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Surgery and IBS
Lin Chang, MD
An increased number of abdominal surgeries have been reported in a random population of patients with IBS compared with individuals without IBS.[9,10] Two studies presented during these meeting proceedings evaluated the prevalence of surgery in patients with IBS compared with control subjects in 2 different patient populations.
In one study,[11] the prevalence of potentially unnecessary surgeries was investigated using computerized patient questionnaire data in HMO health examinees. An analysis of health data on 89,008 examinees was performed. IBS was reported in 5.2% of subjects (3.0% of men and 7.2% of women). Of the different types of surgeries, cholecystectomy, appendectomy, hysterectomy, and back surgery were significantly more common in patients with IBS than in patients without IBS. Patients with IBS reported these surgeries 2-3 times more than individuals without IBS, except for back surgery (reported 1.5 times more often). Various medical history parameters were evaluated as predictive factors for the types of surgeries. An IBS diagnosis yielded the highest odds ratio (OR) for cholecystectomy and appendectomy. The diagnoses of IBS and fibromyalgia tied for the highest OR for hysterectomy, and fibromyalgia had the highest OR for back surgery.
The second study[12] retrospectively determined the prevalence of gastrointestinal-related surgeries in a 2-state Medicaid IBS patient population compared with a non-IBS control group matched for age, sex, race, and months of eligibility (both, n = 2546). Patients with IBS had a corresponding ICD (International Classification of Diseases) code as a primary or secondary diagnosis. The gastrointestinal-related procedures included cholecystectomy, appendectomy, colectomy, obesity procedures, and abdominal and vaginal hysterectomy. The 1-year prevalence of gastrointestinal-related procedures in the IBS group was significantly higher than that of the control group (n = 42 [1.65%] vs n = 23 [0.9%]; P = .01). The prevalence of vaginal hysterectomy was higher in the IBS group than in the control group (0.5% vs 0.2%; P = .02).
Summary. These studies confirm that factors that contribute to the increased healthcare and economic burden associated with IBS include physician visits, surgical procedures, medication (prescription and OTC), and alternative treatments (that are frequently used by patients with IBS). The lack of satisfaction and effectiveness of current IBS treatments and decreased QOL and work productivity also contribute to the burden of illness.
References
Wells NE, Hahn BA, Whorwell PJ. Clinical economics review: irritable bowel syndrome. Aliment Pharmacol Ther. 1997;11:1019-1030.
Gralnek IM, Hays RD, Kilbourne A, Naliboff B, Mayer EA. The impact of irritable bowel syndrome on health-related quality of life. Gastroenterology. 2000;119:654-60.
Frank L, Kleinman L, Rentz A, Ciesla G, Kim JJ, Zacker C. Health-related quality of life associated with irritable bowel syndrome: comparison with other chronic diseases. Clin Ther. 2002;24:675-689.
Hungin P, Chang L, Barghout V, Kahler K. The impact of IBS on absenteeism and work productivity: United States and eight European countries. Am J Gastroenterol. 2003;98:S227. [Abstract # 687]
Sandler RS, Everhart JE, Donowitz M, et al. The burden of selected digestive diseases in the United States. Gastroenterology. 2002;122:1500-1151.
Dean BB, Aguilar D, Barghout V, Kahler K, Groves D, Ofman JJ. Impairments in worker productivity and health-related quality of life among employees with irritable bowel syndrome: Does bowel habit predominance make a difference? Am J Gastroenterol. 98:S233, 2003. [Abstract # 703]
Palsson OS, Whitehead WE, Barghout V, et al. IBS severity and health-related quality of life improve with age in women but not in men. Am J Gastroenterol. 98:S272, 2003. [Abstract #818]
Gore M, Frech F, Tai K-S, Nguyen AB, Shetzline MA. Burden of illness in patients with irritable bowel syndrome with constipation. Am J Gastroenterol. 2003;98:S219. [Abstract # 662]
Whitehead WE, Cheskin LJ, Heller BR, et al. Evidence for exacerbation of irritable bowel syndrome during menses. Gastroenterology. 1990;98:1485-1489.
