Dietary Magnesium Intake Is Inversely Associated With Ulcerative Colitis: A Case-Control Study.

Background: Ulcerative colitis (UC) causes long-lasting inflammation and ulcers in the gut. Limited observational data are available linking dietary magnesium intake and UC. In the present study, we aimed to investigate the association between dietary magnesium intake and UC in adults. Methods: The current population-based case-control study was performed on 109 UC patients and 218 age (±2 years) and sex-matched controls. The diagnosis of UC was made according to the standard criteria by a gastroenterology specialist. Dietary intakes were assessed using a validated self-administrated 106-item dish-based Food Frequency Questionnaire (FFQ). We also used a pretested questionnaire to collect data on potential confounders. Results: Individuals in the top tertile of magnesium intake were less likely to have UC compared with those in the bottom tertile. A significant inverse relationship was found between dietary magnesium intake and UC (odds ratio [OR]: 0.32, 95% confidence interval [CI]: 0.18-0.59) in the crude model. This relationship was also observed when we took several potential confounding into account (OR: 0.30, 95% CI: 0.14-0.68). Conclusions: Adherence to a magnesium-rich diet may have a role in preventing UC. However, further studies are needed to confirm our findings.

Association between food-based dietary inflammatory potential and ulcerative colitis: a case-control study.

Despite several studies on the link between dietary inflammatory potential and risk of several conditions, limited studies investigated the association between pro-inflammatory diet and ulcerative colitis (UC). The objective of the present study was to examine the link between food-based dietary inflammatory potential (FDIP) and odds of UC in Iranian adults. This case-control study was carried out among 109 cases and 218 randomly chosen healthy controls. UC was diagnosed and confirmed by a gastroenterologist. Patients with this condition were recruited from Iranian IBD registry. Age- and sex-matched controls were selected randomly from participants of a large cross-sectional study. Dietary data were obtained using a validated 106-item semi-quantitative food frequency questionnaire (FFQ). We calculated FDIP score using subjects' dietary intakes of 28 pre-defined food groups. In total 67% of subjects were female. There was no significant difference in mean age between cases and controls (39.5 vs. 41.5y; p = 0.12). The median (interquartile range) of FDIP scores for cases and controls were - 1.36(3.25) and - 1.54(3.15), respectively. We found no significant association between FDIP score and UC in the crude model (OR 0.93; 95% CIs 0.53-1.63). Adjustment for several potential confounders in multivariate model did not change this association (OR 1.12; 95% CIs 0.46-2.71). We failed to observe any significant association between greater adherence to a pro-inflammatory diet and risk of UC in this study. Prospective cohort studies are needed to further assess this relationship.

Low fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet is associated with increased risk of uninvestigated chronic dyspepsia and its symptoms in adults.

BACKGROUND: Assessing the potential effects of a low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) diet on functional gastrointestinal symptoms, particularly upper gastrointestinal symptoms, is not clearly understood. The current study aimed to explore the association of a diet low in FODMAPs with uninvestigated chronic dyspepsia (UCD) and functional dyspeptic symptoms in a large population of Iranian adults. METHODS: This cross-sectional study was conducted on 2987 adults. Dietary FODMAPs intake estimated using a validated food-frequency questionnaire. UCD, early satiation, postprandial fullness and gastric pain were determined using a modified and validated version of the Rome III Questionnaire. RESULTS: After controlling for various confounders, consumption of a diet low in FODMAPs was associated with increased risk of UCD in the whole population (OR=1.85; 95% CI: 1.23-2.78; P=0.009) and women (OR=2.41; 95% CI: 1.46-3.95; P=0.004), but not in men. Higher consumption of a low-FODMAPs diet was related to increased risk of postprandial fullness (OR=1.38; 95% CI: 1.08-1.78; P=0.046). The inverse association between FODMAPs and epigastric pain tended to be significant after controlling for eating behaviors (OR=1.31; 95% CI: 0.98-1.76; P=0.084). No significant association was observed for early satiation. CONCLUSIONS: Our data suggest that consumption of a low-FODMAPs diet may increase the risk of UCD and postprandial fullness; however, well-planned randomized controlled trials and prospective cohorts are required to ascertain the effect of FODMAPs on upper gastrointestinal symptoms.

