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Biomedical subjects

Robin C Spiller

Publications and source records attributed to Robin C Spiller.

26 records · Page 2Linked to original sources
PubMed2003

Relative importance of enterochromaffin cell hyperplasia, anxiety, and depression in postinfectious IBS.

BACKGROUND & AIMS: Both psychological and mucosal changes (increased enterochromaffin [EC] cells and T lymphocytes) have been associated with postinfectious irritable bowel syndrome (PI-IBS). However, previous studies have been underpowered to determine the relative importance of these changes in predicting the development of PI-IBS. Our aim was to prospectively determine the relative importance of both psychological and histologic factors in the development of PI-IBS after Campylobacter infection. METHODS: Questionnaires detailing psychological and bowel symptoms were sent to 1977 patients 3 months after infection. Twenty-eight patients with new-onset PI-IBS, 28 age- and sex-matched patient controls who were asymptomatic after infection, and 34 healthy volunteers underwent rectal biopsy, which was assessed for serotonin-containing EC cells, mast cells, and lamina propria T lymphocytes. RESULTS: PI-IBS, predominantly of the diarrhea-predominant subtype, occurred in 103 of 747 (13.8%) of those infected. EC cell counts per high-power field (hpf) were higher in patients with PI-IBS (35.8 +/- 1.2) compared with patient controls (30.6 +/- 1.9; P = 0.022) and volunteers (29.1 +/- 1.8; P = 0.006). Lamina propria T lymphocytes per hpf were higher in patients with PI-IBS (127.1 +/- 8.7) and patient controls (113.4 +/- 6.2) in contrast to healthy volunteers (97.1 +/- 5.7) (P = 0.006 and P = 0.058, respectively). Anxiety, depression, and fatigue were significantly increased in patients with PI-IBS compared with patient controls. Multivariate analysis indicated that increased EC cell counts and depression were equally important predictors of developing PI-IBS (relative risk, 3.8 and 3.2 for each standard deviation increase in respective values). CONCLUSIONS: Both increased EC cells and depression are important independent predictors of developing PI-IBS.

Adolescent↗
PubMed2003

Patterns of pain in diverticular disease and the influence of acute diverticulitis.

BACKGROUND: While the association of recurrent bouts of abdominal pain with colonic diverticulosis is well recognized, the cause of this pain is obscure since in most cases it occurs without obvious diverticulitis or other potential causes. AIMS: To define the patterns of pain in diverticular disease and the influence of acute diverticulitis. METHODS: Two studies were undertaken to establish the relationship between bouts of prolonged abdominal pain (> 24 h) presumed to be due to inflammatory diverticulitis and recurrent short-lived pain. In Study 1, 261 patients with a barium enema showing diverticulosis completed a postal questionnaire concerning episodes of both prolonged and short-lived pain. In Study 2, 26 patients previously admitted to hospital with a firm diagnosis of diverticulitis were interviewed for details of their bowel habits since discharge. RESULTS: Study 1: 94/261 patients experienced recurrent, short-lived pain on a median of five days a month, with a median duration of 3 h. In addition, 51/261 patients described episodes of prolonged pain with a median duration of three days. Of these, 31/51 (61%) experienced recurrent, short-lived pain compared with 63/210 (30%) who had not had an episode of prolonged pain. More specifically, 12/17 (71%) who received antibiotic treatment for presumed acute diverticulitis during their bout of prolonged pain experienced recurrent pain compared with 82/244 (34%) who did not experience such an episode. Study 2: 18/26 patients hospitalized for acute diverticulitis developed new, recurrent, short-lived abdominal pain following discharge, with a median duration of 4 h. CONCLUSION: Episodes of prolonged, presumed inflammatory pain due to diverticulitis are frequently followed by recurrent, short-lived pain similar to that seen in irritable bowel syndrome.

Abdominal Pain↗
PubMed2003

Distinctive clinical, psychological, and histological features of postinfective irritable bowel syndrome.