Kennedy TM, Jones RH. Epidemiology of cholecystectomy and irritable bowel syndrome in a UK population. Br J Surg. 2000;87:1568-1563.
Longstreth GF, Yao JF. Irritable bowel syndrome and surgery in HMO health examinees. Am J Gastroenterol. 2003;98:S265. [Abstract #797]
Ganguly R, Barghout V, Pannicker S, Martin BC. Prevalence of GI related surgical procedures among Medicaid eligible patients with and without irritable bowel syndrome. Am J Gastroenterol. 2003 98:S274-S275. [Abstract # 825]
Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Muller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999; 45(suppl II):1143-1147.
Dean BB, Aguilar D, Barghout V, Kahler K, Groves D, Ofman JJ. Identifying IBS patients using Rome II symptom criteria: 3- or 12-month reporting? Am J Gastroenterol. 2003;98:S235-S236. [Abstract # 711]
Gore M, Frech F, Nguyen AB, Tai K-S, Shetzline MA. Development of a new symptom-based algorithm for classifying IBS patients into IBS subgroups. Am J Gastroenterol. 2003;98:S219. [Abstract # 663]
Locke GR, Zinsmeister AR, Melton LJ, Talley NJ. Who is an "alternator?" -- a population based study. Am J Gastroenterol. 2003;98:S275. [Abstract # 828]
Drossman DA, Camilleri M, Mayer EA, Whitehead WE. AGA technical review on irritable bowel syndrome. Gastroenterology. 2002;123:2108-2131.
Whitehead WE, Palsson O, Jones KR. Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications? Gastroenterology. 2002;122:1140-1156.
Crowell MD, Schettler VA, Lacy BE, Jones MP, Olden KW, Whitehead WE. Impact of somatization on gastrointestinal (GI) and extra-intestinal comorbidities in IBS. Am J Gastroenterol. 2003;98:S271-S272. [Abstract #816]
Muller-Lissner SA, Fumagalli I, Bardhan KD, et al. Tegaserod, a 5-HT(4) receptor partial agonist, relieves symptoms in irritable bowel syndrome patients with abdominal pain, bloating and constipation. Aliment Pharmacol Ther. 2001;15:1655-1666.
Camilleri M, Northcutt AR, Kong S, Dukes GE, McSorley D, Mangel AW. Efficacy and safety of alosetron in women with irritable bowel syndrome: A randomised placebo-controlled trial. Lancet. 2000;355:1035-1040.
Dunger-Baldauf C, Nyhlin H, Rueegg P, Wagner A. Subject's global assessment of satisfactory relief as a measure to assess treatment effect in clinical trials in irritable bowel syndrome (IBS). Am J Gastroenterol. 2003;98:S269. [Abstract #809]
Prather CM, Camilleri M, Zinsmeister AR, McKinzie S, Thomforde G. Tegaserod accelerates orocecal transit in patients with constipation-predominant irritable bowel syndrome. Gastroenterology. 2000;118:463-468.
Talley N, Kamm M, Mueller-Lissner S, et al. Tegaserod is effective in relieving the multiple symptoms of constipation: Results from a 12-week multinational study in patients with chronic constipation. Am J Gastroenterol. 2003;98:S269-S270. [Abstract #810]
Kariv R, Tiomny E, Grenshpon R, Waisman G, Halpern Z. Low-dose naltrexone for the treatment of irritable bowel syndrome. Am J Gastroenterol. 2003 98:S268. [Abstract #805]
http://www.medscape.com/viewarticle/463421
--------------------
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The Effect of Somatization on Gastrointestinal and Extraintestinal Symptoms of IBS
Lin Chang, MD
Psychosocial disturbances (eg, depression, anxiety, stressful life events, and somatization) are commonly found in patients with IBS, particularly those with more severe symptoms or those seen in tertiary referral populations.[17] In addition, extraintestinal symptoms, such as fatigue, myalgias, sleep, and sexual disturbances are also frequently reported by patients with IBS.[18] The association between psychosocial factors and extraintestinal symptoms in IBS is not well understood.
