Background and 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 below 100 mug/g stool (indicating pancreatic exocrine insufficiency; group 1) were:
• Compared with age- and sex-matched patients with D-IBS and a normal levels of Fel-1 (group 2),
• Given pancreatic enzyme therapy,
• And reassessed at 12 weeks.
Results: Fel-1 levels were less than 100 mug/g stool in 19 of 314 patients with D-IBS (6.1%, 95% CI 3.7-9.3%), 0 of 105 patients with chronic diarrhea (95% CI 0.0-3.5%), and 0 of 95 controls (95% 0.0-3.8%) (p=<0.001).
Following enzyme supplementation, improvements in stool frequency (p<0.001), stool consistency (p<0.001), and abdominal pain (p=0.003) 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.
Source: Clinical Gastroenterology and Hepatology, Oct 13, 2009. PMID: 19835990, by Leeds JS, Hopper AD, Sidhu R, Simmonette A, Azadbakht N, Hoggard N, Morley S, Sanders DS. Departments of Gastroenterology, Radiology, and Clinical Chemistry, Royal Hallamshire Hospital, Sheffield, UK. [E-mail: