Rome III Criteria for IBS. Irritable Bowel Syndrome: What s the Latest? IBS: What s the Latest? Distinguishing IBS-C from CC
|
|
- Elinor Lindsey
- 6 years ago
- Views:
Transcription
1 Rome III Criteria for IBS Irritable Bowel Syndrome: What s the Latest? Tim Burke, DO Pacific Digestive Associates Clackamas, OR Recurrent abdominal pain or discomfort at least 3 days/month in the last 3 months associated with 2 of the following: Improvement with defecation Onset associated with a change in frequency of stool Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis Onset associated with change in form of stool Longstreth GF, et al. Gastroenterology2006; 130: IBS: What s the Latest? IBS subtypes: patients aren t stagnant Distinguishing IBS-C from CC Utility of testing Methane Antibiotics Probiotics Celiac disease Diet Osmotic agents Secretagogues In Clinical Practice Patients Move from Group to Group IBS-C IBS-M CC Simren M, et al. Scand J Gastroenterol 2001; 36(5): Tillisch K, et al. Am J Gastroenterol 2005; 100(4): Simren M, et al. Eur J Gastroenterol Hepatol 2003; 15(2): Simren M, et al. Gastroenterology2005; 128(3):580-9 Simren M, et al. Am J Gastroenterol 2010; 105: IBS-C: IBS with constipation CC: Chronic Constipation IBS-M: mixed or alternating symptoms of constipation and diarrhea Distinguishing IBS-C from CC No firm rationale to distinguish IBS-C from CC by the Rome committee Treatments are often similar Tegaserod (no longer available in N.A.) Lubiprostone Prucalopride (available in the EU) Linaclotide Distinguishing IBS-C from CC Symptom-based criteria for CC and IBS overlap Abdominal pain/discomfort and gas/bloating creates a spectrum between CC and IBS - PAIN/DISCOMFORT & GAS/BLOATING + CC IBS-C Brandt LJ, et al. Am J Gastroenterol 2005; 100(suppl 1): S5 1
2 Utility of Testing: Yield of Colonoscopy in IBS Lesion Histologic Findings in IBS Patients and Controls; Populations Not Matched for Age and Gender IBS Patients n=466 Controls n=451 PValue Adenomas 36 (7.7) 118 (26.1) < Hyperplastic Polyps 39 (8.4) 52 (11.5) NS Colorectal adenocarcinoma 0 (0.0) 1 (0.2) NS IBD 2 (0.4) 0 (0.0) NS Microscopic colitis 7 (1.5) N/A N/A Pretest Probability of Organic Disease 1 Organic Disease IBS Patients Control/Population Colitis/IBD Colorectal cancer (varies with age) Lactose malabsorption Thyroid dysfunction Celiac Disease Celiac disease: antibodies Celiac disease: confirmed Microscopic colitis was more common in a subset of patients with IBS-D who were 45 years (2.3%). IBD, inflammatory bowel disease; IBS-D, irritable bowel syndrome diarrhea-predominant; N/A, not applicable; NS, not significant. Chey WD, et al. Am J Gastroenterol 2010; 105: American College of Gastroenterology Task Force on Irritable Bowel Syndrome, et al. Am J Gastroenterol 2009; 104(suppl 1): S1-S Cash BD, et al. Gastroenterology2011; 141: Methane & Constipation Methane and Constipation About 1/3 rd of the population produces CH 4 Prevalence of CH 4 in slow transit Constipation AUC of methane on breath test Predominant organism is Methanobrevibacter smithii Thought to be present in 60% of humans in left colon per g dry weight Attaluri, et al. Am J Gastro, 2010;105, Methane Gas Infusion Slows Transit 69% mean slowing of transit Rifaximin: Most Extensively Studied Antibiotic for IBS Gut-directed antibiotic Not systemically absorbed Doses studied for IBS: 400 mg BID to 550 mg TID Generally well tolerated Adverse effects include: headache, abdominal pain, and upper respiratory tract infection Pimentel, et al. AJPGI. 290;1089,2006. *This agent is not currently FDA approved for IBS Ford AC, et al. Clin Gastroenterol Hepatol 2009;7: Pimentel M, et al. N Engl J Med 2011; 364:
3 RifaximinTrials: Global Relief of IBS Without Constipation 2 Phase 3 randomized controlled trials; n=1260 patients Rifaximin 550 mg TID x 2 weeks; patients followed additional 10 weeks Probiotics What about Probiotics? Could some methane-producing bacteria respond to probiotics? 40.7% vs. 31.7% with adequate relief of global symptoms (p<0.001) T-I, TARGET 1 trial; T-II, TARGET 2 trial; Comb, Combination of both trials. *Rifaximin is not currently FDA-pproved for IBS Pimentel M, et al. N Engl J Med 2011;364:22-32 Probiotics for IBS Lactobacilli anaerobic, gram (+) rods casei plantarum acidophilus reuteri Bifidobacteria anaerobic, gram (+) rods VSL #3 (8 separate organisms: 3 Bifidobacteria, 1 Stretococcus, 4 Lactobacilli) Enterococcus Streptococcus salivarius Saccharomyces Probiotics: Mechanisms of Action Competitive inhibition Barrier protection Immune effects Anti-inflammatory effects Production of various substances (enzymes, SCFA, bacteriocidal agents) Ability to alter local ph and physiology Provides nutrition to colonocytes Moayyedi P, et al. GUT 2010:59: Epub 2008 Dec 17 Camilleri. J Clin Gastroenterol2006;40,264. BifidobacteriaInfantis35624 for IBS Global Assessment of Relief B Infantis B Infantis B Infantis Placebo 1x x10 8 1x10 6 SGA: (Subjects Global Assessment) a yes/no response to the following question: Please consider how your felt in the past week in regard to your IBS, in particular your general well being, and symptoms of abdominal discomfort or pain, bloating or distention, and altered bowel habit. Compared with the way you felt before beginning the medication, have you had adequate relief of your IBS symptoms? Whorwell PJ, et al. Am J Gastroenterol 2006;101: Wheat & IBS Gluten-related disorders Celiac disease Dermatitis herpetiformis Gluten Ataxia Non-celiac gluten sensitivity 3
