Bioten Snc, Turin, Italy).

    METHODS: Ninety-one consecutive patients were included, suffering from functional dyspepsia, who had been previously submitted to therapy to eradicate the infection from Helicobacter pylori (H. pylori) and were waiting to perform the Urea Breath Test (UBT). The primary goal was to establish the percentage of patients who continued to abstain from proton pump inhibitors (PPI) as they waited to carry out the UBT, differentiating between patients who were treated (N.=55) with Perdiges and those who were not (N.=36). Our secondary goal was to document the differences within the 2 groups in terms of symptoms perceived between the start and end of the observation period. The wellness reported, during or in absence of treatment with Perdiges, was evaluated by the use of the VAS scale (Visual Analogical Scale) completed before the start of the treatment and after 30 days.

    RESULTS: All the patients treated with Perdiges (55/55, 100%) and 31/36 (86.1%) patients who were not (P=0.008) continued to abstain from PPI in the period awaiting the UBT. The VAS scale of those who took Perdiges improved on average by 1.78 points versus a worsening of 0.08 points of those who did not take it (P<0.0001). Furthermore, while among those who took Perdiges there was a statistically significant improvement (P<0.0001) in the VAS scale, between the baseline and the end of treatment, a worsening of 0.08 points (P=0.78) was noticed among the patients who did not take it.

    CONCLUSION: Perdiges is significantly effective in the period following treatment to eradicate the infection from H. pylori in patients with functional dyspepsia. This allows to reduce the need to use antisecretive drugs. Further randomised studies, with wide ranging case histories, must assess its long-term efficacy.

    Be well!

    JP

  5. JP Says:

    Update 05/30/15:

    http://www.ncbi.nlm.nih.gov/pubmed/26023339

    Iran Red Crescent Med J. 2015 Apr 25;17(4):e23844.

    Comparison of the Effects of pH-Dependent Peppermint Oil and Synbiotic Lactol (Bacillus coagulans + Fructooligosaccharides) on Childhood Functional Abdominal Pain: A Randomized Placebo-Controlled Study.

    BACKGROUND: Still there is no consensus on the best treatment for abdominal pain-related functional Gastrointestinal Disorders (FGIDs).

    OBJECTIVES: The purpose of this study was to compare the effects of a synbiotic Lactol (Bacillus coagulans + fructooligosaccharide (FOS)), peppermint oil (Colpermin) and placebo (folic acid) on abdominal pain-related FGIDs except for abdominal migraine.

    PATIENTS AND METHODS: This placebo-controlled study was conducted on 120 children aged 4 – 13 years to compare the efficacy of pH-dependent peppermint oil (Colpermin) versus synbiotic Lactol (Bacillus coagulans + fructooligosaccharids (FOS)) in decreasing duration, severity and frequency of functional abdominal pain. The patients were randomly allocated into three equal groups (n = 40 in each group) and each group received Colpermin or Lactol or placebo.

    RESULTS: Eighty-eight out of 120 enrolled patients completed a one-month protocol and analyses were performed on 88 patients’ data. Analyses showed that improvement in pain duration, frequency and severity in the Colpermin group was better than the placebo group (P = 0.0001, P = 0.0001 and P = 0.001, respectively). Moreover, pain duration and frequency were decreased in the Lactol group more than the placebo (P = 0.012 and P = 0.0001, respectively), but changes in pain severity were not significant (P = 0.373). Colpermin was superior to Lactol in decreasing pain duration and severity (P = 0.040 and P = 0.013, respectively). No known side effects or intolerance were seen with Colpermin or Lactol.

    CONCLUSIONS: The pH-dependent peppermint oil capsule and Lactol tablet (Bacillus coagulans+ FOS) as synbiotics seem to be superior to placebo in decreasing the severity, duration and frequency of pain in abdominal pain-related functional GI disorders.

    Be well!

    JP

  6. JP Says:

    Update 06/02/15:

    http://link.springer.com/article/10.1007%2Fs00394-015-0922-1

    Eur J Nutr. 2015 May 17.

    Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis.

    BACKGROUND: Functional gastrointestinal symptoms such as abdominal pain, bloating, distension, constipation, diarrhea and flatulence have been noted in patients with irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD). The diversity of symptoms has meant that finding an effective treatment has been challenging with most treatments alleviating only the primary symptom. A novel treatment option for IBS and IBD currently generating much excitement is the low fermentable, oligo-, di-, mono-saccharides and polyol (FODMAP) diet. The aim of this meta-analysis was to determine the evidence of the efficacy of such a diet in the treatment of functional gastrointestinal symptoms.

    METHODS: Electronic databases were searched through to March 2015 to identify relevant studies. Pooled odds ratios (ORs) and 95 % confidence intervals were calculated for the effect of a low FODMAP diet on the reduction in IBS [Symptoms Severity Score (SSS)] score and increase in IBS quality of life (QOL) score for both randomized clinical trials (RCTs) and non-randomized interventions using a random-effects model.

    RESULTS: Six RCTs and 16 non-randomized interventions were included in the analysis. There was a significant decrease in IBS SSS scores for those individuals on a low FODMAP diet in both the RCTs (OR 0.44, 95 % CI 0.25-0.76; I 2 = 35.52, p = 0.00) and non-randomized interventions (OR 0.03, 95 % CI 0.01-0.2; I 2 = 69.1, p = 0.02). In addition, there was a significant improvement in the IBS-QOL score for RCTs (OR 1.84, 95 % CI 1.12-3.03; I 2 = 0.00, p = 0.39) and for non-randomized interventions (OR 3.18, 95 % CI 1.60-6.31; I 2 = 0.00, p = 0.89). Further, following a low FODMAP diet was found to significantly reduce symptom severity for abdominal pain (OR 1.81, 95 % CI 1.13-2.88; I 2 = 0.00, p = 0.56), bloating (OR 1.75, 95 % CI 1.07-2.87; I 2 = 0.00, p = 0.45) and overall symptoms (OR 1.81, 95 % CI 1.11-2.95; I 2 = 0.00, p = 0.4) in the RCTs. In the non-randomized interventions similar findings were observed.

    CONCLUSION: The present meta-analysis supports the efficacy of a low FODMAP diet in the treatment of functional gastrointestinal symptoms. Further research should ensure studies include dietary adherence, and more studies looking at greater number of patients and long-term adherence to a low FODMAP diet need to be conducted.

    Be well!

    JP

  7. JP Says:

    Update 05/19/15:

    http://www.ncbi.nlm.nih.gov/pubmed/26086986

    Psychol Health Med. 2015 Jun 18:1-13.

    Self-regulation evaluation of therapeutic yoga and walking for patients with irritable bowel syndrome: a pilot study.

