Search

Abstract: Background: We have shown that bran exacerbates irritable bowel syndrome symptoms in a large proportion of secondary-care patients. However, it is unknown if this also happens in primary-care or whether a better response to bran occurs, leading to bran failures being selected for referral to the specialist. Aims: To assess the response to bran in primary-care irritable bowel syndrome comparing it to that obtained in secondary-care. Patients and methods: One hundred consecutive primary-care irritable bowel syndrome patients were asked how bran or soluble fibre products affected their symptoms. Results: Bran improved symptoms in 27% of primary-care and 10% of secondary-care patients (p <0.01) and exacerbated symptoms in 22% of primary-care and 55% of secondary-care patients (p <0.001). Fifty-one percent of primary-care and 33% of secondary-care patients reported no change with bran. In primary-care, proprietary fibre led to improvement in 25%, deterioration in 19% and no change in 56% which was not significantly different to secondary-care. Conclusion: Although not especially effective in primary-care irritable bowel syndrome patients, bran does not cause so many problems and is more helpful than in secondary-care. The effects of soluble fibre are similar in both primary-care and secondary-care. This study highlights the problem of extrapolating the response to treatment in irritable bowel syndrome from different care settings. [Copyright &y& Elsevier]

Recent studies suggest that patients with irritable bowel syndrome lBS have elevated levels of plasma 5-HT following meal ingestion compared with healthy controls. Moreover, patients who exhibit postprandial symptoms have higher plasma 5-HT levels compared with those who do not, suggesting a possible relationship between Dost-prandial symptoms and abnormalities in 5-HT release. Given functional dyspepsia (FD) belongs to the same family of disorders as lBS, the aims of this study were to assess platelet depleted plasma (PDP) 5-HT concentrations under fasting and fed (760 kcal meal) conditions in 11 patients with FD (aged 30-61 years; 6 males) and 12 healthy volunteers (aged 20-48 years; 5 males) and assess any relationship to gender and epigastric pain/discomfort (p/d). Results: Under fasting conditions FD patients had similar levels of PDP 5-HT to controls (FD (n = 11): 4.65 ng/ml (geometric mean) vs controls (n = 12): 4.57ng/ml; ratio FD:controls (95%CI), 1.02 (0.14, 1.26)). However, under fed conditions, although the peak PDP 5-HT concentration for the whole group of FD patients was not significantly different from controls (11.19 ng/ml vs 8.43 ng/ml; 1.33(0.69, 2.54); p = 0.37, patients who reported post-prandial p/d had a higher PDP 5-HT peak (n = 8:14.74 ng/ml) than both patients who did not report p/d (5.36ng/ml; ratio with:without p/d 2.75(1.24, 6.10); p = 0.02) and controls (8.43 ng/ml; ratio FD with p/d:controls, 1.75 (0.79, 3.87); p = 0.14). This was as a consequence of a higher PDP 5-HT peak in the female FD patients with p/d (36.56 ng/ml), as all other females (FD and controls (n = 9): 7.71 ng/ml; ratio FD with p/d:FD and controls 4.74 (2.5, 9.0 p < 0.001) and all males (FD and contro s (n = 11): 8.07 ng/ml; ratio female FD with p/d: all males, 4.53 (2.19,9.35); p < 0.001) had lower PDP 5-HT peaks. Lastly, symptom severity tended to correlate with peak PDP 5-HT concentration (rho = 0.37; p = 0.08). Conclusions: These data provide evidence for a role... [ABSTRACT FROM AUTHOR]

Examines the symptoms of irritable bowel syndrome among patients in Great Britain. Main symptoms of the bowel syndrome; Prevalence of non-colonic symptoms; Advice on the management of the symptoms.