Some patients with irritable bowel syndrome may have exocrine pancreatic insufficiency
Leeds J et al. Clin Gastroenterol Hepatol 2010;8:433–438.
IBS-D
Short summary
Diarrhoea and abdominal pain are common symptoms of irritable bowel syndrome (IBS), which can cause psychological stress and reduction in the quality of life in affected patients. It has been suggested that IBS may have other underlying pathologies. Early-stage pancreatic disease presents with similar symptoms to IBS and it is therefore possible that there is a clinical overlap between these two conditions.
This study looked at faecal elastase-1 (Fe-1) levels in 314 patients meeting the Rome II criteria for diarrhoea-predominant IBS (IBS-D). Levels of Fe-1 were less than 100 µg/g of stool in 6.1% of patients with IBS-D compared with none in a group of 105 patients with chronic diarrhoea (without IBS symptoms) nor in any of 95 control patients. Levels of Fe-1 less than 100 µg/g are indicative of pancreatic exocrine insufficiency.
To assess the effects of pancreatic enzyme supplementation, stool frequency, stool consistency and abdominal pain were recorded in two groups of patients; group 1 had IBS-D and Fe-1 levels less than 100 µg/g and group 2 (therapeutic controls) had IBS-D and Fe-1 levels greater than 200 µg/g.
A clinically significant response to therapy was observed in 94.7% (18 of 19) patients in group 1, compared with only 6.7% (1 of 15) in group 2. Significant improvements in stool frequency, stool consistency and abdominal pain were observed in patients in group 1, but not in
group 2.
These results suggest that pancreatic exocrine insufficiency should be considered in patients referred from primary care with IBS-like symptoms. Where this is confirmed, pancreatic enzyme supplementation therapy may help to reduce diarrhoea and abdominal pain, and improve quality of life.
Job number: JB02444UK Date of Preparation: March 2023