    With limited efficacy of medications for symptom relief, non-medication treatments may play an important role in the treatment of irritable bowel syndrome (IBS), the most common functional gastrointestinal (GI) disorder. This study aimed to evaluate the efficacy of two self-regulation strategies for symptom relief and mood management in IBS patients. Thirty-five adult participants meeting ROME III criteria for IBS were enrolled, 27 of the 35 participants (77%) completed treatment and pre- and post-treatment visits (89% women, 11% men; M (SD) age = 36 (13)), and 20 of the 27 (74%) completed a 6-month follow-up. Participants were randomly assigned to 16 biweekly group sessions of Iyengar yoga or a walking program. Results indicated a significant group by time interaction on negative affect with the walking treatment showing improvement from pre- to post-treatment when compared to yoga (p < .05). There was no significant group by time effect on IBS severity. Exploratory analyses of secondary outcomes examined change separately for each treatment condition. From pre- to post-treatment, yoga showed significant decreases in IBS severity measures (p < .05), visceral sensitivity (p < .05), and severity of somatic symptoms (p < .05). Walking showed significant decreases in overall GI symptoms (p < .05), negative affect (p < .05), and state anxiety (p < .05). At 6-month follow-up, overall GI symptoms for walking continued to significantly decline, while for yoga, GI symptoms rebounded toward baseline levels (p < .05). When asked about self-regulated home practice at 6 months, significantly more participants in walking than in yoga practiced at least weekly (p < .05). In sum, results suggest that yoga and walking as movement-based self-regulatory behavioral treatments have some differential effects but are both beneficial for IBS patients, though maintenance of a self-regulated walking program may be more feasible and therefore more effective long term.

    Be well!

    JP

  8. JP Says:

    Update 06/25/15:

    http://www.ncbi.nlm.nih.gov/pubmed/26104013

    Aliment Pharmacol Ther. 2015 Jun 24.

    Randomised clinical trial: gut microbiome biomarkers are associated with clinical response to a low FODMAP diet in children with the irritable bowel syndrome.

    BACKGROUND: A low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet can ameliorate symptoms in adult irritable bowel syndrome (IBS) within 48 h.

    AIM: To determine the efficacy of a low FODMAP diet in childhood IBS and whether gut microbial composition and/or metabolic capacity are associated with its efficacy.

    METHODS: In a double-blind, crossover trial, children with Rome III IBS completed a 1-week baseline period. They then were randomised to a low FODMAP diet or typical American childhood diet (TACD), followed by a 5-day washout period before crossing over to the other diet. GI symptoms were assessed with abdominal pain frequency being the primary outcome. Baseline gut microbial composition (16S rRNA sequencing) and metabolic capacity (PICRUSt) were determined. Metagenomic biomarker discovery (LEfSe) compared Responders (≥50% decrease in abdominal pain frequency on low FODMAP diet only) vs. Nonresponders (no improvement during either intervention).

    RESULTS: Thirty-three children completed the study. Less abdominal pain occurred during the low FODMAP diet vs. TACD [1.1 ± 0.2 (SEM) episodes/day vs. 1.7 ± 0.4, P < 0.05]. Compared to baseline (1.4 ± 0.2), children had fewer daily abdominal pain episodes during the low FODMAP diet (P < 0.01) but more episodes during the TACD (P < 0.01). Responders were enriched at baseline in taxa with known greater saccharolytic metabolic capacity (e.g. Bacteroides, Ruminococcaceae, Faecalibacterium prausnitzii) and three Kyoto Encyclopedia of Genes and Genomes orthologues, of which two relate to carbohydrate metabolism.

    CONCLUSIONS: In childhood IBS, a low FODMAP diet decreases abdominal pain frequency. Gut microbiome biomarkers may be associated with low FODMAP diet efficacy.

    Be well!

    JP

  9. JP Says:

    Update 07/09/15:

    http://www.hindawi.com/journals/ecam/2015/915087/

    Evid Based Complement Alternat Med. 2015;2015:915087.

    The Effect of Ginger (Zingiber officinalis) and Artichoke (Cynara cardunculus) Extract Supplementation on Functional Dyspepsia: A Randomised, Double-Blind, and Placebo-Controlled Clinical Trial.

    Objective. Functional dyspepsia (FD) is a frequent clinical finding in western world. The aim of this study is to compare the efficacy of a ginger and artichoke supplementation versus placebo in the treatment of FD.

    Methods. A prospective multicentre, double blind, randomized, placebo controlled, parallel-group comparison of the supplement and placebo over a period of 4 weeks was performed. Two capsules/day were supplied (before lunch and dinner) to 126 FD patients (supplementation/placebo: 65/61).

    Results. After 14 days of treatment, only supplementation group (SG) showed a significant amelioration (SG: α S = +1.195 MCA score units (u), P = 0.017; placebo: α P = +0.347 u, P = 0.513). The intercept (α) resulted to be significantly higher in SG than in placebo (α S – α P = +0.848 u, P < 0.001). At the end of the study, the advantage of SG versus placebo persists without variation (β S – β P = +0.077 u, P = 0.542). In SG, a significant advantage is observed for nausea (β S – β P = -0.398 u, P < 0.001), epigastric fullness (β S – β P = -0.241, P < 0.001), epigastric pain (β S – β P = -0.173 u, P = 0.002), and bloating (β S – β P = -0.167 u, P = 0.017).

    Conclusions. The association between ginger and artichoke leaf extracts appears safe and efficacious in the treatment of FD and could represent a promising treatment for this disease.

    Be well!

    JP

  10. JP Says:

    Updated 09/22/15:

    http://www.sciencedirect.com/science/article/pii/S0378874115301471

    J Ethnopharmacol. 2015 Sep 16.

    Efficacy and safety of Honey based formulation of nigella sativa seed oil in functional dyspepsia: A double blind randomized controlled clinical trial.

    ETHNOPHARMACOLOGICAL RELEVANCE: A honey based formulation from Nigella sativa L. (N. sativa) has been used in Traditional Persian Medicine for upper gastrointestinal symptoms. Considering the traditional use of this formulation and its ingredients known pharmacologic effects, this study aimed to evaluate the efficacy and safety of N. sativa seed oil mixed with honey in treatment of patients with functional dyspepsia.

    METHODS AND MATERIALS: Seventy patients diagnosed with functional dyspepsia according to ROME III criteria and confirmed by upper gastrointestinal endoscopy were selected to receive a traditional honey based formulation of Nigella sativa (5mlN. sativa oil orally daily) or placebo for 8 weeks in a double-blind randomized placebo-controlled clinical trial using a parallel design with a 1:1 allocation ratio. Patients were evaluated prior to and following 8 weeks of the intervention in terms of the Hong Kong index of dyspepsia severity, presence of H. pylori infection based on urease test, scores in different domains of short form (SF-36) health survey, and any observed adverse events.

    RESULTS: The mean scores of Hong Kong index of dyspepsia severity sores and the rate of H. pylori infection were significantly lower in the N. sativa group comparing the placebo group after the intervention (P<0.001). No serious adverse event was reported.

    CONCLUSION: This study showed that adjuvant supplementation of honey based formulation of N. sativa can cause significant symptomatic improvement of patients with functional dyspepsia whom received the standard anti-secretory therapy. The results should be investigated further in studies with longer duration and larger sample size.

    Be well!

    JP

  11. JP Says:

    Updated 11/06/15:

    http://onlinelibrary.wiley.com/doi/10.1002/ptr.5502/abstract

    Phytother Res. 2015 Nov 2.

    Treatment of Mild Gastrointestinal Disorders with a Herbal Combination: Results of a Non-interventional Study with Gastritol® Liquid.