Effects of Duloxetine on Gastrointestinal Symptoms, Depression, Anxiety, Stress, and Quality of Life in Patients with the Moderate-to-Severe Irritable Bowel Syndrome.

Background: Irritable bowel syndrome (IBS) is a chronic disease. There are very few studies on the Duloxetine efficacy in improving the gastrointestinal and psychological symptoms, in IBS. The current study attempted to evaluate the effectiveness of Duloxetine in symptoms and quality of life in moderate-to-severe IBS patients. Materials and Methods: This is a double-blind placebo-controlled clinical trial in which the population is composed of 37 patients with moderate-to-severe IBS in Isfahan from March 2018 to March 2019. For the intervention group, Duloxetine was administered for three months, and the treatment protocol was the same for the control group but using a placebo. The severity of IBS symptoms, quality of life, and negative emotions such as depression, anxiety, and stress were assessed. Results: Our data showed no significant difference between the two groups of the study for the severity of IBS symptoms (P value = 0.150); however, in the intervention group, it was significantly lower than controls after six, eight, and ten weeks of the intervention (P value = 0.023). Overall evaluation of the quality of life in patients indicated significantly higher quality of life in the Duloxetine group than the control group from the eighth week to the twelfth week after the intervention (P value <0.038). Anxiety and stress in the Duloxetine group were significantly lower than controls after the intervention (P value <0.05). Conclusion: Duloxetine is probably helpful for reducing anxiety, stress, and the severity of symptoms in IBS patients. It also could increase the quality of life in patients.

Relationship between Depression and Constipation: Results from a Large Cross-sectional Study in Adults.

Background/Aims: Accumulating evidence based on a few studies suggests a relationship between depression and functional constipation. This study examined whether depression is associated with a higher risk of functional constipation and whether it is gender specific. Methods: This cross-sectional study was carried out on 3,362 adults aged 18-55 years. In this study, functional gastrointestinal symptoms were determined using an Iranian reliable and valid version of the modified Rome III questionnaire. The Iranian validated version of the hospital anxiety and depression scale was used to evaluate the psychological health. Scores of eight or more on the depression subscale in the questionnaire were considered the presence of depression. Simple and multiple binary logistic regression were used for data analysis. Results: The mean±SD age of participants was 36.29±7.87 years, and 58.5% were female. The prevalence of depression and constipation in the study sample was 28.6% and 23.9%, respectively. In the full adjusted model, in the total sample, depressed people showed a significantly higher risk of constipation; adjusted OR (AOR), 1.69 (95% CI, 1.37-2.09). Although a significant association was observed between depression and constipation in both genders, the association was stronger in men than women (AOR, 2.28; 95% CI, 1.50, 3.63 vs. AOR, 1.55; 95% CI, 1.21, 1.99). Conclusions: These study findings showed that depressed people are at a significantly higher risk of being affected by constipation. The current study findings justify the importance of mental health evaluations in all patients with functional gastrointestinal disorders, particularly among constipated individuals.

A population based case-control study of association between dietary calcium intake and ulcerative colitis in adults.

Limited data are available on the association of dietary calcium intake and ulcerative colitis (UC). We aimed to investigate the relation between dietary calcium intake and UC prevalence in Iranian adults. In this population-based case-control study, diagnosed patients with UC by gastroenterologists that were registered in the Iranian inflammatory bowel disease registry were included as cases. Age and sex-matched healthy controls were selected from Study on the Epidemiology of Psychological, Alimentary Health and Nutrition (SEPAHAN) dataset. Dietary calcium intakes of participants were examined through a validated food frequency questionnaire. We included 327 middle-aged participants (109 cases and 218 controls) in the analysis; 52.1% of them were females. After adjustments for potential confounders, individuals in the third tertile of dietary calcium intake had 92% lower odds of UC, compared to those in the first tertile (OR = 0.08, 95% CI 0.02-0.27). Our analysis based on recommended dietary allowances (RDAs) intake showed that dietary Ca intake deficiency was related to increased odds of UC (OR = 9.5, 95% CI 2.98-30.91). Stratified analysis by gender revealed that these associations were significant in both genders; although the results were stronger in the male population. A Significant decreasing trend was observed for odds of UC in tertiles of dietary calcium intakes, in both males and females. Higher dietary calcium intake was associated with lower UC prevalence in Iranian adults. Inadequate dietary calcium intake was also linked to elevated odds of UC. Further prospective investigations are needed to affirm these findings.

