Introduction : Le syndrome de l’intestin irritable (SII) est un désordre gastro-intestinal qui atteint environ 15% de la population mondiale. La diète FODMAP (Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols), fractionnée en trois phases (élimination, réintroduction, personnalisation), a été développée pour établir une tolérance personnelle aux nutriments (glucides) qui accentuent les symptômes. Une approche a été créée avec la plateforme web SOSCuisine.com afin de permettre aux gens atteints du SII de suivre la diète FODMAP dans un contexte de libre-service. Celle-ci combine un service en ligne de menus hebdomadaires personnalisés faibles en FODMAP avec des instructions pour chaque étape de la diète et l'accès à un groupe de soutien par les pairs modéré par une nutritionniste spécialisée. Objectif : Évaluer l’impact de ce service sur la qualité de vie et le contrôle des symptômes physiologiques et psychologiques des gens atteints du SII. Méthode : Étude prospective observationnelle effectuée auprès de patients (suivis dans deux hôpitaux montréalais) souffrant du SII. Ceux-ci devaient effectuer la diète FODMAP via la plateforme web et des questionnaires leur ont été administrés en ligne avant et après les deux premières phases. Résultats : 35 personnes ont été incluses et 14 ont complété l’étude. Après l’intervention, la sévérité du SII et l’anxiété situationnelle des participants étaient significativement améliorées tandis que la qualité de vie demeurait inchangée. Conclusion : Cette étude pilote démontrent la pertinence et l’utilité de l’enseignement de la diète FODMAP à l’aide de méthodes alternatives. Cependant, des études de plus grande envergure sont nécessaires pour confirmer ces résultats. / Introduction: Irritable Bowel Syndrome (IBS) is a gastrointestinal disorder that affects approximately 15% of the worldwide population. The Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols (FODMAP) diet was developed to establish a personal tolerance to these nutrients (carbohydrates) that accentuate the symptoms related to IBS. This diet, lasting on average twelve weeks, is separated into three steps: elimination, reintroduction and personalization. An innovative approach has been developed by the online platform SOSCuisine.com to allow people with IBS to safely follow the FODMAP diet in a ‘self-service’ way. It combines an online service of personalized low-FODMAP weekly menus with instructions for each step of the diet in combination with an access to a peer support group moderated by a specialized registered dietitian. Objective: Assess the impact of this service on the quality of life and the control of physiological and psychological symptoms of people with IBS. Method: Prospective observational study involving patients (followed in two Montreal hospitals) suffering from IBS. They had to perform the FODMAP diet via the web platform and several variables were evaluated, via questionnaires administered online, before and after phase one and. Results: 35 people were included and 14 completed the study. After the intervention, the severity of the IBS and the situational anxiety of the participants were significantly improved while the quality of life was not changed. Conclusion: The data from this pilot study demonstrate the relevance and utility of teaching the FODMAP diet using alternative methods. However, larger studies are needed to confirm these results.

<p dir="ltr">The gastrointestinal (GI) tract and its diverse microbial community play a significant role in overall health, impacting various aspects such as metabolism, physiology, nutrition, and immune function. Disruptions in the gut microbiota have been associated with metabolic diseases, colorectal cancer, diabetes, obesity, inflammatory bowel disease, Alzheimer's disease, and depression. Despite recognizing the importance of the gut microbiota, the interrelationship between microbiota, diet, and disease prevention remains unclear. Current techniques for monitoring the microbiome often rely on fecal samples or invasive endoscopic procedures, limiting the understanding of spatial variations in the gut microbiota and posing invasiveness challenges. To address these limitations, this dissertation focuses on the design and development of an electronic-free smart capsule platform capable of targeted sampling of GI fluid within specific regions of the GI tract. The capsule can be retrieved for subsequent bacterial culture and sequencing analysis. The capsule design is based on stimuli-responsive polymers and superabsorbent hydrogels, chosen for their proven safety, compatibility, and scalability. By leveraging the pH variation across the GI tract, the pH-sensitive polymeric coatings dissolve at the desired region, activating the sampling process. The superabsorbent hydrogel inside the capsule collects the sampled GI fluid and facilitates capsule closure upon completion of sampling. Systematic studies were conducted to identify suitable pH-responsive polymer coatings, superabsorbent hydrogels, and processing conditions that effectively operated within the physiological conditions of the GI tract. The technology's