    A combination of extracts from chamomile, silverweed, licorice, angelica, blessed thistle and wormwood, Gastritol® Liquid, is registered for the use of indigestion and gastrointestinal spasmodic complaints. To gain data on the experience in practice, a non-interventional open study was conducted in ambulatory patients including diabetics which were treated for 2 weeks. The efficacy of treatment was assessed by medical examination and evaluation of typical symptoms by patients. A total of 149 patients was enrolled, 90 without and 59 with diabetes. The treatment led to relevant improvements in all symptoms in both study groups. The most notable improvements were seen for the symptoms vomiting (-66.7%; diabetics: -63.9%) and retching (-52.2%; diabetics: -53.6%). An overall improvement was rated by about 90% in both study groups. In seven patients adverse events had been reported (5 times temporary nausea after intake, one time gastric spasm and one time oral burning sensation), all of them of mild nature. The global tolerability was assessed as good or very good in more than 80% by practitioners and patients. Under the conditions of this open study method Gastritol® Liquid had been shown to be safe and effective in the treatment of mild gastrointestinal disorders, including diabetic patients.

    Be well!

    JP

  12. JP Says:

    Updated 12/10/15:

    http://www.hindawi.com/journals/ecam/2015/860463/

    Evid Based Complement Alternat Med. 2015;2015:860463.

    Brain-Gut Axis Modulation of Acupuncture in Functional Dyspepsia: A Preliminary Resting-State fcMRI Study.

    Objective. To explore acupuncture effects on brain functional connectivity in patients with functional dyspepsia (FD).

    Methods. Eight patients in an acupuncture treatment group and ten healthy adults in the control group participated in the study. Acupuncture effectiveness was evaluated based on changes of the gastrointestinal symptoms, gastric motility measurements, and gastrin levels and comparisons with the control group when appropriate. To investigate functional connectivity changes related to FD and potential modulation after acupuncture, a set of regions of interest (ROIs) were selected according to previous fMRI reports of acupuncture.

    Results. Patients showed significant improvements of FD signs and symptoms after acupuncture treatments. For all of the ROIs, we identified subportions of the networks showing reduced connectivity in patients with FD. Connectivity between the ROIs and corresponding disease targets showed significant improvement after acupuncture treatment (P < 0.05) in all ROIs except for right medial temporal lobe-hippocampus and right inferior parietal lobule.

    Conclusion. Functional connectivity of the brain is changed in patients with FD but approximates that in healthy control after acupuncture treatment. The relief of gastrointestinal signs and symptoms by acupuncture is likely due to the normalization of brain-gut axis associated with FD.

    Be well!

    JP

  13. JP Says:

    Updated 1/18/16:

    http://www.cghjournal.org/article/S1542-3565%2815%2901715-2/abstract

    Clin Gastroenterol Hepatol. 2015 Dec 31.

    Efficacy of a Gluten-free Diet in Subjects With Irritable Bowel Syndrome-Diarrhea Unaware of Their HLA-DQ2/8 Genotype.

    BACKGROUND & AIMS: A gluten-containing diet alters bowel barrier function in patients with irritable bowel syndrome-diarrhea (IBS-D), particularly those who are positive for human leukocyte antigen (HLA) allele DQ2/8. We studied the effects of a gluten-free diet (GFD) in patients with IBS-D who have not previously considered the effects of gluten in their diet and were unaware of their HLA-DQ2/8 genotype.

    METHODS: We performed a prospective study of 41 patients with IBS-D (20 HLA-DQ2/8-positive and 21 HLA-DQ2/8-negative) at the Royal Hallamshire Hospital in Sheffield, United Kingdom, from September 2012 through July 2015. All subjects were placed on a 6 week GFD following evaluation by a dietician. Subjects completed validated questionnaires at baseline and week 6 of the GFD. The primary endpoint was mean change in IBS symptom severity score (IBS-SSS); a 50 point reduction was considered to indicate a clinical response. Secondary endpoints were changes in hospital anxiety and depression score, fatigue impact score, and short form 36 results. Clinical responders who chose to continue a GFD after the study period were evaluated on average 18 months later to assess diet durability, symptom scores, and anthropometric and biochemical status.

    RESULTS: A 6 week GFD reduced IBS-SSS by ≥50 points in 29 patients overall (71%). The mean total IBS-SSS decreased from 286 before the diet to 131 points after 6 weeks on the diet (P<.001)-the reduction was similar in each HLA-DQ group. However, HLA-DQ2/8-negative subjects had a greater reduction in abdominal distension (P=.04). Both groups had marked mean improvements in hospital anxiety and depression scores, fatigue impact score, and short form 36 results, although HLA-DQ2/8-positive subjects had a greater reduction in depression score and increase in vitality score than HLA-DQ2/8-negative subjects (P=.02 and P=.03, respectively). Twenty-one of the 29 subjects with a clinical response (72%) planned to continue the GFD long term; 18 months after the study they were still on a GFD, with maintained symptom reductions, and demonstrated similar anthropometric and biochemical features compared to baseline.

    CONCLUSION: A dietitian-led GFD provided sustained benefit to patients with IBS-D. The symptoms that improved differed in magnitude according to HLA-DQ status.

    Be well!

    JP

  14. JP Says:

    Updated 02/19/16:

    http://www.ncbi.nlm.nih.gov/pubmed/26873392

    J Evid Based Complementary Altern Med. 2016 Feb 11.

    Effectiveness of Anise Oil for Treatment of Mild to Moderate Depression in Patients With Irritable Bowel Syndrome: A Randomized Active and Placebo-Controlled Clinical Trial.

    Depression is a prevalent disorder among patients suffering from irritable bowel syndrome. The current study was performed to evaluate the effect of a traditional Persian medicine product, anise oil, in removing the symptoms of mild to moderate depression in patients with irritable bowel syndrome. In a randomized double-blinded active and placebo controlled clinical trial, 120 participants with mild to moderate depression according to the Beck Depression Inventory-II total scores were categorized into 3 equal groups and received anise oil, Colpermin, and placebo. The results at the end of trial (week 4) and follow-up (week 6) demonstrated significant priority against active and placebo groups. Although the mechanism is unknown yet, anise oil could be a promising choice of treatment for depressed patients with irritable bowel syndrome.

    Be well!

    JP

  15. JP Says:

    Updated 05/09/16:

    http://www.ncbi.nlm.nih.gov/pubmed/27156182

    J Pediatr. 2016 May 4.

    Lactobacillus reuteri DSM 17938 for the Management of Functional Abdominal Pain in Childhood: A Randomized, Double-Blind, Placebo-Controlled Trial.

    OBJECTIVE: To determine whether administration of Lactobacillus reuteri DSM 17938 is beneficial in functional abdominal pain (FAP) of childhood.

    STUDY DESIGN: A total of 101 children, aged 6-15 years, who fulfilled the Rome III criteria for FAP were enrolled in a randomized double-blind, placebo-controlled trial, and were randomly assigned to receive either L reuteri DSM 17938 or placebo for 4 weeks, with further follow-up of additional 4 weeks. Response to therapy was based on a self-reported daily questionnaire monitoring frequency and intensity of abdominal pain, using the faces scoring system by Hicks.