4 Gluten A storage protein in wheat, barley, and rye Genetically susceptible individuals (HLA-DQ2 and HLA-DQ8) develop an immune response Worldwide prevalence of celiac disease in IBS patients = 4% 1 US prevalence of celiac disease in IBS patients = 0.41% 2 KEY POINT: The vast majority of IBS patients do not have celiac disease Low carbohydrate Low fructose/fructan IBS & Diet Low gluten Low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccarides, and Polyol) 1 Green. Lancet 362; 383:2003; 2 Cash et al. Gastroenterology141;1187:2011 Low Carbohydrate Diet Prospective, randomized, controlled study 17 moderate-severe IBS-D patients 4-week very low carbohydrate diet (VLCD) 51% fat; 45% protein; 4% carbohydrate Endpoint: adequate relief for > 2weeks 13 completed the study All 13 met the responder definition 10 experienced adequate relief for all 4 weeks Low Carbohydrate Diet Secondary Endpoints also improved Decrease in stool frequency Improvement in stool consistency Decreased abdominal pain Improvement in quality-of-life Austin et al, Clin Gastro & Hepatol7;706:2009 IBS & Low Fructose/Fructan Diet 26 IBS patients with fructose malabsorption (Rome II; + breath test; mean age = 38) Prior response to low fructose/low fructan diet Randomly re-challenged with offending foods 70% of those receiving fructose, 77% receiving fructans, and 79% receiving a mixture noted return/worsening of symptoms compared to glucose (14%; p < 0.002) Sheperdet al, Clin GastroenterolHepatol2008; 6: IBS & Low Gluten R, DB, PC, re-challenge study 34 IBS patients (Rome III); celiac excluded Prior improvement in Sx on gluten-free diet 16 gm of non-fermentable gluten/day vs. 16 grams of gluten Primary endpoint: adequate symptom relief Gluten-group had less improvement in Sx than those on gluten-free (68% vs. 40%; p =.001) Biesiekierski et al, Am J Gastro 2011;106:508. 4
5 IBS & Low Gluten Diet IBS and Gluten-free Diet 45 Pts with ISB-D (43 women); 4-weeks Gluten-free diet (23) vs. Gluten-diet (22) Genotype analysis performed Stool frequency, intestinal transit and intestinal permeability measured Results: Gluten diet was associated with increased SB permeability, especially in HLA- DQ2/8 positive patients Biesiekierski et al, Am J Gastro, 2011; 106:508. Vazquez-Roque et al, Gastroenterology2013; 144: What Are FODMAPs? Fermentable Oligo-, Di-, Monosaccharides And Polyols Excess Fructose Fructans Sorbitol Raffinose Honey, apples, pears, peaches, mangos, fruit juice, dried fruit Wheat(large amounts), rye (large amounts), onions, leeks, zucchini Apricots, peaches, artificial sweeteners, artificially sweetened gums Lentils, cabbage, brussel sprouts, asparagus, green beans, legumes IBS & Low FODMAP Diet: Or, what is there left to eat? Lean proteins Gluten-free breads, rolls, pasta Rice, corn, oat products Quinoa Safe fruits and vegetables: Snow peas, bok choy, mangarin oranges Shepherd SJ, et al. J Am Diet Assoc.2006;106: Shepherd SJ, et al. Clin GastroenterolHepatol2008;6: Gibson PR, et al. J GastroenterolHepatol 2010;25: IBS & Low FODMAP Diet: Some Problems Exist What is the cut-off for FODMAP content? Resources differ on low FODMAP diets Total meal FODMAPs should be counted, not individual FODMAPs IBS: Prospective study to Evaluate Low FODMAP diet 82 consecutive IBS patients (NICE criteria) Detailed symptom and dietary evaluation 9 month evaluation performed in UK Individual symptoms and global IBS symptoms measured 39 in the standard diet group 42 in the low FODMAP diet group Staudacheret al, J Hum Nutr Diet, 2011, 24,
6 Improvements in IBS Symptom Scores: Low FODMAP vs. Control Diet * *p p < 0.05 IBS Symptom Improvement: Low FODMAP Diet vs. Standard Diet Bloating (82% vs. 49%) Abdominal pain (85% vs. 61%) Flatulence (87% vs. 50%) Nausea (67% vs. 29%) Diarrhea (83% vs. 62%; ns) Composite symptom score (86% vs. 49%) Staudacher HM, et al. J Hum Nutr Diet 2011;24: Osmotic Agents: PEG for IBS-C SMs, bowel movements; PEG, polyethylene glycol KhoshooV, et al. Aliment PharmacolTher2006;23: adolescents: PEG improved number of BMs (p < 0.05) but not pain in IBS-C patients Osmotic Agents: PEG for IBS-C Prospective, multi-center, R, DB, PC Rome III criteria 139 patients (mean age = 41; 83% women) 28 day study; 13.8 gm/sachet; 1-3 sachets/day vs. placebo Primary endpoint: mean # of SBM/day Results: At week 4, 4.4 SBM/week vs. 3.1 SBM/week (PEG vs. placebo; p <.0001) Chapman. Am J Gastroenterol 2013;108,1508 PEG 3350 for IBS-C Efficacy of Linaclotidein Patients with IBS-C Treatment Period* RW Period n = 800 Treatment Period RW Treatment Sequence ANCOVA, analysis of convariance; RW, randomized withdrawl Rao S, et al. Am J Gastroenterol2012;107: *p < for linaclotide patients vs. placebo patients (ANCOVA) p < for linaclotide/linaclotide patients vs. linaclotide/placebo patients (ANCOVA) 6
