P J Whorwell's research while affiliated with Central Manchester University Hospitals NHS Foundation Trust and other places
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Publications (441)
Background
Gut‐directed hypnotherapy is effective for patients with irritable bowel syndrome (IBS). Despite its considerable evidence base, gut‐directed hypnotherapy is not widely available and remains a limited resource. This emphasises the need to select patients who are most likely to benefit.
Aim
To determine whether baseline patient character...
Background
Irritable bowel syndrome with diarrhoea is characterised by frequent, loose or watery stools with associated urgency, resulting in marked reduction of quality of life. Ondansetron, a 5-hydroxytryptamine-3 receptor antagonist, has been shown to benefit patients with irritable bowel syndrome with diarrhoea.
Objective
To evaluate the effec...
Introduction
Disorders of gut-brain interaction (DGBI) account for a significant proportion of the budget for healthcare in the UK and the workload of gastroenterologists. However, there is minimal epidemiological data comparing the prevalence and impact of DGBI in the UK to other countries. We therefore compared the national prevalence of each of...
Introduction
Despite novel, life-prolonging therapies, patients with Cystic fibrosis (CF) often suffer persistent gastrointestinal symptoms. These symptoms have been highlighted as a priority for research. CF is predominantly managed by pulmonologists without gastroenterology training despite associations with altered gut physiology, transit, early...
Introduction
Functional sphincter of Oddi disorder (SOD) is recognised as a painful disorder of gut brain interaction (DGBI). Patients with functional SOD are at risk of iatrogenic harm from invasive hepatobiliary procedures and opioids, with minimal benefit. Despite this, there are limited evidence-based therapeutic options. Gut-directed hypnother...
Background:
There are minimal epidemiological data comparing the burden of disorders of gut brain interaction (DGBI) in the UK with other countries. We compared the prevalence of DGBI in the UK with other countries that participated in the Rome Foundation Global Epidemiology Study (RFGES) online.
Methods:
Participants from 26 countries completed...
Background and aims:
The Rome Foundation Global Epidemiology Study (RFGES) assessed the prevalence, burden, and associated factors of Disorders of Gut-Brain Interaction (DGBI) in 33 countries around the world. Achieving worldwide sampling necessitated use of two different surveying methods: In-person household interviews (9 countries) and Internet...
Objective:
Many studies have been published on disorders of the gut-brain interaction (DGBI) in Asia and Western Europe, but no previous study has directly assessed the difference between the two regions. The aim was to compare the prevalence of DGBI in Asia and Western Europe.
Methods:
We used data collected in a population-based Internet surve...
An online survey of 691 clinicians who use hypnosis was conducted in 31 countries to gain a broad real-world picture of current practices, views, and experiences in clinical hypnosis. Among 36 common clinical uses, stress reduction, wellbeing and self-esteem-enhancement, surgery preparations, anxiety interventions, mindfulness facilitation, and lab...
Background
Ondansetron may be beneficial in irritable bowel syndrome with diarrhoea (IBS‐D).
Aim
To conduct a 12‐week parallel group, randomised, double‐blind, placebo‐controlled trial of ondansetron 4 mg o.d. (titrated up to 8 mg t.d.s.) in 400 IBS‐D patients. Primary endpoint: % responders using the Food and Drug Administration (FDA) composite e...
Objective
Gut-directed hypnotherapy (GDH) is an evidence-based treatment for irritable bowel syndrome (IBS). Adoption of remote GDH has been accelerated by the COVID-19 pandemic. We aimed to evaluate patient experience and satisfaction following remote GDH.
Design
On completing 12 sessions of remote GDH via Skype using the Manchester protocol, pat...
Constipation is a common problem, affects 15% of the population, and is often self-diagnosed and self-managed. Over the last 3 decades, there have been significant advances in our understanding and management of chronic constipation, with the emerging recognition that occasional constipation (OC) is another subtype that falls outside current classi...