    RESULTS: L reuteri (n = 47) was significantly superior to placebo (n = 46) in relieving frequency (1.9 ± 0.8 vs 3.6 ± 1.7 episodes/wk, P < .02) and intensity (4.3 ± 2.2 vs 7.2 ± 3.1 Hicks score/wk, P < .01) of abdominal pain following 4 weeks of supplementation. There was no difference in school absenteeism rate or other gastrointestinal symptoms, except for a lower incidence of perceived abdominal distention and bloating, favoring L reuteri.

    CONCLUSIONS: L reuteri DSM 17938, compared with placebo, significantly reduced the frequency and intensity of FAP in children.

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    JP

  16. JP Says:

    Updated 05/17/16:

    http://link.springer.com/article/10.1007%2Fs00535-016-1224-y

    J Gastroenterol. 2016 May 13.

    Efficacy of double-coated probiotics for irritable bowel syndrome: a randomized double-blind controlled trial.

    BACKGROUND: The purpose of this study was to elucidate the effects of a dual-coated probiotic supplement (Duolac Care) on symptoms of diarrhea-predominant irritable bowel syndrome in a randomized double-blind clinical trial.

    METHODS: Fifty subjects with diarrhea-predominant irritable bowel syndrome were randomly assigned to either the non-coating group or the dual-coating group in order to receive two capsules per day of multi-species probiotics containing 5 billion bacteria per capsule for 4 weeks. Data from an adequate relief questionnaire were used in assessment of primary outcome. Daily records of stool frequencies and the Bristol stool scale, a weekly symptom diary using 100-mm visual analog scale, and Beck depression inventories were collected. Blood tests including blood cell counts, interleukin-10, tumor necrosis factor-alpha and inducible nitric oxide synthase, and regulatory T cells-CD4 + CD25high T cells, CD4 + LAP + T cells and CD25high + LAP + T cells-were analyzed before and after the study. The shift of gut microbiota was investigated using a quantitative real-time polymerase chain reaction assay.

    RESULTS: Responses to the adequate relief questionnaire indicated significant improvement in overall discomfort in the dual-coating group and the ratio of normal stools to hard or watery stools had a better effect from dual-coated probiotics compared to non-coated probiotics. This may be due to a shift of intestinal microbiota, as our correlation analysis showed significant negative correlation between Bifidobacterium and urgency of defecation.

    CONCLUSIONS: Our result implies that dual-coating layers of probiotic supplement can be a candidate for treatment of diarrhea-predominant irritable bowel syndrome.

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    JP

  17. JP Says:

    Updated 06/26/16:

    http://www.jgld.ro/wp/y2016/n2/a6.pdf

    J Gastrointestin Liver Dis. 2016 Jun;25(2):151-7.

    Curcumin and Fennel Essential Oil Improve Symptoms and Quality of Life in Patients with Irritable Bowel Syndrome.

    BACKGROUND AND AIMS: Irritable Bowel Syndrome (IBS) patients still require effective treatment. The anti-inflammatory property of curcumin and the antispasmodic and carminative effect of fennel suggests that combination of these nutraceutical compounds would be useful in functional bowel disorders including IBS. We assessed the efficacy and tolerability of a combination of curcumin and fennel essential oil (CU-FEO) in IBS symptoms relief.

    METHODS: 121 patients with mild-to-moderate symptoms of IBS defined by an Irritable Bowel Syndrome- symptom severity score (IBS-SSS) 100-300 and abdominal pain score 30-70 on a 100 mm Visual Analogue Scale (VAS), were randomly assigned to CU-FEO or placebo (2 capsules b.d. for 30 days). Primary endpoint was the mean decrease of IBS-SSS at the end of the treatment corrected for the mean baseline score (relative decrease). The impact of the treatment on quality of life was assessed through IBS-QoL questionnaire.

    RESULTS: CU-FEO was safe, well-tolerated and induced symptom relief in patients with IBS; a significant decrease in the mean relative IBS-SSS was observed after 30 days of treatment (50.05 +/- 28.85% vs 26.12 +/- 30.62%, P<0.001). This result matched the reduction of abdominal pain and all the other symptoms of IBS-SSS. The percentage of symptom-free patients was significantly higher in the CU-FEO than in the placebo group (25.9% vs. 6.8%, P = 0.005). All domains of IBS-QoL improved consistently.

    CONCLUSION: CU-FEO significantly improved symptoms and quality of life in IBS patients over 30 days.

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    JP

  18. JP Says:

    Updated 07/17/16:

    http://www.karger.com/Article/FullText/445392

    Ann Nutr Metab. 2016;68 Suppl 1:33-41.

    Role of Diet in Inflammatory Bowel Disease.

    The incidence of inflammatory bowel disease (IBD) is steadily in the rise in Western as well as in developing countries paralleling the increase of westernized diets, characterized by high protein and fat as well as excessive sugar intake, with less vegetables and fiber. An interesting hypothesis is that environmental (food-) triggered changes of the intestinal microbiome might cause a proinflammatory state preceding the development of IBD. Indeed, an intact intestinal epithelial barrier assuring a normal bacterial clearance of the intestinal surface is crucial to guarantee intestinal homeostasis. Any factors affecting the epithelial barrier function directly or indirectly may impact on this homeostasis, as well as any changes of the intestinal microbial composition. It is intriguing to learn that some frequently used food components impact on the quality of the intestinal barrier, as well as on the composition of the intestinal microbiome. This highlights the close interaction between living conditions, hygiene, food habits and food quality with the bacterial composition of the intestinal microbiome and the activation status of the intestinal immune system. There is clear evidence that nutritional therapy is highly successful in the treatment of Crohn’s disease (CD). Exclusive enteral nutrition is well established as induction therapy of CD. New diets, such as a CD exclusion diet or defined diets (specific carbohydrate diets, FODMAP diet, Paleolithic diet) are being discussed as treatment options for IBD. Well-designed clinical trials in IBD are urgently required to define the precise role of each of these diets in the prevention or management of IBD. Up to now, the role of diet in IBD is highly undermined by lay and anecdotal reports without sufficient scientific proof.

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    JP

  19. JP Says:

    Updated 08/20/16:

    http://www.ncbi.nlm.nih.gov/pubmed/27527893

    Rev Recent Clin Trials. 2016 Aug 15.

    The Effect of Alcohol on Gastrointestinal Motility.

    The Gastrointestinal (GI) tract is one of the most affected systems by alcohol consumption. Alcohol can affect the esophagus in several ways: induces mucosal inflammation, increases the risk for Barrett esophagus and esophageal cancer, and also impairs the esophageal motility. Numerous studies have reported an increased prevalence of Gastroesophageal Reflux Disease (GERD) or erosive esophagitis in alcoholics. Some alcoholics exhibit an abnormality of esophageal motility known as a “nutcracker esophagus”. Alcohol effect on gastric motility depends on the alcohol concentration. In general, beverages with high alcohol concentrations (i.e., above 15 percent) appear to inhibit gastric motility and low alcohol doses (wine and beer) accelerate gastric emptying. Also, acute administration of ethanol inhibits the gastric emptying, while chronic administration of a large dose of alcohol accelerates gastric motility. The effect of alcohol on small bowel motility differs according to the type of consumption (acute or chronic). Acute administration of alcohol has been found to inhibit small bowel transit and chronic administration of a large dose of alcohol accelerates small bowel transit. This article reviews some of the below findings.