7 Linaclotide Phase 3 IBS-C Trial: Adbominal Pain Over 26 Weeks p = for week 1 P < for weeks 2-26 Summary IBS is a constantly evolving field Rome IV 2015 expect changes in the definition Our understanding of IBS physiology continues to expand Expect new treatment options within the next few years ITT population, observed cases, LS-mean presented: p-values basted on ANCOVA at each week. Bars represent 95% CI ITT, intention to treat; LS, least squares n = 804 CheyWD, et al. Am J Gastroenterol2012;107:
What s the Latest? Rome III Criteria for IBS
Irritable Bowel lsyndrome: What s the Latest? American College of Gastroenterology Las Vegas, January 2014 Bi Brian E. Lacy, Ph.D., PhD M.D., MD FACG Professor of Medicine Geisel School of Medicine at
More informationAn Evidence-based Approach to Dietary Treatment of Irritable Bowel Syndrome
An Evidence-based Approach to Dietary Treatment of Irritable Bowel Syndrome American College of Gastroenterology August 2014, Indianapolis Brian E. Lacy, Ph.D., M.D. Professor of Medicine, Geisel School
More informationTreatment of IBS - Diet or Drugs?
Treatment of IBS - Diet or Drugs? Brooks D. Cash, MD, FACG Professor of Medicine University of South Alabama Director, GI Physiology, USA Medical Center Mobile, AL Learning objectives Review the evolving
More informationSlide #43. Functional Disorders - An Update 11/8/ MA ACP Annual Scientific Meeting. Functional Disorders: An Update
Functional Disorders: An Update Anthony Lembo, M.D. Associate Professor of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston, MA Disclosure of Financial Relationships Anthony
More informationWilliam D. Chey, MD, FACG. Page 1 of ACG Midwest Regional Postgraduate Course Copyright 2016 American College of Gastroenterology
Dietary and Other Non-pharmacological Management of IBS William D. Chey, MD, FACG Nostrant Professor of Medicine Director GI Nutrition Program University of Michigan Peter Loftus, May 2, 2016 Page 1 of
More informationWilliam D. Chey, MD Professor of Medicine University of Michigan
Evidence-based Treatment Strategies for IBS William D. Chey, MD Professor of Medicine University of Michigan Rome III criteria for IBS Recurrent abdominal pain or discomfort at least 3 days / month in
More informationManagement of Functional Bowel Disorders
Management of Functional Bowel Disorders Amy Foxx-Orenstein, DO, FACG, FACP Professor of Medicine Mayo Clinic Tucson Osteopathic Medical Foundation May 1, 2016 Objectives Review epidemiology and pathophysiology
More informationIrritable Bowel Syndrome
Irritable Bowel Syndrome Irritable bowel syndrome (IBS) has a variety of symptoms, most commonly cramping, abdominal pain, bloating, constipation, and diarrhea. Symptoms can vary from person to person,
More informationThe long-term impact of the low-fodmap diet for management of irritable bowel syndrome. Dr Miranda Lomer RD.
The long-term impact of the low-fodmap diet for management of irritable bowel syndrome Dr Miranda Lomer RD Email: miranda.lomer@kcl.ac.uk What is IBS - ROME IV Criteria A functional bowel disorder in which
More informationFood Choices and Alternative Techniques in Management of IBS: Fad Versus Evidence
Food Choices and Alternative Techniques in Management of IBS: Fad Versus Evidence Maria Vazquez Roque, MD, MSc Assistant Professor Gastroenterology and Hepatology 2010 MFMER slide-1 Objectives Gluten-free
More informationSESSION 5 2:30pm 3:45pm
SESSION 5 2:3pm 3:45pm Optimizing the Diagnosis, Treatment, and Management of Irritable Bowel Syndrome SPEAKERS Richard J. Saad, MD, MS Spencer Dorn, MD, MPH, MHA Presenter Disclosure Information The following
More informationState of the Art: Management of Irritable Bowel Syndrome
ACG/FGS Annual Spring Symposium March 16-18, 2018 Bonita Springs, FL State of the Art: Management of Irritable Bowel Syndrome William D. Chey, MD Professor of Medicine University of Michigan IBS: Rome
More informationRefractory IBS-D: An Evidence-Based Approach to Therapy
Refractory IBS-D: An Evidence-Based Approach to Therapy Darren M. Brenner, MD, AGAF Associate Professor of Medicine and Surgery Director, Northwestern Neurogastromotility, Functional, and Integrated Bowel
More informationIt is believed that a meal plan that includes low FODMAPs also may help ease symptoms from other health conditions, such as:
If you have digestive issues, this could be why. You don't have to have IBS (Irritable Bowel Syndrome) or Colitis (a chronically inflammed colon), to experience some of these symptoms. FODMAP The acronym
More informationGETTING REAL WITH GUT HEALTH
THE IMPORTANCE OF YOUR HEALTH STORY Reflections Do you regularly experience any of the following: Indigestion or food repeats on you after you eat Excessive burping or belching following meals Bloating
More informationDiagnosis and Management of Irritable Bowel Syndrome (IBS) For the Primary Care Provider
Diagnosis and Management of Irritable Bowel Syndrome (IBS) For the Primary Care Provider Elizabeth Coss, MD General Gastroenterologist Audie Murphy Veterans Hospital UT Health This presentation does not
More informationWhat Is the Low-FODMAP Diet?