effectiveness and safety were validated through rigorous <i>in vitro</i> and <i>in vivo</i> studies using pig models. These studies demonstrated the potential of the technology for targeted sampling of GI fluid in both small and large intestinal regions, enabling subsequent bacterial culture and gene sequencing analysis. Additionally, the capsule design was enhanced with the integration of a metal tracer, enabling traceability throughout the GI tract using X-ray imaging and portable metal detectors for ambulatory screening. This technology holds promise as a non-invasive tool for studying real-time metabolic and molecular interactions among the host, diet, and microbiota in challenging-to-access GI regions. Its application in clinical studies can provide new insights into diet-host-microbiome interactions and contribute to addressing the burden faced by patients and their families dealing with GI-related diseases.</p>

Introduction: Irritable Bowel Syndrome (IBS) is estimated to affect 11% of the population globally with a significant female predominance. IBS appears to afflict all age groups and socioeconomic conditions, thus making it a disease that permeates a very large part of society. While often debilitating, only 30% of those with IBS will indeed visit their physician. In an era dominated by social media, it is no surprise that 40% of all consumers report that online information affects the way they deal with their health. YouTube is one of the top 5 most accessed online resources for medical information. The strong reliance on online information as well as the rising prevalence of IBS has prompted us to determine the educational quality of IBS YouTube videos. Methods: We performed a YouTube search using the keywords “Irritable Bowel Syndrome” from September 3-25, 2016. The top 297most viewed videos were included and analyzed for characteristics, source, as well as content. The source was classified as healthcare provider, alternative medicine provider, patient and/or parents, company, media, or professional society. Content was further classified as medical professional education, advertisement, personal experience, patient education, alternative treatment or increase awareness. A scoring system was designed based on current accepted guidelines from multiple professional and academic societies to evaluate quality (-10 to +25 points). Negative points were assigned for misleading information. Videos were also scored by a global quality score. Six blinded reviewers were asked to view the videos and score each video independently. Results: A total of two hundred and ninety-seven videos were analyzed, with a median of 6,671 views, 25 likes, and 2 dislikes. Females were most commonly depicted (36.4%). The most commonly depicted race was White/Caucasian (62.0%). Among video sources, alternative medicine was most represented (32.3%) with treatments that included water fasting, yoga, hypnotherapy, frequency healing, massage therapy, and essential oil therapy. The least represented source was professional societies such as hospitals (5.4%). Mean scores were statistically different from each other (pConclusion: YouTube videos on IBS are mostly produced by alternative treatment sources with often controversial treatments that did not align with Page 16 2017 Appalachian Student Research Forum current evidence based guidelines. Furthermore, videos from healthcare professionals provided better and more accurate quality of information compared to other sources.

INTRODUÇÃO: A síndrome do intestino irritável (SII) é uma doença funcional do trato gastrintestinal que afeta até 20% da população adulta. Os principais sintomas envolvem o mau funcionamento do intestino, associados com dores abdominais, manifestação de diarreia ou constipação, sem alterações estruturais e bioquímicas do intestino. A maneira mais adequada de tratar o paciente é por meio de uma abordagem ampla e integral, porém individualizada, com identificação dos fatores desencadeantes e/ou agravantes da sintomatologia, inerentes a cada paciente. Em todos os níveis de atendimento, deve-se orientar o paciente com relação à dieta. OBJETIVO: o principal objetivo do estudo foi avaliar os alimentos desencadeadores de sintomas nos pacientes com diagnóstico de SII atendidos no ambulatório especializado do Serviço de Gatroenterologia Clínica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). Além disso, foram avaliados dados clínicos, estado nutricional, ingestão alimentar e hábito intestinal desta população. METODOLOGIA: foram avaliados 140 pacientes que preencherem o critério de Roma III. As informações foram obtidas por meio de inquérito clínico e dietético aplicado pela nutricionista no momento da consulta e pela revisão do prontuário. Os dados coletados foram: idade, sexo, grau de escolaridade, peso, altura, hábito intestinal, sintomas, aspecto das fezes, alimentos menos toleráveis e consumo alimentar. RESULTADOS: Dos pacientes avaliados, 63% estavam eutróficos. Dor abdominal, flatulência/distensão, sensação de evacuação incompleta e sensação de estufamento abdominal foram mencionadas por mais de 60% dos pacientes. Houve associação