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    JP

  20. JP Says:

    Updated 09/12/16:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4993960/

    Biomed Res Int. 2016;2016:4740907.

    A Randomized, Double-Blind, Placebo-Controlled Trial: The Efficacy of Multispecies Probiotic Supplementation in Alleviating Symptoms of Irritable Bowel Syndrome Associated with Constipation.

    Background and Aim. The efficacy of supplementation treatment with two multispecies probiotic formulates on subjects diagnosed with IBS-C and the assessment of their gut microbiota were investigated. Methods. A randomized, double-blind, three-arm parallel group trial was carried out on 150 IBS-C subjects divided into three groups (F_1, F_2, and F_3). Each group received a daily oral administration of probiotic mixtures (for 60 days) F_1 or F_2 or placebo F_3, respectively. Fecal microbiological analyses were performed by species-specific qPCR to assess the different amount of probiotics. Results. The percentage of responders for each symptom was higher in the probiotic groups when compared to placebo group during the treatment period (t60) and was maintained quite similar during the follow-up period (t90). Fecal analysis demonstrated that probiotics of the formulations increased during the times of treatment only in fecal DNA from subjects treated with F_1 and F_2 and not with F_3, and the same level was maintained during the follow-up period. Conclusions. Multispecies probiotic supplementations are effective in IBS-C subjects and induce a different assessment in the composition of intestinal microbiota.

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    JP

  21. JP Says:

    Updated 09/18/16:

    http://www.ncbi.nlm.nih.gov/pubmed/27638834

    Dig Dis Sci. 2016 Sep 16.

    Patients Perceive Clinical Benefit with the Specific Carbohydrate Diet for Inflammatory Bowel Disease.

    BACKGROUND: Recent studies suggest that dietary therapy may be effective for patients with inflammatory bowel disease (IBD), but limited published data exist on the usage and efficacy of dietary therapy.

    AIM: To evaluate the perspective of IBD patients using the specific carbohydrate diet (SCD).

    METHODS: An anonymous online survey was conducted using REDCap, a Web-based survey tool. Survey links were sent to known Web sites as well as support groups in an attempt to characterize patient utilization of the SCD and perception of efficacy of the SCD.

    RESULTS: There were 417 respondents of the online survey on the SCD with IBD. Mean age for individuals on the SCD was 34.9 ± 16.4 years. Seventy percent were female. Forty-seven percent had Crohn’s disease, 43 % had ulcerative colitis, and 10 % had indeterminate colitis. Individuals perceived clinical improvement on the SCD. Four percent reported clinical remission prior to the SCD, while 33 % reported remission at 2 months after initiation of the SCD, and 42 % at both 6 and 12 months. For those reporting clinical remission, 13 % reported time to achieve remission of less than 2 weeks, 17 % reported 2 weeks to a month, 36 % reported 1-3 months, and 34 % reported greater than 3 months. For individuals who reported reaching remission, 47 % of individuals reported associated improvement in abnormal laboratory values.

    CONCLUSIONS: The SCD is utilized by many patients as a primary and adjunct therapy for IBD. Most patients perceive clinical benefit to use of the SCD.

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    JP

  22. JP Says:

    Updated 10/15/16:

    http://online.liebertpub.com/doi/10.1089/acm.2016.0208

    J Altern Complement Med. 2016 Oct 12.

    Individualized Acupuncture for Symptom Relief in Functional Dyspepsia: A Randomized Controlled Trial.

    OBJECTIVES: This study was implemented to evaluate the effect of individualized acupuncture treatment (AT) on functional dyspepsia (FD).

    METHODS: A randomized, waitlist-controlled, two-center trial was performed. Seventy-six patients with FD were enrolled in the trial with partially individualized AT in a more realistic clinical setting performed twice a week for 15 minutes a session over 4 weeks. The participants were randomly allocated to a group receiving 8 sessions of AT for 4 weeks or a waitlist control group. After 4 consecutive weeks, the AT group was followed up without AT and the control group received the identical AT. The proportion of responders with adequate symptom relief, Nepean Dyspepsia Index (NDI), FD-related quality of life, Beck Depression Inventory, State-Trait Anxiety Inventory, Acupuncture Belief Scale, and acupuncture credibility test were assessed.

    RESULTS: After the first 4 weeks, the proportion of responders significantly improved (59% in AT group [n = 37] versus 3% in control group [n = 39]; p < 0.001). The difference was no longer significant at 8 weeks, at which point the waitlist control group showed similar improvement after receiving AT (68% in the AT group versus 79% in the control group). Total NDI scores were significantly reduced in the AT group compared with the waitlist group (p = 0.03). Among NDI items, discomfort (p = 0.01), burning (p = 0.02), fullness after eating (p = 0.02), and burping (p = 0.02) were significantly improved in the AT group compared with the control group. No significant differences were observed between groups in other secondary variables.

    CONCLUSION: Individualized AT adequately relieves symptoms in patients with FD, and this effect may persist up to 8 weeks.

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    JP

  23. JP Says:

    Updated 10/17/16:

    http://www.ncbi.nlm.nih.gov/pubmed/27655151

    Mycopathologia. 2016 Sep 21.

    Intestinal Dysbiosis and Yeast Isolation in Stool of Subjects with Autism Spectrum Disorders.

    High frequency of gastrointestinal yeast presence in ASD subjects was shown through a simple cultural approach (Candida spp. in 57.5 % of ASDs and no controls); the identification of aggressive form (pseudo-hyphae presenting) of Candida spp. at light microscope means that adhesion to intestinal mucosa is facilitated. Dysbiosis appears sustained by lowered Lactobacillus spp. and decreased number of Clostridium spp. Absence of C. difficilis and its toxins in both ASDs and controls is also shown. Low-mild gut inflammation and augmented intestinal permeability were demonstrated together with the presence of GI symptoms. Significant linear correlation was found between disease severity (CARs score) and calprotectin and Clostridium spp. presence. Also GI symptoms, such as constipation and alternating bowel, did correlate (multivariate analyses) with the increased permeability to lactulose. The present data provide rationale basis to a possible specific therapeutic intervention in restoring gut homeostasis in ASDs.

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    JP

  24. JP Says:

    Updated 11/04/16:

    http://www.turkjgastroenterol.org/sayilar/294/buyuk/439-43.pdf

    Turk J Gastroenterol. 2016 Sep;27(5):439-443.

    Efficacy of synbiotic, probiotic, and prebiotic treatments for irritable bowel syndrome in children: A randomized controlled trial.

    BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is an important health problem that presents serious social burdens and high costs. Our study investigated the efficacy of synbiotic (Bifidobacterium lactis B94 with inulin), probiotic (B. lactis B94), and prebiotic (inulin) treatment for IBS in a pediatric age group.

