Some Patients with Irritable Bowel Syndrome may have Exocrine Pancreatic Insufficiency

Clin Gastroenterol Hepatol. 2009 Oct 13. [Epub ahead of print]

Some Patients with Irritable Bowel Syndrome may have Exocrine Pancreatic Insufficiency.

Leeds JS, Hopper AD, Sidhu R, Simmonette A, Azadbakht N, Hoggard N, Morley S, Sanders DS. Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK.

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 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 19/314 patients with D-IBS (6.1%, 95% CI 3.7-9.3%), 0/105 patients with chronic diarrhea (95% CI 0.0-3.5%), and 0/95 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.

PMID: 19835990 [PubMed - as supplied by publisher]

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written by Maff, October 26, 2009

Important confirmation that a small but significant number of patients with diarrhoea predominant irritable bowel syndrome (IBS-D) have digestive enzyme deficiency due to low output from the pancreas.

This is an area that conventional medicine has ignored but which has been well recognised by complementary and alternative medical practitioners such as nutritional therapists and doctors who have chosen to educate themselves in functional medicine. A number of functional laboratory tests such as the comprehensive digestive stool analysis (CDSA) can provide data that may confirm digestive enzyme insufficiency and resulting problems of digestion and absorption. As the study authors suggest, digestive enzyme supplements may be helpful in such cases.