Irritable bowel syndrome (IBS) is a chronic disease of the digestive tract that is characterised by decades-long chronicity. At the same time, it is particularly challenging to treat since successful treatment often requires a combination of pharmacological and non-pharmacological measures. The pathomechanisms of IBS have only just started to be elucidated, meaning that causally effective treatments are largely lacking. In contrast to earlier notions of a \"psychosomatic disorder\", IBS is an organic disease in the vast majority of cases. The predominant symptoms are usually intestinal cramps or abdominal pain, meteorism/flatulence, constipation, and diarrhea. The patient should be fully included in a joint treatment concept from the outset. Given the lack of causal treatment methods, each treatment approach is initially by way of trial; if there is no effect, treatment should be discontinued after 3 months at the latest. Effective treatments can be continued, adapted, and/or combined with other procedures as an on-demand or permanent treatment. Supplementing the targeted drug treatment of the dominant individual symptoms with somewhat unspecific but often relevantly effective basic or accompanying treatments has proven useful. Such a multimodal treatment strategy, in which general measures as well as nutritional, psychological, and pharmacotherapies are individually combined, is significantly superior to drug monotherapy. This article describes first- and second-line drug treatments in addition to options for refractory symptoms. The choice of drug therapy is primarily determined by the dominant symptoms. Depending on the symptom constellation, it may be beneficial to combine different drugs.
UNASSIGNED: Das Reizdarmsyndrom (RDS) ist eine chronische Erkrankung des Verdauungstrakts mit oft jahrzehntelanger Chronizität. Gleichzeitig ist die Therapie besonders anspruchsvoll, weil ein Behandlungserfolg häufig eine Kombination medikamentöser und nichtmedikamentöser Maßnahmen erfordert. Die Pathomechanismen des RDS sind erst in Ansätzen aufgeklärt, entsprechend fehlen kausal wirksame Therapien weitgehend. Im Gegensatz zu früheren Vorstellungen einer „psychosomatischen Störung“ handelt es sich beim RDS in der großen Mehrzahl der Fälle um eine organische Erkrankung. Die üblicherweise dominierenden Beschwerden sind Darmkrämpfe oder Leibschmerzen, Meteorismus/Flatulenz, Obstipation und Diarrhö. Der Patient sollte von Anfang an umfassend in ein gemeinsames Behandlungskonzept einbezogen werden. Aufgrund des Fehlens kausaler Behandlungsverfahren hat jeder Behandlungsansatz zunächst probatorischen Charakter, bei fehlender Wirkung sollte eine Therapie spätestens nach 3 Monaten beendet werden. Wirksame Behandlungen können als Bedarfs- oder Dauertherapie fortgesetzt, adaptiert und/oder mit weiteren Verfahren kombiniert werden. Es hat sich bewährt, die gezielte medikamentöse Behandlung der dominanten Einzelsymptome durch eher unspezifische, aber oft relevant wirksame Basis- oder Begleittherapien zu ergänzen. Eine solche multimodale Therapiestrategie, in der Allgemeinmaßnahmen, Ernährungs‑, Psycho- und Pharmakotherapien individuell kombiniert werden, ist einer medikamentösen Monotherapie signifikant überlegen. Im vorliegenden Beitrag werden medikamentöse Erst- und Zweitlinientherapien sowie Optionen bei refraktärer Symptomatik beschrieben. Die Wahl der medikamentösen Therapie wird hauptsächlich durch die dominanten Symptome bestimmt. Abhängig von der Symptomkonstellation kann es sinnvoll sein, verschiedene Substanzen zu kombinieren.

Fructans are commonly used as dietary fibre supplements for their ability to promote the growth of beneficial gut microbes. However, fructan consumption has been associated with various dosage-dependent side effects. We characterised side effects in an exploratory analysis of a randomised trial in healthy adults (n = 40) who consumed 18 g/day inulin or placebo. We found that individuals weighing more or habitually consuming higher fibre exhibited the best tolerance. Furthermore, we identified associations between gut microbiome composition and host tolerance. Specifically, higher levels of Christensenellaceae R-7 group were associated with gastrointestinal discomfort, and a machine-learning-based approach successfully predicted high levels of flatulence, with [Ruminococcus] torques group and (Oscillospiraceae) UCG-002 sp. identified as key predictive taxa. These data reveal trends that can help guide personalised recommendations for initial inulin dosage. Our results support prior ecological findings indicating that fibre supplementation has the greatest impact on individuals whose baseline fibre intake is lowest.