Crowell and colleagues[19] studied the influence of somatization (measured by the psychological questionnaire SCL-90R) on gastrointestinal and extraintestinal symptoms in IBS consulters in 133 consecutive Rome-positive IBS patients. Abdominal pain, pain sites, and upper and lower gastrointestinal symptoms were reported to a significantly greater degree by patients with IBS with elevated scores for somatization. In addition, somatization scores significantly correlated with the presence of extraintestinal symptoms such as chronic fatigue, temporomandibular joint, low back pain, and both anxiety and panic attacks. Patients with IBS with elevated scores for somatization also had reduced functional abilities and QOL.
The study authors concluded that IBS is a heterogeneous disorder in which the presence of multiple gastrointestinal and nongastrointestinal symptoms could be a marker for psychologic factors that could play a role in the etiology, healthcare utilization, and treatment outcome of IBS. It is still not known whether the increased prevalence of extraintestinal symptoms is due to coexistent psychologic disorders that may share similar symptoms with IBS, or if the gastrointestinal, extraintestinal, and psychologic symptoms all result from a shared central pathophysiologic mechanism underlying IBS. However, this study supports the concept that somatization is an important confounding factor that should be considered when evaluating or interpreting data on gastrointestinal, extraintestinal, and other psychologic symptoms in IBS.
Summary
These IBS symptom-related studies reiterate the challenges of diagnosing IBS and of understanding the underlying clinical relevance and pathophysiologic mechanisms of specific symptoms, including altered bowel habits, other gastrointestinal symptoms, and extraintestinal symptoms. Future studies that can help establish a biologic marker(s) for IBS would be important in overcoming these challenges.
References
Wells NE, Hahn BA, Whorwell PJ. Clinical economics review: irritable bowel syndrome. Aliment Pharmacol Ther. 1997;11:1019-1030.
Gralnek IM, Hays RD, Kilbourne A, Naliboff B, Mayer EA. The impact of irritable bowel syndrome on health-related quality of life. Gastroenterology. 2000;119:654-60.
Frank L, Kleinman L, Rentz A, Ciesla G, Kim JJ, Zacker C. Health-related quality of life associated with irritable bowel syndrome: comparison with other chronic diseases. Clin Ther. 2002;24:675-689.
Hungin P, Chang L, Barghout V, Kahler K. The impact of IBS on absenteeism and work productivity: United States and eight European countries. Am J Gastroenterol. 2003;98:S227. [Abstract # 687]
Sandler RS, Everhart JE, Donowitz M, et al. The burden of selected digestive diseases in the United States. Gastroenterology. 2002;122:1500-1151.
Dean BB, Aguilar D, Barghout V, Kahler K, Groves D, Ofman JJ. Impairments in worker productivity and health-related quality of life among employees with irritable bowel syndrome: Does bowel habit predominance make a difference? Am J Gastroenterol. 98:S233, 2003. [Abstract # 703]
Palsson OS, Whitehead WE, Barghout V, et al. IBS severity and health-related quality of life improve with age in women but not in men. Am J Gastroenterol. 98:S272, 2003. [Abstract #818]
Gore M, Frech F, Tai K-S, Nguyen AB, Shetzline MA. Burden of illness in patients with irritable bowel syndrome with constipation. Am J Gastroenterol. 2003;98:S219. [Abstract # 662]
Whitehead WE, Cheskin LJ, Heller BR, et al. Evidence for exacerbation of irritable bowel syndrome during menses. Gastroenterology. 1990;98:1485-1489.
Kennedy TM, Jones RH. Epidemiology of cholecystectomy and irritable bowel syndrome in a UK population. Br J Surg. 2000;87:1568-1563.
