scholarly journals Effect of Heat-Killed Lactobacillus casei DKGF7 on a Rat Model of Irritable Bowel Syndrome

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 568
Author(s):  
Gyeol Seong ◽  
Seungbaek Lee ◽  
Yang Won Min ◽  
Yeon Sil Jang ◽  
Hong Seog Kim ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Treatment Group ◽  
Lactobacillus Casei ◽  
Disease Model ◽  
Symptomatic Improvement ◽  
Stool Consistency ◽  
Control Group ◽  
Colon Tissue ◽  
Serum Corticosterone ◽  
Irritable Bowel

Non-viable bacteria, referred to as “paraprobiotics,” have attracted attention as potentially safer alternatives to probiotics. The aim of this study was to investigate the efficacy of heat-killed Lactobacillus casei DKGF7 on the symptomatic improvement of irritable bowel syndrome (IBS) in a rat disease model and to elucidate the underlying mechanisms that contribute to the beneficial effects of heat-killed probiotics. Seven male Wistar rats were induced with IBS by restraint stress and administered heat-killed L. casei DKGF7 for four weeks and then compared with seven rats in the control group. Stool consistency measured four weeks after initial treatment was the primary outcome measure. To investigate the mechanism of action of the heat-killed bacteria on IBS, we measured serum corticosterone levels, inflammatory cytokines in colon tissue, and expression of tight junction proteins (TJPs) in the epithelium. The treatment group showed significantly better stool consistency scores than the control group at week 4, as well as at every measured time point (all p values < 0.05). The treatment group showed lower serum corticosterone levels, lower colonic inflammatory cytokine levels, and higher expression of TJPs compared with the control group. Paraprobiotics such as heat-killed L. casei DKGF7 can improve stool consistency in a rat IBS model, which may indicate a potential therapeutic strategy for IBS treatment.

scholarly journals Therapeutic Analysis of Fuzi Lizhong Wan with Trimebutine in the Treatment of Diarrhea Type Irritable Bowel Syndrome

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Ying Chang ◽  
Quanwei Di ◽  
Gaixian Di
Keyword(s):  
Irritable Bowel Syndrome ◽  
Treatment Group ◽  
Clinical Efficacy ◽  
Combined Therapy ◽  
Control Group ◽  
Symptom Scores ◽  
Before And After ◽  
Random Number Table ◽  
Irritable Bowel

Objective: To evaluate the clinical efficacy of Fuzi Lizhong Wan and trimebutine in the treatment of diarrhea irritable bowel syndrome. Methods: A total of 90 patients with diarrhea irritable bowel syndrome were divided into control group  (n=45) and treatment group (n=45) using the random number table method. Patients in the control group were po administered with trimebutine 0.2 g, three time daily for 4 weeks. Patients in the treatment group were po administered with Fuzi Lizhong Wan 9 g, three time daily for 4 weeks on the basis of the control group. The clinical efficacy and the TCM symptom scores were evaluated after treatment. The serological indicators in two groups were compared before and after treatment. Results: After treatment, the clinical efficacy and the TCM symptom scores in treatment group were significantly lower than that in control group(P<0.05).The levels of serological indicators in both groups improved significantly, and those in the treatment group were better than the control group(P<0.05). Conclusion: Combined therapy of Fuzi Lizhong Wan and trimebutine in the treatment of diarrhea type irritable bowel syndrome has a significant effect, which can relieve clinical symptom, and reduce visceral sensitivity, and improve levels of inflammatory and quality of life. So it is suggested to be applied.

scholarly journals The Efficacy of Zemedy, a Mobile Digital Therapeutic for the Self-Management of Irritable Bowel Syndrome: a Cross-Over, Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Melissa Hunt ◽  
Sofia Miguez ◽  
Benji Dukas ◽  
Obinna Onwude ◽  
Sarah White
Keyword(s):  
Irritable Bowel Syndrome ◽  
Treatment Group ◽  
Controlled Trial ◽  
Post Treatment ◽  
Secondary Outcome ◽  
Control Group ◽  
Randomized Controlled ◽  
Irritable Bowel ◽  
Intent To Treat

