Irritable bowel syndrome (IBS) is a functional condition of the bowel that is diagnosed using clinical criteria. This paper discusses the nature of the diagnostic process for IBS and how this impacts epidemiological measurements. Depending on the diagnostic criteria employed, IBS affects around 11% of the population globally. Around 30% of people who experience the symptoms of IBS will consult physicians for their IBS symptoms. These people do not have significantly different abdominal symptoms to those who do not consult, but they do have greater levels of anxiety and lower quality of life. Internationally, there is a female predominance in the prevalence of IBS. There is 25% less IBS diagnosed in those over 50 years and there is no association with socioeconomic status. IBS aggregates within families and the genetic and sociological factors potentially underlying this are reviewed. Patients diagnosed with IBS are highly likely to have other functional disease and have more surgery than the general population. There is no evidence that IBS is associated with an increased mortality risk. The epidemiological evidence surrounding these aspects of the natural history is discussed.

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The epidemiology of irritable bowel syndrome.

Author(s): Thung, I; Aramin, H; Vavinskaya, V; Gupta, S; Park, JY; Crowe, SE; Valasek, MA | Abstract: BackgroundHelicobacter pylori is one of the most prevalent global pathogens and can lead to gastrointestinal disease including peptic ulcers, gastric marginal zone lymphoma and gastric carcinoma.AimTo review recent trends in H. pylori antibiotic resistance rates, and to discuss diagnostics and treatment paradigms.MethodsA PubMed literature search using the following keywords: Helicobacter pylori, antibiotic resistance, clarithromycin, levofloxacin, metronidazole, prevalence, susceptibility testing.ResultsThe prevalence of bacterial antibiotic resistance is regionally variable and appears to be markedly increasing with time in many countries. Concordantly, the antimicrobial eradication rate of H. pylori has been declining globally. In particular, clarithromycin resistance has been rapidly increasing in many countries over the past decade, with rates as high as approximately 30% in Japan and Italy, 50% in China and 40% in Turkey; whereas resistance rates are much lower in Sweden and Taiwan, at approximately 15%; there are limited data in the USA. Other antibiotics show similar trends, although less pronounced.ConclusionsSince the choice of empiric therapies should be predicated on accurate information regarding antibiotic resistance rates, there is a critical need for determination of current rates at a local scale, and perhaps in individual patients. Such information would not only guide selection of appropriate empiric antibiotic therapy but also inform the development of better methods to identify H. pylori antibiotic resistance at diagnosis. Patient-specific tailoring of effective antibiotic treatment strategies may lead to reduced treatment failures and less antibiotic resistance.

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Review article: the global emergence of Helicobacter pylori antibiotic resistance.

SummaryBackground
Gastric cancer can be divided into cardia and noncardia gastric adenocarcinoma (NCGA). Non cardia gastric cancer is a disease that has declined in global incidence but has remained as an extremely lethal cancer.

Aim
To review recent advances in epidemiology and strategies in prevention of non cardia gastric cancer.

Methods
A rapid literature search strategy was developed for all English language literature published before March 2013. The search was conducted using the electronic databases PubMed and EMBASE. The search strategy included the keywords ‘stomach neoplasms’, ‘gastric cancer’, ‘epidemiology’, ‘risk factor’, ‘early detection of cancer’, ‘mass screening’, ‘cancer burden’, ‘prevention’ and ‘cost-effectiveness’. The search strategy was adjusted according to different requirements for each database. The specific search was also performed in cancer-related websites for country-specific information. The search was limited to past 10 years.

Results
Gastric cancer is the fifth most common cancer but the third leading cause of cancer death. The case fatality rate is 75%. Screening by radiological or endoscopic methods has limited success in prevention of gastric cancer. Helicobacter pylori has been identified as a carcinogen, accounting for 60–70% of gastric cancer globally and eradication is a potential preventive measure. A meta-analysis in 2009 demonstrated that individuals treated with H. pylori eradication therapy can reduce gastric cancer risk. The extended Shandong Intervention trial that lasted 14.3 years showed that H. pylori eradication therapy significantly reduced gastric cancer incidence by 39%. Consensus groups from Asia, Europe and Japan have recommended H. pylori eradication as primary prevention in high-risk areas. Following eradication therapy, endoscopic surveillance of pre-malignant lesions using enhanced imaging appears to be another promising preventive strategy.