Oral manifestations in inflammatory bowel disease: A cross-sectional study in Isfahan.

BACKGROUND: Various systemic diseases can cause oral manifestations, such as inflammatory bowel disease (IBD). This study is designed to investigate the frequency of oral manifestations in patients with IBD referred to health centers and offices in Isfahan in 2018. MATERIALS AND METHODS: This cross-sectional study was done among 161 patients suffering from IBD in Isfahan, Iran. They were chosen by the systematic randomized sampling. Finally, the data were analyzed using the logistic regression test in the SPSS software. Significance was assigned at P < 0.05. RESULTS: The number of patients with ulcerative colitis and Crohn's syndrome was, respectively, 119 persons (73.9%) and 42 persons (26.1%). Oral manifestations were seen among 52 (32.3%) of the samples. The frequency of oral manifestations was 35.6% (31 cases) in males and 28.4% (21 cases) in females. Oral manifestations were seen in 29.4% of patients with ulcerative colitis and 40.5% of patients with Crohn's disease. Based on the logistic regression, there was a statistically significant relationship between the use of azathioprine and mesalazine with oral manifestations (P < 0.05), whereas the severity of disease and smoking were not statistically significantly related to oral manifestations (P > 0.05). CONCLUSION: The severity of the disease was not significantly correlated with oral manifestations, which are in agreement with the results of previous studies. It was also found that among patients with IBD, the oral aphthous ulcers can appear 1-3 years before the diagnosis of the disease. Besides that, some of the drugs used to treat the disease have a significant relationship with oral manifestations.

The association between meal and snack frequency and irritable bowel syndrome.

OBJECTIVE: The relationship between daily meal and snack frequency with irritable bowel syndrome (IBS) was less investigated in the literature. We aimed to evaluate this association with IBS symptoms. DESIGN: A cross-sectional study. SETTING: This investigation was performed in Isfahan, a large province in the centre of Iran. Individuals were asked to complete a self-administered questionnaire to quantify the numbers of daily main meals (one, two or three), snacks (never, 1-2, 3-5 or >5) and the total of them (<3, 3-5, 6-7 or ≥8). IBS and its subtypes were diagnosed according to Rome Ш criteria. PARTICIPANTS: General adults (n 4669, 2063 men and 2606 women). RESULTS: The prevalence of IBS was 18·6 % in males and 24·1 % in females. Individuals consuming three main meals had 30 % decreased risk of IBS (OR 0·70, 95 % CI 0·52, 0·94) compared with those with one main meal in the crude model. After adjustments for all potential confounders this relation disappeared (OR 0·67, 95 % CI 0·43, 1·03). Gender-specified analysis revealed that women consuming three main meals per day had 32 % decreased likelihood of having IBS symptoms compared with one daily main meal takers (OR 0·68, 95 % CI 0·47, 0·99). This relation remained significant after adjustment for potential confounders (OR 0·56, 95 % CI 0·36, 0·89). A decreased likelihood of IBS in the highest category of main meal consumption compared with the lowest one was found in obese or overweight subjects (OR 0·54, 95 % CI 0·32, 0·91), after adjustment for all confounders. CONCLUSIONS: Our findings suggested that there was no significant relation between main meal or snack frequency and IBS in Iranian adults, but a small inverse association was found among females and overweight/obese individuals in subgroup analysis. Further prospective studies are needed confirming these associations.

Association Between Inflammatory Potential of the Diet and Ulcerative Colitis: A Case-Control Study.

