Clinical, endoscopical and morphological efficacy of mesalazine in patients with irritable bowel syndrome

Figures & data

Table 1 Diagnostic criteria according to the latest issue of “Rome II”²

Recurrent abdominal pain or discomfort* at least 3 days/month in the last 3 months associated with two or more of the following: Improvement with defecation Onset associated with a change in frequency of stool Onset associated with a change in form (appearance) of stool Criterion fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis.

Notes:

* “Discomfort” means an uncomfortable sensation not described as pain. In pathophysiology research and clinical trials, a pain/discomfort frequency of at least 2 days a week during screening evaluation is recommended for subject eligibility.

Table 2 Subtyping of IBS by predominant stool pattern modified according to Longstreth²

IBS with constipation (IBS-C) – hard or lumpy stools^a ≥25% and loose (mushy) or watery stools^b <25% of bowel movements^c. IBS with diarrhea (IBS-D) – loose (mushy) or watery stools^b ≥25% and hard or lumpy stool^a <25% of bowel movements^c. Mixed IBS (IBS-M) – hard or lumpy stools^a ≥25% and loose (mushy) or watery stools^b ≥25% of bowel movements^c. Undifferentiated (IBS-U) – insufficient abnormality of stool consistency to meet criteria for IBS-C, -D, or -M^c.

Notes:

a Bristol Stool Form Scale 1–2 (separate hard lumps like nuts [difficult to pass] or sausage-shaped but lumpy);

b Bristol Stool Form Scale 6–7 (fluffy pieces with ragged edges, a mushy stool or watery, no solid pieces, entirely liquid);

c In the absence of use of antidiarrheals or laxatives.

Figure 1 Gender-dependent age distribution of patients at onset of IBS symptoms.

Abbreviation: IBS, Irritable Bowel Syndrome.

Figure 2 Gender-dependent distribution of duration of IBS symptoms at first diagnosis.

Abbreviation: IBS, Irritable Bowel Syndrome.

Figure 3 Age distribution of IBS categories.

Abbreviation: IBS, Irritable Bowel Syndrome.

Figure 4 Frequency of predisposing factors (100% equals n = 360).

Figure 5 Pain intensity judged by patients with different categories of IBS (constipation, diarrhea, mixed and undifferentiated type) on a visual analog scale (0–10).

Notes: “Total” refers to the intention to treat population; columns with significant difference between control and mesalazine group are marked by *(P < 0.05). Values before treatment are represented by black columns, control group values are in white columns and values from the mesalazine group are in gray. Vertical bars represent standard deviations.
Abbreviation: IBS, Irritable Bowel Syndrome.

Figure 6 Pain duration (hours per day) in patients with different categories of IBS (constipation, diarrhea, mixed and undifferentiated type).

Notes: “Total” refers to the intention to treat population; columns with significant difference between control and mesalazine group are marked by *(P < 0.05); “n.s.:” not significant. Values before treatment are represented by black columns, control group values are in white columns, and values from the mesalazine group are in gray. Vertical bars represent standard deviations.
Abbreviation: IBS, Irritable Bowel Syndrome.

Figure 7 Incidence of stool abnormalities (%) in patients with different categories of IBS (constipation, diarrhea, mixed and undifferentiated type).

Notes: “Total” refers to the intention to treat population; columns with significant difference between control and mesalazine group are marked by *(P < 0.05). Values before treatment are represented by black columns, control group values are in white columns, and values from the mesalazine group are in gray.
Abbreviation: IBS, Irritable Bowel Syndrome.

Figure 8 Incidence of meteorism (%) in patients with different categories of IBS (constipation, diarrhea, mixed and undifferentiated type).

Notes: “Total” refers to the intention to treat population; columns with significant difference between control and mesalazine group are marked by *(P < 0.05). Values before treatment are represented by black columns, control group values are in white columns, and values from the mesalazine group are in gray.
Abbreviation: IBS, Irritable Bowel Syndrome.

Figure 9 Incidence (%) of cytomorphologic parameters in patients with different categories of IBS (constipation, diarrhea, mixed and undifferentiated type).

Notes: Only those parameters are represented where significant differences occurred between the total group and the individual categories. 1 – Pavement epithelial cells without changes, 2 – Columnar epithelial cells, 3 – Epithelial cells with degeneration, 4 – Nuclear polymorphism in epithelial cells, 5 – Mixed bacterial flora; columns with significant difference are marked by *(P < 0.05).
Abbreviation: IBS, Irritable Bowel Syndrome.

Figure 10 Incidence of cytomorphologic parameters after 28 day of treatment with mesalazine (white columns) compared with controls (black columns).

Notes: 1 – Colon mucus changes, 2 – Cytological or histological changes, 3 – Epithelial cell degeneration, 4 – Singular leukocytes or macrophages, 5 – Mild cell infiltrations, 6 – Mucus production; columns with significant difference are marked by *(P < 0.05) and **(P < 0.01) respectively.

Figure 11 Colon mucosa of IBS patient (1 – columnar epithelium, 2 – goblet cells, 3 – endocrinocytes, hematoxylin-eosin staining, bar = 100 μm).

Abbreviation: IBS, Irritable Bowel Syndrome.

Figure 12 Flattening of superficial epithelium (1) in colon mucosa in IBS patient (hematoxylin-eosin staining, bar = 200 μm).

Abbreviation: IBS, Irritable Bowel Syndrome.

Figure 13 Goblet cells (1), crypts (2) in colon mucosa in IBS patient (hematoxylineosin staining, bar = 100 μm).

Abbreviation: IBS, Irritable Bowel Syndrome.

Figure 14 Cell infiltrations A) and edema B) in colon mucosa in IBS patient (1 – plasmocytes, 2 – lymphocytes, 3 – eosinophils, 4 – fibroblasts, hematoxylineosin staining). Bars = 50 μm.

Abbreviation: IBS, Irritable Bowel Syndrome.

Figure 15 Plethora of microcapillaries A) and areas of cell infiltrations in the submucous layer of the submucosa B) of IBS patient (1 – microcapillaries with venous stasis phenomena, 2 – plasmocytic infiltrations, hematoxylin-eosin staining). Bars: a = 200 μm, b = 100 μm.

Abbreviation: IBS, Irritable Bowel Syndrome.

LongstrethGFThompsonWGCheyWDHoughtonLAMearinFSpillerRCFunctional bowel disordersGastroenterology20061301480149116678561

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