Original article—alimentary tract
Some Patients With Irritable Bowel Syndrome May Have Exocrine Pancreatic Insufficiency

https://doi.org/10.1016/j.cgh.2009.09.032Get rights and content

Background & Aims

Patients with irritable bowel syndrome (IBS) might have other underlying pathologies. Pancreatic disease can be elusive—especially in the early stages, and some symptoms overlap with those of IBS. We evaluated the prevalence of exocrine pancreatic insufficiency in diarrhea-predominant IBS (D-IBS) and assessed the effects of pancreatic enzyme supplementation.

Methods

The study included patients who met the Rome II criteria for D-IBS, patients with chronic diarrhea, and subjects without diarrhea (controls). Subjects' baseline weight, stool frequency, stool consistency (using the Bristol score), and fecal elastase-1 (Fel-1) levels were determined. Patients were assessed using British Society of Gastroenterology IBS guidelines. Patients with Fel-1 levels less than 100 μg/g stool (indicating pancreatic exocrine insufficiency; group 1) were compared with age- and sex-matched patients with D-IBS and normal levels of Fel-1 (group 2), given pancreatic enzyme therapy, and reassessed at 12 weeks.

Results

Fel-1 levels were less than 100 μg/g in stool from 19 of 314 patients with D-IBS (6.1%; 95% confidence interval [CI], 3.7%–9.3%), none of the 105 patients with chronic diarrhea (95% CI, 0.0%–3.5%), and none of 95 controls (95% CI, 0.0–3.8%) (P < .001). After enzyme supplementation, improvements in stool frequency (P < .001), stool consistency (P < .001), and abdominal pain (P = .003) were observed in patients in group 1, but not in group 2.

Conclusions

Pancreatic exocrine insufficiency was detected in 6.1% of patients who fulfilled the Rome II criteria for D-IBS. In these patients, pancreatic enzyme therapy might reduce diarrhea and abdominal pain. Pancreatic exocrine insufficiency should be considered in patients with D-IBS.

Section snippets

Patients

We undertook this study at a university hospital in South Yorkshire, United Kingdom, that serves a population of about 250,000 people. Data were collected from April 2005 to March 2008. Patients referred to a general adult gastrointestinal clinic were excluded from the study if they did not fulfill Rome II criteria or had sinister symptoms such as weight loss, rectal bleeding, or nocturnal diarrhea. Furthermore, patients meeting the criteria for D-IBS specifically were selected (Table 1).

Results

During the study period, 403 patients were referred who met the Rome II criteria for D-IBS. From this group 314 (77.9%) took part in the study (mean age, 46.3 y; 96 men). A total of 105 individuals with chronic diarrhea and 95 individuals without diarrhea were included as prevalence controls. All 314 patients had initial hematologic, biochemical, and immunologic testing performed, as well as providing a sample for Fel-1 measurement.

The treating physician arranged further investigations for 227

Discussion

The present study describes a cross-sectional analysis for exocrine pancreatic insufficiency in patients referred to a university hospital with symptoms fulfilling the Rome II criteria for D-IBS. The prevalence of a low Fel-1 level (suggestive of exocrine pancreatic insufficiency) in D-IBS was 6.1%. In addition, a low Fel-1 level was significantly more common than in either diarrhea or nondiarrhea control groups. Furthermore, supplementation with pancreatic enzymes led to improvements in stool

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    Conflicts of interest The authors disclose no conflicts.

    Funding This study was supported by Bardhan Research and Education Trust of Rotherham and Solvay Pharmaceuticals. Dr Leeds' salary was funded partly by Solvay pharmaceuticals; however, Solvay had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

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