Longstreth GF, Yao JF. Irritable bowel syndrome and surgery in HMO health examinees. Am J Gastroenterol. 2003;98:S265. [Abstract #797]
Ganguly R, Barghout V, Pannicker S, Martin BC. Prevalence of GI related surgical procedures among Medicaid eligible patients with and without irritable bowel syndrome. Am J Gastroenterol. 2003 98:S274-S275. [Abstract # 825]
Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Muller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999; 45(suppl II):1143-1147.
Dean BB, Aguilar D, Barghout V, Kahler K, Groves D, Ofman JJ. Identifying IBS patients using Rome II symptom criteria: 3- or 12-month reporting? Am J Gastroenterol. 2003;98:S235-S236. [Abstract # 711]
Gore M, Frech F, Nguyen AB, Tai K-S, Shetzline MA. Development of a new symptom-based algorithm for classifying IBS patients into IBS subgroups. Am J Gastroenterol. 2003;98:S219. [Abstract # 663]
Locke GR, Zinsmeister AR, Melton LJ, Talley NJ. Who is an "alternator?" -- a population based study. Am J Gastroenterol. 2003;98:S275. [Abstract # 828]
Drossman DA, Camilleri M, Mayer EA, Whitehead WE. AGA technical review on irritable bowel syndrome. Gastroenterology. 2002;123:2108-2131.
Whitehead WE, Palsson O, Jones KR. Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications? Gastroenterology. 2002;122:1140-1156.
Crowell MD, Schettler VA, Lacy BE, Jones MP, Olden KW, Whitehead WE. Impact of somatization on gastrointestinal (GI) and extra-intestinal comorbidities in IBS. Am J Gastroenterol. 2003;98:S271-S272. [Abstract #816]
Muller-Lissner SA, Fumagalli I, Bardhan KD, et al. Tegaserod, a 5-HT(4) receptor partial agonist, relieves symptoms in irritable bowel syndrome patients with abdominal pain, bloating and constipation. Aliment Pharmacol Ther. 2001;15:1655-1666.
Camilleri M, Northcutt AR, Kong S, Dukes GE, McSorley D, Mangel AW. Efficacy and safety of alosetron in women with irritable bowel syndrome: A randomised placebo-controlled trial. Lancet. 2000;355:1035-1040.
Dunger-Baldauf C, Nyhlin H, Rueegg P, Wagner A. Subject's global assessment of satisfactory relief as a measure to assess treatment effect in clinical trials in irritable bowel syndrome (IBS). Am J Gastroenterol. 2003;98:S269. [Abstract #809]
Prather CM, Camilleri M, Zinsmeister AR, McKinzie S, Thomforde G. Tegaserod accelerates orocecal transit in patients with constipation-predominant irritable bowel syndrome. Gastroenterology. 2000;118:463-468.
Talley N, Kamm M, Mueller-Lissner S, et al. Tegaserod is effective in relieving the multiple symptoms of constipation: Results from a 12-week multinational study in patients with chronic constipation. Am J Gastroenterol. 2003;98:S269-S270. [Abstract #810]
Kariv R, Tiomny E, Grenshpon R, Waisman G, Halpern Z. Low-dose naltrexone for the treatment of irritable bowel syndrome. Am J Gastroenterol. 2003 98:S268. [Abstract #805]
http://www.medscape.com/viewarticle/463421
--------------------
Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!
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Fam Pract. 2003 Dec;20(6):670-4.
Family practitioners' attitudes and knowledge about IBS: effect of a trial of physician education.
Longstreth GF, Burchette RJ.