BACKGROUND Patients with irritable bowel syndrome (IBS) experience abdominal pain, altered bowel habits, and defecation-related anxiety which can result in reduced productivity and impaired health related quality of life (HRQL). Cognitive-behavioral therapy (CBT) has been shown to reduce symptoms of IBS and to improve HRQL, but access to qualified therapists is limited. Smartphone-based digital therapeutic interventions have the potential to increase access to guided CBT at scale but require careful study to assess their benefits and risks. OBJECTIVE To test the efficacy of a novel app, Zemedy - a mobile digital therapeutic that delivers a comprehensive CBT program to individuals with IBS. METHODS This was a cross-over randomized controlled trial (registration number NCT04170686). Participants were recruited online. Patients were randomly allocated to either immediate treatment (N = 62) or waitlist control (N = 59). The Zemedy app consists of 8 modules focusing on psychoeducation, relaxation training, exercise, the cognitive model of stress management, applying CBT to IBS symptoms, reducing avoidance through exposure therapy and behavioral experiments, and information about diet. Users interact with a chatbot that presents the information and encourages specific plans, homework and exercises. The treatment was fully automated, with no therapist involvement or communication. At baseline and after 8 weeks, participants were asked to complete the battery of primary (Irritable Bowel Syndrome Quality of Life (IBS-QoL), Gastrointestinal Symptom Rating Scale (GSRS)) and secondary outcome measures (the Fear of Food Questionnaire (FFQ), the Visceral Sensitivity Index (VSI), the GI Cognition Questionnaire (GI-COG), the Depression, Anxiety Stress Scale (DASS) and the Patient Health Questionnaire (PHQ-9)). Waitlist controls were then offered the opportunity to cross over. All participants were assessed one more time at 3 months post-treatment completion. RESULTS Both intent-to-treat and completer analyses at post-treatment revealed significant improvement for the immediate treatment group compared to the waitlist control group on both primary and secondary outcome measures. Gains were generally maintained at 3 months post-treatment. Scores on the GSRS, IBS-QoL, GI-COG, and VSI all improved significantly more in the treatment group [F(1,79) = 20.49, P < .001, Cohen’s d = 1.01; F(1,79) = 20.12, P < .001, d = 1.25; F(1,79) = 34.71, P < .001, d = 1.47 and F(1,79) = 18.7, P < .001, d = 1.07]. Fear of food also decreased for the treatment group relative to the control group [F(1,79) = 12.13, P = .001, d = .62]. Depression improved significantly as measured by both the PHQ9 [F(1,79) = 10.5, P = .002, d = 1.07] and the DASS Depression Subscale [F(1,79) = 6.03, P = .016, d = .83], as did the stress subscale of the DASS [F(1,79) = 4.47, P = .04, d = .65] in the completer analysis but not the intent-to-treat analysis. The impact of treatment on HRQL was mediated by reductions in catastrophizing and visceral sensitivity. CONCLUSIONS Despite its relatively benign physical profile, IBS can be an extraordinarily debilitating condition. Zemedy is an effective modality to deliver CBT for individuals with IBS, and could increase accessibility of this evidence based treatment. CLINICALTRIAL This trial was registered at ClinicalTrials.gov as NCT04170686

scholarly journals Effect of a Synbiotic Containing Lactobacillus paracasei and Opuntia humifusa on a Murine Model of Irritable Bowel Syndrome

Nutrients ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 3205
Author(s):  
Gyeol Seong ◽  
Seungbaek Lee ◽  
Yang Won Min ◽  
Yeon Sil Jang ◽  
So-Young Park ◽  
...  
Keyword(s):  
Murine Model ◽  
Stool Consistency ◽  
Control Group ◽  
Colon Tissue ◽  
Beneficial Effects ◽  
Opuntia Humifusa ◽  
Tnf Α ◽  
Microbial Analysis ◽  
Irritable Bowel ◽  
Junction Proteins

