TGI Friday! Our latest weekend round-up of recent research abstracts | 19 October 2012

October 19, 2012

From BMC Infectious Diseases (open access journal – full provisional text available as a pdf), 14 October 2012.

Immunophenotyping in post-giardiasis functional gastrointestinal disease and chronic fatigue syndrome

Kurt Hanevik(1,2,*), Einar K Kristoffersen(3,4), Steinar Sørnes(5), Kristine Mørch(6), Halvor Næss(7), Ann C Rivenes(8), Jørn E Bødtker(9), Trygve Hausken (10) and Nina Langeland(11)

1 Institute of Medicine, University of Bergen, Bergen N-5021, Norway
2 Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen N-5021, Norway
3 Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
4 The Gade Institute, University of Bergen, Bergen, Norway
5 Institute of Medicine, University of Bergen, Bergen, Norway
6 Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
7 Department of Neurology, Haukeland University Hospital, Bergen, Norway
8 Division of Psychiatry, Haukeland University Hospital, Bergen, Norway 9 Division of Psychiatry, Haukeland University Hospital, Bergen, Norway 10 Institute of Medicine, University of Bergen, Bergen, Norway
11 Institute of Medicine, University of Bergen, Bergen, Norway
* Corresponding author. Institute of Medicine, University of Bergen, Bergen N- 5021, Norway



A Giardia outbreak was associated with development of post-infectious functional gastrointestinal disorders (PI-FGID) and chronic fatigue syndrome (PI-CFS). Markers of immune dysfunction have given conflicting results in CFS and FGID patient populations. The aim of this study was to evaluate a wide selection of markers of immune dysfunction in these two co-occurring post-infectious syndromes.


48 patients, reporting chronic fatigue in a questionnaire study, were clinically evaluated five years after the outbreak and grouped
according to Fukuda criteria for CFS (n=19) and idiopathic chronic fatigue (n=5) and Rome II criteria for FGIDs (n=54). 22 Giardia
exposed non-fatigued individuals and 10 healthy unexposed individuals were recruited as controls. Peripheral blood lymphocyte subsets were analyzed by flow cytometry.


In peripheral blood we found significantly higher CD8 T-cell levels in PI-FGID, and significantly lower NK-cell levels in PI-CFS patients. Severity of abdominal and fatigue symptoms correlated negatively with NK-cell levels. A tendency towards lower T-cell CD26 expression in FGID was seen.


Patients with PI-CFS and/or PI-FGID 5 years after Giardia lamblia infection showed alterations in NK-cell and CD8-cell populations
suggesting a possible immunological abnormality in these conditions. We found no significant changes in other markers examined in this
well-defined group of PI-CFS and PI-FGID elicited by a gastrointestinal infection. Controlling for co-morbid conditions is
important in evaluation of CFS-biomarkers.

From Quality of Life Research, 7 October 2012 [Epub ahead of print].

Health-related quality of life in patients with interstitial cystitis/bladder pain syndrome and frequently associated comorbidities.

Suskind AM, Berry SH, Suttorp MJ, Elliott MN, Hays RD, Ewing BA, Clemens JQ.
Department of Urology, University of Michigan Health System, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.



To estimate the association of chronic non-urologic conditions [i.e., fibromyalgia (FM), chronic fatigue syndrome (CFS), and irritable bowel syndrome (IBS)] with health-related quality of life (HRQOL) in patients with interstitial cystitis/bladder pain syndrome (IC/BPS).


A total of 276 women with established diagnoses of IC/BPS completed a telephone interview which included demographics, self-reported medical conditions, the SF-36 health survey, and the interstitial cystitis symptom index (ICSI). Multivariate linear regression analysis was used to identify correlates of SF-36 physical and mental component summary scores.


Mean patient age was 45.1 (SD 15.9) years, and 83 % of the subjects were white. Mean values for the SF-36 Physical Component Score (PCS) and Mental Component Score (MCS) means were 39 (SD 14) and 45 (SD 12), respectively, indicating significant HRQOL reductions. Mean ICSI score was 11.27 (SD = 4.86). FM and IBS were significantly associated with worse SF-36 scores: -8 points on the PCS (p < 0.001) and -6 points on the MCS (p < 0.001). CFS and the presence of other pelvic conditions (overactive bladder, vulvodynia, endometriosis) were not significantly associated with SF-36 PCS and MCS scores.CONCLUSIONS In patients with IC/BPS, the presence of FM, CFS, and IBS has a significant association with HRQOL, equivalent in impact to the bladder symptoms themselves. These results emphasize the importance of a multidisciplinary approach to treating patients with IC/BPS and other conditions.

From the Quarterly Journal of Medicine, 26 August 2012. [Epub ahead of print].

Is chronic fatigue syndrome the same illness as fibromyalgia: evaluating the ‘single syndrome' hypothesis.

Abbi B, Natelson BH.

The War Related Illness and Injury Study Center, DVA Medical Center, East Orange, NJ and Pain and Fatigue Study Center, Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, USA.


Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are medically unexplained syndromes that can and often do co-occur. For this reason, some have posited that the two are part of the same somatic syndrome-examples of symptom amplification.

This hypothesis would suggest that few differences exist between the two syndromes.

To evaluate this interpretation, we have searched the literature for articles comparing CFS to FM, reviewing only those articles which report differences between the two.

This review presents data showing differences across a number of parameters-implying that the underlying pathophysiology in CFS may differ from that of FM. We hope that our review encourages other groups to look for additional differences between CFS and FM.

By continuing to preserve the unique illness definitions of the two syndromes, clinicians will be able to better identify, understand and provide treatment for these individuals.

From Autoimmune Reviews, 11 June 2012. Epub 2011 Oct 22.

Is fibromyalgia a discrete entity?

Ablin JN, Buskila D, Van Houdenhove B, Luyten P, Atzeni F, Sarzi-Puttini P.
Institute of Rheumatology and Internal Medicine F, Tel Aviv Sourasky
Medical Center, Israel.


Fibromyalgia (FM) is defined as chronic widespread pain (CWP) with allodynia or hyperalgesia to pressure pain, and is classified as one of the largest group of soft tissue pain syndromes.

Its pathogenesis is not entirely understood, although it is currently believed to be the result of a central nervous system (CNS)
malfunction that increases pain transmission and perception. There are no instrumental tests to confirm the diagnosis, but many of the
differential diagnoses can be excluded by means of an extensive clinical examination and patient history.

Although fibromyalgia is a recognisable clinical entity, it would seem appropriate to consider the entire range of tenderness and distress in clinic patients in order to tailor treatment on an individual basis.

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