Department of Gastroenterology, Kaiser Permanente Medical Care Program, 4647 Zion Avenue, San Diego, CA 92120, USA. George.F.Longstreth@kp.org
BACKGROUND: Primary physicians care for most patients with irritable bowel syndrome (IBS), but data on their attitudes and knowledge about the disorder are limited to research in the UK. OBJECTIVE: The purpose of the present study was to assess US family practitioners' attitudes and knowledge about IBS and determine the effect of a single education class on these measures. METHODS: In a large health maintenance organization (HMO), a baseline group of family practitioners twice completed a questionnaire on attitudes and knowledge about IBS, 3 months apart. A class group completed it pre-class, immediately post-class and 3 months post-class. RESULT: Thirty-five physicians ranked IBS among five chronic, painful syndromes as highest in difficulty satisfying patients, tied with headache for highest in difficulty in practice strategy decision, second in time required, and fourth in diagnostic confidence and satisfaction in caring for patients. IBS and heartburn had widely separated rankings in all five attitudes. The correct answer rate on seven of 13 knowledge questions was <50%, and a majority did not identify the Rome II symptom criteria as typical and lacked other important knowledge. Of the 30 class physicians, the knowledge scores (mean +/- SD; maximum possible, 13) of 29 increased from 5.59 +/- 1.84 pre-class to 10.21 +/- 1.76 immediately post-class (P < 0.0001); 3 months later, the scores were lower (8.93 +/- 0.36) than post-class (P < 0.0001), but still higher than pre-class (P < 0.0001). Their attitude rankings were nearly identical pre-class and 3 months later (P > 0.05). In the 19 baseline physicians, IBS attitude rankings and knowledge scores did not change significantly over 3 months (P > 0.05). CONCLUSION: These US family practitioners had attitudes about IBS patients and lacked knowledge that could interfere with patient care. A single class improved short-term knowledge but had little effect on attitudes about IBS.
PMID: 14701890 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14701890&dopt=Abstract
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Curr Med Res Opin. 2003;19(8):771-80.
Utilization patterns and net direct medical cost to Medicaid of IBS.
Martin BC, Ganguly R, Pannicker S, Frech F, Barghout V.
University of Georgia College of Pharmacy, Pharmacy Care Administration Graduate Program, Athens, Georgia 30602, USA. bmartin@rx.uga.edu
BACKGROUND: Patients with irritable bowel syndrome are frequent users of the health care system. DESIGN AND METHODS: This retrospective matched case-control study assessed the economic impact of irritable bowel syndrome on the Medicaid program by comparing the health care utilization and expenditures of Medicaid patients with irritable bowel syndrome in California and North Carolina with age-, sex-, and race-matched control groups without the syndrome. RESULTS: Average annual Medicaid expenditures per case of diagnosed irritable bowel syndrome were 2952 dollars and 5908 dollars in California and North Carolina, respectively; corresponding unadjusted net incremental expenditures were 962 dollars and 2191 dollars, respectively. In both states, patients with irritable bowel syndrome incurred greater costs than controls for physician visits, outpatient visits, and prescription drugs. CONCLUSIONS: Irritable bowel syndrome was shown to impose an economic burden on the Medicaid program. The cost of treating patients with irritable bowel syndrome is higher than the cost of treating matched ambulatory Medicaid recipients without the condition.
PMID: 14687449 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14687449&dopt=Abstract
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Am J Gastroenterol. 2004 Jan;99(1):122-30.
Splitting IBS: from original Rome to Rome II criteria.
Mearin F, Roset M, Badia X, Balboa A, Baro E, Ponce J, Diaz-Rubio M, Caldwell E, Cucala M, Fueyo A, Talley NJ.
Institute of Functional and Motor Digestive Disorders, Centro Medico Teknon, Barcelona, Spain.
