Fecal incontinence in irritable bowel syndrome: Prevalence and associated factors in Swedish and American patients

Fecal incontinence (FI) is a prevalent but poorly recognized problem in the general population with profound negative effects on daily life. The prevalence of FI in IBS and its association with clinical, demographic and pathophysiological factors are largely unknown

Central Processing of Noxious Stimuli in Patients with Irritable Bowel Syndrome Compared to Healthy Controls

Irritable Bowel Syndrome (IBS) is a complex disorder of unknown etiology. Research into the pathophysiology of IBS suggests the involvement of psychological, hormonal, immunological, genetic, cardiovascular, and autonomic nervous system factors, as well as peripheral and central sensitization of pain signals in the etiology and/or maintenance of IBS. Visceral hyperalgesia is consistently observed in IBS patients. However, recent investigations have found evidence of somatic hyperalgesia, not seen in earlier studies, suggesting the possibility of a dysfunction in central pain regulatory mechanisms. Evidence suggests a role for central sensitization in IBS pain. Psychophysical investigations into dysregulation of the endogenous pain regulatory mechanisms of temporal summation and diffuse noxious inhibitory controls (DNIC) have been consistently demonstrated in other chronic pain conditions such as Fibromyalgia and Temporomandibular Disorder, which show high comorbidity with IBS. The primary objective of this investigation was to explore the role of central sensitization in IBS pain by assessing both efferent (DNIC) and afferent (temporal summation) central modulation of nociception in IBS patients. Group differences in psychological, autonomic nervous system, and general pain measures were also assessed. Forty eight pre-menopausal females (27 with IBS) participated in this investigation. No group differences were seen in temporal summation or the DNIC effect on temporal summation. Similarly, no group differences were seen in any general pain measures or in sympathetic tone. IBS subjects reported significantly greater stress than Controls on measures of; state anxiety, depression, catastrophizing, and anger-out expression. IBS subjects also demonstrated significantly lower levels of DNIC than Controls during noxious tonic conditioning stimuli. However, non-noxious conditioning stimuli also produced an apparent DNIC effect in a counterbalanced design. After controlling for non-specific effects occurring in the non-painful conditioning protocol (distraction, and psychological measures associated with DNIC), IBS subjects continue to show deficient DNIC (p < 0.01). This is the second investigation that has attempted to account for non-specific effects in the investigation of DNIC. Only by controlling for non-specific effects, can evidence of deficient DNIC can be attributed to dysregulation in endogenous analgesic mechanisms. Further studies are needed to elucidate whether deficient DNIC is a cause or consequence of IBS pain

Patient preferences for endpoints in fecal incontinence treatment studies

Background: Randomized controlled trials of treatments for fecal incontinence (FI) are difficult to compare because case definitions and study endpoints vary. Our aims were to assess patient perspectives on the case definition for FI and how treatment success should be measured. Methods: In Phase 1, 28 FI patients participated in anonymous on-line focus groups, and in Phase 2, 186 people with FI, stratified by gender, race, and age completed an online survey. Key Results: Focus group participants described frequency and urgency as the most important characteristics for defining FI. Most (80%) thought staining of underwear constitutes FI, but only 33% thought gas leakage was FI. When asked how the success of treatment should be defined, 77% said by a reduction in frequency or complete cure, but less than half thought a 50% reduction in frequency was enough. When asked how much reduction would be needed, responses averaged 80%. The Phase 2 survey confirmed that frequency, urgency, and intestinal discomfort are the most important characteristics for case definition, and that success should be defined by at least a 75% decrease in frequency. A 50% reduction was an acceptable endpoint for 58% overall but only 26% for those aged ≥65. “Adequate relief” was acceptable to 78%. Conclusions and Inferences: Inclusion criteria for trials should specify a minimum frequency of FI. Most patients would require a ≥75% reduction in FI frequency to call a treatment successful but young adults and those with more severe FI would accept a ≥50% reduction as meaningful

Factors That Affect Consultation and Screening for Fecal Incontinence

Fecal incontinence (FI) affects 15% of people age 70 years and older, but only 10%–30% discuss FI with their physicians. We aimed to identify barriers that prevent people from consulting with their physicians, and physicians from screening for FI

Effect of Glycemic Load on Peptide-YY Levels in a Biracial Sample of Obese and Normal Weight Women

Black women suffer a disproportionately higher rate of obesity than their white counterparts. Reasons for this racial disparity may reflect underlying differences in the appetite suppressing peptide-YY (PYY). The PYY response to food is differentially influenced by macronutrient content but the effect of glycemic load on PYY response is unknown. This study examined whether glycemic load influences fasting and postprandial PYY levels and whether fasting and postprandial PYY levels are lower in obese black women compared to normal weight black women and to white women. Data were collected from 40 women (20 black, 20 white; 10 each normal weight vs. obese) at the University of North Carolina Clinical and Translational Research Center (CTRC). Participants completed in counterbalanced order two 4½-day weight-maintenance, mixed macronutrient high vs. low glycemic load diets followed by a test meal of identical composition. Total PYY levels were assessed before and after each test meal. Results show no differences in fasting PYY levels but significantly less postprandial PYY area under the curve (PYYAUC) in the group of obese black women compared to each other group (race × obesity interaction, P 0.27). These findings indicate that postprandial PYY secretion is not affected by glycemic load but is blunted in obese black women compared with normal weight black women and with white women; additionally, they begin to address whether blunted PYY secretion contributes uniquely to the pathogenesis of obesity in black women

