IBD & Intestinal Disorders

Among patients with constipation, reduced rectoanal gradient found during high-resolution anorectal manometry (HR-ARM) is the strongest parameter for predicting how a patient is likely to perform on a rectal balloon expulsion test (BET). Findings of both reduced rectoanal gradient and abnormal BET should be considered diagnostic for a defecatory disorder.

Those are the findings of a study out of the Mayo Clinic in Rochester, Minn., which was published in Gastroenterology. The research could help streamline diagnosis of defecatory disorders: Currently there is a lack of consensus on what tests should be performed and in what order to achieve a reliable diagnosis, according to the authors.

The authors recommend that, in patients with a suggestive history, a prolonged time on BET or reduced rectoanal gradient individually indicate a probable defecatory disorder, while the presence of both could be considered diagnostic even in the absence of defecography.

The research should provide clarity about the findings from HR-ARM, which can be complex, according to Kyle Staller, MD, who was asked to comment on the study. “You get lots of different numbers, you get lots of different parameters [with HR-ARM], and figuring out which ones are really relevant is somewhat difficult. [This study] is really a tour de force that distills down many of these parameters into some that we might want to pay attention to more than others,” said Dr. Staller, who is director of the GI Motility Laboratory at Massachusetts General Hospital and a professor of medicine at Harvard Medical School, both in Boston.

He pointed out that one limitation of the study is it didn’t attempt to answer the question of what parameters predict benefit from biofeedback therapy.

“I think the practice right now is that we tend to put the most weight on the balloon expulsion test. I think what this paper convincingly argues is that maybe someone who has an abnormal rectoanal gradient and a normal balloon expulsion test should also be referred for biofeedback with the caveat that we still don’t know if they’re going to do well on biofeedback or not,” said Dr. Staller.

The study included 658 patients, 474 with constipation and 184 healthy controls. In addition to HR-ARM and BET, 158 underwent defecography. Females made up 89% of constipated patients and 73% of healthy individuals. Healthy individuals were younger than constipated individuals (median age 35 versus 49 years).

Overall, 11% of healthy patients and 32% of constipated patients had prolonged BET time (P < .001) and 11% and 21% had a reduced rectoanal gradient on HR-ARM (P = .003). Among those with a normal BET time, 13% had a reduced rectoanal gradient, compared with 34% of those with a prolonged BET time (P < .001).

The authors report that HR-ARM variables had good specificity but worse sensitivity for predicting prolonged BET. The rectoanal gradient was the best-performing variable, with a specificity of 85% and a sensitivity of 36%.

HR-ARM and BET findings were associated with reduced rectal evacuation found on defecography. The median rectal evacuation was 79% if both BET and rectoanal gradient were normal, 35% if either one was abnormal, and 3% if both were abnormal (P < .001). Having either prolonged BET time or reduced anorectal gradient alone had a 73% sensitivity and specificity of 72% for incomplete evacuation on defecography. If both abnormalities were present, the sensitivity was 31% but the specificity was 95%.

A reduced rectoanal gradient was associated with incomplete rectal evacuation (odds ratio, 4.35; P = .002); prolonged BET time showed a similar association (OR, 4.57; P < .001).

The authors proposed terminology to help differentiate the findings: “probable defecatory disorder,” or “probable DD,” to describe patients with one abnormal result from the three tests and “definite DD” for those with two abnormal test results. “Although a single abnormal finding may be a false-positive result, pursuing a trial of biofeedback therapy for patients with a probable DD may be reasonable, especially when defecography is not feasible. However, this approach should be confirmed by prospective studies that assess the response to anorectal biofeedback therapy in patients with probable and definite DD, as defined above.”

The authors disclosed no conflicts of interest. Dr. Staller has consulted for GI Supply.

Among patients with constipation, reduced rectoanal gradient found during high-resolution anorectal manometry (HR-ARM) is the strongest parameter for predicting how a patient is likely to perform on a rectal balloon expulsion test (BET). Findings of both reduced rectoanal gradient and abnormal BET should be considered diagnostic for a defecatory disorder.

Those are the findings of a study out of the Mayo Clinic in Rochester, Minn., which was published in Gastroenterology. The research could help streamline diagnosis of defecatory disorders: Currently there is a lack of consensus on what tests should be performed and in what order to achieve a reliable diagnosis, according to the authors.

The authors recommend that, in patients with a suggestive history, a prolonged time on BET or reduced rectoanal gradient individually indicate a probable defecatory disorder, while the presence of both could be considered diagnostic even in the absence of defecography.

The research should provide clarity about the findings from HR-ARM, which can be complex, according to Kyle Staller, MD, who was asked to comment on the study. “You get lots of different numbers, you get lots of different parameters [with HR-ARM], and figuring out which ones are really relevant is somewhat difficult. [This study] is really a tour de force that distills down many of these parameters into some that we might want to pay attention to more than others,” said Dr. Staller, who is director of the GI Motility Laboratory at Massachusetts General Hospital and a professor of medicine at Harvard Medical School, both in Boston.

He pointed out that one limitation of the study is it didn’t attempt to answer the question of what parameters predict benefit from biofeedback therapy.

“I think the practice right now is that we tend to put the most weight on the balloon expulsion test. I think what this paper convincingly argues is that maybe someone who has an abnormal rectoanal gradient and a normal balloon expulsion test should also be referred for biofeedback with the caveat that we still don’t know if they’re going to do well on biofeedback or not,” said Dr. Staller.

The study included 658 patients, 474 with constipation and 184 healthy controls. In addition to HR-ARM and BET, 158 underwent defecography. Females made up 89% of constipated patients and 73% of healthy individuals. Healthy individuals were younger than constipated individuals (median age 35 versus 49 years).

Overall, 11% of healthy patients and 32% of constipated patients had prolonged BET time (P < .001) and 11% and 21% had a reduced rectoanal gradient on HR-ARM (P = .003). Among those with a normal BET time, 13% had a reduced rectoanal gradient, compared with 34% of those with a prolonged BET time (P < .001).

The authors report that HR-ARM variables had good specificity but worse sensitivity for predicting prolonged BET. The rectoanal gradient was the best-performing variable, with a specificity of 85% and a sensitivity of 36%.