Background/Aim: Despite the inflammatory nature of inflammatory bowel disease (IBD), limited data are available on the association of inflammatory potential of the diet and risk of ulcerative colitis (UC). We aimed to investigate the association of inflammatory potential of the diet (IPD) score and odds of UC in a case-control study. Methods: Patients with UC were enrolled from Iranian IBD registry, whose disease was confirmed by a gastroenterologist. Controls were selected randomly from the Study of the Epidemiology of Psycho Alimentary Health and Nutrition (SEPAHAN) study, a large population-based study on more than 8,000 apparently healthy individuals. Dietary intakes of 28 food items obtained from a validated dish-based food frequency questionnaire (FFQ), were used to compute IPD score. Results: This case-control study was carried out among 109 cases and 218 randomly chosen controls. Mean age of cases and controls was 39.5 ± 10.0 and 41.5 ± 11.8 y, respectively. Totally, 52% of study participants were female and 48% were male. After controlling for age, sex, and body mass index (BMI), we found that the patients with UC were more likely to be in the highest quartile of IPD score compared with controls (OR: 2.83; 95% CI: 1.41-5.69, P-trend < 0.001). This association strengthened after additional adjustment for education, smoking, medical history, and physical activity (OR: 3.48; 95% CI: 1.32-9.10, P-trend = 0.003). When we took dietary habits into account, the association was slightly attenuated (OR: 3.33; 95% CI: 1.20-9.20, P-trend = 0.005). Conclusions: We found that adherence to a pro-inflammatory diet was positively associated with greater odds of UC. Further studies are required to confirm these findings.

Effects of venlafaxine on gastrointestinal symptoms, depression, anxiety, stress, and quality of life in patients with the moderate-to-severe irritable bowel syndrome.

BACKGROUND: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder which its treatment is still a question. According to the literature, the use of antidepressants is common for IBS, while its efficacy in this regard is controversial. This study has been raised to assess the efficacy of venlafaxine in IBS patients. MATERIALS AND METHODS: In this double-blind, randomized clinical trial, 33 patients with moderate-to-severe IBS were included and randomly divided into two groups by using permuted block randomization process of size 4 for each block to receive Venlafaxine or placebo. Venlafaxine in 37.5 mg/day for 2 weeks, followed by 75 mg/day for the next 2 weeks and then 150 mg/day until the end of the study was prescribed. Gastrointestinal symptoms severity, depression, anxiety, stress as main, and quality of life (QoL) as the secondary outcomes were evaluated at the study initiation, within 2, 6, and 12 weeks after treatment and 3 months after intervention cessation. RESULTS: The gastrointestinal symptoms severity, depression, anxiety, stress, and QoL scores significantly improved in patients who received Venlafaxine but not in placebo group; although after treatment discontinuation they experienced relapse (P < 0.05). Patients treated with venlafaxine experienced significant improvement in IBS symptoms, all three psychological disorders and QoL than placebo group (P < 0.01). The frequency of observed side effects in venlafaxine group including vomiting, nausea, and sleep disturbance was higher than placebo. CONCLUSION: Venlafaxine could be considered as an effective treatment for improving gastrointestinal symptoms severity, depression, anxiety, stress, and QoL of patients with IBS. Further studies with larger sample size and longer treatment duration are recommended.

Spicy Food Consumption and Risk of Uninvestigated Heartburn in Isfahani Adults.

BACKGROUND/OBJECTIVE: Dietary recommendations for the consumption of spicy foods in uninvestigated heartburn are still under debate. We examine the association between spicy food consumption and the prevalence of uninvestigated heartburn in a large sample of Iranian adults. METHODS: This cross-sectional study was conducted among 4,633 Iranian adults living in Isfahan (2,046 men, 2,587 women) in 2010. The average daily intake of spicy foods was estimated using a dietary habit questionnaire. Uninvestigated heartburn was defined, using a validated Rome III questionnaire, as the presence of heartburn sometimes, often or always during the last 3 months. RESULTS: Uninvestigated heartburn was prevalent in 23.8% (n = 1,103) of participants. After controlling for potential confounders, including dietary behaviors and body mass index, men consuming spicy foods ≥10 times/week were 2.63 times more likely to have uninvestigated heartburn (95% CI:1.28-5.36) compared with those who never consumed spicy foods. Also, those men with the highest consumption of spicy foods were 3 times more likely to experience heartburn frequently (95% CI 1.44-6.39) compared with men with the lowest intake. No overall significant associations were found between the consumption of spicy foods and uninvestigated heartburn, including the frequency and severity of heartburn, in women. When the analysis was restricted to those with uninvestigated heartburn, no significant associations were found between consumption of spicy foods and frequency of heartburn either in men or women. CONCLUSION: The present findings suggest that high consumption of spicy foods was associated with a greater risk of uninvestigated heartburn in men, but not in women. Further studies, particularly of a prospective nature, are needed to confirm our findings, as well as underlying mechanisms.

