Nutrient drink test: A promising new tool for irritable bowel syndrome diagnosis
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摘要
BACKGROUND Irritable bowel syndrome(IBS) is a highly prevalent condition. It is diagnosed on the basis of chronic symptoms after the clinical and/or investigative exclusion of organic diseases that can cause similar symptoms. There is no reproducible noninvasive test for the diagnosis of IBS, and this raises diagnostic uncertainty among physicians and hinders acceptance of the diagnosis by patients.Functional gastrointestinal(GI) syndromes often present with overlapping upper and lower GI tract symptoms, now believed to be generated by visceral hypersensitivity. This study examines the possibility that, in IBS, a nutrient drink test(NDT) provokes GI symptoms that allow a positive differentiation of these patients from healthy subjects.AIM To evaluate the NDT for the diagnosis of IBS.METHODS This prospective case-control study compared the effect of two different nutrient drinks on GI symptoms in 10 IBS patients(patients) and 10 healthy controls(controls). The 500 kcal high nutrient drink and the low nutrient 250 kcal drink were given in randomized order on separate days. Symptoms were assessed just before and at several time points after drink ingestion. Global dyspepsia and abdominal scores were derived from individual symptom data recorded by two questionnaires designed by our group, the upper and the general GI symptomquestionnaires, respectively. Psycho-social morbidity and quality of life were also formally assessed. The scores of patients and controls were compared using single factor analysis of variance test.RESULTS At baseline, IBS patients compared to controls had significantly higher levels of GI symptoms such as gastro-esophageal reflux(P = 0.05), abdominal pain(P =0.001), dyspepsia(P = 0.001), diarrhea(P = 0.001), and constipation(P = 0.001) as well as higher psycho-social morbidity and lower quality of life. The very low incidence of GI symptoms reported by control subjects did not differ significantly for the two test drinks. Compared with the low nutrient drink, IBS patients with the high nutrient drink had significantly more dyspeptic symptoms at 30(P =0.014), 45(P = 0.002), 60(P = 0.001), and 120 min(P = 0.011). Dyspeptic symptoms triggered by the high nutrient drink during the first 120 min gave the best differentiation between healthy controls and patients(area under receiver operating curve of 0.915 at 45 min for the dyspepsia score). Continued symptom monitoring for 24 h did not enhance separation of patients from controls.CONCLUSION A high NDT merits further evaluation as a diagnostic tool for IBS.
BACKGROUND Irritable bowel syndrome(IBS) is a highly prevalent condition. It is diagnosed on the basis of chronic symptoms after the clinical and/or investigative exclusion of organic diseases that can cause similar symptoms. There is no reproducible noninvasive test for the diagnosis of IBS, and this raises diagnostic uncertainty among physicians and hinders acceptance of the diagnosis by patients.Functional gastrointestinal(GI) syndromes often present with overlapping upper and lower GI tract symptoms, now believed to be generated by visceral hypersensitivity. This study examines the possibility that, in IBS, a nutrient drink test(NDT) provokes GI symptoms that allow a positive differentiation of these patients from healthy subjects.AIM To evaluate the NDT for the diagnosis of IBS.METHODS This prospective case-control study compared the effect of two different nutrient drinks on GI symptoms in 10 IBS patients(patients) and 10 healthy controls(controls). The 500 kcal high nutrient drink and the low nutrient 250 kcal drink were given in randomized order on separate days. Symptoms were assessed just before and at several time points after drink ingestion. Global dyspepsia and abdominal scores were derived from individual symptom data recorded by two questionnaires designed by our group, the upper and the general GI symptomquestionnaires, respectively. Psycho-social morbidity and quality of life were also formally assessed. The scores of patients and controls were compared using single factor analysis of variance test.RESULTS At baseline, IBS patients compared to controls had significantly higher levels of GI symptoms such as gastro-esophageal reflux(P = 0.05), abdominal pain(P =0.001), dyspepsia(P = 0.001), diarrhea(P = 0.001), and constipation(P = 0.001) as well as higher psycho-social morbidity and lower quality of life. The very low incidence of GI symptoms reported by control subjects did not differ significantly for the two test drinks. Compared with the low nutrient drink, IBS patients with the high nutrient drink had significantly more dyspeptic symptoms at 30(P =0.014), 45(P = 0.002), 60(P = 0.001), and 120 min(P = 0.011). Dyspeptic symptoms triggered by the high nutrient drink during the first 120 min gave the best differentiation between healthy controls and patients(area under receiver operating curve of 0.915 at 45 min for the dyspepsia score). Continued symptom monitoring for 24 h did not enhance separation of patients from controls.CONCLUSION A high NDT merits further evaluation as a diagnostic tool for IBS.