The administration of a combination of probiotics and prebiotics is expected to be a promising strategy for improving irritable bowel syndrome (IBS) symptoms. This study aimed to investigate the efficacy of a synbiotic containing Lactobacillus paracasei and Opuntia humifusa extract for symptomatic improvement of IBS in a murine model and to evaluate the mechanism underlying the beneficial effects of this synbiotic. A total of 20 male Wistar rats aged 8 weeks with IBS induced by restraint stress were assigned into four groups and administered L. paracasei as a probiotic and O. humifusa extract as a prebiotic for 4 weeks. The primary outcome was stool consistency at week 4. To evaluate the mechanism underlying the beneficial effects of the synbiotic, fecal microbial analysis was conducted, and the serum corticosterone levels, tumor necrosis factor-α (TNF-α) levels in the colon tissue, and expression of tight junction proteins were investigated. All three treatment groups showed significantly lower scores for stool consistency than the control group at week 4 (all p < 0.001). When compared with the control group, the synbiotic groups showed a significantly greater abundance of L. paracasei in fecal microbial analysis, lower serum corticosterone levels, lower TNF-α levels in the colon tissue, and higher expression of tight junction proteins. This novel synbiotic containing L. paracasei and O. humifusa extract can improve the stool consistency in a murine model of IBS. It may be a promising treatment option for IBS, and human studies are warranted.

scholarly journals Blastocystis sp. Carriage and Irritable Bowel Syndrome: Is the Association Already Established?

Biology ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 340
Author(s):  
Fernando Salvador ◽  
Beatriz Lobo ◽  
Lidia Goterris ◽  
Carmen Alonso-Cotoner ◽  
Javier Santos ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Microscopic Examination ◽  
Parasitic Infection ◽  
Diagnostic Technique ◽  
Control Group ◽  
Cross Sectional ◽  
Significant Difference ◽  
Blastocystis Sp ◽  
Irritable Bowel ◽  
Asymptomatic Subjects

Background: The aim of the present study is to describe the occurrence of Blastocystis sp. detection among asymptomatic subjects and patients with irritable bowel syndrome in order to evaluate the potential association between irritable bowel syndrome and the parasitic infection. Methods: Cross-sectional study where adult patients with irritable bowel syndrome diagnosed according to Rome IV criteria were included. A control group was formed by asymptomatic subjects older than 18 years. Exclusion criteria were: immunosuppressive condition or having received any drug with demonstrated activity against Blastocystis sp. within the last 6 months before study inclusion. Epidemiological and clinical information was collected from all included participants. Two stool samples were obtained from all participants: one sample for microscopic examination and one sample for Blastocystis sp. PCR detection. Blastocystis sp. infection was defined by the positivity of any of the diagnostic techniques. Results: Seventy-two participants were included (36 asymptomatic subjects and 36 patients with irritable bowel syndrome). Thirty-five (48.6%) were men, and median age of participants was 34 (IQR 29–49) years. The overall rate of Blastocystis sp. carriage was 27.8% (20/72). The prevalence assessed through microscopic examination was 22.2% (16/72), while the prevalence measured by PCR was 15.3% (11/72). When comparing the presence of Blastocystis sp. between asymptomatic subjects and IBS patients, we did not find any statistically significant difference (36.1% vs. 19.4% respectively, p = 0.114). Conclusions: regarding the occurrence of Blastocystis sp., no differences were found between asymptomatic participants and patients with irritable bowel disease irrespective of the diagnostic technique performed.

scholarly journals Digestive symptoms in daily life of chronic adrenal insufficiency patients are similar to irritable bowel syndrome symptoms

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
L. Quénéhervé ◽  
D. Drui ◽  
J. Blin ◽  
M. Péré ◽  
E. Coron ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Irritable Bowel Syndrome ◽  
Adrenal Insufficiency ◽  
Gastrointestinal Symptoms ◽  
Control Group ◽  
Non Profit ◽  
Acute Adrenal Insufficiency ◽  
Irritable Bowel ◽  
Rome Iv