LOW-FODMAP DIET What Is the Low-FODMAP Diet? FODMAP refers to a group of five sugars found in certain foods. These sugars are lactose, fructose (in excess), fructans, galactans and polyols. Specifically,
More informationWHOLE HEALTH: INFORMATION FOR VETERANS. Eating to Reduce Irritable Bowel Symptoms: The FODMaP Diet
WHOLE HEALTH: INFORMATION FOR VETERANS Eating to Reduce Irritable Bowel Symptoms: The FODMaP Diet Whole Health is an approach to health care that empowers and enables YOU to take charge of your health
More informationI. Identification Presenters: Date: Name of Organization: Goal Statement: Title of Presentation: Audience Description: Physical Set-up: -
I. Identification Presenters: Written by Jen Barnes, training will be presented by Cooking Matters managers Date: TBD Name of Organization: Cooking Matters Spring 2013 Contact: Jessica Caouette jcaouette@strength.org
More informationDigesting the Facts in IBS: From Early Diagnosis to Effective Treatment Options
Digesting the Facts in IBS: From Early Diagnosis to Effective Treatment Options September 19, 213 Boston, Massachusetts Educational Partner: Session 3: Digesting the Facts in IBS: From Early Diagnosis
More informationDisorders in which symptoms cannot be explained by the presence of structural or tissue abnormalities Irritable bowel syndrome Functional heartburn Functional dyspepsia Functional constipation Functional
More informationSlide #43. Disclosure of Financial Relationships. IBS: Is it in Your Head or Gut? Anthony Lembo, M.D. Associate Professor of Medicine
Disclosure of Financial Relationships : Is it in Your Head or Gut? Anthony Lembo, M.D. Associate Professor of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston, MA Anthony Lembo,
More informationNew Tests and Treatments for Dyspepsia and Irritable Bowel Syndrome
New Tests and Treatments for Dyspepsia and Irritable Bowel Syndrome Soojong Hong Chae, MD Clinical Assistant Professor Digestive Diseases and Nutrition University of South Florida ROME III Functional dyspepsia
More information5 Things to Know About Irritable Bowel Syndrome
5 Things to Know About Irritable Bowel Syndrome Mike Kolber MD, CCFP, MSc PEIP 2017 Faculty/Presenter Disclosure Presenter: Mike Kolber Relationships that may introduce potential bias and/or conflict of
More informationIrritable Bowel Disease. Dr. Alexandra Ilnyckyj MD
Irritable Bowel Disease Dr. Alexandra Ilnyckyj MD Exactly what is IBS? Common condition affecting mostly women Symptoms are variable but they reflect altered gut movement (motility) and sensation Commonly
More informationFODMAPs. Presented by: Joanna Baker Date: 18 th May 2018
FODMAPs Presented by: Joanna Baker Date: 18 th May 2018 FODMAP approach to managing Irritable Bowel Syndrome (IBS) What is IBS & how is it managed FODMAPs & IBS Wheat & FODMAPs How much wheat is an issue
More informationFood is Medicine: A Nutritional Approach to IBS and More. Kathleen N. Mueller, M.D. CAFP Scientific Symposium 2017
Food is Medicine: A Nutritional Approach to IBS and More Kathleen N. Mueller, M.D. CAFP Scientific Symposium 2017 Nutritional approaches to IBS:FODMaP. New insight into food influences and gout. Breast
More informationDavid Leff, DO. April 13, Disclosure. I have the following financial relationships to disclosure:
David Leff, DO AOMA 94 th Annual Convention April 13, 2016 Disclosure I have the following financial relationships to disclosure: Speaker s Bureau: Allergan Labs, Takeda Pharmaceutical, Valeant Pharmaceutical
More informationGAPS AND FODMAPS
GAPS AND FODMAPS GAPS Gut and Psychology Syndrome Recommended for a host of conditions but is primarily known for autism, learning disabilities, ADD/ADHD, depression and schizophrenia An adaptation of
More informationIrritable Bowel Syndrome Now. George M. Logan, MD Friday, May 5, :35 4:05 PM
Irritable Bowel Syndrome Now George M. Logan, MD Friday, May 5, 2017 3:35 4:05 PM Dr. Logan indicated no potential conflict of interest to this presentation. He does not intend to discuss any unapproved/investigative
More informationInflammatory or Irritable? (the bowel, not the speaker)
South GP CME Edgar Centre, Dunedin August 2014 Inflammatory or Irritable? (the bowel, not the speaker) Dr Jason Hill MBChB FRACP FRCP Edin Department of Gastroenterology, Southern DHB Dunedin School Of
More informationThe role of FODMAPs in irritable bowel syndrome
REVIEW C URRENT OPINION The role of FODMAPs in irritable bowel syndrome Susan J. Shepherd a,b, Emma Halmos b, and Simon Glance c Purpose of review Irritable bowel syndrome (IBS) is a condition affecting
More informationIrritable Bowel Syndrome 4/11/2017. New Insights in Irritable Bowel Syndrome. Overview
70 60 50 40 30 20 10 0 0 15 30 45 60 75 90 105 120 135 150 165 180 Time (Minutes) 4/11/2017 New Insights in Irritable Bowel Syndrome Christopher Chang, MD, PhD Division of Gastroenterology/Hepatology University
More informationAmy Bernhard, MS, ACSM-CES Dietetic Intern Morrison Chartwell s Dietetic Internship
Amy Bernhard, MS, ACSM-CES Dietetic Intern Morrison Chartwell s Dietetic Internship 1 Objectives Discuss Lactose Intolerance MNT Lactose Intolerance Low-FODMAP Diet Discussion 2 3 Statistics/Risk Factors
More informationWhat s New in IBS with Diarrhea. Dr. Geoffrey K. Turnbull, MD April 6, 2018.