HR-ARM and BET findings were associated with reduced rectal evacuation found on defecography. The median rectal evacuation was 79% if both BET and rectoanal gradient were normal, 35% if either one was abnormal, and 3% if both were abnormal (P < .001). Having either prolonged BET time or reduced anorectal gradient alone had a 73% sensitivity and specificity of 72% for incomplete evacuation on defecography. If both abnormalities were present, the sensitivity was 31% but the specificity was 95%.

A reduced rectoanal gradient was associated with incomplete rectal evacuation (odds ratio, 4.35; P = .002); prolonged BET time showed a similar association (OR, 4.57; P < .001).

The authors proposed terminology to help differentiate the findings: “probable defecatory disorder,” or “probable DD,” to describe patients with one abnormal result from the three tests and “definite DD” for those with two abnormal test results. “Although a single abnormal finding may be a false-positive result, pursuing a trial of biofeedback therapy for patients with a probable DD may be reasonable, especially when defecography is not feasible. However, this approach should be confirmed by prospective studies that assess the response to anorectal biofeedback therapy in patients with probable and definite DD, as defined above.”

The authors disclosed no conflicts of interest. Dr. Staller has consulted for GI Supply.

Among patients with constipation, reduced rectoanal gradient found during high-resolution anorectal manometry (HR-ARM) is the strongest parameter for predicting how a patient is likely to perform on a rectal balloon expulsion test (BET). Findings of both reduced rectoanal gradient and abnormal BET should be considered diagnostic for a defecatory disorder.

Those are the findings of a study out of the Mayo Clinic in Rochester, Minn., which was published in Gastroenterology. The research could help streamline diagnosis of defecatory disorders: Currently there is a lack of consensus on what tests should be performed and in what order to achieve a reliable diagnosis, according to the authors.

The authors recommend that, in patients with a suggestive history, a prolonged time on BET or reduced rectoanal gradient individually indicate a probable defecatory disorder, while the presence of both could be considered diagnostic even in the absence of defecography.

The research should provide clarity about the findings from HR-ARM, which can be complex, according to Kyle Staller, MD, who was asked to comment on the study. “You get lots of different numbers, you get lots of different parameters [with HR-ARM], and figuring out which ones are really relevant is somewhat difficult. [This study] is really a tour de force that distills down many of these parameters into some that we might want to pay attention to more than others,” said Dr. Staller, who is director of the GI Motility Laboratory at Massachusetts General Hospital and a professor of medicine at Harvard Medical School, both in Boston.

He pointed out that one limitation of the study is it didn’t attempt to answer the question of what parameters predict benefit from biofeedback therapy.

“I think the practice right now is that we tend to put the most weight on the balloon expulsion test. I think what this paper convincingly argues is that maybe someone who has an abnormal rectoanal gradient and a normal balloon expulsion test should also be referred for biofeedback with the caveat that we still don’t know if they’re going to do well on biofeedback or not,” said Dr. Staller.

The study included 658 patients, 474 with constipation and 184 healthy controls. In addition to HR-ARM and BET, 158 underwent defecography. Females made up 89% of constipated patients and 73% of healthy individuals. Healthy individuals were younger than constipated individuals (median age 35 versus 49 years).

Overall, 11% of healthy patients and 32% of constipated patients had prolonged BET time (P < .001) and 11% and 21% had a reduced rectoanal gradient on HR-ARM (P = .003). Among those with a normal BET time, 13% had a reduced rectoanal gradient, compared with 34% of those with a prolonged BET time (P < .001).

The authors report that HR-ARM variables had good specificity but worse sensitivity for predicting prolonged BET. The rectoanal gradient was the best-performing variable, with a specificity of 85% and a sensitivity of 36%.

HR-ARM and BET findings were associated with reduced rectal evacuation found on defecography. The median rectal evacuation was 79% if both BET and rectoanal gradient were normal, 35% if either one was abnormal, and 3% if both were abnormal (P < .001). Having either prolonged BET time or reduced anorectal gradient alone had a 73% sensitivity and specificity of 72% for incomplete evacuation on defecography. If both abnormalities were present, the sensitivity was 31% but the specificity was 95%.

A reduced rectoanal gradient was associated with incomplete rectal evacuation (odds ratio, 4.35; P = .002); prolonged BET time showed a similar association (OR, 4.57; P < .001).

The authors proposed terminology to help differentiate the findings: “probable defecatory disorder,” or “probable DD,” to describe patients with one abnormal result from the three tests and “definite DD” for those with two abnormal test results. “Although a single abnormal finding may be a false-positive result, pursuing a trial of biofeedback therapy for patients with a probable DD may be reasonable, especially when defecography is not feasible. However, this approach should be confirmed by prospective studies that assess the response to anorectal biofeedback therapy in patients with probable and definite DD, as defined above.”

The authors disclosed no conflicts of interest. Dr. Staller has consulted for GI Supply.

• Fairbrass et al: Natural history and impact of IBS-type symptoms in inflammatory bowel disease during 6 years of longitudinal follow-up
• Nabi et al: Endometriosis and IBS — a systematic review and meta-analyses
• Wang et al: Factors related to IBS and differences among subtypes — a cross-sectional study in the UK Biobank

Combined diseases can make assessment and treatment very difficult for clinicians. Having a thorough understanding of the pathophysiology and phenotype of each of these diseases is imperative to ensuring that they are managed to the standard of care. When these diseases are in remission and abdominal symptoms persist, it begs the question what is the cause? IBS should always be in the differential diagnosis. The dynamic relationship between the varying presentations of IBS and co-occurring conditions can greatly affect the patient's quality of life and experience with the healthcare system. Thus, it is vital to implement an interdisciplinary approach in order to comprehensively care for the patient and build a therapeutic relationship with the patient. Establishing short-term and long-term goals through shared decision-making will create a foundation of trust and allow for improved patient experience.