AbstractGastrointestinal symptoms are frequent in acute adrenal insufficiency. Although digestive symptoms can significantly reduce quality of life, they are rarely described in patients with treated chronic adrenal insufficiency (CAI). We aimed to characterize digestive symptoms in CAI patients. We used the section pertaining functional bowel disorders of the Rome IV questionnaire. A questionnaire was published on the website of the non-profit patient association “Adrenals” (NPPA of CAI patients) for five months. Information on demographics, characteristics of adrenal insufficiency, digestive symptoms and quality of life was collected. The relatives of CAI patients served as a control group. We analyzed responses of 33 control subjects and 119 patients (68 primary adrenal insufficiency (PAI), 30 secondary adrenal insufficiency (SAI) and 21 congenital adrenal hyperplasia (CAH)). Abdominal pain at least once a week over the past 3 months was reported by 40%, 47% and 33% of patients with PAI, SAI and CAH respectively versus 15% for the controls (p = 0.01). Symptoms were consistent with the Rome IV criteria for irritable bowel syndrome in 27%, 33% and 33% of patients respectively versus 6% for the controls (p < 0.0001). Quality of life was described as poor or very poor in 35%, 57% and 24% of patients respectively versus 5% for the controls (p < 0.0001). In conclusion, digestive symptoms are frequent and incapacitating in CAI patients and similar to symptoms of irritable bowel syndrome in 30% of CAI patients. Assessment and management of digestive symptoms should be considered a priority for physicians treating patients with CAI.

Does Psychological Treatment Help Only Those Patients with Severe Irritable Bowel Syndrome Who Also Have a Concurrent Psychiatric Disorder?

2005 ◽  
Vol 39 (9) ◽  
pp. 807-815 ◽  
Author(s):  
Francis Creed ◽  
Elspeth Guthrie ◽  
Joy Ratcliffe ◽  
Lakshmi Fernandes ◽  
Christine Rigby ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Irritable Bowel Syndrome ◽  
Treatment Group ◽  
Psychiatric Disorder ◽  
Psychological Treatment ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Irritable Bowel

Objective: We have previously reported improved health-related quality of life in patients with severe irritable bowel syndrome (IBS) following psychological treatments. In this paper, we examine whether this improvement was associated with improvement in psychological symptoms and was confined to those patients who had concurrent psychiatric disorder. Method: Two hundred and fifty-seven patients with severe IBS entering a psychological treatment trial were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry. At entry to the trial and 15 months later, patients were also assessed using the Hamilton Depression Rating Scale, Symptom Cheecklist-90 (SCL-90) and Short Form-36 (SF36) physical component summary score as the main outcome measure. Partial correlation was used to compare changes in SF36 score and changes in psychological scores while controlling for possible confounders, treatment group and baseline scores. Multiple regression analysis was used to examine whether changes in psychological scores, changes in pain and a history of abuse could account for most of the variance of change in SF36 physical component score. Results: Of 257 patients with severe IBS, 107 (42%) had a depressive, panic or generalized anxiety disorder at trial entry. There were moderate but significant correlations (0.21–0.47) between change in the psychological scores and the change in SF36 physical component scores. The correlation coefficients were similar in the groups with and without psychiatric disorder. The superiority of psychotherapy and antidepressant groups over treatment as usual was similar in those with and without psychiatric disorder. Multiple regression found significant independent effects of change in depression, anxiety, somatization and abdominal pain but there was still variance explained by treatment group. Conclusions: In severe IBS improvement in health-related quality of life following psychotherapy or antidepressants is correlated with, but not explained fully by reduction of psychological scores. A more complete understanding of how these treatments help patients with medically unexplained symptoms will enable us to refine them further.

scholarly journals Integrative analysis of the gut microbiome and metabolome in a rat model with stress induced irritable bowel syndrome

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yue Hu ◽  
Fang Chen ◽  
Haiyong Ye ◽  
Bin Lu
Keyword(s):  
Irritable Bowel Syndrome ◽  
Gut Microbiota ◽  
Rat Model ◽  
Gut Microbiome ◽  
16S Rrna Gene Sequencing ◽  
Metabolic Phenotype ◽  
Control Group ◽  
Rrna Gene ◽  
Microbial Dysbiosis ◽  
Irritable Bowel