What s New in IBS with Diarrhea Dr. Geoffrey K. Turnbull, MD April 6, 2018. Objectives To learn how to diagnose IBS with particular emphasis on patients who have diarrhea predominantly. Review management
More informationENZYMES: Clinical Considerations in IBS, SIBO, Dysbiosis, and the Leaky Gut
ENZYMES: Clinical Considerations in IBS, SIBO, Dysbiosis, and the Leaky Gut Michael T. Murray, N.D. AllHealth BeginsintheGut Hippocrates Key Objectives To provide an overview of the key role digestive
More informationEmerging Treatments for IBS-C and Clinical Trial Endpoints
Emerging Treatments for IBS-C and Clinical Trial Endpoints Lin Chang, M.D. Oppenheimer Family Center for Neurobiology of Stress David Geffen School of Medicine at UCLA Learning Objectives Describe current
More informationRe-challenging FODMAPs: the low FODMAP diet phase two
bs_bs_banner doi:10.1111/jgh.13687 REVIEW ARTICLE Re-challenging FODMAPs: the low FODMAP diet phase two Caroline Tuck and Jacqueline Barrett * Department of Gastroenterology, Monash University, Melbourne,
More informationIBS: Updates on Diagnostics and Therapeutics for the Primary Practitioner
Rome IV: Diagnostic Criteria* IBS: Updates on Diagnostics and Therapeutics for the Primary Practitioner Darren M. Brenner, MD, AGAF Associate Professor of Medicine and Surgery Director Northwestern Functional
More informationUnder Pressure: The Need to Expedite IBS Diagnosis and Treatment in Primary Care
Under Pressure: The Need to Expedite IBS Diagnosis and Treatment in Primary Care February 7, 2013 Fort Lauderdale, Florida Educational Partner: Session 4: Under Pressure: The Need to Expedite IBS Diagnosis
More informationLow FODMAP Diet. OK, but what are FODMAPs and who should avoid them?
Low FODMAP Diet FODMAP? What does that stand for? Fermentable Oligosaccharides (oligo few, saccharide sugar ) Disaccharides ( two sugars ) Monosaccharides ( one sugar ) And Polyols (these are sugar alcohols)
More informationFODMAPs: Emerging Science and Implications for Practice
FODMAPs: Emerging Science and Implications for Practice Megan Rossi, PhD RD @DrMegan_RD @Dr_Megan www.drmeganrossi.com BDA guidelines for dietary management of IBS 1) Healthy eating and lifestyle Alcohol
More informationThe Role of Food in the Functional Gastrointestinal Disorders
The Role of Food in the Functional Gastrointestinal Disorders H. Vahedi, MD. Gastroentrologist Associate professor of medicine DDRI 92.4.27 vahedi@ams.ac.ir Disorder Sub-category A. Oesophageal disorders
More informationFODMAPs: Major role in food sensitivities
: Major role in food sensitivities Jessica Biesiekierski Post-doctoral Research Fellow Translational Research Center for Gastrointestinal Disorders KU Leuven, Belgium Role of food in GI symptoms? Abdominal
More informationNew Insights into Functional Bowel Disorders. Diagnostic and Non medical Treatment Challenges in IBS
Presenter Disclosure Information 1:45 2:45pm New Insights into Functional Bowel Disorders The following relationships exist related to this presentation: William Chey, MD, AGAF, FACG, FACP, is a consultant
More informationPrimary Management of Irritable Bowel Syndrome
Primary Management of Irritable Bowel Syndrome Jasmine Zia, MD Acting Instructor, Division of Gastroenterology Current Concepts in Drug Therapy CME Course April 23, 2015 Irritable Bowel Syndrome (IBS)
More informationIrritable Bowel Syndrome, Inflammatory Bowel Disease and Gastroesophageal Reflux Disease Study Guide
Irritable Bowel Syndrome, Inflammatory Bowel Disease and Gastroesophageal Reflux Disease Study Guide Class Preparation: Before class, students will be expected to review the online lecture, study guide
More informationMashhad University of Medical Sciences. Azita Ganji MD, MPH
Mashhad University of Medical Sciences Azita Ganji MD, MPH 30.2.95 CD Food sensitivity (NCGS, ) Food intolerance IBS Gluten translocate through the epithelial mucosa via increased tight junction (TJ)
More informationDisclosures. 4 th Annual Digestive Disease IBS: New Management Approaches. Early description of symptoms defining IBS 1849 W Cumming.