• Fairbrass et al: Natural history and impact of IBS-type symptoms in inflammatory bowel disease during 6 years of longitudinal follow-up
• Nabi et al: Endometriosis and IBS — a systematic review and meta-analyses
• Wang et al: Factors related to IBS and differences among subtypes — a cross-sectional study in the UK Biobank

Combined diseases can make assessment and treatment very difficult for clinicians. Having a thorough understanding of the pathophysiology and phenotype of each of these diseases is imperative to ensuring that they are managed to the standard of care. When these diseases are in remission and abdominal symptoms persist, it begs the question what is the cause? IBS should always be in the differential diagnosis. The dynamic relationship between the varying presentations of IBS and co-occurring conditions can greatly affect the patient's quality of life and experience with the healthcare system. Thus, it is vital to implement an interdisciplinary approach in order to comprehensively care for the patient and build a therapeutic relationship with the patient. Establishing short-term and long-term goals through shared decision-making will create a foundation of trust and allow for improved patient experience.

• Fairbrass et al: Natural history and impact of IBS-type symptoms in inflammatory bowel disease during 6 years of longitudinal follow-up
• Nabi et al: Endometriosis and IBS — a systematic review and meta-analyses
• Wang et al: Factors related to IBS and differences among subtypes — a cross-sectional study in the UK Biobank

Combined diseases can make assessment and treatment very difficult for clinicians. Having a thorough understanding of the pathophysiology and phenotype of each of these diseases is imperative to ensuring that they are managed to the standard of care. When these diseases are in remission and abdominal symptoms persist, it begs the question what is the cause? IBS should always be in the differential diagnosis. The dynamic relationship between the varying presentations of IBS and co-occurring conditions can greatly affect the patient's quality of life and experience with the healthcare system. Thus, it is vital to implement an interdisciplinary approach in order to comprehensively care for the patient and build a therapeutic relationship with the patient. Establishing short-term and long-term goals through shared decision-making will create a foundation of trust and allow for improved patient experience.

Patients with inflammatory bowel disease (IBD) are 70% more likely to use benzodiazepines and “Z-drugs” than are the general population, a large study from Canada suggests. 

Mood/anxiety disorders and sleep disorders are common in patients with IBD, but few studies have looked at use of benzodiazepines and Z-drugs (such as zolpidem, zaleplon, and eszopiclone) in this patient population.

The results are “concerning, and especially as the IBD population ages, these drugs are associated with health risks, including something as simple as falls,” first author Charles Bernstein, MD, of the IBD clinical and research centre, University of Manitoba, Winnipeg, told this news organization.

“Clinicians need to find better strategies to deal with anxiety disorders and sleep disorders in the IBD population,” Dr. Bernstein said.

The study was published online in the American Journal of Gastroenterology.
 

High burden of use

Using administrative data from Manitoba, Dr. Bernstein and colleagues identified 5,741 patients with IBD (2,381 with Crohn’s disease and 3,360 with ulcerative colitis) and matched them (1:5) to 28,661 population controls without IBD.

Over a 20-year period (1997-2017), there was a “high burden” of benzodiazepine and Z-drug use in the IBD population. In 2017, roughly 20% of Manitobans with IBD were using benzodiazepines, and 20% were using Z-drugs, the study team reports.

The benzodiazepine use rate (per 1,000) was 28.06 in the IBD cohort vs. 16.83 in the non-IBD population (adjusted rate ratio, 1.67). The use rate for Z-drugs was 21.07 in the IBD cohort vs. 11.26 in the non-IBD population (adjusted RR, 1.87).

Benzodiazepine use declined from 1997 to 2016, but it remained at least 50% higher in patients with IBD than in the general population over this period, the researchers found. The rate of Z-drug use also was higher in the IBD population than in the general population but remained stable over the 20-year study period.

Regardless of age, men and women had similarly high use rates for benzodiazepines, Z-drugs, and joint use of benzodiazepines and Z-drugs. The highest incidence rates for joint benzodiazepine and Z-drug use were in young adults (age 18-44 years), and these rates were similar among men and women.

Patients with IBD and a mood/anxiety disorder also were more likely to use benzodiazepines and Z-drugs and to be continuous users than were those without a mood/anxiety disorder.
 

Mental health and IBD go hand in hand

“The results are not very surprising, but they highlight the importance of mental health and mood disturbances in patients with IBD,” Ashwin Ananthakrishnan, MBBS, MPH, with Massachusetts General Hospital and Harvard Medical School in Boston, who wasn’t involved in the study, told this news organization.

“It is important for treating physicians to be aware of the important mental health implications of IBD diagnosis and disease activity, to screen patients for these disturbances, and to institute early effective interventions,” Dr. Ananthakrishnan said.

Also offering perspective, Laurie Keefer, PhD, academic health psychologist and director of psychobehavioral research within the division of gastroenterology, Mount Sinai Health System, New York, said that she is “concerned but not surprised” by the results of this study.

“One in three patients with IBD meets criteria for an anxiety disorder,” Dr. Keefer told this news organization.

And with the ongoing mental health crisis and shortage of mental health providers, “gastroenterologists are, unfortunately, in the position where they may have to manage these issues,” she said.

Dr. Keefer noted that when patients are first diagnosed with IBD, they will likely be on prednisone, and “an antidote” for the side effects of prednisone are benzodiazepines and sleeping medications because prednisone itself causes insomnia. “However, that’s really just a band-aid,” she said.

A major concern, said Dr. Keefer, is that young men and women who are diagnosed with IBD in their 20s may start using these drugs and become reliant on them.

“People do build up a tolerance to these drugs, so they need more and more to receive the same effect,” she said.

A better approach is to figure out why patients are so anxious and teach them skills to manage their anxiety and sleep problems so that they’re not dependent on these drugs, Dr. Keefer said.

“There are behavioral strategies that can help. These are harder to do, and they’re not a quick fix. However, they are skills you can learn in your 20s and so when you have an IBD flare at 50, you have the skills to deal with it,” she said.

“We just have to be a little more proactive in really encouraging patients to learn disease management skills,” Dr. Keefer added.

The study was funded by the Canadian Institutes of Health Research and Crohn’s and Colitis Canada. Dr. Bernstein has disclosed relationships with AbbVie Canada, Amgen Canada, Bristol-Myers Squibb Canada, Roche Canada, Janssen Canada, Sandoz Canada, Takeda and Takeda Canada, Pfizer Canada, Mylan Pharmaceuticals, and Medtronic Canada. Dr. Ananthakrishnan and Dr. Keefer report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Patients with inflammatory bowel disease (IBD) are 70% more likely to use benzodiazepines and “Z-drugs” than are the general population, a large study from Canada suggests. 