BACKGROUND Irritable bowel syndrome(IBS) is a highly prevalent condition. It is diagnosed on the basis of chronic symptoms after the clinical and/or investigative exclusion of organic diseases that can cause similar symptoms. There is no reproducible noninvasive test for the diagnosis of IBS, and this raises diagnostic uncertainty among physicians and hinders acceptance of the diagnosis by patients.Functional gastrointestinal(GI) syndromes often present with overlapping upper and lower GI tract symptoms, now believed to be generated by visceral hypersensitivity. This study examines the possibility that, in IBS, a nutrient drink test(NDT) provokes GI symptoms that allow a positive differentiation of these patients from healthy subjects.AIM To evaluate the NDT for the diagnosis of IBS.METHODS This prospective case-control study compared the effect of two different nutrient drinks on GI symptoms in 10 IBS patients(patients) and 10 healthy controls(controls). The 500 kcal high nutrient drink and the low nutrient 250 kcal drink were given in randomized order on separate days. Symptoms were assessed just before and at several time points after drink ingestion. Global dyspepsia and abdominal scores were derived from individual symptom data recorded by two questionnaires designed by our group, the upper and the general GI symptomquestionnaires, respectively. Psycho-social morbidity and quality of life were also formally assessed. The scores of patients and controls were compared using single factor analysis of variance test.RESULTS At baseline, IBS patients compared to controls had significantly higher levels of GI symptoms such as gastro-esophageal reflux(P = 0.05), abdominal pain(P =0.001), dyspepsia(P = 0.001), diarrhea(P = 0.001), and constipation(P = 0.001) as well as higher psycho-social morbidity and lower quality of life. The very low incidence of GI symptoms reported by control subjects did not differ significantly for the two test drinks. Compared with the low nutrient drink, IBS patients with the high nutrient drink had significantly more dyspeptic symptoms at 30(P =0.014), 45(P = 0.002), 60(P = 0.001), and 120 min(P = 0.011). Dyspeptic symptoms triggered by the high nutrient drink during the first 120 min gave the best differentiation between healthy controls and patients(area under receiver operating curve of 0.915 at 45 min for the dyspepsia score). Continued symptom monitoring for 24 h did not enhance separation of patients from controls.CONCLUSION A high NDT merits further evaluation as a diagnostic tool for IBS.
