Each month, the CDI team rounds up some of the latest #GIcommunity research, news, and trends, and how they impact functional GI diagnostics and treatment of patients worldwide.
This month, we feature content from the AGA, Nature.com, Owlstone Medical, and the Journal of Gastroenterology and Hepatology. Our roundup features new guidance on IBS treatments, overlooked but treatable GI conditions in patients presenting with IBS symptoms, levels of hydrogen sulfide in patients with gastroenterological disorders, and a study on Celiac patients unresponsive to a gluten-free diet.
New AGA guidelines: A targeted approach to IBS-C and IBS-D treatment
The AGA’s newest clinical guidelines outline when to use which IBS drug based on your patient’s symptoms. The two new treatment guidelines were published in Gastroenterology and provide a personalized approach for treating your patients with approved drug treatments for irritable bowel syndrome (IBS) with constipation (IBS-C) or IBS with diarrhea (IBS-D). These treatment guidelines explain when to use newly introduced IBS drugs, when to rely on old medications approved by the FDA and when to use over-the-counter medicines.
Additional AGA Resources:
A systematic review and meta‑analysis on the prevalence of non‑malignant, organic gastrointestinal disorders misdiagnosed as irritable bowel syndrome
This study focuses on the treatable gastrointestinal disorders that may be overlooked in patients with symptoms typical of irritable bowel syndrome (IBS). In this systematic review, the authors aimed to clarify the prevalence of five other often overlooked conditions in adults, including:
- bile acid diarrhea (BAD)
- carbohydrate malabsorption (CM),
- microscopic colitis (MC)
- pancreatic exocrine insufficiency (PEI)
- and small intestinal bacterial overgrowth (SIBO)
Specialist clinicians should be aware of such conditions, and further tests should be considered in patients who do not respond to conventional treatments for IBS.
Hydrogen Sulfide and its Role in Gastrointestinal Disease
This new paper from Owlstone Medical reviews Hydrogen Sulfide (H2S), a “gut health regulator that influences motility, ischemia, and reperfusion, and can promote or inhibit inflammation depending on concentration.” Excessive H2S has been linked to small intestinal bacterial overgrowth (SIBO) or colonic dysbiosis, ulcerative colitis, Crohn’s Disease, and irritable bowel syndrome. H2S can be measured utilizing breath tests, and the paper reviews several previous limited studies on H2S levels in exhaled breath. The paper also examines a new healthy subject study conducted by Owlstone Medical to establish a baseline range for H2S. The study concluded that H2S levels were “consistently below 50ppb which allows us to establish the normal range that can be used in future clinical studies.”
Links between celiac disease and small intestinal bacterial overgrowth: A systematic review and meta-analysis
A recent systematic review shows that celiac disease is associated with small intestinal bacterial overgrowth (SIBO). Roughly 7-30% of Celiac patients are unresponsive to a gluten-free diet. Gastrointestinal symptoms such as bloating, distension, flatulence, abdominal discomfort, diarrhea, and weight loss are frequently associated with SIBO and may cause structural changes to the small intestinal villi. SIBO overlaps with other gastrointestinal disorders, often making it unclear if it is the cause. Antibiotics improved symptoms in 96% of patients studied.