OBJECTIVES: Diagnosis of irritable bowel syndrome (IBS) and other functional bowel disorders (FBD) is based on symptom evaluation. Clinical criteria have changed over time, yielding different proportions of subjects fulfilling diagnostic requirements. According to new diagnostic criteria (Rome II), subjects considered some years ago to have IBS no longer do so. The aim of this article is to evaluate how patients diagnosed as having IBS according to original Rome criteria have been split, and to which clinical diagnosis they belong today. METHODS: Two hundred and eleven subjects meeting original Rome IBS diagnostic criteria were studied: 65 also met Rome II criteria while 146 did not. Subjects were extracted from an epidemiological survey, using home-based personal interviews, on 2000 subjects randomly selected as representative of the Spanish population. Clinical complaints, personal well-being, resource utilization, and health-related quality of life (HRQOL) were compared. RESULTS: Of the subjects meeting original Rome but not Rome II criteria, the present diagnosis should be: 40%"minor" IBS (IBS symptoms of less than 12 wk duration), 37% functional constipation, 12% alternating bowel habit, 7% functional diarrhea, 3% functional abdominal bloating, and 1% unspecified functional bowel disorder (FBD). Thus, 52 subjects (36%) should not be diagnosed with IBS because they really had other FBD, 59 (40%) because of symptoms consistent with IBD diagnosis but not the required duration or frequency, and 35 (24%) because of symptoms consistent with some other FBD diagnosis but not meeting the required duration. Clinical complaints, personal well-being, resource utilization, and HRQOL were more severely affected in IBS than in other FBD as a group, and in "major" rather than in "minor" forms. CONCLUSIONS: Many subjects meeting original Rome criteria for IBS do not meet Rome II criteria: approximately one quarter of subjects do not have sufficient symptom duration or frequency to be diagnosed with IBS and almost half are now considered as having other ("major" or "minor") FBD.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14687153&dopt=Abstract
PMID: 14687153 [PubMed - indexed for MEDLINE]
Check here to learn about the Rome II Guidelines for IBS
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Researchers Pioneer Accessible, Cost-Effective Treatments for Post-Traumatic Stress Disorder and Irritable Bowel Syndrome
Contact: Karl Luntta (518) 437-4980
ALBANY, N.Y. (February 17, 2004) -- University at Albany researchers are pioneering more accessible, cost-effective treatment programs for two of the nation's common ailments, Post-Traumatic Stress Disorder (PTSD) and Irritable Bowel Syndrome (IBS).
Rather than relying on the common face-to-face, therapist-patient relationships, the unique treatments are self-managed, with the patient undertaking much of the therapy through reading material, structured homework, and diagnostic tools.
"It's the wave of the future," says doctoral research supervisor Edward B. Blanchard, director of the UAlbany Center for Stress and Anxiety Disorders. "The treatment is very accessible to people who have limited mobility or limited access to areas where therapists tend to locate, such as cities. It's self-managed and self-paced, and less expensive than traditional treatment. And it's done under the trained eye of a clinician, who can help assess progress."
Therapy for Crash Victims
Doctoral student Jill Sabsevitz is developing a treatment program for sufferers of PTSD specifically related to the aftermath of motor vehicle accidents (MVA). Some studies suggest that 45 percent of accident survivors who seek medical attention will develop PTSD within one year of the event, and an additional 15 to 30 percent will develop less overt, subclinical levels of PTSD. Sabsevitz' treatment utilizes the book Coping With Your Crash, by Blanchard and Edward Hickling, as the focal point of the self-managed program. After an initial consultation and assessment with a therapist, patients undergo a series of exercises described in the book designed to overcome feelings of anxiety, anger, vulnerability, and depression, as well as steps such as the incorporation of pleasant events into the daily routine. The patient mails in "homework" to his therapist, who then gives the okay for advancing to the next step. The last step is self-assessment, in conjunction with a trained therapist.
"With physical injuries often preventing people from traveling," said Sabsevitz, "and with PTSD symptoms also inhibiting accident victims from getting out, this type of therapy aims to meet their needs and get them on the road, literally, to better health, physically and mentally."
Web-based Treatment Reaches Worldwide Audience
Jonathan Lerner has taken the program one step further by researching entirely Web-based self-managed treatments for MVA-related PTSD. He offers a comprehensive assessment, treatment, and evaluation on his Web site www.afterthecrash.com, and to date has had responses from more than 100 MVA survivors on five continents. While his treatment does not offer an initial face-to-face consultation, he has high hopes for its efficacy. He notes, "To date, there's strong evidence indicating that a cognitive-behavioral intervention like the one developed by Dr. Blanchard can successfully decrease symptoms of PTSD and improve functioning in individuals who have survived a motor vehicle accident. There is also preliminary data showing positive clinical outcomes in individuals who have used Internet-based assessment and treatment for problem areas such as headache, panic disorder, substance abuse, weight loss, and smoking cessation."