OBJECTIVE: Considering the significant prevalence of ileus after abdominal surgery and the beneficial effects of Cuminum cyminum in digestive problems, this study aimed to examine whether Cuminum cyminum has any effect on the return of bowel motility after abdominal surgery.
METHODS: In this triple-blind clinical trial study, 74 patients undergoing abdominal surgery were assigned to the intervention and control groups using minimization methods. The patients in the intervention group consumed 250 mg capsules containing Cuminum cyminum extract 4 h after the surgery and another dose of the drug 1 h afterward. The patients in the control group consumed a 250 mg capsule containing starch as a placebo at hours similar to those in the intervention group. The instruments used to collect the data were a demographic questionnaire and a researcher-made checklist to assess bowel habits. The data were analyzed using SPSS-22 software.
RESULTS: The average time of gas passing in the intervention and control groups was 9.03 ± 3.41 and 11.72 ± 4.21 h, respectively. The defecation times in the intervention and control groups were 16.97 ± 5.02 and 26 ± 9.87 h, showing a significant difference between the two groups as indicated by the independent samples T-test (P > 0.001). Furthermore, abdominal pain, abdominal bloating, nausea, and vomiting were significantly less frequent in the intervention group compared to the control group as confirmed by Fisher\'s exact test (P > 0.001).
CONCLUSIONS: According to the results, the consumption of Cuminum cyminum after abdominal surgery helps to reduce the time of gas passing, defecation, and the return of bowel motility. However, additional studies need to address the effectiveness of Cuminum cyminum by changing the time and duration of its use.

In response to \"Stribling & Ibrahim 2023: Commentary to the Editor\", we wish to thank all authors for their interest in our work. The sole motive behind our narrative review, after learning the lesson from the trans-fat history and its impact on the science and food industry, is to prevent harm before it is too late. We agree with the authors regarding the importance of a worldwide unified definition of dietary fibre, but this should not have potential to worsen symptoms of those with functional bowel disorders nor cause more confusion among the public regarding the health benefits of dietary fibre. Thus, we aim to address the authors\' views and concerns, and to provide future recommendations, which will be summarised below. The following abbreviations will be used: FBDs, functional bowel disorders; DF, dietary fibre; LMW DF, low molecular weight dietary fibre; HMW DF, high molecular weight dietary fibre.

Approximately 30% of milk protein is β-casein. We aimed to determine whether lactose maldigesters who chronically consumed two cups of A1/A2 milk (containing 75% A1 β-casein and 25% A2 β-casein) would adapt to have fewer intolerance symptoms, lower serum inflammatory markers, and/or altered glutathione levels similar to those consuming A2 milk (containing 100% A2 β-casein). A double-blinded, randomized, crossover trial was conducted. Sixteen confirmed lactose maldigesters consumed 250 mL of A1/A2 milk and A2 milk twice daily with meals for two weeks. At the end of the adaptation period on day 15, lactose maldigestion was measured after a challenge with the same milk used for adaptation (0.5 g of lactose per kg of body weight) with a hydrogen breath test. Fecal urgency was higher during the two-week consumption of A1/A2 milk compared to A2 milk (p = 0.04, n = 16). Bloating (p = 0.03, n = 16) and flatulence (p = 0.02, n = 16) were also higher on the 15th day with A1/A2 milk compared to A2 milk challenge. However, day-to-day symptoms, hydrogen, serum inflammatory markers, and antioxidant concentrations were not different after A1/A2 and A2 milk consumption adaptation periods. Adaptation over two weeks did not improve lactose digestion or tolerance of A1/A2 milk to match that of A2 milk.

BACKGROUND: Irritable bowel syndrome (IBS), defined according to the Rome IV diagnostic criteria, is a chronic functional gastrointestinal disorder characterized by recurrent abdominal pain related to altered bowel habits. First-line recommended treatments are limited to combining drugs targeting predominant symptoms, particularly pain (antispasmodics), constipation (laxatives), and diarrhea (loperamide), yielding only a limited therapeutic gain. GASTRAP® DIRECT is a class IIa medical formulation composed of a combination of chitin-glucan and simethicone indicated for the symptomatic treatment of gas-related gastrointestinal disorders by combining different mechanisms of action.
OBJECTIVE: To evaluate the efficacy, tolerability, and safety of 4-week GASTRAP® DIRECT treatment in patients with IBS.
METHODS: In this prospective, multicenter, open-label trial, 120 patients with IBS received three sticks of GASTRAP® DIRECT (1.5 g/d of chitin-glucan and 0.75 mg/d of simethicone) per day for 4 weeks. The primary endpoint was the responder rate, defined as the number of patients whose abdominal pain score decreased by ≥ 30% from baseline to week (W) 4. The analysis was performed using the per-protocol set. Cardinal symptoms, impact of global symptoms on daily life, change in stool consistency, and improvement in defecatory disorders were evaluated.
RESULTS: Overall, 100 patients were evaluated. At W4, 67% (95%CI: 57-75) showed improvement in abdominal pain (score: 5.8 ± 2.4 vs 2.9 ± 2.0, P < 0.0001). Similar improvements were observed for bloating [8.0 ± 1.7 vs 4.7 ± 2.9, P < 0.0001; 60% (95%CI: 50-70) responders], abdominal distension [7.2 ± 2.1 vs 4.4 ± 3.1, P < 0.0001; 53% (95%CI: 43-63) responders], and impact of global symptoms on daily life [7.1 ± 2.0 vs 4.6 ± 2.9, P < 0.0001; 54% (95%CI: 44-64) responders]. Stool consistency improved in most patients (90% and 57% for patients with liquid and hard stools, respectively). Overall, 42% of patients with defecatory disorders reported very much/considerable improvements by W2. No severe adverse event occurred, and tolerability was rated \"good\" or \"very good\" by 93% of patients.
CONCLUSIONS: GASTRAP® DIRECT is safe and well tolerated, alleviating IBS symptoms rapidly in 2 weeks. This open-label study suggests that the combination of chitin-glucan and simethicone could be beneficial in patients with IBS.