Inflammatory Bowel Disease Registry and Monitoring: Feasibility Study and Application (Isfahan Inflammatory Bowel Disease Surveillance Project).

BACKGROUND: Inflammatory bowel disease (IBD) incidence has been increased in Iran as a developing country. Surveillance is a standard method for accessing valid data about disease epidemiology to make relevant decisions for disease control, prevention, and management. We designed Isfahan IBD Surveillance Project (IISP) to make a surveillance system in this area. METHODS: The project is designed in 3 phases. At the first phase, a model of step-wise approach (core, expanded core, and optional variables) for IBD surveillance was designed and implemented among IBD patients registered at a major referral gastrointestinal diseases clinic in Isfahan. Data bank program and its software were designed with suitable and multifunctional features. A total of 352 IBD cases were registered to data bank and analyzed as a pilot study of IISP. RESULTS: A total of 352 IBD patients, including 245 ulcerative colitis (UC), 80 Crohn's disease (CD), and 27 indeterminate colitis, were registered to the data bank. Bloody stool and abdominal cramp were the most common presentation symptom among UC and CD, respectively. Extensive pancolitis was the most prevalent phenotype (40%) of UC. Over two-thirds of our IBD patients were in remission states. Biologic agents had been prescribed in about 10% of patients during disease. Primary sclerosing cholangitis was detected in about 7% and 10% of CD and UC patients, respectively. CONCLUSIONS: Valid data from a standard surveillance system are a relevant, trustworthy tool for making decision by health policy-makers. Integrated comprehensive interventional programs for disease control and management is the second phase of IISP.

Relations between Coping Skills, Symptom Severity, Psychological Symptoms, and Quality of Life in Patients with Irritable Bowel Syndrome.

BACKGROUND: Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders with significant impact on quality of life (QOL). Considering the role of stress in the clinical course of IBS, we investigated associations between stress coping skills and symptoms and QOL in IBS patient. METHODS: A cross-sectional study was conducted on 95 IBS patients referring to tertiary care centers. Coping skills (Jalowiec coping scale), IBS symptom severity scale, disease-specific QOL (IBS-QOL), and symptoms of depression and anxiety (Hospital Anxiety and Depression Scale [HADS]) were evaluated by questionnaires. Bivariate and multivariate analyses were performed to investigate association among these parameters. RESULTS: Disease severity was positively correlated with emotive (r = 0.30) and fatalistic (r = 0.41) and negatively correlated with optimistic (r = -0.25) and confrontive (r = -0.24) coping strategies. Psychological dysfunction (total HADS score, B [95% (confidence interval) CI] = 2.61 [0.001-5.21]) and fatalistic coping (B [95% CI] = 35.27 [0.42-70.13]) were significant predictors of IBS severity. CONCLUSIONS: However, IBS patients involved in this study utilized adaptive coping strategies more frequently. Our study showed that use of maladaptive coping strategies had positive correlation with symptom severity and degree of anxiety and depression among patients, while implementation of optimistic strategies were found to be negatively correlated to severity of symptoms and also utilization of adaptive coping styles was associated with lesser degree of anxiety and depression.

Physical activity in relation to irritable bowel syndrome among Iranian adults.