Objective
Irritable bowel syndrome with diarrhoea (IBS-D) is a common and challenging condition that significantly reduces quality of life. Enterosgel (polymethylsiloxane polyhydrate) is an intestinal adsorbent which sequesters harmful molecules and is safe and effective in acute infective diarrhoea. This randomised controlled multicentre trial aim...
Introduction
Despite its considerable evidence-base, gut-directed hypnotherapy for Irritable Bowel Syndrome (IBS) is still not widely available, and remains a finite resource, emphasising the need to select the patients most likely to benefit. To evaluate for predictive factors for response to hypnotherapy, we compared baseline characteristics betw...
Introduction
Patients with irritable bowel syndrome with diarrhoea (IBS-D) experience abdominal pain and diarrhoea, with few treatment options. The intestinal adsorbent Enterosgel binds harmful molecules in the gut and can reduce diarrhoea (Howell CA, et al. BMJ Open Gastroenterol. 2019;6(1):e000287).
Methods
This was a randomised multi-centre dou...
Introduction
Gut-directed hypnotherapy is an evidence-based treatment for refractory Irritable Bowel Syndrome (IBS). Traditionally, hypnotherapy has been delivered face-to-face, but the emergence of video-technology has enabled remote delivery with comparable results. However, data on patient experience and acceptance of remote hypnotherapy for IBS...
Background and Aim
Recent studies have highlighted the high worldwide prevalence of irritable bowel syndrome (IBS) and disparities in its management between ethnic groups. For instance, gut-directed hypnotherapy (GDH), one of the most effective evidence-based treatments for IBS, is not recommended in Asian countries partly due to lack of populatio...
Research on the efficacy of hypnosis applications continues to grow, but there remain major gaps between the science and clinical practice. One challenge has been a lack of consensus on which applications of hypnosis are efficacious based on research evidence. In 2018, 6 major hypnosis organizations collaborated to form the Task Force for Establish...
Objective
Baclofen is a centrally acting γ-aminobutyric acid type B (GABA B ) receptor agonist which reduces gastro-oesophageal reflux and suppresses the cough reflex; however, central nervous system side-effects limit its use. Lesogaberan is a novel peripherally acting GABA B agonist, but its effects on refractory chronic cough are unknown.
Desig...
Background:
The COVID-19 pandemic caused unprecedented disruption to healthcare services worldwide with well-documented detrimental effects on mental health. Patients with refractory disorders of gut-brain interaction such as Irritable Bowel Syndrome (IBS) seen in tertiary care tend to exhibit higher levels of psychological comorbidity, but the im...
Introduction:
Numerous studies have shown that hypnotherapy (HT) is effective in irritable bowel syndrome (IBS) using traditional symptom severity end points. However, there is now interest in capturing the patient's perception of their illness and treatment because what patients expect from their treatment may differ from that of their healthcare...
Irritable bowel syndrome (IBS) and non-alcoholic fatty liver disease (NAFLD) are amongst the most common gastrointestinal and liver conditions encountered in primary and secondary care. Recently, there has been interest in the apparent co-incidence of NAFLD in patients with IBS mainly driven by improved understanding of their shared risk factors an...
Introduction
The diameter of high-resolution anorectal manometry (HRAM) catheters vary from 2.6mm up to 10.75mm for some high-definition devices. Other catheter-based physiology assessment tools such as the Functional lumen imaging probe (FLIP) use of a probe with a starting diameter of 3mm. Anal acoustic reflectometry (AAR) however is a ‘catheter-...
Irritable bowel syndrome (IBS) results from disordered brain–gut interactions. Identifying susceptibility genes could highlight the underlying pathophysiological mechanisms. We designed a digestive health questionnaire for UK Biobank and combined identified cases with IBS with independent cohorts. We conducted a genome-wide association study with 5...
