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Background and Aims: Many of the ideas on irritable bowel syndrome (IBS) are derived from studies conducted in Western societies. Their relevance to Asian societies has not been critically examined. Our objectives were to bring to attention important data from Asian studies, articulate the experience and views of our Asian experts, and provide a relevant guide on this poorly understood condition for doctors and scientists working in Asia. Methods: A multinational group of physicians from Asia with special interest in IBS raised statements on IBS pertaining to symptoms, diagnosis, epidemiology, infection, pathophysiology, motility, management, and diet. A modified Delphi approach was employed to present and grade the quality of evidence, and determine the level of agreement. Results: We observed that bloating and symptoms associated with meals were prominent complaints among our IBS patients. In the majority of our countries, we did not observe a female predominance. In some Asian populations, the intestinal transit times in healthy and IBS patients appear to be faster than those reported in the West. High consultation rates were observed, particularly in the more affluent countries. There was only weak evidence to support the perception that psychological distress determines health-care seeking. Dietary factors, in particular, chili consumption and the high prevalence of lactose malabsorption, were perceived to be aggravating factors, but the evidence was weak. Conclusions: This detailed compilation of studies from different parts of Asia, draws attention to Asian patients' experiences of IBS. [ABSTRACT FROM AUTHOR]

Background and Aims: Slow wave (SW) is an essential component in mediating stomach motility. The purpose of the present study was to investigate the SW characteristics in subjects with stomach remnant. Methods: We consecutively enrolled 58 distal radical subtotal gastrectomy (RSG) patients (male/female: 44/14, age: 33–79 years) to receive an electrogastrographic (EGG) measurement. Their Helicobacter pylori status and dyspeptic score were simultaneously assessed. In addition, EGG data of 58 age- and sex-matched healthy subjects were compared. Based on power spectral analysis, the following EGG parameters were derived: dominant frequency (DF)/power (DP), percentage of normal rhythm (2–4 cpm), power ratio (PR) referring the postprandial power change, etc. Results: Visual analysis occasionally found a short period of ∼11 cpm myoelectricity-like rhythm. Distal RSG patients had lower fasting (1.90 ± 0.69 vs 2.97 ± 0.58 cpm, P < 0.001) and postprandial (2.03 ± 0.72 vs 3.35 ± 0.27 cpm, P < 0.001) DF values, while their fasting (36.2 ± 22.3% vs 67.1 ± 23.4%, P < 0.001) and postprandial (33.4 ± 19.9% vs 82.2 ± 16.7%, P < 0.001) percentages of normal rhythms were diminished. In contrast, fasting DP, its meal response and PR (2.99 ± 2.40 vs 2.45 ± 2.63, NS) were comparable to those of controls. Neither gender, age, type of gastroenterostomy, Helicobacter pylori colonization, dyspeptic score nor elapsed time after surgery had an obvious influence on EGG parameters. Conclusions: Distal RSG patients may have decreased SW frequency and less meal ingestion changed EGG parameters in terms of SW frequency, normality and stability, whereas their EGG power remained unchanged irrespective of meal ingestion. [ABSTRACT FROM AUTHOR]

In this review we have unearthed epidemiological data that; support the ‘old’ concept of irritable bowel syndrome (IBS) as a disorder of civilization, build a ‘new’ symptom profile of IBS for Asia, and persuade us against the use of ‘borrowed’ Western diagnostic criteria and illness models by Asian societies. In the 1960s, IBS was described as a disorder of civilization. Early studies from Asia suggested a prevalence of IBS below 5%. Recent studies from Asia suggest a trend for the more affluent city states like Singapore and Tokyo, to have higher prevalence of 8.6% and 9.8%, respectively, while India had the lowest prevalence of 4.2%. Furthermore, there was a trend among the better educated and more affluent strata of society in several urban Chinese populations for a higher prevalence of IBS, as well as a trend for a higher consultation rate. Across Chinese and Indian predominant populations, a majority of patients with IBS criteria report upper abdominal symptoms such as epigastric pain relieved by defecation, bloating and dyspepsia. Bloating and incomplete evacuation appear to be more important determinants of consultation behavior, than psychological factors. The failure of the Rome criteria to recognize the relationship to meals, may have led to a substantial misclassification of IBS as dyspepsia. The relevance of the Western model of psychological disturbance as a determinant of consultation behavior is questionable because of the accessibility and acceptability of medical consultation for gastrointestinal complaints in many Asian communities. [ABSTRACT FROM AUTHOR]