Stress Management Key to Treating Irritable Bowel Syndrome
Irritable Bowel Syndrome (IBS) is the condition doctoral student Kathryn Sanders seeks to alleviate with her self-managed therapy program. Studies estimate that 11 to 22 percent of Americans suffer from IBS, a gastrointestinal disorder with symptoms that include abdominal pain and tenderness accompanied by either diarrhea, constipation or both. IBS affects roughly twice as many women as men, and as much as $25 billion is spent annually on treating symptoms. No drug therapy currently is available. For her treatment, Sanders utilizes the book Breaking the Bonds of Irritable Bowel Syndrome, by therapist Barbara Bradley-Bolen.
"Our goal," said Sanders, "is to help improve patients' health and quality of life through stress management. Patients will ultimately learn to deal with their stress, and with this self-managed therapy they can also learn to manage their IBS symptoms now and for the future."
Also included in her proposed therapy is an initial assessment by a trained clinician, homework based on the book, and the study of individual diet and various relaxation and stress management techniques, plus various follow-up contacts.
"These students are on the cutting edge of what could be a revolution in the treatment of certain conditions," said Blanchard. "But they're not developing radical alternative therapies. They're researching interventions that are based on traditional theories of therapy, but divert from tradition in ways that make alleviating patients' symptoms accessible, comfortable, widely available, and inexpensive, while still benefiting from the support of a qualified counselor."
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http://www.albany.edu/news/releases/2004/feb2004/pts_disorder_ibs.htm
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Title: New Syndrome Connects Gallbladder Dysfunction And Chronic Diarrhea
Doctor's Guide
SUMMIT, NJ -- August 7, 2000 -- A study published in this month's issue of the American Journal of Gastroenterology suggests that millions of Americans believed to be afflicted with chronic diarrhea (CD) as a result of an intestinal disorder may in fact be suffering from gallbladder dysfunction. Furthermore, this research is considered by many prominent gastroenterologists to be the first recognition of a new syndrome that links CD to gallbladder dysfunction.
Referred to as the Habba Syndrome, the groundbreaking research described by Saad F. Habba, M.D., attending gastroenterologist at Atlantic Health System's Overlook Hospital in Summit, N.J., establishes a relationship between gallbladder dysfunction and chronic diarrhea. This independent study included 19 patients with varying degrees of CD (four to 10 bowel movements daily for at least three months) who consistently failed to improve on several traditional therapies, such as antispasmodic drugs and lactose-free diets. These patients routinely experienced quality-of-life issues ranging from social embarrassment to debilitation.
Dr. Habba observed that his patients presented CD symptoms that mimicked those found in some individuals who have had their gallbladders removed. In particular, they experienced CD only after meals and rarely at night unless they ate a heavy, late-night meal. After conducting a series of diagnostic tests and therapeutic trials, Dr. Habba was able to rule out the possibility of irritable bowel syndrome (IBS) and other intestinal disorders. Specifically, he was able to confirm his theory of CD caused by a dysfunctional gallbladder as demonstrated by specific tests indicating abnormal contractions of the gallbladder. He then prescribed low doses of cholestyramine, a cholesterol-lowering drug often used by gastroenterologists to treat CD resulting from gallbladder removal. Each patient in the study experienced almost immediate relief from their chronic diarrhea following this treatment.
"Rising accounts of CD treatment failure have led me to believe that the gallbladder dysfunction demonstrated in my study may be a widespread condition," said Dr. Habba. "Chronic diarrhea results from a variety of causes and all possibilities should be explored before making a treatment decision."
Dr. Habba's independent study helps to create a clearer distinction between CD that results from gallbladder dysfunction and a variety of intestinal abnormalities. In particular, irritable bowel syndrome (IBS) is an intestinal condition experienced by an estimated 35 million people in the U.S. and is a common cause of CD. Patients with this syndrome rarely experience the localized pain associated with IBS. In addition, these patients respond to bile acid binding agents (such as cholestyramine) rather than the antispasmodic drugs that typically control the intestinal contractions associated with IBS.