引文
1 Lovell RM,Ford AC.Global prevalence of and risk factors for irritable bowel syndrome:A meta-analysis.Clin Gastroenterol Hepatol 2012;10:712-721.e4[PMID:22426087 DOI:10.1016/j.cgh.2012.02.029]
2 Ford AC,Talley NJ,Walker MM,Jones MP.Increased prevalence of autoimmune diseases in functional gastrointestinal disorders:Case-control study of 23471 primary care patients.Aliment Pharmacol Ther2014;40:827-834[PMID:25131320 DOI:10.1111/apt.12903]
3 Badia X,Mearin F,Balboa A,BaróE,Caldwell E,Cucala M,Díaz-Rubio M,Fueyo A,Ponce J,Roset M,Talley NJ.Burden of illness in irritable bowel syndrome comparing Rome I and Rome II criteria.Pharmacoeconomics 2002;20:749-758[PMID:12201794 DOI:10.1111/j.1572-0241.2002.07026.x]
4 Mearin F,Lacy BE,Chang L,Chey WD,Lembo AJ,Simren M,Spiller R.Bowel Disorders.Gastroenterology 2016;pii:S0016-5085(16)00222-5[PMID:27144627 DOI:10.1053/j.gastro.2016.02.031]
5 Ford AC,Bercik P,Morgan DG,Bolino C,Pintos-Sanchez MI,Moayyedi P.Validation of the Rome IIIcriteria for the diagnosis of irritable bowel syndrome in secondary care.Gastroenterology 2013;145:1262-70.e1[PMID:23994201 DOI:10.1053/j.gastro.2013.08.048]
6 Quigley EM,Bytzer P,Jones R,Mearin F.Irritable bowel syndrome:The burden and unmet needs in Europe.Dig Liver Dis 2006;38:717-723[PMID:16807154 DOI:10.1016/j.dld.2006.05.009]
7 Talley NJ,Dennis EH,Schettler-Duncan VA,Lacy BE,Olden KW,Crowell MD.Overlapping upper and lower gastrointestinal symptoms in irritable bowel syndrome patients with constipation or diarrhea.Am JGastroenterol 2003;98:2454-2459[PMID:14638348 DOI:10.1111/j.1572-0241.2003.07699.x]
8 van der Veek PP,Van Rood YR,Masclee AA.Symptom severity but not psychopathology predicts visceral hypersensitivity in irritable bowel syndrome.Clin Gastroenterol Hepatol 2008;6:321-328[PMID:18258487 DOI:10.1016/j.cgh.2007.12.005]
9 Di Stefano M,Miceli E,Missanelli A,Mazzocchi S,Corazza GR.Meal induced rectosigmoid tone modification:A low caloric meal accurately separates functional and organic gastrointestinal disease patients.Gut 2006;55:1409-1414[PMID:16434428 DOI:10.1136/gut.2005.076323]
10 Passos MC,Serra J,Azpiroz F,Tremolaterra F,Malagelada JR.Impaired reflex control of intestinal gas transit in patients with abdominal bloating.Gut 2005;54:344-348[PMID:15710981 DOI:10.1136/gut.2003.038158]
11 Tack J,Caenepeel P,Piessevaux H,Cuomo R,Janssens J.Assessment of meal induced gastric accommodation by a satiety drinking test in health and in severe functional dyspepsia.Gut 2003;52:1271-1277[PMID:12912857 DOI:10.1136/gut.52.9.1271]
12 Lied GA,Lillest?l K,Lind R,Valeur J,Morken MH,Vaali K,Gregersen K,Florvaag E,Tangen T,Berstad A.Perceived food hypersensitivity:A review of 10 years of interdisciplinary research at a reference center.Scand J Gastroenterol 2011;46:1169-1178[PMID:21679125 DOI:10.3109/00365521.2011.591428]
13 El-Salhy M,Gundersen D,Ostgaard H,Lomholt-Beck B,Hatlebakk JG,Hausken T.Low densities of serotonin and peptide YY cells in the colon of patients with irritable bowel syndrome.Dig Dis Sci 2012;57:873-878[PMID:22057239 DOI:10.1007/s10620-011-1948-8]
14 Francis CY,Morris J,Whorwell PJ.The irritable bowel severity scoring system:A simple method of monitoring irritable bowel syndrome and its progress.Aliment Pharmacol Ther 1997;11:395-402[PMID:9146781 DOI:10.1046/j.1365-2036.1997.142318000.x]