Background and Aim: Obesity is one of the risk factors for non-alcoholic fatty liver disease (NAFLD) and a common disease that comprises simple steatosis and non-alcoholic steatohepatitis (NASH), and can eventually lead to liver cirrhosis. Adiponectin is an adipocyte-derived protein that has anti-obesity, antidiabetic and anti-inflammatory properties, and is considered to possess a hepatoprotective function. Its role in the development and progression of NAFLD in morbidly obese patients is unknown. In this study, we examined the expression levels of adiponectin and its receptors in liver biopsies of morbidly obese patients and then determined whether there was an association with the disease severity. Methods: Liver biopsies from 30 morbidly obese patients (18 NASH vs 12 steatosis) were analyzed. The needle core biopsies were subjected to routine histological examination and stained immunohistochemically for adiponectin, adiponectin receptor I (adipoRI) and receptor II (adipoRII). Results: The two groups were comparable with respect to body mass index, age and gender distribution. The expression of adiponectin decreased in liver biopsies with NASH as compared to those with simple steatosis (1.61 ± 0.70 vs 2.25 ± 0.75, P = 0.028). Spearman's rank correlation coefficient analysis showed that the staining intensity of adiponectin negatively correlated with the grade of inflammation ( r = −0.368, P = 0.045) and stage of fibrosis ( r = −0.380, P = 0.038). There was no significant difference in expression of adipoRI and adipoRII between the two groups. Conclusion: These findings indicate that decreased liver adiponectin expression may play a role in the development and progression of NAFLD, from simple steatosis to NASH, in morbidly obese patients. [ABSTRACT FROM AUTHOR]

Background and Aim: Dioctahedral smectite (DS) is natural adsorbent clay useful in treating acute diarrhea. The aim of this study was to determine DS efficacy on patients with diarrhea-predominant irritable bowel syndrome (D-IBS in a phase III-, 8-week-randomized, double-blind, placebo-controlled trial. Methods: The 104 patients who met the D-IBS Rome II criteria were randomized to receive either DS ( n = 52) or placebo ( n = 52) treatment for 8 weeks (three sachets daily). The primary efficacy endpoint was the changes of the visual analog scale (VAS) score of IBS overall disorder and pain/discomfort-related symptoms after treatment on days 28 and 56, respectively. Other outcome measures included improvement of bowel movement disorders. The therapeutic global response was assessed by the patients and investigators at each visit, as was drug safety. Results: Both treatments diminished overall disorder at each visit ( P < 0.01), with respect to primary efficacy. This effect was further observed in DS-treated patients on day 56 ( P = 0.0167). Placebo had no effect on the VAS score of pain/discomfort at any visit, whereas DS improved this score on days 28 and 56, respectively ( P < 0.05). DS and placebo similarly diminished bowel disorders at each visit; however, only DS improved abdominal bloating ( P < 0.01). The global therapeutic responses evaluated by the patients and investigators were similarly distributed. The study drug was well tolerated during the 8-week period. Conclusion: DS seems acceptable to treat D-IBS patients, particularly for pain-related symptoms. [ABSTRACT FROM AUTHOR]

Background and Aim: Slow wave is essential to initiate gastrointestinal tract motility. Subjects with total gastrectomy (TG) provide an opportunity to study small intestinal slow wave in the absence of stomach interference. The aims of this study were to determine the origin of 3 cycles per min (cpm) slow wave recorded via electrogastrogram (EGG) and the characteristics of putative small intestinal slow waves in TG subjects. Methods: Thirty-three subjects with TG (25 male, age: 44–83 years) were consecutively enrolled. In each subject, the myoelectricity-like signals of the gastrointestinal tract were recorded using 3-channel EGG. Fourier transform-based spectral analysis was performed to derive the EGG parameters including dominant frequency/power, % normal rhythm (2–4 cpm), and power ratio. Results: Neither visual nor spectral analysis of the EGG revealed any waves at a frequency of about 3 cpm. The most frequently observed peaks in the power spectra of all subjects were those at ∼1, ∼6 and ∼11 cpm with occurrences of 97%, 6.1% and 90.9%, respectively. Based on visual analysis of all recorded signals, the ∼11 cpm signal was exactly rhythmically recorded rather than the ∼1 cpm. The recorded ∼11 cpm wave had a frequency of 10.9 ± 1.0 cpm in the fasting state and 10.9 ± 1.3 cpm in the fed state (NS), and a power of 31.5 ± 3.2 dB in the fasting state and 35.2 ± 3.8 dB in the fed state ( P < 0.0001). None of other factors, including sex, age, and body mass index, had any impact on this ∼11 cpm wave. Conclusions: Small intestinal slow wave can be recorded non-invasively using EGG via cutaneous electrodes in TG subjects. Sex, age and body mass index have no effect on the intestinal slow waves. The power rather than frequency of intestinal slow wave is increased after a solid meal. [ABSTRACT FROM AUTHOR]