    MATERIAL AND METHODS: This study was randomized, double-blind, controlled, and prospective in design and included 71 children between the ages of 4 and 16 years who were diagnosed with IBS according to the Rome III criteria. The first group received synbiotic treatment [5×109 colony forming units (CFU) of B. lactis B94 and 900 mg inulin]; the second group received probiotic treatment (5×109 CFU B. lactis B94), and the third group received prebiotic treatment (900 mg inulin) twice daily for 4 weeks.

    RESULTS: Probiotic treatment improved belching-abdominal fullness (p<0.001), bloating after meals (p=0.016), and constipation (p=0.031), and synbiotic treatment improved belching-abdominal fullness (p=<0.001), bloating after meals (p=0.004), constipation (p=0.021), and mucus in the feces (p=0.021). The synbiotic group had a significantly higher percentage of patients with full recovery than the prebiotic group (39.1% vs. 12.5%, p=0.036).

    CONCLUSION: Administration of synbiotics and probiotics resulted in significant improvements in initial complaints when compared to prebiotics. Additionally, there was a significantly higher number of patients with full recovery from IBS symptoms in the synbiotic group than in the prebiotic group. Therefore, the twice daily administration of synbiotics is suggested for the treatment of children with IBS.

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    JP

  25. JP Says:

    Updated 11/08/16:

    http://www.sciencedirect.com/science/article/pii/S0378874116316294

    J Ethnopharmacol. 2016 Nov 1.

    Efficacy and safety of enteric coated capsules of anise oil to treat irritable bowel syndrome.

    ETHNOPHARMACOLOGICAL RELEVANCE: Anise is a well-recognized plant in Traditional Persian Medicine (TPM) sources. Anise oil has been suggested for the treatment of bowel disorders in Persian medical textbooks. Based on TPM scholars, this ingredient has a favorable effect on gastrointestinal diseases. We did this trial to determine the efficacy and safety of enteric coated capsules of anise oil for clinical symptoms of irritable bowel syndrome (IBS).

    METHODS AND MATERIALS: This three-armed double-blind clinical trial was carried out from August 2014 to February 2015. 120 patients were divided into three groups by block randomization: AnisEncap, placebo and Colpermin®. Patients in each group received 3 similar capsules per day for 4 weeks. The primary outcome was measured as a visual analogue scale (VAS) score, and the secondary outcome was assessed with an IBS-quality of life questionnaire. Chi-squared tests were used for categorical variables and t-tests to compare continuous variables.

    RESULTS: There were no significant differences in demographic characteristics among the three groups. According to intention-to-treat sample analysis, 75% of patients in the treatment group, 35% in the placebo group and 52.5% in active control group were free from IBS symptoms (P<0.001). The effectiveness of AnisEncap in improving IBS symptoms (abdominal discomfort or pain, bloating, diarrhea, constipation severity, difficulty in defecation, gastroesophageal reflux, headache, tiredness, overall satisfaction and quality of life) was significantly greater than placebo or Colpermin® after the 4-week treatment period and the 2-week follow-up period (P<0.0001). The number needed to treat for enteric coated capsules of anise oil was 4, which indicated significantly superior efficacy compared to the other two groups (P<0.001).

    CONCLUSION: The effectiveness of AnisEncap was superior to that of placebo or Colpermin® in patients with IBS. Further studies are suggested to find the main mechanism of action of anise oil in this regard.

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    JP

  26. JP Says:

    Updated 11/12/16:

    http://journals.lww.com/jpgn/pages/articleviewer.aspx?year=9000&issue=00000&article=97305&type=abstract

    J Pediatr Gastroenterol Nutr. 2016 Nov 30.

    Lactobacillus Reuteri DSM 17938 in the Treatment of Functional Abdominal Pain in Children – RCT Study.

    OBJECTIVES: Beneficial therapeutic effect of probiotics has been reported in children with the irritable bowel syndrome (IBS) but not consistently in other functional abdominal pain-related disorders. The aim of this study was to investigate the effect of Lactobacillus (L.) reuteri DSM 17938 in the treatment of functional abdominal pain (FAP) and IBS in children.

    METHODS: Children (age 4-18 years) referred to pediatric gastroenterologist at Children’s Hospital Zagreb from May 2012 to December 2014, diagnosed as FAP or IBS, were randomized to receive L. reuteri DSM 17938 10 CFU daily or placebo. The study was a prospective, randomized, double-blind, placebo-controlled parallel study. Symptoms were evaluated using Wong-Baker FACES pain rating scale for pain and Bristol scale for stool shape and consistence.

    RESULTS: Data were analyzed for 55 children (26 in the intervention group and 29 in the placebo group). Children in the intervention group had significantly more days without pain (median 89.5 vs. 51 days, p = 0.029). Abdominal pain was less severe in children taking probiotics during the 2 month (p < 0.05) and 4 month (p < 0.01). The two groups did not differ in the duration of abdominal pain, stool type or absence from school. Both groups experienced significant reduction in the severity of abdominal pain from 1 to 4 month, with the reduction more prominent in the intervention group (p < 0.001 vs. p = 0.004).

    CONCLUSION: Administration of L. reuteri DSM 17938 was associated with a possible reduction of the intensity of pain and significantly more days without pain in children with FAP and IBS.

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    JP

  27. JP Says:

    Updated 02/19/17:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5292131/

    Iran Red Crescent Med J. 2016 Jun 21;18(11):e23771.

    Combination of Nigella sativa and Honey in Eradication of Gastric Helicobacter pylori Infection.

    BACKGROUND: Gastric Helicobacter pylori is extremely common worldwide.

    OBJECTIVES: The aim of this study was to assess the effectiveness of combination of Nigella sativa and honey (Dosin) in eradication of gastric H. pylori infection.

    PATIENTS AND METHODS: Nineteen patients who had positive result for H. pylori infection by urea breath test (UBT) without a past history of peptic ulcer, gastric cancer or gastrointestinal bleeding, were suggested to receive one teaspoon of the mixture of Dosin (6 g/day of N. sativa as ground seeds and 12 g/day of honey) three times a day after meals for two weeks. The second UBT was used to detect the presence of H. pylori four weeks after completion of the test. In addition, symptoms of dyspepsia were scored before and after the study and analyzed with Wilcoxon signed-rank test.

    RESULTS: Fourteen patients completed the study. Negative UBT was observed in 57.1% (8/14) of participants after intervention. The median and interquartile range (IQR) of total dyspepsia symptoms was significantly reduced from 5.5 (5 – 12) to 1 (0 – 4) (P = 0.005). All the patients tolerated Dosin except for one who was excluded due to mild diarrhea. No serious adverse events were reported.

    CONCLUSIONS: Dosin was concluded to be an anti H. pylori and an anti-dyspeptic agent. Further studies are recommended to investigate the effect of Dosin plus antibiotics (concurrently or following another) on gastric H. pylori infection.