15 Cuomo R,Sarnelli G,Grasso R,Bruzzese D,Pumpo R,Salomone M,Nicolai E,Tack J,Budillon G.Functional dyspepsia symptoms,gastric emptying and satiety provocative test:Analysis of relationships.Scand J Gastroenterol 2001;36:1030-1036[PMID:11589374 DOI:10.1080/003655201750422611]
16 Delgado-Aros S,Camilleri M,Cremonini F,Ferber I,Stephens D,Burton DD.Contributions of gastric volumes and gastric emptying to meal size and postmeal symptoms in functional dyspepsia.Gastroenterology 2004;127:1685-1694[PMID:15578506 DOI:10.1053/j.gastro.2004.09.006]
17 Svedlund J,Sj?din I,Dotevall G.GSRS--a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease.Dig Dis Sci 1988;33:129-134[PMID:3123181DOI:10.1007/BF01535722]
18 Lee S,Park M,Choi S,Nah Y,Abbey SE,Rodin G.Stress,coping,and depression in non-ulcer dyspepsia patients.J Psychosom Res 2000;49:93-99[PMID:11053609 DOI:10.1016/S0022-3999(00)00148-3]
19 Zigmond AS,Snaith RP.The hospital anxiety and depression scale.Acta Psychiatr Scand 1983;67:361-370[PMID:6880820 DOI:10.1111/j.1600-0447.1983.tb09716.x]
20 Ware J,Kosinski M,Keller SD.A 12-Item Short-Form Health Survey:Construction of scales and preliminary tests of reliability and validity.Med Care 1996;34:220-233[PMID:8628042 DOI:10.1097/00005650-199603000-00003]
21 Santa María M,Jaramillo MA,Otero Regino W,Gómez Zuleta MA.Validación del cuestionario de reflujo gastroesofágico“GERDQ”en una población colombiana.Asoc Colomb Gastroenterol Endosc Dig Coloproctología y Hepatol 2013;28:199-206
22 Revicki DA,Rentz AM,Dubois D,Kahrilas P,Stanghellini V,Talley NJ,Tack J.Gastroparesis Cardinal Symptom Index(GCSI):Development and validation of a patient reported assessment of severity of gastroparesis symptoms.Qual Life Res 2004;13:833-844[PMID:15129893 DOI:10.1023/B:QURE.0000021689.86296.e4]
23 Lewis SJ,Heaton KW.Stool form scale as a useful guide to intestinal transit time.Scand J Gastroenterol1997;32:920-924[PMID:9299672 DOI:10.3109/00365529709011203]
24 Haag S,Talley NJ,Holtmann G.Symptom patterns in functional dyspepsia and irritable bowel syndrome:Relationship to disturbances in gastric emptying and response to a nutrient challenge in consulters and non-consulters.Gut 2004;53:1445-1451[PMID:15361493 DOI:10.1136/gut.2003.030049]
25 Posserud I,Strid H,St?rsrud S,T?rnblom H,Svensson U,Tack J,Van Oudenhove L,Simrén M.Symptom pattern following a meal challenge test in patients with irritable bowel syndrome and healthy controls.United European Gastroenterol J 2013;1:358-367[PMID:24917984 DOI:10.1177/2050640613501817]
26 Almansa C,Díaz-Rubio M,Rey E.The burden and management of patients with IBS:Results from a survey in spanish gastroenterologists.Rev Esp Enferm Dig 2011;103:570-575[PMID:22149558 DOI:10.4321/S1130-01082011001100003]
27 Jarb?l DE,Rasmussen S,Balasubramaniam K,Elnegaard S,Haastrup PF.Self-rated health and functional capacity in individuals reporting overlapping symptoms of gastroesophageal reflux disease,functional dyspepsia and irritable bowel syndrome-a population based study.BMC Gastroenterol 2017;17:65[PMID:28521729 DOI:10.1186/s12876-017-0622-9]
28 Halder SL,Locke GR,Schleck CD,Zinsmeister AR,Melton LJ,Talley NJ.Natural history of functional gastrointestinal disorders:A 12-year longitudinal population-based study.Gastroenterology 2007;133:799-807[PMID:17678917 DOI:10.1053/j.gastro.2007.06.010]