Mood/anxiety disorders and sleep disorders are common in patients with IBD, but few studies have looked at use of benzodiazepines and Z-drugs (such as zolpidem, zaleplon, and eszopiclone) in this patient population.

The results are “concerning, and especially as the IBD population ages, these drugs are associated with health risks, including something as simple as falls,” first author Charles Bernstein, MD, of the IBD clinical and research centre, University of Manitoba, Winnipeg, told this news organization.

“Clinicians need to find better strategies to deal with anxiety disorders and sleep disorders in the IBD population,” Dr. Bernstein said.

The study was published online in the American Journal of Gastroenterology.
 

High burden of use

Using administrative data from Manitoba, Dr. Bernstein and colleagues identified 5,741 patients with IBD (2,381 with Crohn’s disease and 3,360 with ulcerative colitis) and matched them (1:5) to 28,661 population controls without IBD.

Over a 20-year period (1997-2017), there was a “high burden” of benzodiazepine and Z-drug use in the IBD population. In 2017, roughly 20% of Manitobans with IBD were using benzodiazepines, and 20% were using Z-drugs, the study team reports.

The benzodiazepine use rate (per 1,000) was 28.06 in the IBD cohort vs. 16.83 in the non-IBD population (adjusted rate ratio, 1.67). The use rate for Z-drugs was 21.07 in the IBD cohort vs. 11.26 in the non-IBD population (adjusted RR, 1.87).

Benzodiazepine use declined from 1997 to 2016, but it remained at least 50% higher in patients with IBD than in the general population over this period, the researchers found. The rate of Z-drug use also was higher in the IBD population than in the general population but remained stable over the 20-year study period.

Regardless of age, men and women had similarly high use rates for benzodiazepines, Z-drugs, and joint use of benzodiazepines and Z-drugs. The highest incidence rates for joint benzodiazepine and Z-drug use were in young adults (age 18-44 years), and these rates were similar among men and women.

Patients with IBD and a mood/anxiety disorder also were more likely to use benzodiazepines and Z-drugs and to be continuous users than were those without a mood/anxiety disorder.
 

Mental health and IBD go hand in hand

“The results are not very surprising, but they highlight the importance of mental health and mood disturbances in patients with IBD,” Ashwin Ananthakrishnan, MBBS, MPH, with Massachusetts General Hospital and Harvard Medical School in Boston, who wasn’t involved in the study, told this news organization.

“It is important for treating physicians to be aware of the important mental health implications of IBD diagnosis and disease activity, to screen patients for these disturbances, and to institute early effective interventions,” Dr. Ananthakrishnan said.

Also offering perspective, Laurie Keefer, PhD, academic health psychologist and director of psychobehavioral research within the division of gastroenterology, Mount Sinai Health System, New York, said that she is “concerned but not surprised” by the results of this study.

“One in three patients with IBD meets criteria for an anxiety disorder,” Dr. Keefer told this news organization.

And with the ongoing mental health crisis and shortage of mental health providers, “gastroenterologists are, unfortunately, in the position where they may have to manage these issues,” she said.

Dr. Keefer noted that when patients are first diagnosed with IBD, they will likely be on prednisone, and “an antidote” for the side effects of prednisone are benzodiazepines and sleeping medications because prednisone itself causes insomnia. “However, that’s really just a band-aid,” she said.

A major concern, said Dr. Keefer, is that young men and women who are diagnosed with IBD in their 20s may start using these drugs and become reliant on them.

“People do build up a tolerance to these drugs, so they need more and more to receive the same effect,” she said.

A better approach is to figure out why patients are so anxious and teach them skills to manage their anxiety and sleep problems so that they’re not dependent on these drugs, Dr. Keefer said.

“There are behavioral strategies that can help. These are harder to do, and they’re not a quick fix. However, they are skills you can learn in your 20s and so when you have an IBD flare at 50, you have the skills to deal with it,” she said.

“We just have to be a little more proactive in really encouraging patients to learn disease management skills,” Dr. Keefer added.

The study was funded by the Canadian Institutes of Health Research and Crohn’s and Colitis Canada. Dr. Bernstein has disclosed relationships with AbbVie Canada, Amgen Canada, Bristol-Myers Squibb Canada, Roche Canada, Janssen Canada, Sandoz Canada, Takeda and Takeda Canada, Pfizer Canada, Mylan Pharmaceuticals, and Medtronic Canada. Dr. Ananthakrishnan and Dr. Keefer report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Patients with inflammatory bowel disease (IBD) are 70% more likely to use benzodiazepines and “Z-drugs” than are the general population, a large study from Canada suggests. 

Mood/anxiety disorders and sleep disorders are common in patients with IBD, but few studies have looked at use of benzodiazepines and Z-drugs (such as zolpidem, zaleplon, and eszopiclone) in this patient population.

The results are “concerning, and especially as the IBD population ages, these drugs are associated with health risks, including something as simple as falls,” first author Charles Bernstein, MD, of the IBD clinical and research centre, University of Manitoba, Winnipeg, told this news organization.

“Clinicians need to find better strategies to deal with anxiety disorders and sleep disorders in the IBD population,” Dr. Bernstein said.

The study was published online in the American Journal of Gastroenterology.
 

High burden of use

Using administrative data from Manitoba, Dr. Bernstein and colleagues identified 5,741 patients with IBD (2,381 with Crohn’s disease and 3,360 with ulcerative colitis) and matched them (1:5) to 28,661 population controls without IBD.

Over a 20-year period (1997-2017), there was a “high burden” of benzodiazepine and Z-drug use in the IBD population. In 2017, roughly 20% of Manitobans with IBD were using benzodiazepines, and 20% were using Z-drugs, the study team reports.

The benzodiazepine use rate (per 1,000) was 28.06 in the IBD cohort vs. 16.83 in the non-IBD population (adjusted rate ratio, 1.67). The use rate for Z-drugs was 21.07 in the IBD cohort vs. 11.26 in the non-IBD population (adjusted RR, 1.87).

Benzodiazepine use declined from 1997 to 2016, but it remained at least 50% higher in patients with IBD than in the general population over this period, the researchers found. The rate of Z-drug use also was higher in the IBD population than in the general population but remained stable over the 20-year study period.