4 th Annual Digestive Disease IBS: New Management Approaches Disclosures Consultant Alkermes, Allergan, Forest, Ironwood, Prometheus, Salix Anthony Lembo, M.D. Beth Israel Deaconess Medical Center Harvard
More informationCarbohydrates: The Energy Nutrient Brooks/Cole, a division of Thomson Learning, Inc. Thomson Learning is a trademark used herein under license.
Carbohydrates: The Energy Nutrient 2001 Brooks/Cole, a division of Thomson Learning, Inc. Thomson Learning is a trademark used herein under license. CARBOHYDRATES Functions of Carbohydrates 1. Energy 2.
More informationDr. Ann Haiden. Your Best Health, Vitality, Life! with bonus FODMAPs food list. The Do s. Get Rid of Sugar, Starches & FODMAPs
Dr. Ann Haiden Your Best Health, Vitality, Life! 6 IBS Do s Don ts and with bonus FODMAPs food list Try these six tips to break free from IBS! The Do s 1 Get Rid of Sugar, Starches & FODMAPs Remove these
More information4/14/2018 LEARNING OBJECTIVES
T H E L O W F O D M A P D I E T K E L L E Y W I L S O N M S, R D N, C N S C U W H E A LT H D I G E S T I V E H E A LT H C E N T E R LEARNING OBJECTIVES 1. Understand the basics of FODMAPs and their impact
More informationPresenter. Irritable Bowel Syndrome. Objectives. Introduction. Rome Criteria. Irritable Bowel Syndrome 2/28/2018
Presenter Irritable Bowel Syndrome Current evidence for diagnosis & management Julie Daniels DNP, CNM Assistant Professor Course Coordinator of Primary Care of Women Faculty at Frontier Nursing University
More informationNW SMS icons. MFLN Intro
NW SMS icons The low FODMAP diet for irritable bowel syndrome: from evidence to practice Get handouts etc. by following the link below: learn.extension.org/events/3300 This material is based upon work
More informationROME IV CRITERIA FOR IBS
PRACTICAL CONSIDERATIONS IN THE MANAGEMENT OF IBS BRENDA HORWITZ MD PROFESSOR OF CLINICAL MEDICINE LEWIS KATZ SCHOOL OF MEDICINE AND TEMPLE UNIVERSITY HEALTH SCIENCES CENTER OR THINGS I ALWAYS WANTED TO
More informationStatement of Sponsorship and Support
Case Studies in the Practical Evaluation and Management of Irritable Bowel Syndrome with Diarrhea Louis Kuritzky MD Clinical Assistant Professor Emeritus Department of Community Health and Family Medicine
More informationIRRITABLE BOWEL SYNDROME
IRRITABLE BOWEL SYNDROME CONTENT CREATED BY Learn more at www.health.harvard.edu TALK WITH YOUR DOCTOR Table of Contents Here are some questions to ask your doctor. WHAT IS IRRITABLE BOWEL SYNDROME? 4
More informationCurrent and Emerging Pharmacological Treatments in Irritable Bowel Syndrome
Current and Emerging Pharmacological Treatments in Irritable Bowel Syndrome Anthony Lembo, M.D. Associate Professor of Medicine Beth Israel Deaconess Medical Center Harvard Medical School What is the general
More informationFODMAPS: Presenta(on Overview
FODMAPS: Prac%cal Applica%on in Paediatrics Stephanie Brown, NZRD Paediatric Gastroenterology DieFFan Christchurch Public Hospital Presenta(on Overview What are FODMAPs? FODMAP diet and IBS? Foods high
More informationDOWNLOAD OR READ : THE LOW FODMAP DIET FOR BEGINNERS PDF EBOOK EPUB MOBI
DOWNLOAD OR READ : THE LOW FODMAP DIET FOR BEGINNERS PDF EBOOK EPUB MOBI Page 1 Page 2 the low fodmap diet for beginners the low fodmap diet pdf the low fodmap diet for beginners What is a low FODMAP diet?