BACKGROUND: Irritable bowel syndrome (IBS) is the most prevalent functional gastrointestinal disorder worldwide. Physical activity in relation to IBS has been investigated in few studies and data in this regard are conflicting. AIM: To investigate the association between physical activity and IBS in a large sample of Iranian adults. METHODS: This cross-sectional study was done on 4763 Iranian adults in the framework of SEPAHAN (The Study on the Epidemiology of Psycho-Alimentary Health and Nutrition) project. The physical activity of study participants was assessed using the General Practice Physical Activity Questionnaire (GPPAQ). Using a validated self-administered modified Rome III questionnaire, functional gastrointestinal disorders including irritable bowel syndrome was assessed. RESULTS: The mean age of study participants was 36.5 years. Irritable bowel syndrome was prevalent among 21.5% of participants. Compared with physically active individuals (≥ 1 hour/wk), those with sedentary physical activity (<1 hour/wk) had 1.27 times greater probability of suffering from IBS (OR: 1.27, 95% CI: 1.08-1.49). However, this association was attenuated after adjusting for age, sex, cigarette smoking and medical history of colitis and diabetes. When the analysis was additionally adjusted for diet-related practices and body mass index (BMI), a non-significant association was found between sedentary physical activity and IBS (OR: 1.18, 95% CI: 0.98-1.41). Gender-stratified analysis revealed similar findings in women either before (OR: 1.29, 95% CI: 1.04-1.61) or after controlling for covariates (OR: 1.27, 95% CI: 0.99-1.62). In BMI-stratified analysis, a significant positive association was seen between sedentary physical activity and IBS among individuals with normal BMI (OR: 1.38, 95% CI: 1.07-1.79). CONCLUSION: We found a significant positive association between sedentary physical activity and IBS, particularly among women and individuals of normal weight.

Therapeutic Effects of Low-dose Bismuth Subcitrate on Symptoms and Health-related Quality of Life in Adult Patients with Irritable Bowel Syndrome: A Clinical Trial.

OBJECTIVE: Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal tract that causes abdominal pain or discomfort and alters bowel with no organic abnormalities. Treatment options for IBS have increased in number in the past decade, and clinicians should not be limited to use only conventional treatments to cure it. This article is a placebo-controlled clinical trial to assess the therapeutic effects of low-dose bismuth subcitrate on symptoms and the health-related quality of life in adult patients with IBS. METHODS: This clinical trial was done during July 2015 to January 2016 in Isfahan, Iran. For each of three subtypes (IBS-constipation dominant, IBS-diarrhea dominant [IBS-D], and IBS-mixed), we included patients with IBS aged 18-70 years, diagnosed according to the Rome III criteria. In this study, 129 eligible patients were enrolled, of which 119 continued on the protocol to the end of study. They were allocated in placebo group (Group A) and intervention group (Group B). The medication for Group B was mebeverine and bismuth subcitrate and for Group A was mebeverine and placebo of bismuth subcitrate. Initially, the patients of both groups completed IBS-related questionnaires (IBS-quality of life, IBS-severity scoring system), then given drugs for a 4-week period (1st on-drug period). Then, both groups were given only mebeverine hydrochloride 200 mg capsule for another 4 weeks (off-drug period). At last, Group A and Group B were given medication (2nd on-drug period), the same as 1st on-drug period. FINDINGS: With respect to quality of life, the trend of IBS-QOL score changed significantly during the study period in both the intervention and placebo groups; however, no significant differences were observed between the two groups (P < 0.005). In subgroups analysis, quality of life significantly improved in IBS-D during the study from the first measurement to the end of study (P = 0.004). The trends of changes in the severity of pain during the study between the intervention and control group were significantly different (P = 0.018). CONCLUSION: According to our study, IBS-D patients' symptoms improved significantly with bismuth therapy. We found that adding low-dose bismuth to mebeverine in nonresponsive IBS patients in conventional treatment could be helpful.

Empirically derived dietary habits are associated with irritable bowel syndrome.