Regardless of age, men and women had similarly high use rates for benzodiazepines, Z-drugs, and joint use of benzodiazepines and Z-drugs. The highest incidence rates for joint benzodiazepine and Z-drug use were in young adults (age 18-44 years), and these rates were similar among men and women.

Patients with IBD and a mood/anxiety disorder also were more likely to use benzodiazepines and Z-drugs and to be continuous users than were those without a mood/anxiety disorder.
 

Mental health and IBD go hand in hand

“The results are not very surprising, but they highlight the importance of mental health and mood disturbances in patients with IBD,” Ashwin Ananthakrishnan, MBBS, MPH, with Massachusetts General Hospital and Harvard Medical School in Boston, who wasn’t involved in the study, told this news organization.

“It is important for treating physicians to be aware of the important mental health implications of IBD diagnosis and disease activity, to screen patients for these disturbances, and to institute early effective interventions,” Dr. Ananthakrishnan said.

Also offering perspective, Laurie Keefer, PhD, academic health psychologist and director of psychobehavioral research within the division of gastroenterology, Mount Sinai Health System, New York, said that she is “concerned but not surprised” by the results of this study.

“One in three patients with IBD meets criteria for an anxiety disorder,” Dr. Keefer told this news organization.

And with the ongoing mental health crisis and shortage of mental health providers, “gastroenterologists are, unfortunately, in the position where they may have to manage these issues,” she said.

Dr. Keefer noted that when patients are first diagnosed with IBD, they will likely be on prednisone, and “an antidote” for the side effects of prednisone are benzodiazepines and sleeping medications because prednisone itself causes insomnia. “However, that’s really just a band-aid,” she said.

A major concern, said Dr. Keefer, is that young men and women who are diagnosed with IBD in their 20s may start using these drugs and become reliant on them.

“People do build up a tolerance to these drugs, so they need more and more to receive the same effect,” she said.

A better approach is to figure out why patients are so anxious and teach them skills to manage their anxiety and sleep problems so that they’re not dependent on these drugs, Dr. Keefer said.

“There are behavioral strategies that can help. These are harder to do, and they’re not a quick fix. However, they are skills you can learn in your 20s and so when you have an IBD flare at 50, you have the skills to deal with it,” she said.

“We just have to be a little more proactive in really encouraging patients to learn disease management skills,” Dr. Keefer added.

The study was funded by the Canadian Institutes of Health Research and Crohn’s and Colitis Canada. Dr. Bernstein has disclosed relationships with AbbVie Canada, Amgen Canada, Bristol-Myers Squibb Canada, Roche Canada, Janssen Canada, Sandoz Canada, Takeda and Takeda Canada, Pfizer Canada, Mylan Pharmaceuticals, and Medtronic Canada. Dr. Ananthakrishnan and Dr. Keefer report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Key clinical point: Pediatric patients with irritable bowel syndrome (IBS) and normal weight had higher levels of fecal calprotectin than those with IBS and obesity, suggesting the role of obesity and intestinal inflammation in the development and manifestations of IBS in children.

Major finding: The mean calprotectin levels were significantly higher in patients with body mass index <85^th vs 85^th to <95^th percentile (P = .028) and ≥95^th percentile (P ≥ .025), with the difference being prominent among children aged between 6 and 12 years (P = .029) but not among adolescents aged between 12 and 18 years (P = .139).

Study details: The data come from a retrospective analysis of 277 pediatric patients with IBS.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Kim JH et al. Association between body mass index and fecal calprotectin levels in children and adolescents with irritable bowel syndrome. Medicine (Baltimore). 2022;101(32):e29968 (Aug 12). Doi: 10.1097/MD.0000000000029968.

Key clinical point: Pediatric patients with irritable bowel syndrome (IBS) and normal weight had higher levels of fecal calprotectin than those with IBS and obesity, suggesting the role of obesity and intestinal inflammation in the development and manifestations of IBS in children.

Major finding: The mean calprotectin levels were significantly higher in patients with body mass index <85^th vs 85^th to <95^th percentile (P = .028) and ≥95^th percentile (P ≥ .025), with the difference being prominent among children aged between 6 and 12 years (P = .029) but not among adolescents aged between 12 and 18 years (P = .139).

Study details: The data come from a retrospective analysis of 277 pediatric patients with IBS.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Kim JH et al. Association between body mass index and fecal calprotectin levels in children and adolescents with irritable bowel syndrome. Medicine (Baltimore). 2022;101(32):e29968 (Aug 12). Doi: 10.1097/MD.0000000000029968.

Key clinical point: Pediatric patients with irritable bowel syndrome (IBS) and normal weight had higher levels of fecal calprotectin than those with IBS and obesity, suggesting the role of obesity and intestinal inflammation in the development and manifestations of IBS in children.

Major finding: The mean calprotectin levels were significantly higher in patients with body mass index <85^th vs 85^th to <95^th percentile (P = .028) and ≥95^th percentile (P ≥ .025), with the difference being prominent among children aged between 6 and 12 years (P = .029) but not among adolescents aged between 12 and 18 years (P = .139).

Study details: The data come from a retrospective analysis of 277 pediatric patients with IBS.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Kim JH et al. Association between body mass index and fecal calprotectin levels in children and adolescents with irritable bowel syndrome. Medicine (Baltimore). 2022;101(32):e29968 (Aug 12). Doi: 10.1097/MD.0000000000029968.

Key clinical point: Meta-analysis indicated a relatively higher but nonsignificantly increased risk for Helicobacter pylori infection (HPI) in patients with irritable bowel syndrome (IBS) vs non-IBS participants; however, the association between IBS and HPI could be an underestimation, with a positive association persisting between HPI and diarrhea-type IBS (IBS-D).

Major finding: A nonsignificant positive association was observed between HPI and IBS (odds ratio [OR], 1.03 ;lt; P = .84); however, the association was significant after excluding studies with defined confounding factors (adjusted OR, 1.29; P = .03), indicating an underestimation. The positive association of HPI persisted with IBS-D (OR, 1.54; P = .0003) but not with IBS-C (P = .17) or IBS-M (P = .33).