More informationFood Sources of Soluble Fibre
Food Sources of Soluble Fibre Dietary fibre comes from plant foods. There are two types: soluble and insoluble fibre. Most fibre containing foods have a mix of both. Insoluble fibre is found in the skins
More informationTop 5 Strategies to Relieve IBS
Top 5 Strategies to Relieve IBS Congratulations! You have just downloaded the Top 5 Strategies to Relieve Digestive Distress from FindClairity.com These Five Strategies will help you remove foods from
More informationXifaxan, Lotronex and Viberzi Prior Authorization and Quantity Limit Program Summary
Xifaxan, Lotronex and Viberzi Prior Authorization and Quantity Limit Program Summary FDA APPROVED INDICATIONS DOSAGE 1,2 Lotronex (alosetron) a Indication For women with severe diarrheapredominant irritable
More informationGas in the Digestive Tract
Gas in the Digestive Tract National Digestive Diseases Information Clearinghouse NATIONAL INSTITUTES OF HEALTH U.S. Department of Health and Human Services Everyone has gas and eliminates it by burping
More informationBringing the Low FODMAP Diet into your Nutrition Practice
Bringing the Low FODMAP Diet into your Nutrition Practice An online practical course for nutrition professionals by Dr Glenda Bishop, R.Nutr. Copyright Information These slides are provided by Glenda Bishop
More informationSpectrum of Gluten and Wheat Related Disorders
Spectrum of Gluten and Wheat Related Disorders Sheila E. Crowe, MD, FRCPC, FACP, FACG, AGAF Department of Medicine University of California, San Diego Disclosures Author of Celiac Disease for Dummies,
More informationAdvancing gastroenterology, improving patient care
American College of Gastroenterology Advancing gastroenterology, improving patient care Note to Visitors: A fully updated ACG Systematic Review on the Management of Chronic Idiopathic Constipation and
More informationOur microbiome: The role of vital gut bacteria, diet, nutrition and obesity
Our microbiome: The role of vital gut bacteria, diet, nutrition and obesity Prof Kevin Whelan Professor of Dietetics King s College London @ProfWhelan #BSG2017 Speaker Declarations This presenter has the
More informationIrritable Bowel Syndrome
Irritable Bowel Syndrome A Simple Tool for Identification and Dietary Management Dr Adrian Gilliland, GP and Clinical Advisor Primary Care, Capital and Coast DHB. Dr Rees Cameron, Gastroenterologist, Capital
More informationCauses Of Flatulence. How to Stop Farting Fast by Using Natural Remedies for Gas
How to Stop Farting Fast by Using Natural Remedies for Gas 4.5 (90.23%) 43 votes Gases are a taboo subject and farting is something very personal and quite embarrassing when it happens in a public place
More informationIrritable Bowel Syndrome
Irritable Bowel Syndrome Irritable Bowel Syndrome Jeffrey Jump, MD CHI Memorial Integrative Medicine Associates Jeffrey_jump@memorial.org Chronic abdominal pain and altered bowel function in the absence
More informationFiber In Your Diet. Provided by Hemorrhoid Centers of America Version Fiber
In Your Diet The lack of dietary fiber and fluids is a contributing factor to the development of hemorrhoids and anal fissures. We recommend consuming 25-35 grams of fiber and drinking 7 glasses of fluids
More informationThe Roadmap to FODMAP
The Roadmap to FODMAP Food Intolerance and Sugar Malabsorption in Chronic Abdominal Pain Food The Good the Bad and the Ugly April 2017 Pediatrics Disclosure I have the following financial relationships
More informationGut microbiota in IBS and its modification by diet: probiotics, prebiotics and low FODMAP diet
Gut microbiota in IBS and its modification by diet: probiotics, prebiotics and low FODMAP diet Kevin Whelan PhD RD FBDA Professor of Dietetics Department of Nutritional Sciences King s College London Nutritional
More informationMicrobiome GI Disorders
Microbiome GI Disorders Prof. Ram Dickman Neurogastroenterology Unit Rabin Medical Center Israel 1 Key Points Our gut microbiota Were to find them? Symbiosis or Why do we need them? Dysbiosis or when things
More informationLevel 2. Non Responsive Celiac Disease KEY POINTS:
Level 2 Non Responsive Celiac Disease KEY POINTS: Celiac Disease (CD) is an autoimmune condition triggered by ingestion of gluten leading to intestinal damage and a variety of clinical manifestations.
More informationGluten Free Alphabet Soup!
Gluten Free Alphabet Soup! Kate Scarlata, RDN, LDN Owner, For a Digestive Peace of Mind Digestive Health Nutrition Consulting Medway, MA DISCLOSERS Advisor and consultant Nestle Health Science, FODY foods,
More informationEvolving Therapy in Irritable Bowel Syndrome (IBS)
Evolving Therapy in Irritable Bowel Syndrome (IBS) Dr. Syed Mohammad Arif MBBS, FCPS (Medicine), MD (Gastro) Associate Professor Department of Medicine Dhaka Medical College A good set of bowels is worth
More informationCurrent Pharmacological Treatment Options in Chronic Constipation and IBS with Constipation
Current Pharmacological Treatment Options in Chronic Constipation and IBS with Constipation Anthony Lembo, M.D. Associate Professor of Medicine Harvard Medical School Director, GI Motility Center Beth
More informationDr. Melvyn Letier Constantiaberg Mediclinic October 2016
Dr. Melvyn Letier Constantiaberg Mediclinic October 2016 This presentation will enable you to: Understand the pathophysiology of IBS Recognize the clinical manifestations of IBS Make a confident diagnosis
More informationIBS - Definition. Chronic functional disorder of GI generally characterized by:
IBS - Definition Chronic functional disorder of GI generally characterized by: 3500 3000 No. of Publications 2500 2000 1500 1000 Irritable Bowel syndrome Irritable Bowel Syndrome 500 0 1968-1977 1978-1987
More informationUnder Pressure: The Need to Expedite IBS Diagnosis and Treatment in Primary Care
Under Pressure: The Need to Expedite IBS Diagnosis and Treatment in Primary Care May 1, 2013 Anaheim, California Educational Partner: Session 5: Under Pressure: The Need to Expedite IBS Diagnosis and Treatment
More informationFACTS ABOUT FIBER Dietary fiber is the part of a plant that provides and maintains the plant's structure. Cellulose, hemicellulose, polysaccharides,
FACTS ABOUT FIBER Dietary fiber is the part of a plant that provides and maintains the plant's structure. Cellulose, hemicellulose, polysaccharides, pectins, gums, mucilages, and lignins are dietary fibers.