AbstractStress is one of the major causes of irritable bowel syndrome (IBS), which is well-known for perturbing the microbiome and exacerbating IBS-associated symptoms. However, changes in the gut microbiome and metabolome in response to colorectal distention (CRD), combined with restraint stress (RS) administration, remains unclear. In this study, CRD and RS stress were used to construct an IBS rat model. The 16S rRNA gene sequencing was used to characterize the microbiota in ileocecal contents. UHPLC-QTOF-MS/MS assay was used to characterize the metabolome of gut microbiota. As a result, significant gut microbial dysbiosis was observed in stress-induced IBS rats, with the obvious enrichment of three and depletion of 11 bacterial taxa in IBS rats, when compared with those in the control group (q < 0.05). Meanwhile, distinct changes in the fecal metabolic phenotype of stress-induced IBS rats were also found, including five increased and 19 decreased metabolites. Furthermore, phenylalanine, tyrosine and tryptophan biosynthesis were the main metabolic pathways induced by IBS stress. Moreover, the altered gut microbiota had a strong correlation with the changes in metabolism of stress-induced IBS rats. Prevotella bacteria are correlated with the metabolism of 1-Naphthol and Arg.Thr. In conclusion, the gut microbiome, metabolome and their interaction were altered. This may be critical for the development of stress-induced IBS.

scholarly journals Treatment of postinfectious irritable bowel syndrome and noninfective irritable bowel syndrome with mesalazine

2011 ◽  
Vol 48 (1) ◽  
pp. 36-40 ◽  
Author(s):  
Mauro Bafutto ◽  
José Roberto de Almeida ◽  
Nayle Vilela Leite ◽  
Enio Chaves Oliveira ◽  
Salustiano Gabriel-Neto ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Abdominal Pain ◽  
Symptom Score ◽  
Stool Frequency ◽  
Total Symptom Score ◽  
Stool Consistency ◽  
Mucosal Inflammation ◽  
Irritable Bowel Syndrome Group ◽  
Irritable Bowel ◽  
Postinfectious Irritable Bowel Syndrome

CONTEXT: Recent studies support the hypothesis that postinfectious irritable bowel syndrome and some irritable bowel syndrome patients display persistent signs of minor mucosal inflammation. Mesalazine has intestinal anti-inflammatory properties including cyclooxygenase and prostaglandin inhibition. The effects of mesalazine on postinfectious irritable bowel syndrome and noninfective irritable bowel syndrome patients are still unknown. OBJECTIVE: To observe the effects of mesalazine on postinfectious irritable bowel syndrome and noninfective irritable bowel syndrome with diarrhea patients. METHODS: Based on Rome III criteria, 61 irritable bowel syndrome with diarrhea patients (18 years old or more) were included in the evaluation. Patients were divided into two groups: postinfectious irritable bowel syndrome group, with 18 patients medicated with mesalazine 800 mg 3 times a day for 30 days; noninfective irritable bowel syndrome group, with 43 patients medicated with mesalazine 800 mg 3 times a day for 30 days. Symptom evaluations at baseline and after treatment were performed by means of a four-point Likert scale including stool frequency, stool form and consistency (Bristol Stool Scale), abdominal pain and distension (maximum score: 16; minimum score: 4). RESULTS: Postinfectious irritable bowel syndrome group presented a statistically significant reduction of the total symptom score (P<0.0001). The stool frequency was significantly reduced (P<0.0001), and stool consistency, improved (P<0.0001). Abdominal pain (P<0.0001) and abdominal distension were significantly reduced (P<0.0001). Noninfective irritable bowel syndrome group presented a statistically significant reduction of total symptom score (P<0.0001). Also, the stool frequency was significantly reduced (P<0.0001) and stool consistency, improved (P<0.0001). Abdominal pain (P<0.0001) and abdominal distention were significantly reduced (P<0.0001). There was no statistical difference between postinfectious irritable bowel syndrome group and noninfective irritable bowel syndrome group on total symptom score results at 30th day of therapy with mesalazine 800 mg 3 times a day. (P = 0.13). CONCLUSION: Mesalazine reduced key symptoms of postinfectious irritable bowel syndrome and noninfective irritable bowel syndrome with diarrhea patients.