Study details: Findings are from a systematic review and meta-analysis of 13 studies including 1,403 patients with IBS and 11,770 non-IBS participants.

Disclosures: This research was funded by the National Natural Science Foundation of China and the Natural Science Foundation of Guangdong Province. The authors declared no conflicts of interest.

Source: Wang Z et al. Helicobacterpylori infection-A risk factor for irritable bowel syndrome? An updated systematic review and meta-analysis. Medicina (Kaunas). 2022;58(8):1035 (Aug 2). Doi: 10.3390/medicina58081035.

Key clinical point: Meta-analysis indicated a relatively higher but nonsignificantly increased risk for Helicobacter pylori infection (HPI) in patients with irritable bowel syndrome (IBS) vs non-IBS participants; however, the association between IBS and HPI could be an underestimation, with a positive association persisting between HPI and diarrhea-type IBS (IBS-D).

Major finding: A nonsignificant positive association was observed between HPI and IBS (odds ratio [OR], 1.03 ;lt; P = .84); however, the association was significant after excluding studies with defined confounding factors (adjusted OR, 1.29; P = .03), indicating an underestimation. The positive association of HPI persisted with IBS-D (OR, 1.54; P = .0003) but not with IBS-C (P = .17) or IBS-M (P = .33).

Study details: Findings are from a systematic review and meta-analysis of 13 studies including 1,403 patients with IBS and 11,770 non-IBS participants.

Disclosures: This research was funded by the National Natural Science Foundation of China and the Natural Science Foundation of Guangdong Province. The authors declared no conflicts of interest.

Source: Wang Z et al. Helicobacterpylori infection-A risk factor for irritable bowel syndrome? An updated systematic review and meta-analysis. Medicina (Kaunas). 2022;58(8):1035 (Aug 2). Doi: 10.3390/medicina58081035.

Key clinical point: Meta-analysis indicated a relatively higher but nonsignificantly increased risk for Helicobacter pylori infection (HPI) in patients with irritable bowel syndrome (IBS) vs non-IBS participants; however, the association between IBS and HPI could be an underestimation, with a positive association persisting between HPI and diarrhea-type IBS (IBS-D).

Major finding: A nonsignificant positive association was observed between HPI and IBS (odds ratio [OR], 1.03 ;lt; P = .84); however, the association was significant after excluding studies with defined confounding factors (adjusted OR, 1.29; P = .03), indicating an underestimation. The positive association of HPI persisted with IBS-D (OR, 1.54; P = .0003) but not with IBS-C (P = .17) or IBS-M (P = .33).

Study details: Findings are from a systematic review and meta-analysis of 13 studies including 1,403 patients with IBS and 11,770 non-IBS participants.

Disclosures: This research was funded by the National Natural Science Foundation of China and the Natural Science Foundation of Guangdong Province. The authors declared no conflicts of interest.

Source: Wang Z et al. Helicobacterpylori infection-A risk factor for irritable bowel syndrome? An updated systematic review and meta-analysis. Medicina (Kaunas). 2022;58(8):1035 (Aug 2). Doi: 10.3390/medicina58081035.

Key clinical point: Irritable bowel syndrome (IBS) is prevalent among veterans and is associated with significant psychological comorbidities.

Major finding: Overall, 28.4% of veterans met Rome IV IBS criteria, and significant associations of IBS with anxiety (adjusted odds ratio [aOR], 3.47; P < .001), depression (aOR, 2.88; P < .001), post-traumatic stress disorder (aOR, 3.09; P < .001), prior infectious enteritis (aOR, 4.44; P < .001), and a history of bowel problems after antibiotics (aOR, 1.84; P = .005) were observed.

Study details: The data come from a cross-sectional survey including 858 veteran respondents (mean age, 53.6 years), of whom 244 had IBS.

Disclosures: The authors declared no conflicts of interest.

Source: Shin A et al. The prevalence, humanistic burden, and healthcare impact of irritable bowel syndrome (IBS) among United States veterans. Clin Gastroenterol Hepatol. 2022 (Aug 11). Doi: 10.1016/j.cgh.2022.08.005.

Key clinical point: Irritable bowel syndrome (IBS) is prevalent among veterans and is associated with significant psychological comorbidities.

Major finding: Overall, 28.4% of veterans met Rome IV IBS criteria, and significant associations of IBS with anxiety (adjusted odds ratio [aOR], 3.47; P < .001), depression (aOR, 2.88; P < .001), post-traumatic stress disorder (aOR, 3.09; P < .001), prior infectious enteritis (aOR, 4.44; P < .001), and a history of bowel problems after antibiotics (aOR, 1.84; P = .005) were observed.

Study details: The data come from a cross-sectional survey including 858 veteran respondents (mean age, 53.6 years), of whom 244 had IBS.

Disclosures: The authors declared no conflicts of interest.

Source: Shin A et al. The prevalence, humanistic burden, and healthcare impact of irritable bowel syndrome (IBS) among United States veterans. Clin Gastroenterol Hepatol. 2022 (Aug 11). Doi: 10.1016/j.cgh.2022.08.005.

Key clinical point: Irritable bowel syndrome (IBS) is prevalent among veterans and is associated with significant psychological comorbidities.

Major finding: Overall, 28.4% of veterans met Rome IV IBS criteria, and significant associations of IBS with anxiety (adjusted odds ratio [aOR], 3.47; P < .001), depression (aOR, 2.88; P < .001), post-traumatic stress disorder (aOR, 3.09; P < .001), prior infectious enteritis (aOR, 4.44; P < .001), and a history of bowel problems after antibiotics (aOR, 1.84; P = .005) were observed.

Study details: The data come from a cross-sectional survey including 858 veteran respondents (mean age, 53.6 years), of whom 244 had IBS.

Disclosures: The authors declared no conflicts of interest.

Source: Shin A et al. The prevalence, humanistic burden, and healthcare impact of irritable bowel syndrome (IBS) among United States veterans. Clin Gastroenterol Hepatol. 2022 (Aug 11). Doi: 10.1016/j.cgh.2022.08.005.

Key clinical point: Somatization and celiac disease are the primary risk factors associated with irritable bowel syndrome (IBS) in both men and women.