significativa entre aspecto das fezes e habito intestinal. Intolerância alimentar foi mencionada por 82,8% dos pacientes. Os alimentos citados pelos pacientes como exacerbadores dos sintomas foram frituras em geral, leite, massas com molhos, feijão, chocolate, café, pizza, repolho, tortas e doces. Constataram-se correlações estatisticamente significativas entre consumo de frituras e flatulência, chocolate e pizza com sensação de estufamento abdominal, margarina com constipação, leite com presença de muco nas fezes, pão branco com pirose retroesternal, massas com molho com dor abdominal e feijão com sensação de estufamento abdominal. CONCLUSÕES: o presente estudo revelou alta prevalência de intolerância alimentar na população ambulatorial de pacientes com SII atendida no HCFMUSP. Os principais alimentos desencadeadores e exacerbadores de sintomas/sinais foram identificados, devidamente listados e servirão para nortear a abordagem dietética nesses pacientes em futuros estudos / INTRODUCTION: Irritable Bowel Syndrome (IBS) is a functional disorder of the GI tract that affects about 20% of the adult population. The main symptoms involve the malfunction of the bowel, associated with abdominal pain, diarrhea or constipation manifestation, without providing structural and biochemical alterations of the intestine. The most appropriate way to treat the patient is through a broad and comprehensive approach, but individualized, trying to identify the factors triggering or aggravating symptoms, inherent to each patient. At all levels of care, the patient should be guided regarding diet. OBJECTIVE: The primary objective of the study was to evaluate the group of foods that exacerbate or trigger symptoms/signs in IBS patients treated in the outpatient clinic of our hospital. Additionaly, we evaluated clinical characteristics and nutritional features such as nutritional status, food intake and bowel habits. METHODOLOGY: 140 patients who met were studied in the present work. Information was obtained through clinical and dietary surveys at the appointment by a nutritionist and by chart review. Data collected included age, sex, educational level, height, weight, bowel habits, symptoms, appearance of feces (Bristol Scale), food intake and food intolerance (aliments that exacerbate or trigger symptoms/signs). RESULTS: Among the patients, 63% were eutrophic. Abdominal pain, flatulence / bloating, sensation of incomplete evacuation and abdominal bloating was mentioned by over 60% of patients. There was a significant association between the appearance of the feces and bowel habits. Food intolerance was mentioned by 82.8% of patients. Foods most cited by patients as exacerbating or triggering IBS symptoms were fried foods in general, milk, beans, chocolate, coffee, cabage and pastries (i.e pasta, pizza). Statistically significant correlations were detected between consumption of fried foods and flatulence; chocolate and pizza and bloating; margarine and constipation; milk and mucus in feces; white bread and heartburn; pasta with sauce and beans and abdominal pain and bloating. CONCLUSIONS: This study revealed a high prevalence of food intolerance in our outpatient population of IBS patients. The main food triggers of IBS symptoms/signs were identified, duly listed and will certainly guide the dietary approach in IBS patients in future studies

Background and aims: This interdisciplinary thesis was designed to deepen understanding of the co-morbidity of anxiety and depression with chronic diseases of the digestive tract, and inflammatory bowel disease (IBD) in particular. The first part of the thesis aimed to explore the prevalence of psychological problems in IBD compared to irritable bowel syndrome (IBS) and chronic hepatitis C (HCV) groups. It also explored the relationship between the number of co-morbid functional gastrointestinal disorders and the severity of psychological problems in IBD and IBS. It also aimed to determine whether there is a relationship between psychological problems and the response to standard medical treatment/physical outcomes in patients with IBD, IBS and HCV. Furthermore, it aimed to explore whether disclosure of the psychological status of depressed and/or anxious IBD patients to their gastroenterologists influences doctors’ behaviour and affects patients’ responses to treatment/physical outcomes. The second part of the thesis aimed to investigate the potential role of antidepressants in IBD and to determine the feasibility of future randomised controlled trials on the role of antidepressants in IBD. Methods: Overall, a cohort of 139 outpatients (64 IBD, 41 HCV, and 34 IBS) and 18 gastroenterologists participated in the six studies comprising this thesis. A mixed methods design was applied. Two cross-sectional studies, an observational cohort prospective management study, a randomised controlled trial, a systematic review and an exploratory interview study were conducted. Differences between the groups for continuous variables were assesed with one way analysis of variance (ANOVA) and independent samples ttests. Differences in categorical variables were assessed with contingency