More informationLow FODMAP Dietary Approach For FGD/IBS. Our Experience. Charlotte McCamphill 19 th February 2015
Low FODMAP Dietary Approach For FGD/IBS Our Experience Charlotte McCamphill 19 th February 2015 CONTENTS What Is IBS What are FODMAPs Service Provision Audit Results Future Work WHAT IS IBS The Rome III
More informationAll About Gut Health. Bowel Cancer Awareness. Bowel Cancer Risk: We are what we eat
All About Gut Health Bowel Cancer Awareness www.spotscreen.net.au Bowel cancer is the 2nd biggest cancer killer after lung cancer; 77 Australians each week. 15,151 people are diagnosed each year Claims
More informationTitle: Low FODMAP in 2017: Lessons learned from clinical trials and mechanistic studies.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 DR SHANTI ESWARAN (Orcid ID : 0000-0002-4660-3670) Received Date : 19-Jan-2017 Revised Date : 31-Jan-2017 Accepted Date
More informationMelbourne GI & Endoscopy
1 Melbourne GI & Endoscopy Multi-disciplinary care for your patients Gastroenterology Hepatobiliary & upper gastrointestinal surgery Colorectal surgery Oncology Perioperative care One contact & one address
More informationA FODMAP Diet Update: Craze or Credible?
A FODMAP Diet Update: Craze or Credible? Carol Rees Parrish, M.S., R.D., Series Editor J. Reggie Thomas Rakesh Nanda Lin H Shu FODMAP is an acronym for Fermentable Oligosaccharides, Disaccharides, Monosaccharides,
More informationWhat is Irritable Bowel Syndrome (IBS)?
What is Irritable Bowel Syndrome (IBS)? Irritable bowel syndrome (IBS) is a health issue found in your intestines (gut). IBS can cause symptoms such as: Belly pain. Cramping. Gas. Bloating (or swelling)
More informationObjectives. Pain Types Brief Review. Referred Pain. Chronic/Recurrent Abdominal Pain 1/12/2017. I have no conflicts of interest to disclose
Joshua D Noe, MD Associate Professor of Pediatric Gastroenterology Hepatology and Nutrition Medical College of Wisconsin I have no conflicts of interest to disclose Objectives Differentiate functional
More informationMy Diabetic Meal Plan during Pregnancy
My Diabetic Meal Plan during Pregnancy When you have diabetes and are pregnant, you need to eat small meals and s throughout the day to help control your blood sugar. This also helps you get in enough
More informationBloating, Flatulence, and
A 45-Year-Old Man With Recurrent Abdominal Pain, Bloating, Flatulence, and Intermittent Loose Stools Anthony J. Lembo, MD Associate Professor of Medicine Harvard Medical School Director, GI Motility Laboratory
More informationThe relationship between FODMAP intake and acute gastrointestinal symptoms in adults with IBS A novel analysis using the FAST Diary
The relationship between FODMAP intake and acute gastrointestinal symptoms in adults with IBS A novel analysis using the FAST Diary Macintosh A 1, Wright-McNaughton M 1, Frampton C 2, Skidmore P 1, Gearry
More informationHealth Benefits of Prebiotic Dietary Fiber
Health Benefits of Prebiotic Dietary Fiber JENNIFER ERICKSON, PhD, RD Objectives Provide some background on dietary fiber To define the term "prebiotic dietary fiber" To discuss potential health effects
More informationUnder Pressure: The Need to Expedite IBS Diagnosis and Treatment in Primary Care
Under Pressure: The Need to Expedite IBS Diagnosis and Treatment in Primary Care June 23, 2012 New York, New York Educational Partner: CME Incite, LLC Session 4: Under Pressure: The Need to Expedite IBS
More informationHompes Method. Practitioner Training Level II. Lesson Eight Part 1C SIBO Protocols
Hompes Method Practitioner Training Level II Lesson Eight Part 1C SIBO Protocols Health for the People Ltd not for reuse without expressed permission Hompes Method is a trading name of Health For The People
More informationGeographical and Cultural Food-related Symptoms, Food Avoidance and Elimination
Geographical and Cultural Food-related Symptoms, Food Avoidance and Elimination Sheila E. Crowe, MD, FRCPC, FACP, FACG, AGAF Digestive Health Center of Excellence University of Virginia Adverse Reactions
More informationDiet, Nutrition and Inflammatory
Diet, Nutrition and Inflammatory Bowel Disease Sumner Brooks, MPH, RDN, LD March 11, 2017 Objectives Identify factors that may alter nutritional status in IBD Understand the role of diet and nutrition
More informationWhat to eat when you have Short Bowel Syndrome
What to eat when you have Short Bowel Syndrome What is Short Bowel Syndrome? Your bowel is an organ, shaped like a long tube, and is made up of the small and large bowel. The small bowel is about 15 to
More informationWhole Health in Your Practice - Applying CIH March Whole Health in Your Practice 14. APPLYING CIH. Lucky Sarah VETERANS HEALTH ADMINISTRATION
Whole Health in Your Practice 14. APPLYING CIH Lucky Sarah 1 Not-so-lucky Joe Joe - GI 31 yo Diarrhea predominant IBS after being treated for a GI infection during a tour in Iraq Symptoms: Bloating and
More information