Major finding: The risk for IBS was almost 4-fold higher in men (adjusted odds ratio [aOR] 4.786; 95% CI 4.544-5.041) and women (aOR 5.326; 95% CI 4.863-5.832) experiencing somatization, with the second important influencing factor being celiac disease (men: aOR 4.107; 95% CI 3.132-5.385; women: aOR 3.783; 95% CI 3.310-4.323).

Study details: This study included 31,918 participants who met the Rome III criteria for IBS and completed the Digestive Health Questionnaire.

Disclosures: This study was supported by QW of the National Natural Science Foundation of China and the National Office for Philosophy and Social Sciences. The authors declared no potential conflicts of interest.

Source: Wang K et al. Factors related to irritable bowel syndrome and differences among subtypes: A cross-sectional study in the UK Biobank. Front Pharmacol. 2022;13:905564 (Aug 26). Doi: 10.3389/fphar.2022.905564

Key clinical point: Somatization and celiac disease are the primary risk factors associated with irritable bowel syndrome (IBS) in both men and women.

Major finding: The risk for IBS was almost 4-fold higher in men (adjusted odds ratio [aOR] 4.786; 95% CI 4.544-5.041) and women (aOR 5.326; 95% CI 4.863-5.832) experiencing somatization, with the second important influencing factor being celiac disease (men: aOR 4.107; 95% CI 3.132-5.385; women: aOR 3.783; 95% CI 3.310-4.323).

Study details: This study included 31,918 participants who met the Rome III criteria for IBS and completed the Digestive Health Questionnaire.

Disclosures: This study was supported by QW of the National Natural Science Foundation of China and the National Office for Philosophy and Social Sciences. The authors declared no potential conflicts of interest.

Source: Wang K et al. Factors related to irritable bowel syndrome and differences among subtypes: A cross-sectional study in the UK Biobank. Front Pharmacol. 2022;13:905564 (Aug 26). Doi: 10.3389/fphar.2022.905564

Key clinical point: Somatization and celiac disease are the primary risk factors associated with irritable bowel syndrome (IBS) in both men and women.

Major finding: The risk for IBS was almost 4-fold higher in men (adjusted odds ratio [aOR] 4.786; 95% CI 4.544-5.041) and women (aOR 5.326; 95% CI 4.863-5.832) experiencing somatization, with the second important influencing factor being celiac disease (men: aOR 4.107; 95% CI 3.132-5.385; women: aOR 3.783; 95% CI 3.310-4.323).

Study details: This study included 31,918 participants who met the Rome III criteria for IBS and completed the Digestive Health Questionnaire.

Disclosures: This study was supported by QW of the National Natural Science Foundation of China and the National Office for Philosophy and Social Sciences. The authors declared no potential conflicts of interest.

Source: Wang K et al. Factors related to irritable bowel syndrome and differences among subtypes: A cross-sectional study in the UK Biobank. Front Pharmacol. 2022;13:905564 (Aug 26). Doi: 10.3389/fphar.2022.905564

Key clinical point: Supplementation with a multistrain probiotic for 30 days improved intestinal permeability, stool consistency, and health-related quality-of-life (QoL) in a considerable proportion of patients with diarrhea-predominant irritable bowel syndrome (IBS-D).

Major finding: On day 30, the intestinal permeability improved or normalized in 81.5% of patients, with the intestinal permeability decreasing by 3.4 units (P = .0005), the Bristol Stool Scale score decreasing by 0.9 units (P = .0057), and the IBS-QoL total score increasing by 8.0 points (95% CI 3.0-12.9). The multistrain probiotic was well tolerated.

Study details: The data come from a pilot, open-label, prospective, phase 4 study including 30 patients with IBS-D and leaky gut who received 2 capsules of multistrain probiotic daily for 30 days.

Disclosures: This study was sponsored by PiLeJe Laboratoire. SA Abdellah and C Gal declared being employees of PiLeJe Laboratoire. L Laterza and A Gasbarrini reported ties with various sources.

Source: Ait Abdellah S et al. Effect of a multistrain probiotic on leaky gut in patients with diarrhea-predominant irritable bowel syndrome (IBS-D): A pilot study. Dig Dis. 2022 (Aug 25). Doi: 10.1159/000526712

Key clinical point: Supplementation with a multistrain probiotic for 30 days improved intestinal permeability, stool consistency, and health-related quality-of-life (QoL) in a considerable proportion of patients with diarrhea-predominant irritable bowel syndrome (IBS-D).

Major finding: On day 30, the intestinal permeability improved or normalized in 81.5% of patients, with the intestinal permeability decreasing by 3.4 units (P = .0005), the Bristol Stool Scale score decreasing by 0.9 units (P = .0057), and the IBS-QoL total score increasing by 8.0 points (95% CI 3.0-12.9). The multistrain probiotic was well tolerated.

Study details: The data come from a pilot, open-label, prospective, phase 4 study including 30 patients with IBS-D and leaky gut who received 2 capsules of multistrain probiotic daily for 30 days.

Disclosures: This study was sponsored by PiLeJe Laboratoire. SA Abdellah and C Gal declared being employees of PiLeJe Laboratoire. L Laterza and A Gasbarrini reported ties with various sources.

Source: Ait Abdellah S et al. Effect of a multistrain probiotic on leaky gut in patients with diarrhea-predominant irritable bowel syndrome (IBS-D): A pilot study. Dig Dis. 2022 (Aug 25). Doi: 10.1159/000526712

Key clinical point: Supplementation with a multistrain probiotic for 30 days improved intestinal permeability, stool consistency, and health-related quality-of-life (QoL) in a considerable proportion of patients with diarrhea-predominant irritable bowel syndrome (IBS-D).

Major finding: On day 30, the intestinal permeability improved or normalized in 81.5% of patients, with the intestinal permeability decreasing by 3.4 units (P = .0005), the Bristol Stool Scale score decreasing by 0.9 units (P = .0057), and the IBS-QoL total score increasing by 8.0 points (95% CI 3.0-12.9). The multistrain probiotic was well tolerated.

Study details: The data come from a pilot, open-label, prospective, phase 4 study including 30 patients with IBS-D and leaky gut who received 2 capsules of multistrain probiotic daily for 30 days.