tables with the Chi-Square test and the Fisher’s Exact Test. Propsective analyses were conducted with repeated measures ANOVA, logistic regression and Poisson regression. Qualitative data were analysed using content analysis. Results: Overall, 42% of participants were anxious and 19% were depressed. Participants with HCV had higher levels of psychological impairment compared with the IBS, the IBD group and the general population (p<0.05). Those IBD participants with fewer co-morbid functional disorders had better physical quality of life than participants with a greater number of these disorders (p=0.025). Moreover, depression/anxiety at baseline did not explain medical outcomes after 12 months in this cohort of patients with chronic diseases of the digestive tract. Doctors’ knowledge of patients’ psychological status was found to have no impact on IBD patients’ outcomes after 12 months. However, interestingly, the level of anxiety in IBD participants significantly dropped between the baseline and nine months indicating a possible benefit from participating in the study. In the literature review, insufficient evidence was found to conclude that antidepressants are efficacious for treatment of psychological co-morbidities or somatic complaints in IBD. However, the qualitative interview study indicated a potential positive impact of treatment with antidepressants on coping with disease symptoms and general wellbeing in patients with IBD. Conclusion: The thesis confirms that there is a significant burden of psychological co-morbidity in patients with chronic gastroenterological diseases. Interdisciplinary approaches to the management of these diseases are therefore warranted in Australian gastroenterology clinics. Anxiety targeted interventions and research in this setting are urgently needed, especially with respect to patients with HCV. Larger studies exploring the gastroenterologists’ role in treatment of co-morbid psychological problems in their patients are recommended. Longer prospective studies on homogenous samples of patients are also needed to clarify the nature of the relationship between psychological problems and relapse of somatic symptoms. Finally, randomised controlled trials exploring the efficacy of antidepressants in IBD are warranted. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1321006 / Thesis (Ph.D.) -- University of Adelaide, School of Population Health and Clinical Practice, 2008

Bakgrund: Avföringsproblemen förstoppning, avföringsinkontinens och irritabel tarm är vanliga åkommor hos människor i det västerländska samhället. Alla tre har liknande symtom och problematik. Åkommorna påverkar hela människan inte bara den fysiska kroppen. Få studier har fokuserat på människors upplevelse av att leva med avföringsproblem. Syfte: Syftet med litteraturstudien var att beskriva hur människor med avföringsproblem upplever sin livssituation. Metod: Studien var baserad på tio vetenskapliga artiklar med kvalitativ ansats. Resultat: Studien resulterade i tre huvudteman; upplevelsen av det egna lidandet, upplevelsen av det dagliga livet och upplevelsen av relationer med åtta underteman. Resultatet visade att människor som lider av avföringsproblemen förstoppning, irritabel tarm och avföringsinkontinens upplevde att hela deras livssituation påverkades av avföringsproblemen. Hela människan drabbades psykiskt, emotionellt, fysiskt och socialt. Människorna var tvungna att leva ett liv fullt av dagliga begränsningar. Slutsats: Att leva med avföringsproblem innebar för människorna att vara involverad i en evig kamp som de ofta var ensamma i. Resultatet indikerar på att avföringsproblem är ett dolt problem och tystnaden kring problemen gör att många människor inte får den hjälp och stöd som de behöver. / Background: Bowel movement problems as constipation, faecal incontinence and irritable bowel syndrome are common problems in the community. All three has similar symptoms and the same complex of problems. The disorders affect the whole human being not just the physical body. Few studies have been focusing on peoples experiences of living with bowel movement problems. Aim: The aim of this literature study was to describe how people with bowel movement problems experienced their life situation. Method: The study was based on ten scientific articles in qualitative approach. Results: The study resulted in three main themes; the experience of the own suffering, the experience of the daily life and the experience of relations with eight subthemes. The result showed that people suffering from bowel movement problems as constipation, irritable bowel syndrome and faecal incontinence experienced that their whole life situation was affected by the problems. The whole human being was affected psychological, emotional, physical and social. These people had to live a life full of daily restrictions. Conclusion: A life with bowel movement problems meant being involved in an everlasting fight, which they often fought alone. The result indicates that bowel movement problems are a hidden problem in the community and because of the silence many people does not get the help and support that they need.