BACKGROUND: With the increasing prevalence of colorectal cancer (CRC), optimizing perioperative management is of paramount importance. This study investigates the potential of stellate ganglion block (SGB), known for its stress response-mediating effects, in improving postoperative recovery. We postulate that preoperative SGB may enhance the postoperative recovery of patients undergoing laparoscopic CRC surgery.
METHODS: We conducted a randomized controlled trial of 57 patients undergoing laparoscopic colorectal cancer surgery at a single center. Patients, aged 18-70 years, were randomly assigned to receive either preoperative SGB or standard care. SGB group patients received 10 mL of 0.2% ropivacaine under ultrasound guidance prior to surgery. Primary outcome was time to flatus, with secondary outcomes encompassing time to defecation, lying in bed time, visual analog scale (VAS) pain score, hospital stays, patient costs, intraoperative and postoperative complications, and 3-year mortality. A per-protocol analysis was used.
RESULTS: Twenty-nine patients in the SGB group and 28 patients in the control group were analyzed. The SGB group exhibited a significantly shorter time to flatus (mean [SD] hour, 20.52 [9.18] vs. 27.93 [11.69]; p = 0.012), accompanied by decreased plasma cortisol levels (mean [SD], postoperatively, 4.01 [3.42] vs 7.75 [3.13], p = 0.02). Notably, postoperative pain was effectively managed, evident by lower VAS scores at 6 h post-surgery in SGB-treated patients (mean [SD], 4.70 [0.91] vs 5.35 [1.32]; p = 0.040). Furthermore, patients in the SGB group experienced reduced hospital stay length (mean [SD], day, 6.61 [1.57] vs 8.72 [5.13], p = 0.042).
CONCLUSIONS: Preoperative SGB emerges as a promising approach to enhance the postoperative recovery of patients undergoing laparoscopic CRC surgery.
BACKGROUND: ChiCTR1900028404, Principal investigator: Xia Feng, Date of registration: 12/20/2019.

暂无摘要。

The enhanced recovery after surgery (ERAS) protocol, including prokinetic medications, is commonly used to prevent postoperative ileus. Prospective studies evaluating the effectiveness of mosapride citrate, a prokinetic 5-hydroxytryptamine 4 receptor agonist, in patients undergoing gastrectomy within the ERAS framework are lacking. This double-blind randomized trial included patients who were scheduled for laparoscopic or robotic gastrectomy for gastric cancer. Participants were randomly assigned to either a control (placebo) or experimental (mosapride citrate) group, with drugs administered on postoperative days 1-5. Bowel motility was evaluated based on bowel transit time measured using radiopaque markers, first-flatus time, and amount of food intake. No significant differences were observed in baseline characteristics between the two groups. On postoperative day 3, no significant difference was observed in the number of radiopaque markers visible in the colon between the groups. All factors associated with bowel recovery, including the time of first flatus, length of hospital stay, amount of food intake, and severity of abdominal discomfort, were similar between the two groups. Mosapride citrate does not benefit the recovery of intestinal motility after minimally invasive gastrectomy in patients with gastric cancer. Therefore, routine postoperative use of mosapride citrate is not recommended in such patients.

BACKGROUND: There is scarce literature on the effect of mechanical abdominal massage on the duration of ileus after colectomy, particularly in the era of enhanced recovery after surgery (ERAS). The aim of this study was to determine whether abdominal massage after colorectal surgery with anastomosis and no stoma helps toward a faster return of intestinal transit.
METHODS: This study was a superiority trial and designed as a prospective open-label, single-center, randomized controlled clinical trial with two parallel groups. Patients scheduled to undergo intestinal resection and follow an ERAS protocol were randomly assigned to either the standard ERAS group or the ERAS plus massage group. The primary endpoint was the return of intestinal transit, defined as the first passage of flatus following the operation. Secondary endpoints included time of the first bowel motion, maximal pain, 30 day complications, complications due to massage, anxiety score given by the Hospital Anxiety and Depression (HAD) questionnaire, and quality of life assessed by the EQ-5D-3L questionnaire.
RESULTS: Between July 2020 and June 2021, 36 patients were randomly assigned to the ERAS group or the ERAS plus massage group (n = 19). Patients characteristics were comparable. There was no significant difference in time to passage of the first flatus between the ERAS group and the ERAS plus abdominal massage group (1065 versus 1389 min, p = 0.274). No statistically significant intergroup difference was noted for the secondary endpoints.
CONCLUSIONS: Our study, despite its limitations, failed to demonstrate any advantage of abdominal massage to prevent or even reduce symptoms of postoperative ileus after colorectal surgery.
BACKGROUND: 38RC20.021.