Disclosures: This study was sponsored by PiLeJe Laboratoire. SA Abdellah and C Gal declared being employees of PiLeJe Laboratoire. L Laterza and A Gasbarrini reported ties with various sources.

Source: Ait Abdellah S et al. Effect of a multistrain probiotic on leaky gut in patients with diarrhea-predominant irritable bowel syndrome (IBS-D): A pilot study. Dig Dis. 2022 (Aug 25). Doi: 10.1159/000526712

Key clinical point: Endometriosis is associated with a 3-fold increase in the risk for irritable bowel syndrome (IBS), with 1 in every 5 women with endometriosis having IBS.

Major finding: The odds of IBS were significantly higher in women with endometriosis compared with healthy controls (odds ratio 2.97; 95% CI 2.17-4.06), and the pooled prevalence of IBS among women with endometriosis was 23.4% (95% CI 9.7%-37.2%).

Study details: This study evaluated the prevalence of IBS in endometriosis (meta-analysis of 6 studies) and association between endometriosis and IBS (meta-analysis of 11 studies involving 18,887 patients with endometriosis and 77,171 healthy controls).

Disclosures: This study did not report any source of funding. The authors declared no conflicts of interest.

Source: Nabi MY et al. Endometriosis and irritable bowel syndrome: A systematic review and meta-analyses. Front Med (Lausanne). 2022;9:914356 (Jul 25). Doi: 10.3389/fmed.2022.914356

Key clinical point: Endometriosis is associated with a 3-fold increase in the risk for irritable bowel syndrome (IBS), with 1 in every 5 women with endometriosis having IBS.

Major finding: The odds of IBS were significantly higher in women with endometriosis compared with healthy controls (odds ratio 2.97; 95% CI 2.17-4.06), and the pooled prevalence of IBS among women with endometriosis was 23.4% (95% CI 9.7%-37.2%).

Study details: This study evaluated the prevalence of IBS in endometriosis (meta-analysis of 6 studies) and association between endometriosis and IBS (meta-analysis of 11 studies involving 18,887 patients with endometriosis and 77,171 healthy controls).

Disclosures: This study did not report any source of funding. The authors declared no conflicts of interest.

Source: Nabi MY et al. Endometriosis and irritable bowel syndrome: A systematic review and meta-analyses. Front Med (Lausanne). 2022;9:914356 (Jul 25). Doi: 10.3389/fmed.2022.914356

Key clinical point: Endometriosis is associated with a 3-fold increase in the risk for irritable bowel syndrome (IBS), with 1 in every 5 women with endometriosis having IBS.

Major finding: The odds of IBS were significantly higher in women with endometriosis compared with healthy controls (odds ratio 2.97; 95% CI 2.17-4.06), and the pooled prevalence of IBS among women with endometriosis was 23.4% (95% CI 9.7%-37.2%).

Study details: This study evaluated the prevalence of IBS in endometriosis (meta-analysis of 6 studies) and association between endometriosis and IBS (meta-analysis of 11 studies involving 18,887 patients with endometriosis and 77,171 healthy controls).

Disclosures: This study did not report any source of funding. The authors declared no conflicts of interest.

Source: Nabi MY et al. Endometriosis and irritable bowel syndrome: A systematic review and meta-analyses. Front Med (Lausanne). 2022;9:914356 (Jul 25). Doi: 10.3389/fmed.2022.914356

Key clinical point: More than two-thirds of patients with inflammatory bowel disease (IBD) were affected by irritable bowel syndrome (IBS)-type symptoms, which were associated with worse depression, anxiety, somatoform symptoms, and quality-of-life scores.

Major finding: Overall, 67.2% of patients reported IBS-type symptoms at least once during the follow-up, with anxiety, depression, and somatoform symptom scores being worse in patients with vs without IBS-type symptoms (P < .001).

Study details: The data come from a 6-year longitudinal follow-up study including 760 individuals with well-characterized IBD.

Disclosures: This study was funded by The Leeds Teaching Hospitals Charitable Foundation and Tillotts Pharma U.K. Ltd. The authors declared no conflicts of interest.

Source: Fairbrass KM et al. Natural history and impact of irritable bowel syndrome-type symptoms in inflammatory bowel disease during 6 years of longitudinal follow-up. Aliment Pharmacol Ther. 2022 (Aug 22). Doi: 10.1111/apt.17193

Key clinical point: More than two-thirds of patients with inflammatory bowel disease (IBD) were affected by irritable bowel syndrome (IBS)-type symptoms, which were associated with worse depression, anxiety, somatoform symptoms, and quality-of-life scores.

Major finding: Overall, 67.2% of patients reported IBS-type symptoms at least once during the follow-up, with anxiety, depression, and somatoform symptom scores being worse in patients with vs without IBS-type symptoms (P < .001).

Study details: The data come from a 6-year longitudinal follow-up study including 760 individuals with well-characterized IBD.

Disclosures: This study was funded by The Leeds Teaching Hospitals Charitable Foundation and Tillotts Pharma U.K. Ltd. The authors declared no conflicts of interest.

Source: Fairbrass KM et al. Natural history and impact of irritable bowel syndrome-type symptoms in inflammatory bowel disease during 6 years of longitudinal follow-up. Aliment Pharmacol Ther. 2022 (Aug 22). Doi: 10.1111/apt.17193

Key clinical point: More than two-thirds of patients with inflammatory bowel disease (IBD) were affected by irritable bowel syndrome (IBS)-type symptoms, which were associated with worse depression, anxiety, somatoform symptoms, and quality-of-life scores.

Major finding: Overall, 67.2% of patients reported IBS-type symptoms at least once during the follow-up, with anxiety, depression, and somatoform symptom scores being worse in patients with vs without IBS-type symptoms (P < .001).

Study details: The data come from a 6-year longitudinal follow-up study including 760 individuals with well-characterized IBD.

Disclosures: This study was funded by The Leeds Teaching Hospitals Charitable Foundation and Tillotts Pharma U.K. Ltd. The authors declared no conflicts of interest.

Source: Fairbrass KM et al. Natural history and impact of irritable bowel syndrome-type symptoms in inflammatory bowel disease during 6 years of longitudinal follow-up. Aliment Pharmacol Ther. 2022 (Aug 22). Doi: 10.1111/apt.17193