Background and aims: This interdisciplinary thesis was designed to deepen understanding of the co-morbidity of anxiety and depression with chronic diseases of the digestive tract, and inflammatory bowel disease (IBD) in particular. The first part of the thesis aimed to explore the prevalence of psychological problems in IBD compared to irritable bowel syndrome (IBS) and chronic hepatitis C (HCV) groups. It also explored the relationship between the number of co-morbid functional gastrointestinal disorders and the severity of psychological problems in IBD and IBS. It also aimed to determine whether there is a relationship between psychological problems and the response to standard medical treatment/physical outcomes in patients with IBD, IBS and HCV. Furthermore, it aimed to explore whether disclosure of the psychological status of depressed and/or anxious IBD patients to their gastroenterologists influences doctors’ behaviour and affects patients’ responses to treatment/physical outcomes. The second part of the thesis aimed to investigate the potential role of antidepressants in IBD and to determine the feasibility of future randomised controlled trials on the role of antidepressants in IBD. Methods: Overall, a cohort of 139 outpatients (64 IBD, 41 HCV, and 34 IBS) and 18 gastroenterologists participated in the six studies comprising this thesis. A mixed methods design was applied. Two cross-sectional studies, an observational cohort prospective management study, a randomised controlled trial, a systematic review and an exploratory interview study were conducted. Differences between the groups for continuous variables were assesed with one way analysis of variance (ANOVA) and independent samples ttests. Differences in categorical variables were assessed with contingency tables with the Chi-Square test and the Fisher’s Exact Test. Propsective analyses were conducted with repeated measures ANOVA, logistic regression and Poisson regression. Qualitative data were analysed using content analysis. Results: Overall, 42% of participants were anxious and 19% were depressed. Participants with HCV had higher levels of psychological impairment compared with the IBS, the IBD group and the general population (p<0.05). Those IBD participants with fewer co-morbid functional disorders had better physical quality of life than participants with a greater number of these disorders (p=0.025). Moreover, depression/anxiety at baseline did not explain medical outcomes after 12 months in this cohort of patients with chronic diseases of the digestive tract. Doctors’ knowledge of patients’ psychological status was found to have no impact on IBD patients’ outcomes after 12 months. However, interestingly, the level of anxiety in IBD participants significantly dropped between the baseline and nine months indicating a possible benefit from participating in the study. In the literature review, insufficient evidence was found to conclude that antidepressants are efficacious for treatment of psychological co-morbidities or somatic complaints in IBD. However, the qualitative interview study indicated a potential positive impact of treatment with antidepressants on coping with disease symptoms and general wellbeing in patients with IBD. Conclusion: The thesis confirms that there is a significant burden of psychological co-morbidity in patients with chronic gastroenterological diseases. Interdisciplinary approaches to the management of these diseases are therefore warranted in Australian gastroenterology clinics. Anxiety targeted interventions and research in this setting are urgently needed, especially with respect to patients with HCV. Larger studies exploring the gastroenterologists’ role in treatment of co-morbid psychological problems in their patients are recommended. Longer prospective studies on homogenous samples of patients are also needed to clarify the nature of the relationship between psychological problems and relapse of somatic symptoms. Finally, randomised controlled trials exploring the efficacy of antidepressants in IBD are warranted. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1321006 / Thesis (Ph.D.) -- University of Adelaide, School of Population Health and Clinical Practice, 2008

INTRODUÇÃO: A síndrome do intestino irritável (SII) é uma doença funcional do trato gastrintestinal que afeta até 20% da população adulta. Os principais sintomas envolvem o mau funcionamento do intestino, associados com dores abdominais, manifestação de diarreia ou constipação, sem alterações estruturais e bioquímicas do intestino. A maneira mais adequada de tratar o paciente é por meio de uma abordagem ampla e integral, porém individualizada, com identificação dos fatores desencadeantes e/ou agravantes da sintomatologia, inerentes a cada paciente. Em todos os níveis de atendimento, deve-se orientar o paciente com relação à dieta. OBJETIVO: o principal objetivo do estudo foi avaliar os alimentos desencadeadores de sintomas nos pacientes com diagnóstico de SII atendidos no ambulatório especializado do Serviço de Gatroenterologia Clínica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). Além disso, foram avaliados dados clínicos, estado