Introduction
Recent data on the natural history of Irritable Bowel Syndrome (IBS) highlight the prognostic importance of extra-intestinal and psychological symptom profiles. Those with a high psychological burden have been shown to have the worst prognosis, and are consequently most likely to be referred to tertiary care. The Covid-19 pandemic caus...
Introduction
High-resolution anorectal manometry (HRAM) is an established assessment modality. Novel techniques, such as the Functional lumen imaging probe (EndoFLIP) and Anal Acoustic Reflectometry (AAR) are currently predominantly considered research tools. However, there is recognised, and well-documented, discordance between HRAM parameters, sy...
Introduction
Recent studies have confirmed a high worldwide prevalence of Irritable Bowel Syndrome (IBS) and suggest that cultural factors including; social taboos, stigmatisation, dietary factors, healthcare beliefs and communication gaps may contribute to disparities in the management of IBS between ethnic groups. It is unknown whether these fact...
Background
Gas-related symptoms (GRS) are common in the general population (GPop) and among patients with disorders of gut-brain interactions but there is no patient-reported outcome evaluating these symptoms and their impact on daily life. We have previously developed a 43-item intestinal gas questionnaire (IGQ). The aim of the present study is to...
Background and aims
Conditions such as irritable bowel syndrome (IBS), functional dyspepsia and functional constipation are among the prevalent gastrointestinal disorders classified as disorders of gut brain interaction (DGBI), which can adversely affect the lives of sufferers. This study aimed to assess the degree and consequences of overlapping D...
The research on the efficacy of hypnosis applications continues to grow, yet there is frequently a chasm between scientific knowledge and clinical practice. One challenge has been a lack of a unified standard for efficacy research in hypnosis. In 2018, six major hypnosis organizations collaborated to form a Task Force for Establishing Efficacy Stan...
Introduction
Refractory gastrointestinal symptoms are an increasingly recognised area of unmet need, which cause significant morbidity and impair the quality-of-life of patients with Cystic Fibrosis (CF). Recent studies have suggested a high prevalence of both gastro-oesophageal reflux, and bowel symptoms in CF. However the association between refl...
Objective
Severe irritable bowel syndrome (IBS) in school children and adolescents often leads to stigmatisation, social withdrawal, disrupted education and psychological distress. While there are few effective treatment options for IBS in this age group, gut-focused hypnotherapy (GFH) has shown promise in several trials. Unfortunately, GFH is not...
Background & Aims
Although functional gastrointestinal disorders (FGIDs), now called disorders of gut–brain interaction, have major economic effects on healthcare systems and adversely affect quality of life, little is known about their global prevalence and distribution. We investigated the prevalence of and factors associated with 22 FGIDs, in 33...
Background:
Irritable bowel syndrome (IBS) with diarrhoea (IBS-D) is a common and chronic condition that can significantly impair quality of life. The emergence of new drugs for IBS-D has been slow and there is a need for new treatments, including drug-free treatments, which are easy to use and suitable for different patient groups. Currently avai...
This Review highlights the stigma associated with irritable bowel syndrome and its impact on patient care and clinical outcomes. Stigma around irritable bowel syndrome is prevalent among the general public, health-care professionals, and co-workers, and is often related to poor understanding of the condition. Furthermore, stigma is associated with...
Introduction:
Chronic constipation is a common disorder with a reported prevalence ranging from 3% to 27% in the general population. Several management strategies, including diagnostic tests, empiric treatments, and specific treatments, have been developed. Our aim was to develop European guidelines for the clinical management of constipation.
De...
LINKED CONTENT
This article is linked to Gunn et al and Black et al papers. To view these articles, visit https://doi.org/10.1111/apt.15420 and https://doi.org/10.1111/apt.15455.
Background:
Irritable bowel syndrome with diarrhoea (IBS-D) affects up to 4% of the general population. Symptoms include frequent, loose, or watery stools with associated urgency, resulting in marked reduction of quality of life and loss of work productivity. Ondansetron, a 5HT3 receptor antagonist, has had an excellent safety record for over 20 y...