2 Ford AC,Talley NJ,Walker MM,Jones MP.Increased prevalence of autoimmune diseases in functional gastrointestinal disorders:Case-control study of 23471 primary care patients.Aliment Pharmacol Ther2014;40:827-834[PMID:25131320 DOI:10.1111/apt.12903]
3 Badia X,Mearin F,Balboa A,BaróE,Caldwell E,Cucala M,Díaz-Rubio M,Fueyo A,Ponce J,Roset M,Talley NJ.Burden of illness in irritable bowel syndrome comparing Rome I and Rome II criteria.Pharmacoeconomics 2002;20:749-758[PMID:12201794 DOI:10.1111/j.1572-0241.2002.07026.x]
4 Mearin F,Lacy BE,Chang L,Chey WD,Lembo AJ,Simren M,Spiller R.Bowel Disorders.Gastroenterology 2016;pii:S0016-5085(16)00222-5[PMID:27144627 DOI:10.1053/j.gastro.2016.02.031]
5 Ford AC,Bercik P,Morgan DG,Bolino C,Pintos-Sanchez MI,Moayyedi P.Validation of the Rome IIIcriteria for the diagnosis of irritable bowel syndrome in secondary care.Gastroenterology 2013;145:1262-70.e1[PMID:23994201 DOI:10.1053/j.gastro.2013.08.048]
6 Quigley EM,Bytzer P,Jones R,Mearin F.Irritable bowel syndrome:The burden and unmet needs in Europe.Dig Liver Dis 2006;38:717-723[PMID:16807154 DOI:10.1016/j.dld.2006.05.009]
7 Talley NJ,Dennis EH,Schettler-Duncan VA,Lacy BE,Olden KW,Crowell MD.Overlapping upper and lower gastrointestinal symptoms in irritable bowel syndrome patients with constipation or diarrhea.Am JGastroenterol 2003;98:2454-2459[PMID:14638348 DOI:10.1111/j.1572-0241.2003.07699.x]
8 van der Veek PP,Van Rood YR,Masclee AA.Symptom severity but not psychopathology predicts visceral hypersensitivity in irritable bowel syndrome.Clin Gastroenterol Hepatol 2008;6:321-328[PMID:18258487 DOI:10.1016/j.cgh.2007.12.005]
9 Di Stefano M,Miceli E,Missanelli A,Mazzocchi S,Corazza GR.Meal induced rectosigmoid tone modification:A low caloric meal accurately separates functional and organic gastrointestinal disease patients.Gut 2006;55:1409-1414[PMID:16434428 DOI:10.1136/gut.2005.076323]
10 Passos MC,Serra J,Azpiroz F,Tremolaterra F,Malagelada JR.Impaired reflex control of intestinal gas transit in patients with abdominal bloating.Gut 2005;54:344-348[PMID:15710981 DOI:10.1136/gut.2003.038158]
11 Tack J,Caenepeel P,Piessevaux H,Cuomo R,Janssens J.Assessment of meal induced gastric accommodation by a satiety drinking test in health and in severe functional dyspepsia.Gut 2003;52:1271-1277[PMID:12912857 DOI:10.1136/gut.52.9.1271]
12 Lied GA,Lillest?l K,Lind R,Valeur J,Morken MH,Vaali K,Gregersen K,Florvaag E,Tangen T,Berstad A.Perceived food hypersensitivity:A review of 10 years of interdisciplinary research at a reference center.Scand J Gastroenterol 2011;46:1169-1178[PMID:21679125 DOI:10.3109/00365521.2011.591428]
13 El-Salhy M,Gundersen D,Ostgaard H,Lomholt-Beck B,Hatlebakk JG,Hausken T.Low densities of serotonin and peptide YY cells in the colon of patients with irritable bowel syndrome.Dig Dis Sci 2012;57:873-878[PMID:22057239 DOI:10.1007/s10620-011-1948-8]
14 Francis CY,Morris J,Whorwell PJ.The irritable bowel severity scoring system:A simple method of monitoring irritable bowel syndrome and its progress.Aliment Pharmacol Ther 1997;11:395-402[PMID:9146781 DOI:10.1046/j.1365-2036.1997.142318000.x]