Low-Glycemic Load Decreases Postprandial Insulin and Glucose and Increases Postprandial Ghrelin in White but Not Black Women

Alterations in appetite hormones favoring increased postprandial satiety have been implicated in both the glycemic control and potential weight-loss benefits of a low-glycemic diet. Racial differences exist in dietary glycemic load and appetite hormone concentrations. This study examined the impact of glycemic load on appetite hormones in 20 black women [10 normal weight, BMI = 22.8 ± 1.42 (mean ± SD); 10 obese, BMI = 35.1 ± 2.77] and 20 white women (10 normal weight, BMI = 22.9 ± 1.45; 10 obese, BMI = 34.3 ± 2.77). Each woman completed two 4.5-d weight-maintenance, mixed-macronutrient, high-glycemic vs. low-glycemic load diets that concluded with a test meal of identical composition. Blood samples collected before and serially for 3 h after each test meal were assayed for plasma ghrelin and serum insulin and glucose concentrations. Compared with the high-glycemic load meal, the low-glycemic load meal was associated with lower insulinAUC (P = 0.02), glucoseAUC (P = 0.01), and urge to eat ratings (P = 0.05) but with higher ghrelinAUC (P = 0.008). These results suggest the satiating effect of a low-glycemic load meal is not directly linked to enhanced postprandial suppression of ghrelin. Notably, these effects were significant among white but not black women, suggesting that black women may be less sensitive than white women to the glucoregulatory effects of a low-glycemic load. These findings add to a growing literature demonstrating racial differences in postprandial appetite hormone responses. If reproducible, these findings have implications for individualized diet prescription for the purposes of glucose or weight control in women

Central Processing of Noxious Somatic Stimuli in Patients With Irritable Bowel Syndrome Compared With Healthy Controls

To compare a central analgesic mechanism known as diffuse noxious inhibitory controls (DNIC) using somatic test stimuli and somatic conditioning stimuli, (CS) in irritable bowel syndrome (IBS) patients and healthy controls

Fecal Incontinence Diagnosed by the Rome IV Criteria in the United States, Canada, and the United Kingdom

Background & Aims: The diagnostic criteria for fecal incontinence (FI) were made more restrictive in the Rome IV revision. We aimed to determine the characteristics of FI patients defined by the Rome IV criteria, assess how FI frequency and amount affect quality of life, identify risk factors, and compare prevalence values among countries. Methods: We performed an internet-based survey of 5931 subjects in the United States, Canada, and the United Kingdom, from September to December 2015. Subjects were stratified by country, sex, and age. Responders answered questions about diagnosis, health care use, and risk factors. We performed multivariate linear regression analysis to identify risk factors for FI. Results: FI was reported by 957 subjects (16.1%) but only 196 (3.3%) fulfilled the Rome IV criteria. Frequency of FI was less than twice a month for 672/957 subjects (70.2%) and duration was less than 6 months for 285/957 subjects (29.8%). Quality of life was significantly impaired in all subjects with FI compared to subjects with fecal continence. The strongest risk factors for FI were diarrhea, urgency to defecate, and abdominal pain. FI was more prevalent in the United States than in the United Kingdom. Between-country differences were due to less diarrhea and urgency in the United Kingdom. Conclusions: Rome IV FI prevalence is lower than previous estimates because the new criteria exclude many individuals with less frequent or short duration FI. These excluded patients have impaired quality of life. It might be appropriate to make a diagnosis of FI for all patients with FI ≥2 times in 3 months and to provide additional information on frequency, duration, and amount of stool lost to assist clinicians in treatment selection

Endovascular treatment for isolated posterior cerebral artery occlusion stroke in the MR CLEAN registry

BACKGROUND: Endovascular treatment (EVT) is standard of care in anterior circulation large vessel occlusions. In posterior circulation occlusions, data on EVT in isolated posterior cerebral artery (PCA) occlusions are limited, although PCA occlusions can cause severe neurological deficit.OBJECTIVE: To describe in a prospective study the clinical manifestations, outcomes, and safety of EVT in isolated PCA occlusions.METHODS: We used data (2014-2017) from the MR CLEAN Registry, a nationwide, prospective cohort of EVT-treated patients in the Netherlands. We included patients with acute ischemic stroke (AIS) due to an isolated PCA occlusion on CT angiography. Patients with concurrent occlusion of the basilar artery were excluded. Outcomes included change in National Institutes of Health Stroke Scale (ΔNIHSS) score, modified Rankin Scale (mRS) score 0-3 after 90 days, mortality, expanded Thrombolysis in Cerebral Infarction (eTICI), and periprocedural complications.RESULTS: Twenty (12%) of 162 patients with posterior circulation occlusions had an isolated PCA occlusion. Median age was 72 years; 13 (65%) were women. Median baseline NIHSS score was 13 (IQR 5-21). Six (30%) patients were comatose. Twelve patients (60%) received IVT. Median ΔNIHSS was -4 (IQR -11-+1). At follow-up, nine patients (45%) had mRS score 0-3. Seven (35%) died. eTICI 2b-3 was achieved in 13 patients (65%). Nine patients (45%) had periprocedural complications. No symptomatic intracranial hemorrhages (sICH) occurred.CONCLUSIONS: EVT should be considered in selected patients with AIS with an isolated PCA occlusion, presenting with moderate-severe neurological deficits, as EVT was technically feasible in most of our patients and about half had good clinical outcome. In case of lower NIHSS score, a more conservative approach seems warranted, since periprocedural complications are not uncommon. Nonetheless, EVT seems reasonably safe considering the absence of sICH in our study.</p