Background Irritable Bowel Syndrome (IBS) with diarrhoea (IBS-D) is a common and chronic condition that can significantly impair quality of life. The emergence of new drugs for IBS-D has been slow and there is a need for new treatments, including drug-free treatments, which are easy to use and suitable for different patient groups. Currently availa...
Background Irritable Bowel Syndrome (IBS) with diarrhoea (IBS-D) is a common and chronic condition that can significantly impair quality of life. The emergence of new drugs for IBS-D has been slow and there is a need for new treatments, including drug-free treatments, which are easy to use and suitable for different patient groups. Currently availa...
Background:
Irritable bowel syndrome with diarrhoea (IBS-D) is a common condition, greatly reducing the quality of life with few effective treatment options available.
Aims:
To report the beneficial response shown in our trial with the 5-hydroyxtryptamine (5-HT) receptor 3 antagonist, ondansetron in IBS-D METHODS: A randomised, placebo-controlle...
Until recently, with the exception of coeliac disease, gastroenterologists have not been particularly interested in the role of diet in the management of gastrointestinal disorders. However, patients have always felt that diet must play a part in their symptoms and, in the absence of any medical interest, have turned to alternative dietary practiti...
Introduction
Irritable Bowel Syndrome (IBS) symptoms in school children and adolescents are relatively common, often causing considerable embarrassment, social withdrawal, disruption to education and psychological distress. Pharmacological options in this group are limited due to safety concerns concerning antidepressants, making behavioural therap...
Opioids have recently received much attention because of the epidemic in their use in some countries such as the USA and the UK. Concerns have been raised about the possibility that they can increase mortality in patients when used on a long-term basis. Moreover, they are known to induce paradoxical hyperalgesia as well as alterations of gut functi...
Background
Despite their high prevalence and advances in the field of neurogastroenterology, there remain few effective treatment options for functional gastrointestinal disorders (FGIDs). It is recognized that approximately 25% of sufferers will have symptoms refractory to existing therapies, causing significant adverse effects on quality of life...
Background. Minor digestive symptoms are common and dietary approaches such as probiotic administration or fibre and fermentable carbohydrate intake adjustments are often recommended. A Fermented Milk Product (FMP) containing Bifidobacterium animalis subsp. lactis CNCM I-2494 and lactic acid bacteria has been shown to improve digestive symptoms aft...
Gut-focused hypnotherapy is an effective treatment for irritable bowel syndrome but is not widely available. This study assessed whether providing hypnotherapy by Skype might partially overcome this problem. Using a 50-point or more reduction in the IBS Symptom Severity Score as the primary outcome measure, 65% of subjects responded to Skype hypnot...
BACKGROUND: Hypnotherapy for irritable bowel syndrome (IBS) has been used primarily in patients with refractory symptoms in specialised departments and delivered on an individual basis. We aimed to test the hypothesis that hypnotherapy would be more effective than educational supportive therapy, and that group hypnotherapy would be non-inferior to...
Background & aims:
Abdominal distension is a common feature of irritable bowel syndrome (IBS), which is difficult to treat and can have the appearance of late pregnancy. It results from an abnormality of the normal accommodation reflex which keeps abdominal girth constant despite changes in gastrointestinal volume resulting from food ingestion or...
Background
Posterior tibial nerve stimulation (PTNS) is a novel treatment for patients with faecal incontinence (FI) and may be effective in selected patients; however, its mechanism of action is unknown. We sought to determine the effects of PTNS on anorectal physiological parameters.
Methods
Fifty patients with FI underwent 30 min of PTNS treatm...
en Linked Content
This article is linked to Clevers et al paper. To view this article visit https://doi.org/10.1111/apt.14612.
Background
The classification and treatment of patients who do not meet the criteria for a functional gastrointestinal (GI) disorder has not been well established. This study aimed to record the prevalence of minor digestive symptoms (MDSs) in the general population attempting to divide them into symptom clusters as well as trying to assess their i...
