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Restless legs syndrome is associated with irritable bowel syndrome and small intestinal bacterial overgrowth.
Sleep Med 2011; 12(6):610-3SM

Abstract

BACKGROUND

Restless legs syndrome (RLS) is linked to gastrointestinal disorders. The prevalence of irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO) in RLS patients was determined.

METHODS

RLS subjects were recruited from unbiased ads that did not mention gastrointestinal symptoms. RLS diagnosis was confirmed by a neurologist and utilized the International RLS Study Group criteria. General population controls (GPC) were spouses of gastrointestinal clinic patients and were excluded for RLS. Completely healthy controls (CHC) were excluded for RLS and gastrointestinal symptoms. IBS was diagnosed by Rome II criteria. SIBO was diagnosed by the lactulose breath test (LBT).

RESULTS

There were 32 RLS subjects (23F/9M; 57 yo), 25 GPC (13F/12M; 58 yo) and 30 CHC (19F/11M; 44 yo). Twenty-nine had RLS unassociated with other GI diseases, one had celiac disease, and two had gastric resections. IBS was diagnosed in 28% of RLS subjects compared to 4% GPC (p=0.0317). SIBO was diagnosed in 69% of RLS subjects compared to 28% of GPC (p=0.0033) and 10% of CHC. Using a false positive rate of 10%, 59% of positive LBT results are associated with RLS.

CONCLUSIONS

IBS and SIBO are common in RLS. Three hypotheses developed are (a) RLS patients are selectively immunocompromised or genetically predisposed and thus more subject to SIBO; (b) SIBO leads to autoimmune changes, and subsequent auto-antibodies attack brain and/or peripheral nerves and (c) SIBO inflammation leads to increased hepcidin and CNS iron deficiency which, in turn, leads to RLS. These hypotheses bear further investigation.

Authors+Show Affiliations

Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA. lw@gidoctor.netNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21570907

Citation

Weinstock, Leonard B., and Arthur S. Walters. "Restless Legs Syndrome Is Associated With Irritable Bowel Syndrome and Small Intestinal Bacterial Overgrowth." Sleep Medicine, vol. 12, no. 6, 2011, pp. 610-3.
Weinstock LB, Walters AS. Restless legs syndrome is associated with irritable bowel syndrome and small intestinal bacterial overgrowth. Sleep Med. 2011;12(6):610-3.
Weinstock, L. B., & Walters, A. S. (2011). Restless legs syndrome is associated with irritable bowel syndrome and small intestinal bacterial overgrowth. Sleep Medicine, 12(6), pp. 610-3. doi:10.1016/j.sleep.2011.03.007.
Weinstock LB, Walters AS. Restless Legs Syndrome Is Associated With Irritable Bowel Syndrome and Small Intestinal Bacterial Overgrowth. Sleep Med. 2011;12(6):610-3. PubMed PMID: 21570907.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Restless legs syndrome is associated with irritable bowel syndrome and small intestinal bacterial overgrowth. AU - Weinstock,Leonard B, AU - Walters,Arthur S, Y1 - 2011/05/13/ PY - 2010/12/11/received PY - 2011/01/28/revised PY - 2011/03/15/accepted PY - 2011/5/17/entrez PY - 2011/5/17/pubmed PY - 2011/10/14/medline SP - 610 EP - 3 JF - Sleep medicine JO - Sleep Med. VL - 12 IS - 6 N2 - BACKGROUND: Restless legs syndrome (RLS) is linked to gastrointestinal disorders. The prevalence of irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO) in RLS patients was determined. METHODS: RLS subjects were recruited from unbiased ads that did not mention gastrointestinal symptoms. RLS diagnosis was confirmed by a neurologist and utilized the International RLS Study Group criteria. General population controls (GPC) were spouses of gastrointestinal clinic patients and were excluded for RLS. Completely healthy controls (CHC) were excluded for RLS and gastrointestinal symptoms. IBS was diagnosed by Rome II criteria. SIBO was diagnosed by the lactulose breath test (LBT). RESULTS: There were 32 RLS subjects (23F/9M; 57 yo), 25 GPC (13F/12M; 58 yo) and 30 CHC (19F/11M; 44 yo). Twenty-nine had RLS unassociated with other GI diseases, one had celiac disease, and two had gastric resections. IBS was diagnosed in 28% of RLS subjects compared to 4% GPC (p=0.0317). SIBO was diagnosed in 69% of RLS subjects compared to 28% of GPC (p=0.0033) and 10% of CHC. Using a false positive rate of 10%, 59% of positive LBT results are associated with RLS. CONCLUSIONS: IBS and SIBO are common in RLS. Three hypotheses developed are (a) RLS patients are selectively immunocompromised or genetically predisposed and thus more subject to SIBO; (b) SIBO leads to autoimmune changes, and subsequent auto-antibodies attack brain and/or peripheral nerves and (c) SIBO inflammation leads to increased hepcidin and CNS iron deficiency which, in turn, leads to RLS. These hypotheses bear further investigation. SN - 1878-5506 UR - https://www.unboundmedicine.com/medline/citation/21570907/Restless_legs_syndrome_is_associated_with_irritable_bowel_syndrome_and_small_intestinal_bacterial_overgrowth_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1389-9457(11)00121-3 DB - PRIME DP - Unbound Medicine ER -