nutricional, ingestão alimentar e hábito intestinal desta população. METODOLOGIA: foram avaliados 140 pacientes que preencherem o critério de Roma III. As informações foram obtidas por meio de inquérito clínico e dietético aplicado pela nutricionista no momento da consulta e pela revisão do prontuário. Os dados coletados foram: idade, sexo, grau de escolaridade, peso, altura, hábito intestinal, sintomas, aspecto das fezes, alimentos menos toleráveis e consumo alimentar. RESULTADOS: Dos pacientes avaliados, 63% estavam eutróficos. Dor abdominal, flatulência/distensão, sensação de evacuação incompleta e sensação de estufamento abdominal foram mencionadas por mais de 60% dos pacientes. Houve associação significativa entre aspecto das fezes e habito intestinal. Intolerância alimentar foi mencionada por 82,8% dos pacientes. Os alimentos citados pelos pacientes como exacerbadores dos sintomas foram frituras em geral, leite, massas com molhos, feijão, chocolate, café, pizza, repolho, tortas e doces. Constataram-se correlações estatisticamente significativas entre consumo de frituras e flatulência, chocolate e pizza com sensação de estufamento abdominal, margarina com constipação, leite com presença de muco nas fezes, pão branco com pirose retroesternal, massas com molho com dor abdominal e feijão com sensação de estufamento abdominal. CONCLUSÕES: o presente estudo revelou alta prevalência de intolerância alimentar na população ambulatorial de pacientes com SII atendida no HCFMUSP. Os principais alimentos desencadeadores e exacerbadores de sintomas/sinais foram identificados, devidamente listados e servirão para nortear a abordagem dietética nesses pacientes em futuros estudos / INTRODUCTION: Irritable Bowel Syndrome (IBS) is a functional disorder of the GI tract that affects about 20% of the adult population. The main symptoms involve the malfunction of the bowel, associated with abdominal pain, diarrhea or constipation manifestation, without providing structural and biochemical alterations of the intestine. The most appropriate way to treat the patient is through a broad and comprehensive approach, but individualized, trying to identify the factors triggering or aggravating symptoms, inherent to each patient. At all levels of care, the patient should be guided regarding diet. OBJECTIVE: The primary objective of the study was to evaluate the group of foods that exacerbate or trigger symptoms/signs in IBS patients treated in the outpatient clinic of our hospital. Additionaly, we evaluated clinical characteristics and nutritional features such as nutritional status, food intake and bowel habits. METHODOLOGY: 140 patients who met were studied in the present work. Information was obtained through clinical and dietary surveys at the appointment by a nutritionist and by chart review. Data collected included age, sex, educational level, height, weight, bowel habits, symptoms, appearance of feces (Bristol Scale), food intake and food intolerance (aliments that exacerbate or trigger symptoms/signs). RESULTS: Among the patients, 63% were eutrophic. Abdominal pain, flatulence / bloating, sensation of incomplete evacuation and abdominal bloating was mentioned by over 60% of patients. There was a significant association between the appearance of the feces and bowel habits. Food intolerance was mentioned by 82.8% of patients. Foods most cited by patients as exacerbating or triggering IBS symptoms were fried foods in general, milk, beans, chocolate, coffee, cabage and pastries (i.e pasta, pizza). Statistically significant correlations were detected between consumption of fried foods and flatulence; chocolate and pizza and bloating; margarine and constipation; milk and mucus in feces; white bread and heartburn; pasta with sauce and beans and abdominal pain and bloating. CONCLUSIONS: This study revealed a high prevalence of food intolerance in our outpatient population of IBS patients. The main food triggers of IBS symptoms/signs were identified, duly listed and will certainly guide the dietary approach in IBS patients in future studies

Background: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder (FGID) which can be defined as chronic, relapsing visceral pain with bloating associated with change in bowel habit. It affects up to 10-15% of the adult population in the UK and is more common in females. The cost of IBS in terms of health care utilisation is substantial, exceeding £45.6 million per year in the UK alone, yet its pathophysiology is incompletely understood. Visceral pain is the main and most difficult symptom to manage in IBS and many IBS female sufferers compare it to labour pain in its severity. Modulating visceral pain in healthy volunteers and IBS patients is therefore an important research area. Non-invasive magnetic stimulation may play a crucial role in this respect. Aim:The aim of this study is to ascertain whether non-invasive repetitive magnetic stimulation applied to the motor cortex and/or lumbosacrum can modulate gastrointestinal pain originating from the anorectum. Methods:Participants: 16 healthy volunteers and 10 IBS patients aged 18 and above were included in the study.Questionnaires: Healthy volunteers and