Background
Chronic gastrointestinal disorders are major burdens in primary care. Although there is some evidence that enhancing self-management can improve outcomes, it is not known if such models of care can be implemented at scale in routine NHS settings and whether or not it is possible to develop effective risk assessment procedures to identify...
Background:
In 2013, a systematic review and Delphi consensus reported that specific probiotics can benefit adult patients with irritable bowel syndrome (IBS) and other gastrointestinal (GI) problems.
Aim:
To update the consensus with new evidence.
Methods:
A systematic review identified randomised, placebo-controlled trials published between...
Background:
Effective management of irritable bowel syndrome (IBS), a common functional gastrointestinal disorder, can be challenging for physicians because of the lack of simple diagnostic tests and the wide variety of treatment approaches available.
Objective:
The objective of this article is to outline a simple algorithm for day-to-day clinic...
Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal (GI) disorder that can significantly erode the quality of life (QoL) of sufferers and places a major cost burden on healthcare services. This paper reviews the literature on the impact of IBS on healthcare services and society, including a recent report on the subject, in ord...
Introduction:
Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder which represents a major cost to healthcare services. IBS-D patients represent about one-third of the IBS population and are currently treated with antispasmodics, loperamide, bile acid sequestrants and antidepressants. Alosetron and rifaximin are also...
Purpose of review:
Microbial dysbiosis is receiving increasing attention as possibly being important in the pathophysiology of irritable bowel syndrome. This review will summarize the most recent literature addressing attempts to explore and target the microbiome in patients with irritable bowel syndrome.
Recent findings:
Manipulation of the int...
Background:
It has been suggested that probiotics may improve gastrointestinal discomfort. Not all probiotics exhibit the same effects and consequently meta-analyses on probiotics should be confined to well-defined strains or strain combinations. The aim of this study was to evaluate the effectiveness of a probiotic fermented milk (PFM) that inclu...
( BJOG. 2015; 122:1226–1234)
There has been a rising demand from the parturient population for alternative forms of labor pain relief beyond epidural analgesia. One of these alternatives, hypnosis, might be able to reduce the use of epidural analgesia for labor and potentially decrease the need for interventions (eg, instrumental birth, neonatal an...
The Rome IV Diagnostic Questionnaires were developed to screen for functional gastrointestinal disorders, serve as inclusion criteria in clinical trials, and support epidemiologic surveys. Separate questionnaires were developed for adults, children and adolescents, and infants and toddlers. For the adult questionnaire, we first surveyed 1162 adults...
Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder, which represents a major cost to healthcare services. Current pharmacological treatment includes fibre supplements, antispasmodics, laxatives, loperamide and antidepressants. This article reviews the novel pharmacological treatments already or recently approved for...
Key content
Chronic pelvic pain has a significant impact on health services, accounting for 20% of gynaecological referrals.
The overlap between irritable bowel syndrome and endometriosis, two of the leading causes of chronic pelvic pain, should not be overlooked.
Visceral sensitivity has been demonstrated in both conditions, further highlighting t...
Background:
Self-hypnosis is becoming increasingly popular as a means of labour pain management. Previous studies have produced mixed results. There are very few data on women's views and experiences of using hypnosis in this context. As part of a randomized controlled trial of self-hypnosis for intra-partum pain relief (the SHIP Trial) we conduct...
The aim of the present study was to investigate the effect of Bifidobacterium animalis subsp. lactis, BB-12®, on two primary end points - defecation frequency and gastrointestinal (GI) well-being - in healthy adults with low defecation frequency and abdominal discomfort. A total of 1248 subjects were included in a randomised, double-blind, placebo-...
Irritable bowel syndrome (IBS) is notoriously difficult to treat and this situation is unlikely to change until the pathophysiology is better understood. There is no doubt that IBS is a multifactorial condition but it is likely that the relative contribution of the various factors involved varies from patient to patient. Consequently, in some indiv...