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    JP

  28. JP Says:

    Updated 04/12/17:

    http://www.mdpi.com/2072-6643/9/4/370/htm

    Nutrients 2017, 9(4), 370

    Oral Supplementation with Bovine Colostrum Decreases Intestinal Permeability and Stool Concentrations of Zonulin in Athletes

    Increased intestinal permeability has been implicated in various pathologies, has various causes, and can develop during vigorous athletic training. Colostrum bovinum is a natural supplement with a wide range of supposed positive health effects, including reduction of intestine permeability. We assessed influence of colostrum supplementation on intestinal permeability related parameters in a group of 16 athletes during peak training for competition. This double-blind placebo-controlled study compared supplementation for 20 days with 500 mg of colostrum bovinum or placebo (whey). Gut permeability status was assayed by differential absorption of lactulose and mannitol (L/M test) and stool zonulin concentration. Baseline L/M tests found that six of the participants (75%) in the colostrum group had increased intestinal permeability. After supplementation, the test values were within the normal range and were significantly lower than at baseline. The colostrum group Δ values produced by comparing the post-intervention and baseline results were also significantly lower than the placebo group Δ values. The differences in stool zonulin concentration were smaller than those in the L/M test, but were significant when the Δ values due to intervention were compared between the colostrum group and the placebo group. Colostrum bovinum supplementation was safe and effective in decreasing of intestinal permeability in this series of athletes at increased risk of its elevation.

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    JP

  29. JP Says:

    Updated 07/12/17:

    https://www.ncbi.nlm.nih.gov/pubmed/28695660

    Neurogastroenterol Motil. 2017 Jul 10.

    A randomized placebo-controlled trial on the effects of Menthacarin, a proprietary peppermint- and caraway-oil-preparation, on symptoms and quality of life in patients with functional dyspepsia.

    BACKGROUND: Functional dyspepsia (FD) is a very common condition affecting more than 10% of the population. While there is no cure, a few drugs have been found to be effective for the relief of symptoms, although most are only effective in a subgroup of patients. We assess and compare the efficacy of a fixed peppermint/caraway-oil-combination (Menthacarin) on symptoms and quality of life (QoL) in patients with FD symptoms consistent with epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS).

    METHODS: In a prospective, double-blind, multicenter trial, 114 outpatients with chronic or recurrent FD were randomized and treated for 4 weeks with the proprietary peppermint- and caraway-oil-preparation Menthacarin or placebo (2×1 capsule/day). Improvement of abdominal pain and discomfort were used as co-primary efficacy measures (scores measured with the validated Nepean Dyspepsia Index).

    KEY RESULTS: After 2 and 4 weeks, active treatment was superior to placebo in alleviating symptoms consistent with PDS and EPS (P all <.001). After 4 weeks of treatment, pain and discomfort scores improved by 7.6±4.8 and 3.6±2.5 points (full analysis set; mean±SD) for Menthacarin and by 3.4±4.3 and 1.3±2.1 points for placebo, respectively. All secondary efficacy measures showed advantages for Menthacarin.

    CONCLUSIONS & INFERENCES: Menthacarin is an effective therapy for the relief of pain and discomfort and improvement of disease-specific QoL in patients with FD and significantly improves symptoms consistent with EPS and PDS.

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    JP

  30. JP Says:

    Updated 08/13/17:

    https://www.karger.com/Article/Abstract/479000

    Digestion. 2017 Jul 29;96(2):92-102.

    The Ameliorating Effect of Lactobacillus gasseri OLL2716 on Functional Dyspepsia in Helicobacter pylori-Uninfected Individuals: A Randomized Controlled Study.

    BACKGROUND/AIMS: Probiotics appear to improve Helicobacter pylori-associated dyspepsia via an inhibitory effect on H. pylori; however, uncertainty exists regarding their effects in H. pylori-uninfected individuals. We evaluated the efficacy of Lactobacillus gasseri OLL2716 (L. gasseri OLL2716) on H. pylori-uninfected individuals with functional dyspepsia (FD).

    METHODS: A double-blind, parallel-group, placebo-controlled, randomized, controlled trial was performed. Participants were randomly assigned to ingest L. gasseri OLL2716-containing yogurt (L. gasseri OLL2716 group) or L. gasseri OLL2716-free yogurt (placebo group) for 12 weeks. Participants completed questionnaires that dealt with a global assessment as well as symptom severity. The per-protocol (PP) population was evaluated for efficacy in accordance with a plan prepared beforehand.

    RESULTS: Randomization was performed on 116 individuals; the PP population consisted of 106 individuals (mean age 42.8 ± 9.0). The impressions regarding the overall effect on gastric symptoms were more positive in the L. gasseri OLL2716 group compared to that in the placebo group (statistical trend; p = 0.073). The elimination rate for major FD symptoms was 17.3 and 35.3% in the placebo and L. gasseri OLL2716 groups respectively (p = 0.048).

    CONCLUSION: L. gasseri OLL2716 has beneficial effects on FD without H. pylori involvement.

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    JP

  31. JP Says:

    Updated 09/05/17:

    http://journals.lww.com/ibdjournal/Abstract/publishahead/Efficacy_of_the_Autoimmune_Protocol_Diet_for.98474.aspx

    Inflamm Bowel Dis. 2017 Aug 29.

    Efficacy of the Autoimmune Protocol Diet for Inflammatory Bowel Disease.

    INTRODUCTION: Data suggest dietary modification can improve clinical responses in inflammatory bowel disease (IBD). The goal of this study was to determine the efficacy of an autoimmune protocol diet in patients with Crohn’s disease and ulcerative colitis.

    METHODS: We enrolled adults with active IBD (Harvey-Bradshaw index ≥ 5 or partial Mayo score ≥3 and erosions on endoscopy and/or elevated fecal calprotectin). For the autoimmune protocol, patients underwent 6-week elimination followed by 5-week maintenance phase. Clinical indices, laboratories, and biomarkers were assessed at baseline and weeks 6 and 11. Endoscopy was performed at study completion.

    RESULTS: The final cohort included 15 patients with IBD, with mean disease duration 19 years (SD 14.6) and active biological use in 7 (47%) patients. Nutrient repletion was initiated for deficiencies in vitamin D (n = 3) and iron (n = 6). From week 0 to weeks 6 and 11, mean partial Mayo score significantly improved from 5.8 (SD 1.2) to 1.2 (SD 2.0) and 1.0 (SD 2.0) for ulcerative colitis, and mean Harvey-Bradshaw index significantly improved from 7 (SD 1.5) to 3.6 (SD 2.1) and 3.4 (SD 2.6) for Crohn’s disease. C-reactive protein did not significantly change during study. Mean fecal calprotectin improved from 471 (SD 562) to 112 (SD 104) at week 11 (P = 0.12). Among those with follow-up endoscopy at week 11 (n = 7), improvements were noted in simple endoscopic score for Crohn’s disease (n = 1), Rutgeerts score (n = 1), and Mayo endoscopy subscore (n = 4).

    DISCUSSION: Dietary elimination can improve symptoms and endoscopic inflammation in patients with IBD. Randomized controlled trials are warranted.

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    JP

  32. JP Says:

    Updated 10/18/17:

    https://www.ncbi.nlm.nih.gov/pubmed/29030980

    Alcohol Clin Exp Res. 2017 Oct 14.

    Beneficial effect of alcohol withdrawal on gut permeability and microbial translocation in patients with alcohol use disorder.