Asian irritable bowel syndrome (IBS) studies not only confirm the truth of this functional disorder but also describe the current disease situation of this continent, with its variable socioeconomic backgrounds. Most Asian community IBS prevalence is within 5–10%, regardless of gender or ethnic character. As well as meeting the main Rome II criteria, Asian IBS subjects also have many minor symptoms. Thus this recommendation remains useful to diagnose Asian IBS. Also, female patients commonly express constipation-predominant (C-) symptoms. Extra-colonic symptoms are common in Asia, for example dyspepsia, insomnia and irritable urinary bladder. Asian IBS subjects do experience psychological disturbances including anxiety, depression, agoraphobia and neuroticism. Accordingly, their quality of life is poor and there is absenteeism leading to excessive physician visits. Abnormal gut motor and sensory functions have been indicated among the Asian IBS subjects. Now, there is evidence of altered colonic neuroimmune function leading to gut hypersensitivity and dysmotility. An Asia–Pacific trial also confirmed tegaserod efficacy on female C-IBS subjects. More than 90% of nurses have very limited IBS knowledge, and are unable even to explain it clearly. In conclusion, Western recommended criteria clearly diagnose Asian IBS and many factors are mutual leading to IBS. Current IBS treatments remain useful but additional reeducation for medical professionals appears to be needed. [ABSTRACT FROM AUTHOR]

Background: Moderate to severe running usually leads to gastrointestinal dysmotility and critical energy exhaustion. It is unknown whether the carbohydrate metabolism of runners can influence gastric emptying (GE). Using a running rat model, the present study explored the impact of exercise/carbohydrate metabolism on liquid GE. Methods: Rats were put on the runways of a moving treadmill for 1 h. Trained rats underwent daily running 5 days a week for 4 weeks. Untrained rats were those put on a quiet treadmill to serve as sham exercise. On the motility study day, trained and untrained rats ran for 45 min. After orogastric feeding of radiochromium marker, they resumed running for an additional 15 min and were then killed in order to measure GE. Another group of trained and untrained rats received lactate infusion for 1 h in the quiet condition to measure their GE. The third group of rats received glucose infusion during running to measure GE. Results: Running of untrained ( P < 0.05) and trained ( P < 0.01) rats enhanced GE compared to sham exercise. Running for the untrained rats rather than the trained counterparts had diminished plasma glucose level ( P < 0.05). Running also elevated plasma lactate levels for both untrained ( P < 0.001) and trained rats ( P < 0.01). Lactate infusion delayed GE in untrained ( P < 0.01) and trained rats ( P < 0.05). Glucose infusion of untrained rats during running was not only to correct hypoglycemia ( P < 0.01) but also to restore their enhanced GE ( P < 0.01). Conclusions: Running-induced hypoglycemia, rather than lactate accumulation, is one of the essential factors leading to enhanced liquid GE in untrained rats. [ABSTRACT FROM AUTHOR]

It remains debatable if duodenal ulcer (DU) or Helicobacter pylori infection has a definite impact on human gastric emptying (GE). We explored the nature of water GE in active DU patients before and after ulcer healing and the influence of H. pylori eradication on GE. A home made applied potential tomography (APT) was used to measure liquid GE. Twelve electrodes were placed in a circular array around the upper abdomen of studied subjects. After drinking 500 mL of ion-free water, paired electrodes injected electrical current and the remaining 10 electrodes recorded signals, one-by-one in a rotating order. Based on tomographical calculation, the serial changes of averaged signals from altered resistivities were constructed to display GE. Initially, 64 H. pylori infected active DU patients were enrolled. After APT measurement, one-week triple therapy (omeprazole, amoxicillin and clarithromycin) was dispensed. Patients were asked back to determine ulcer/ H. pylori status and GE on a scheduled date 3 months later. Finally, 58 patients finished the trial with valid and readable GE data obtained. The ulcer healing and H. pylori eradicated rates were 91.4% and 82.8%, respectively. In general, liquid GE was prolonged in all DU patients at follow up. Of 48 eradicated patients, 35.4% manifested either enhanced or delayed GE before treatment, whereas only five (10.4%) had abnormal GE after treatment ( P < 0.0001). In contrast, this characteristically normalized GE was not found in non-eradicated patients. Water GE of active DU patients ranges from enhanced to delayed, while an effective H. pylori triple therapy is useful not only for healing ulcers, but also for restoring abnormal GE. [ABSTRACT FROM AUTHOR]