Conclusions
Gastric cancer remains a major diagnostic and therapeutic challenge. There is emerging evidence that H. pylori eradication in high gastric cancer regions can lead to a decline in the incidence of this highly lethal disease.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/apt.12814

Review article: the epidemiology and prevention of gastric cancer

Epidemiological studies have consistently demonstrated the benefits of dietary fibre on gastrointestinal health through consumption of unrefined whole foods, such as wholegrains, legumes, vegetables and fruits. Mechanistic studies and clinical trials on isolated and extracted fibres have demonstrated promising regulatory effects on the gut (for example, digestion and absorption, transit time, stool formation) and microbial effects (changes in gut microbiota composition and fermentation metabolites) that have important implications for gastrointestinal disorders. In this Review, we detail the major physicochemical properties and functional characteristics of dietary fibres, the importance of dietary fibres and current evidence for their use in the management of gastrointestinal disorders. It is now well-established that the physicochemical properties of different dietary fibres (such as solubility, viscosity and fermentability) vary greatly depending on their origin and processing and are important determinants of their functional characteristics and clinical utility. Although progress in understanding these relationships has uncovered potential therapeutic opportunities for dietary fibres, many clinical questions remain unanswered such as clarity on the optimal dose, type and source of fibre required in both the management of clinical symptoms and the prevention of gastrointestinal disorders. The use of novel fibres and/or the co-administration of fibres is an additional therapeutic approach yet to be extensively investigated.

Dietary fibre in gastrointestinal health and disease.

Therapeutical use of probiotic formulations in clinical practice

Helicobacter pylori (Hp) is found in half the population of the world. Its prevalence is highly variable in relation to geography, ethnicity, age, and socioeconomic factors high in developing countries and lower in the developed world. In general, however, there has been a decreasing trend in the prevalence of Hp in many parts of the world in recent years. Direct epidemiologic comparisons of peptic ulcer disease (PUD) between developing and developed countries are complex, as peptic ulcers may be asymptomatic and the availability and accessibility of the tests required for diagnosis vary widely. In developing countries, Hp infection is a public-health issue. The high prevalence of the infection means that public-health interventions may be required. Therapeutic vaccination is probably the only strategy that would make a decisive difference in the prevalence and incidence of Hp throughout the world. The short-term approach, however provided that resources allow for this would be a test-andtreat strategy for those who are at risk for peptic ulcer disease or gastric cancer, as well as for those with troublesome dyspepsia. EDuCATION IN GASTROENTEROLOGy

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Helicobacter pylori in developing countries. World Gastroenterology Organisation Global Guideline.

is World Digestive Health Day and the focus this year is Helicobacter pylori infection, the most important risk factor for non-cardia gastric cancer. On this occasion, we urge the medical community to improve their screening and treatment programs and to educate their staff and colleagues. In order to help doctors worldwide detect and treat Helicobacter pylori, a special WGO-OMGE team of experts is currently writing a Guideline on Helicobacter pylori Infection which will be available free on the website in five languages in June 2006. On behalf of the entire WGO-OMGE Executive, I urge everyone to take a moment out of their busy practices on May 29 to honour the scientific work of Marshall and Warren by focussing on the education and screening of this important infection. In developing countries, Helicobacter pylori is a public health issue. The high prevalence of the infection requires the development of public health interventions. Vaccination with an effective vaccine is probably the only strategy that will make a decisive difference in prevalence and incidence worldwide. The World Gastroenterology Organisation plans to address these issues with the release of a guideline on Helicobacter pylori with specific relevance to developing countries.

Helicobacter pylori in developing countries

Review team Prof. Eamonn Quigley (Chairman, Ireland) Prof. Michael Fried (Switzerland) Prof. K.A. Gwee (Singapore) Prof. C. Olano (Uruguay) Prof. F. Guarner (Spain) Prof. I. Khalif (Russia) Prof. P. Hungin (United Kingdom) Prof. G. Lindberg (Sweden) Prof. Z. Abbas (Pakistan) Prof. L. Bustos Fernandez (Argentina) Prof. F. Mearin (Spain) Prof. S.J. Bhatia (India) Prof. P.J. Hu (China) Prof. M. Schmulson (Mexico) Dr. J.H. Krabshuis (France) Dr. A.W. Le Mair (The Netherlands)

/pdf/irritable-bowel-syndrome-a-global-perspective-2dahoo8pyn.pdf

Irritable bowel syndrome : a global perspective.

Helicobacter pylori (Hp) is found in half the population of the world. Its prevalence is highly variable in relation to geography, ethnicity, age, and socioeconomic factors - high in developing countries and lower in the developed world. In general, however, there has been a decreasing trend in the prevalence of Hp in many parts of the world in recent years.

A. Le Mair

Papers

Helicobacter pylori in developing countries. World Gastroenterology Organisation Global Guideline.

Helicobacter pylori in developing countries

Irritable bowel syndrome : a global perspective.

World Gastroenterology Organisation Global Guidelines Helicobacter pylori in developing countries August 2010 : WGO global guidelines

World Gastroenterology Organisation Global Guideline: Irritable bowel syndrome: A global perspective - April 20, 2009