    BACKGROUND: The human intestinal microbiota exerts beneficial or harmful effects in several disorders. Many factors, including alcohol consumption, may influence its composition and trigger bacterial translocation. Excessive alcohol consumption increases gut permeability and translocation of endotoxin into peripheral circulation. Although plasma endotoxin concentrations have been measured often, quantitative changes following alcohol withdrawal have never been described in subjects with alcohol use disorder (AUD). The aim of this study was to measure microbial translocation (MT) and gut permeability markers in patients with AUD, to compare these markers to healthy controls (HC) and to monitor markers during the first six weeks of abstinence.

    METHODS: Sixty-five patients with AUD and hospitalized for alcohol withdrawal were included. Epidemiological, clinical, biological and addictological data were gathered. Blood samples were collected at baseline, then three and six weeks after alcohol withdrawal. A hundred healthy volunteers were used as controls. Three markers of MT were monitored in plasma samples: sCD14 and LBP were quantified using ELISA, and 16S rDNA was quantified using real time PCR. Zonulin and I-FABP blood levels were also monitored as indirect markers of gut permeability, using ELISA.

    RESULTS: At baseline, LBP, 16S rDNA and I-FABP markers were significantly higher in AUD patients than in HC. Six weeks after alcohol withdrawal plasma levels of sCD14 and LBP decreased significantly. Cannabis consumption and BMI before alcohol withdrawal influenced baseline MT levels and the decrease in MT markers after six weeks. Finally, markers of MT and gut permeability did not correlate with each other before and after alcohol withdrawal.

    CONCLUSIONS: Before alcohol withdrawal, MT markers were higher in AUD patients than in HC. After six weeks of abstinence an improvement in MT markers was observed. Our data suggest that there is a link between MT, its improvement, BMI and cannabis consumption.

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    JP

  33. JP Says:

    Updated 11/09/17:

    http://www.europeanreview.org/wp/wp-content/uploads/2249-2254-Casperome-in-irritable-bowel-syndrome.pdf

    Eur Rev Med Pharmacol Sci. 2017 May;21(9):2249-2254.

    Supplementation with a lecithin-based delivery form of Boswellia serrata extract (Casperome®) controls symptoms of mild irritable bowel syndrome.

    OBJECTIVE: Irritable Bowel Syndrome (IBS) is a chronic, gastrointestinal disorder in which abdominal pain or discomfort is associated with defecation or changes in bowel habits. Its multifactorial pathophysiology leads to a variety of available treatments, mainly aimed at controlling symptoms. The management of IBS patients could be optimized by individualized strategies, including non-pharmaceutical approaches. In this study, we evaluated the efficacy and safety of a novel delivery form of Boswellia serrata extracts (BSE) (Casperome®) in patients with IBS.

    PATIENTS AND METHODS: 71 otherwise healthy subjects with idiopathic IBS were recruited. Participants were assigned to the following management strategies: hyoscine butylbromide; papaverine hydrochloride + A. belladonna extract; supplementation with Casperome®. Predominant IBS symptoms were evaluated at inclusion and at the end of the observational period (4 weeks). The numbers of subjects who needed rescue medication or medical attention/hospital admission were recorded. Adverse events were also evaluated.

    RESULTS: In all groups, the IBS symptoms investigated, namely abdominal pain, altered bowel movements, meteorism and cramps improved during the observational period. Of note, the number of subjects who needed medical attention significantly decreased only in Casperome®-supplemented group. In addition, Casperome® supplementation was related to a lower incidence of side effects (mainly stypsis).

    CONCLUSIONS: This preliminary study suggests that Casperome® supplementation could represent a promising alternative approach to manage symptoms associated with IBS in otherwise healthy subjects.

    Be well!

    JP

  34. JP Says:

    Updated 12/10/17:

    http://www.europeanreview.org/wp/wp-content/uploads/102-107-Effect-of-beta-glucan-inositol-and-digestive-enzymes-in-IBD-IBS.pdf

    Eur Rev Med Pharmacol Sci. 2017 Jun;21(2 Suppl):102-107.

    Beta-glucan, inositol and digestive enzymes improve quality of life of patients with inflammatory bowel disease and irritable bowel syndrome.

    OBJECTIVE: To evaluate the efficacy of a mixture of beta-glucan, inositol and digestive enzymes in improving gastrointestinal symptoms in patients affected by inflammatory bowel disease (IBD)-irritable bowel syndrome (IBS).

    PATIENTS AND METHODS: The study was conducted at the IBD Unit of the University of Catanzaro. Forty-three IBD patients with IBS symptoms were included in the study. IBD diagnosis was performed by clinical, endoscopic, histological and radiological criteria. Patients were in clinical remission and in treatment only with systemical and topical mesalamine. All study participants fulfilled the Rome III criteria for the diagnosis of IBS. The study participants were randomized into 2 groups: group A (n=23) received conventional treatment (systemical and topical mesalamine) plus a mixture of beta-glucan, inositol and digestive enzymes (one tablet after lunch and dinner) for four consecutive weeks; group B (n=20) received only conventional treatment. The prevalence and intensity of gastrointestinal (GI) symptoms were evaluated both at the enrollment (T0) and after four weeks of treatment (T1).

    RESULTS: Patients who received mesalamine plus the mixture of beta-glucan, inositol and digestive enzymes (group A) reported a reduction in abdominal pain together with reduction in bloating and flatulence after four weeks of treatment. Importantly, an overall improvement in the general well-being has been recorded. Patients who underwent only mesalamine treatment (group B) reported a mild reduction in the evacuative urgency without any other improvements.

    CONCLUSIONS: We have shown that supplementation with a mixture of beta-glucan, inositol and digestive enzymes reduces bloating, flatulence and abdominal pain, improving the overall clinical condition of IBD-IBS patients.

    Be well!

    JP

  35. JP Says:

    Updated 05/28/18:

    https://bit.ly/2mccUMZ

    Panminerva Med. 2018 Jun;60(2):65-69.

    Pycnogenol® supplementation improves the control of irritable bowel syndrome symptoms.

    BACKGROUND: The aim of this registry was to evaluate the effects of Pycnogenol® on the main symptoms of irritable bowel syndrome (IBS) in otherwise healthy individuals.

    METHODS: This study included 77 healthy individuals with symptoms of IBS. The patients were divided into three groups: group 1 was treated with Buscopan (10 mg when needed), group 2 (Antispasmina col forte; 50 mg papaverine hydrochloride+10 mg belladonna extract when needed) and 3 (Pycnogenol® 150 mg/day) for 3 weeks.

    RESULTS: The number of painful attacks was comparable in all groups after four weeks. Mild pain on manual abdomen pressure was decreased in all groups, with the improvement in the Pycnogenol® group significantly more pronounced that in both control groups (P<0.05). Perceived abdominal bowel movements/distension were significantly relieved in group 2 (Antispasmina Col Forte) and 3 (Pycnogenol®) (P<0.05) in comparison with Buscopan (group 1).

    CONCLUSIONS: Pycnogenol® has shown a significant, protective and preventive activity on IBS symptoms, and thus it may represent a potential “soft” approach to IBS.

    Be well!

    JP

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