scholarly journals Clinical Response and Changes of Cytokines and Zonulin Levels in Patients with Diarrhoea-Predominant Irritable Bowel Syndrome Treated with Bifidobacterium Longum ES1 for 8 or 12 Weeks: A Preliminary Report

2020 ◽  
Vol 9 (8) ◽  
pp. 2353
Author(s):  
Gian Paolo Caviglia ◽  
Alessandra Tucci ◽  
Rinaldo Pellicano ◽  
Sharmila Fagoonee ◽  
Chiara Rosso ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Clinical Response ◽  
Bifidobacterium Longum ◽  
Gastrointestinal Symptoms ◽  
Intestinal Barrier ◽  
Response To Therapy ◽  
Intestinal Barrier Function ◽  
Control Group ◽  
Placebo Control ◽  
Irritable Bowel

Bifidobacterium longum (B. longum) ES1 is a probiotic strain capable of modulating microbiome composition, anti-inflammatory activity and intestinal barrier function. We investigated the use of B. Longum ES1 in the treatment of patients with diarrhoea-predominant irritable bowel syndrome (IBS-D). Sixteen patients were treated for 8 or 12 weeks with B. Longum ES1 (1 × 109 CFU/day). Serum zonulin and cytokines were measured at baseline (T0) and at the end of therapy (T1). Clinical response to therapy was assessed by IBS Severity Scoring System. Interleukin (IL)-6, IL-8, IL-12p70 and tumor necrosis factor (TNF) α levels decreased from T0 to T1, irrespective of treatment duration (p < 0.05), while zonulin levels diminished only in patients treated for 12 weeks (p = 0.036). Clinical response was observed in 5/16 patients (31%): 4/8 (50%) treated for 12 weeks and 1/8 (13%) treated for 8 weeks. Abdominal pain improved only in patients treated for 12 weeks (5/8 vs. 0/8, p = 0.025), while stool consistency improved regardless of therapy duration (p < 0.001). In conclusion, the results of this pilot study showed, in IBS-D patients treated for 12 weeks with B. longum ES1, a reduction in the levels of pro-inflammatory cytokines, and intestinal permeability as well as an improvement in gastrointestinal symptoms, but further studies including a placebo-control group are necessary to prove a causal link.

Self-Concept and Relational Concomitants of Irritable Bowel Syndrome: A Preliminary Study

2001 ◽  
Vol 31 (4) ◽  
pp. 13-20 ◽  
Author(s):  
I. Day ◽  
A.D. Stuart ◽  
H.G. Pretorius
Keyword(s):  
Irritable Bowel Syndrome ◽  
Significant Proportion ◽  
Self Concept ◽  
Control Group ◽  
Social Self ◽  
Supportive Relationships ◽  
Physiological Mechanisms ◽  
Preliminary Study ◽  
Formal Relations ◽  
Irritable Bowel

Irritable bowel syndrome (IBS) is one of the most common conditions referred to gastroenterologists, but one of the least well understood. Part of the reason for this is the lack of consensus of opinion regarding the nature of the complaint. A growing body of evidence attests to the fact that, although certain physiological mechanisms exist that may contribute to the disorder, psychological factors also play an important role in the pathogenesis of IBS in a significant proportion of the patients. In particular, a variety of investigations point to a relationship between self-concept and supportive relationships as being important determinants in health outcomes. The purpose of the study was to determine whether statistically significant differences could be found between individuals suffering from IBS and healthy controls in terms of their self-concept and level of adjustment in terms of relationships, by analysing the results obtained on two psychometric questionnaires, namely the Personal, Home, Social and Formal Relations Questionnaire, and the Adolescent Self-Concept Scale. Statistically significant differences were found between a group of IBS sufferers and a non-IBS control group on the following sub-scales of the Personal, Home, Social and Formal relations Questionnaire: Self-esteem, Nervousness, Health, Family Influences, Personal Influences, Sociability – G, and Moral Sense, with the IBS group achieving higher on these sub-scales. Statistically significant differences were also found in the following dimensions of the Adolescent Self-Concept Scale: Physical Self, Personal Self, Family Self, and Social Self, with the IBS group again achieving higher on these dimensions than the non-IBS group.

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