BACKGROUND/OBJECTIVES: The associations between empirically derived dietary habits and irritable bowel syndrome (IBS) have not been investigated. This study aimed to assess the relationship between empirically derived dietary habits and IBS in a large population of Iranian adults. SUBJECTS/METHODS: In a cross-sectional study, dietary habits of 4763 adults were assessed in three domains, "meal pattern", "eating rate" and "intra-meal fluid intake". We used latent class analysis to identify classes of dietary habits. IBS was defined based on ROME III criteria. RESULTS: IBS was prevalent in 20.3% (n = 966) of the study population. Two distinct classes of meal patterns: "regular" and "irregular", three classes of eating rates: "moderate", "moderate-to-slow" and "moderate-to-fast" and two classes of fluid ingestion with meals: "moderate" and "heavy intra-meal drinking" were identified. After adjustment for confounders, "heavy intra-meal fluid intake" was protectively associated with IBS (OR = 0.79; 95% CI:0.64-0.96). When potential confounders were considered, "meal pattern" and "eating rate" were not significantly associated with IBS in the whole population. After adjustment for confounders, women with "irregular meal pattern" had a 30% greater risk of having IBS, compared with those with "regular meal pattern" (OR = 1.30; 95% CI:1.02-1.67). Overweight participants with "fast eating rate" were 70% more likely to have IBS, compared to those with "moderate eating rate" (OR = 1.70; 95% CI:1.13-2.55). "Irregular meal pattern" was related to frequency and severity of abdominal pain. CONCLUSIONS: We found a significant association between heavy intra-meal fluid intake" and IBS. More large-scale prospective studies are needed to affirm this association.

Adherence to a Low FODMAP Diet in Relation to Symptoms of Irritable Bowel Syndrome in Iranian Adults.

BACKGROUND: Most studies assessing the influence of a low fermentable oligo-, di-, monosaccharides and polyols (FODMAP) diet on irritable bowel syndrome (IBS) symptoms were clinical trials with a small sample size. OBJECTIVE: This study was done to examine the association between adherence to a low FODMAP diet and symptoms of irritable bowel syndrome in Iranian adults. METHODS: In this cross-sectional study, data on 3362 Iranian adults were collected. Dietary intakes of study participants were assessed using a validated 106-item self-administered dish-based, semi-quantitative food frequency questionnaire. Based on earlier studies, we identified all foods with a high FODMAP content in our dataset. Participants were categorized into quartiles in terms of dietary intakes of these foods. Total FODMAP score for each individual was computed by summing up the scores of all foods. Individuals in the highest quintile of FODMAP score were defined as those with the greatest adherence to the low FODMAP diet. A modified Persian version of the ROME III questionnaire was used for assessment of IBS, which was defined according to ROME III criteria. RESULTS: Adherence to the low FODMAP diet was significantly associated with low intakes of macro- and micro-nutrients as well as all food groups (P < 0.001 for all). Participants with the greatest adherence to the low FODMAP diet, compared to those with the lowest adherence, had not significantly lower odds for having IBS, either before (95% CI 0.93, 1.58, P < 0.05) or after adjustment for potential confounders (95% CI 0.80, 1.60, P < 0.05). This was also the case for IBS subtypes; such that those with the greatest adherence to the low FODMAP diet, compared to those with the lowest adherence, were not less likely to have these types of IBS. CONCLUSION: In conclusion, we did not find any significant association between adherence to the low FODMAP diet and IBS. Further studies are required to reach a definite conclusion in this regard.

The comparison of treatments with and without azithromycin in irritable bowel syndrome with diarrhea-predominant in gastrointestinal Clinic of Al-Zahra Hospital, Isfahan, Iran.

BACKGROUND: Irritable bowel syndrome (IBS) is a common gastrointestinal disorder. Recent studies suggest the importance of gut flora in the pathophysiology of it. Therefore, antibiotics have demonstrated a substantial benefit to reduce gut flora. Having few side effects, and applying one-dose per day, we studied the effect of azithromycin to treat IBS. MATERIALS AND METHODS: One hundred and twenty-six patients enrolled a randomized, double-blind, placebo-controlled study. The treatment group received azithromycin in addition to common treatment. Patients were followed for 12 weeks. Patients completed daily diaries documenting their symptoms. RESULTS: One hundred and thirteen patients completed the study. The onset of relief occurred significantly sooner, and duration of relief was significantly longer in azithromycin group. Movement, abdominal pain, bloating, and gas were significantly better in azithromycin group. Monthly results showed superior relief in bloating, gas, overall symptom, and overall bloating during 3 months. Significantly more patients in azithromycin group felt relief in bloating and gas and had greater consistency relief in almost all weeks. CONCLUSION: In our study, azithromycin significantly relieved most symptoms, such as abdominal pain, bloating, and gas. Overall symptom and overall bloating were relieved significantly in more patients in the intervention group in all weeks.