15 Cuomo R,Sarnelli G,Grasso R,Bruzzese D,Pumpo R,Salomone M,Nicolai E,Tack J,Budillon G.Functional dyspepsia symptoms,gastric emptying and satiety provocative test:Analysis of relationships.Scand J Gastroenterol 2001;36:1030-1036[PMID:11589374 DOI:10.1080/003655201750422611]
16 Delgado-Aros S,Camilleri M,Cremonini F,Ferber I,Stephens D,Burton DD.Contributions of gastric volumes and gastric emptying to meal size and postmeal symptoms in functional dyspepsia.Gastroenterology 2004;127:1685-1694[PMID:15578506 DOI:10.1053/j.gastro.2004.09.006]
17 Svedlund J,Sj?din I,Dotevall G.GSRS--a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease.Dig Dis Sci 1988;33:129-134[PMID:3123181DOI:10.1007/BF01535722]
18 Lee S,Park M,Choi S,Nah Y,Abbey SE,Rodin G.Stress,coping,and depression in non-ulcer dyspepsia patients.J Psychosom Res 2000;49:93-99[PMID:11053609 DOI:10.1016/S0022-3999(00)00148-3]
19 Zigmond AS,Snaith RP.The hospital anxiety and depression scale.Acta Psychiatr Scand 1983;67:361-370[PMID:6880820 DOI:10.1111/j.1600-0447.1983.tb09716.x]
20 Ware J,Kosinski M,Keller SD.A 12-Item Short-Form Health Survey:Construction of scales and preliminary tests of reliability and validity.Med Care 1996;34:220-233[PMID:8628042 DOI:10.1097/00005650-199603000-00003]
21 Santa María M,Jaramillo MA,Otero Regino W,Gómez Zuleta MA.Validación del cuestionario de reflujo gastroesofágico“GERDQ”en una población colombiana.Asoc Colomb Gastroenterol Endosc Dig Coloproctología y Hepatol 2013;28:199-206
22 Revicki DA,Rentz AM,Dubois D,Kahrilas P,Stanghellini V,Talley NJ,Tack J.Gastroparesis Cardinal Symptom Index(GCSI):Development and validation of a patient reported assessment of severity of gastroparesis symptoms.Qual Life Res 2004;13:833-844[PMID:15129893 DOI:10.1023/B:QURE.0000021689.86296.e4]
23 Lewis SJ,Heaton KW.Stool form scale as a useful guide to intestinal transit time.Scand J Gastroenterol1997;32:920-924[PMID:9299672 DOI:10.3109/00365529709011203]
24 Haag S,Talley NJ,Holtmann G.Symptom patterns in functional dyspepsia and irritable bowel syndrome:Relationship to disturbances in gastric emptying and response to a nutrient challenge in consulters and non-consulters.Gut 2004;53:1445-1451[PMID:15361493 DOI:10.1136/gut.2003.030049]
25 Posserud I,Strid H,St?rsrud S,T?rnblom H,Svensson U,Tack J,Van Oudenhove L,Simrén M.Symptom pattern following a meal challenge test in patients with irritable bowel syndrome and healthy controls.United European Gastroenterol J 2013;1:358-367[PMID:24917984 DOI:10.1177/2050640613501817]
26 Almansa C,Díaz-Rubio M,Rey E.The burden and management of patients with IBS:Results from a survey in spanish gastroenterologists.Rev Esp Enferm Dig 2011;103:570-575[PMID:22149558 DOI:10.4321/S1130-01082011001100003]
27 Jarb?l DE,Rasmussen S,Balasubramaniam K,Elnegaard S,Haastrup PF.Self-rated health and functional capacity in individuals reporting overlapping symptoms of gastroesophageal reflux disease,functional dyspepsia and irritable bowel syndrome-a population based study.BMC Gastroenterol 2017;17:65[PMID:28521729 DOI:10.1186/s12876-017-0622-9]
28 Halder SL,Locke GR,Schleck CD,Zinsmeister AR,Melton LJ,Talley NJ.Natural history of functional gastrointestinal disorders:A 12-year longitudinal population-based study.Gastroenterology 2007;133:799-807[PMID:17678917 DOI:10.1053/j.gastro.2007.06.010]