OBJECTIVE: Irritable bowel syndrome after gastroenteritis is well recognized. Our aim was to determine whether postinfective IBS (PI-IBS) has histological or clinical features that are distinct from those of IBS patients with no history of preceding infection. METHODS: A total of 75 consecutive IBS outpatients and 36 healthy control subjects completed a questionnaire detailing symptoms, mode of onset, and previous psychiatric history. All underwent a full diagnostic workup including rectal biopsy, which included immunostaining and quantification for lamina propria or intraepithelial T lymphocytes, serotonin-containing enterochromaffin (EC), and mast cells. Patients were divided according to onset of symptoms into PI-IBS (n = 23) or non-PI-IBS (n = 52) patients. RESULTS: Diarrhea predominance occurred more frequently in PI-IBS (70%) than in non-PI-IBS (42%) patients (p = 0.03). A history of previous treatment for anxiety or depression was present in 26% of PI-IBS patients compared to 54% of non-PI-IBS (p = 0.02). Biopsy results for all patients were normal using conventional criteria; however, quantification revealed that PI-IBS showed increased EC cells compared to those of non-PI-IBS patients (p = 0.017) and controls (p = 0.02). Lamina propria T lymphocytes were increased in PI-IBS (p = 0.026) and non-PI-IBS (p = 0.011) patients compared to controls. Mast cells were increased in non-PI-IBS patients (p = 0.054) compared to controls. CONCLUSIONS: Individuals with PI-IBS are a clinically distinct subgroup characterized by diarrheal symptoms, less psychiatric illness, and increased serotonin-containing EC cells compared to those with non-PI-IBS.

Adult↗
PubMed2002

Neuropathology of IBS?

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Colonic Diseases, Functional↗
PubMed2002

Abnormalities of GI transit in bloated irritable bowel syndrome: effect of bran on transit and symptoms.

OBJECTIVES: Bloating is an important but poorly understood symptom in irritable bowel syndrome (IBS) that is often aggravated by bran. The aim of our study was to determine whether IBS patients with bloating responded to bran differently from healthy controls. METHODS: A total of 12 patients with IBS (according to Rome I criteria), all with moderate to severe bloating, and 12 healthy controls participated in a two way, double blind, randomized, cross-over trial of bran versus placebo (crushed biscuits) 15 g b.i.d. An average daily pain index and bloating score were derived from daily symptom diaries. On day 14, gastric emptying, small bowel transit, percent remaining in ascending colon, and geometric center of a meal marker at 24 h were calculated from scintigraphic images obtained after ingesting a Tc99m-labeled rice pudding meal with 15 g of either placebo or coarse bran. RESULTS: Results are given as median (range). Bran significantly increased the pain index and bloating (p < 0.02) in IBS patients but not controls. The most striking finding was that the small bowel transit time of the meal without bran was markedly faster in IBS patients than in controls, being 203 min (range 109-313) versus 367 min (219-543), p < 0.001. Although in controls bran accelerated small bowel transit time to 262 min (180-380), p = 0.03, and significantly reduced % remaining in the ascending colon from 22% (0-46) to 3% (0-25), p = 0.03, this was not seen in the IBS patients. Bran accelerated whole gut transit as assessed by geometric center at 24 h in both IBS patients and controls. CONCLUSIONS: Bran accelerates small bowel transit and ascending colon clearance without causing symptoms in controls. Small bowel transit is rapid in IBS patients with bloating and, unlike in healthy control subjects, cannot be further accelerated by bran, which nevertheless aggravates symptoms of pain and bloating. We speculate that bran-induced bloating may originate in the colon rather than the small bowel.

Adult↗
PubMed2002

Echo-planar magnetic resonance imaging of Gaviscon alginate rafts in-vivo.

Liquid Gaviscon and Gaviscon Advance are established reflux suppressant formulations. This study describes the use of echo-planar magnetic resonance imaging (EPI) to visualise non-invasively intragastric alginate rafts of Liquid Gaviscon and Gaviscon Advance in healthy subjects. Secondly, the feasibility of using relaxation rate (T2(-1)) measurements to monitor changes in the physicochemical properties of the rafts in-vivo is evaluated. Six subjects ingested 500 mL of a liquid meal and received a single dose of 20 mL Liquid Gaviscon or 10 mL Gaviscon Advance on 2 separate visits each and were imaged every 15 min. An alginate raft was observed in the stomach for all subjects and both treatments. The raft was observed to consist of a few large fragments on the majority of the scans for both products. At t = 60 min a raft was still present in all cases. Three-dimensional volume reconstructions showed, for the first time, the spatial distribution of the rafts within the gastric lumen. The T2(-1) data showed potential for assessment of dynamic changes in the physicochemical properties of the alginate rafts in-vivo. We conclude that EPI shows great potential in assessing alginate rafts formation in-vivo.

Adult↗