Life stressors, coping strategies, and social supports in patients with irritable bowel syndrome.

BACKGROUND: The frequency and the perceived intensity of life stressors, coping strategies, and social supports are very important in everybody's well-being. This study intended to estimate the relation of irritable bowel syndrome (IBS) and these factors. MATERIALS AND METHODS: This was a cross-sectional study carried out in Isfahan on 2013. Data were extracted from the framework of the study on the epidemiology of psychological, alimentary health, and nutrition. Symptoms of IBS were evaluated by Talley bowel disease questionnaire. Stressful life event, modified COPE scale, and Multidimensional Scale of Perceived Social Support were also used. About 4763 subjects were completed questionnaires. Analyzing data were done by t-test and multivariate logistic regression. RESULTS: Of all returned questionnaire, 1024 (21.5%) were diagnosed with IBS. IBS and clinically-significant IBS (IBS-S) groups have significantly experienced a higher level of perceived intensity of stressors and had a higher frequency of stressors. The mean score of social supports and the mean scores of three coping strategies (problem engagement, support seeking, and positive reinterpretation and growth) were significantly lower in subjects with either IBS-S or IBS than in those with no IBS. Multivariate logistic regression revealed a significant association between frequency of stressors and perceived intensity of stressors with IBS (odds ratio [OR] =1.09 and OR = 1.02, respectively) or IBS-S (OR = 1.09 and OR = 1.03, respectively). CONCLUSIONS: People with IBS had higher numbers of stressors, higher perception of the intensity of stressors, less adaptive coping strategies, and less social supports which should be focused in psychosocial interventions.

Evaluation of the relationship between major dietary patterns and uninvestigated reflux among Iranian adults.

OBJECTIVES: The etiology of uninvestigated reflux is largely unknown. Although diet has been associated with uninvestigated reflux, the role of dietary patterns is not clear yet. The aim of this study was to investigate dietary patterns in relation to uninvestigated reflux among Iranian adults. METHODS: This cross-sectional study was carried out within the framework of SEPAHAN (Study on the Epidemiology of Psychological, Alimentary Health and Nutrition) among Iranian adults. Dietary data were collected using a self-administered, 106-item, dish-based, semiquantitative food frequency questionnaire. Uninvestigated reflux was considered to be present when an individual reported to be suffering from heartburn sometimes or frequently in the preceding 3 mo. Specific dietary patterns were identified using factor analysis. RESULTS: Complete information from 3846 individuals was available for statistical analysis. We identified four major dietary patterns: fast food, traditional, vegetarian, and Western. After controlling for potential confounders, no overall significant associations were found between these dietary patterns and uninvestigated reflux. However, participants in the third quintile of the traditional dietary pattern had greater odds of uninvestigated reflux, either in the crude (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.09-1.74) or the adjusted (OR, 1.52; 95% CI, 1.16-2.00) model taking into account different confounders. After controlling for age, men in the second (OR, 1.64; 95% CI, 1.10-2.45) and women in the fourth (OR, 1.47; 95% CI, 1.02-2.11) quintiles of the fast food dietary pattern were more likely to have uninvestigated reflux. Moreover, in the age-adjusted model, men in the second (OR, 1.72; 95% CI, 1.14-2.59) and fourth (OR, 1.56; 95% CI, 1.03-2.35) quintiles, and women in the second (OR, 1.48; 95% CI, 1.08-2.04) quintile of the traditional dietary pattern were at higher risk for being diagnosed with uninvestigated reflux. CONCLUSION: Although the present study showed no statistically significant associations between major dietary patterns and the risk for uninvestigated reflux, relative positive associations were found between uninvestigated reflux and adherence to either fast food or traditional dietary patterns, suggesting that these contribute to the risk for developing reflux.