IBS patients were asked to complete anxiety and depression questionnaire and IBS patients were requested to fill in an IBS severity questionnaire.Motor measurements in healthy subjects: Single-pulse lumbosacral magnetic stimulation (LSMS) was applied to the lumbosacral area for the anal sphincter where the largest motor evoked potential (MEP) amplitude response was detected. Single-pulse transcranial magnetic stimulation (TMS) was then performed at the pre-determined resting motor thresholds (RMT) for the anal sphincter and the hand.Sensory measurements in healthy subjects and IBS patients: Electrical stimulation was used to assess the changes in sensory and pain thresholds in the anorectal area. The subjects were asked to score the pain intensity using five-point categorical rating scales. In addition they were asked to describe the pain experienced using a shortened form of the McGill Pain Questionnaire. Intervention: Healthy volunteers received 6 paradigms of magnetic stimulation in a randomised order i.e. 3 repetitive LSMSs (1 Hz, 10 Hz and sham) and 3 repetitive TMSs (1 Hz, 10 Hz and sham) to investigate their modulatory effects on visceral sensitivity and to determine which of these interventions is most effective. The most effective active interventions (1 Hz rLSMS and 10 Hz rTMS) together with one sham were then trialled in a randomised fashion on IBS patients.Post intervention: Motor excitabilities were repeated at 30 min after each intervention. The assessment of sensory and pain thresholds at anal sphincter and rectum were done immediately, 30 and 60 min after each intervention. Results:Application of 1 Hz rLSMS led to alterations of anal sphincter motor excitabilities and resulted in a significant increase in the amplitude of lumbosacal-anal motor evoked potentials (MEPs) in healthy volunteers recorded at 30 min post intervention. In healthy volunteers, 1 Hz rLSMS and 10 Hz rTMS caused a significant increase in the rectal pain thresholds experienced immediately, 30 and 60 min after each intervention. 10 Hz rLSMS and 1 Hz rTMS only led to a significant rise in rectal pain thresholds immediately after their application. Furthermore, there was a significant increase in the rectal pain thresholds immediately, 30 and 60 min following 1 Hz rLSMS and 10 Hz rTMS in IBS patients. Conclusion:The application of magnetic stimulation to the cortical and lumbosacral areas to modulate visceral pain is a new concept, which reduced rectal sensitivity to painful stimuli and offers a much needed new approach in the management of abdominal pain in patients with IBS.

Background: Irritable bowel syndrome (IBS) is an extremely common condition affecting approximately 10-15% of the population. Lower abdominal pain is a common feature and, if the patient also has gynaecological symptoms such as heavy periods, they may be referred to a gynaecologist especially when the bowel symptoms are relatively mild. In this setting a laparoscopy is often undertaken and endometriosis commonly identified as this condition affects up to 10% of women. Consequently pain is frequently attributed to the endometriosis even when it is relatively mild. However it is a common observation amongst gynaecologists that women with mild endometriosis often have severe symptoms which do not seem to respond well to treatment. This raises the possibility that their pain may not actually be due to endometriosis or is being amplified by the visceral hypersensitivity which is a characteristic feature of irritable bowel syndrome.Methods: 20 patients with minimal-mild endometriosis, 20 with moderate-severe endometriosis, 20 healthy volunteers (HV) who have had laparoscopy for sterilisation, 20 IBS patients and 20 patients with pain who were found to have a normal pelvis (on laparoscopy) were studied. Gastrointestinal, gynaecological, and noncolonic symptoms were recorded as well as demography, quality of life and psychological status. Visceral sensitivity was assessed in all patients and abdominal distension was studied in a sub group of 26 endometriosis patients and 20 IBS patients.Results: 20 (100%) of IBS patients, 13 (65%) of minimal-mild endometriosis patients, 11 (55%) of moderate-severe endometriosis patients, 17 (85%) of laparoscopic negative pain patients and no healthy volunteers fulfilled ROME III criteria for IBS. Patients with endometriosis and IBS had similar levels of visceral sensitivity which were significantly lower than that observed in controls (p=0·002, p<0·001).In particular, both minimal-mild and moderate-severe endometriosis patients had significantly lower (mean-95% CI) pain thresholds in mmHg 28.1(24.5, 31.6) and 28.8(24.9, 32.6) respectively compared with controls 39·5 (36·0, 43·0) p=0.001and p=0.002. However, with few exceptions, there were no distinguishing features between patients in terms of demography, symptomatology and distension.Conclusion: Clinically, it is very difficult to distinguish between endometriosis and IBS. However, visceral hypersensitivity appears to be a major component of endometriosis and may explain the problem of excessive pain especially in patients with mild disease offering a potential new target for treatment