"This is an important clinical syndrome for all physicians who encounter CD patients to be aware of, because it is easily treatable and its early recognition may prevent many unnecessary diagnostic investigations," said Warren Finkelstein, M.D., New Jersey Governor of the American College of Gastroenterology. "Dr. Habba's findings of abnormal gallbladder function in his series of patients with chronic diarrhea is of significant interest."
The Habba Syndrome has the potential to provide a large number of patients with a more focused approach to their condition. "This marks an important milestone in the area of digestive diseases," said Carrol Leevy, M.D., distinguished professor and scientific director of the University of Medicine and Dentistry of New Jersey (UMDNJ) Liver Center. "This work brings into focus a therapeutic category that has gone virtually undocumented in the scientific literature and opens the doors to future research initiatives on the origin of the problem."
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Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved
http://www.docguide.com/dg.nsf/PrintPrint/0D16E06A03BFA5E285256934005430C7
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World J Surg. 2004 Mar 4
Diverticular Disease: Electrophysiologic Study and a New Concept of Pathogenesis.
Shafik A, Ahmed I, Shafik AA, El Sibai O.
Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Cairo, Egypt.
Abstract.The cause of diverticular disease (DD) is not exactly known, although colonic motor disorder has been proposed as a factor in the pathogenesis of the condition. We investigated the hypothesis that disordered colonic electrical activity is responsible for the colonic motor dysfunction and the development of DD. The electromyographic (EMG) activity and pressure of the sigmoid colon (SC) were recorded in 36 patients [16 early cases, 20 advanced cases; age (mean +/- SD) 53.3 +/- 5.6 years; 19 women, 17 men] and 22 healthy volunteers. The percutaneous route was used for recording the SC EMG. The healthy volunteers exhibited SC slow waves with a regular rhythm and the same frequency, amplitude, and conduction velocity from the three electrodes in the same subject. The SC basal pressure (7.9 cm H(2)O) was interrupted by bouts of high pressure (26.8 cm H(2)O). The early-DD cases showed slow waves with an irregular rhythm and significantly higher variables ( p < 0.05) than the volunteers. Action potentials followed randomly or were superimposed on the slow waves. The SC basal pressure was significantly higher than that of the volunteers (21.4 cm H(2)O, p < 0.01). Bouts of pressure (58.6 cm H(2)O) coupled with action potentials were recorded. No waves were recorded from 15 of 20 of the advanced-DD patients. In 5 patients, slow waves with an irregular rhythm and lower variables ( p < 0.05) than those of the volunteers were recorded. The basal SC pressure was significantly above normal. Three electrical activity patterns could be identified in DD patients: "tachyrhythmic" in the early-DD patients and "bradyrhythmic" or "silent" in the late-DD patients. These dysrhythmias may result from a disordered colonic pacemaker.
The similarity between early DD and the irritable bowel syndrome suggests that DD is an advanced stage of the irritable bowel syndrome; studies are required to investigate this hypothesis further.
PMID: 14994146 [PubMed - as supplied by publisher]
http://www.docguide.com/news/content.nsf/PaperFrameSet?OpenForm&refid=2&id=48DDE4A73E09A969852568880078C249&c=&newsid=8525697700573E1885256E4D0037934F&u=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=14994146&ref=/news/content.nsf/SearchResults?openform&Query=irritable%20bowel&so=date&id=48DDE4A73E09A969852568880078C249
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A link between irritable bowel syndrome and fibromyalgia
An abnormal lactulose breath test (LBT), indicative of small intestinal bacterial overgrowth, in fibromyalgia patients and in irritable bowel syndrome (IBS) patients may help to explain common features of the conditions, researchers report in the April issue of the Annals of the Rheumatic Diseases.
Dr. Mark Pimentel from Cedars-Sinai Medical Center, Los Angeles, California and colleagues note that nearly a third of fibromyalgia patients in some studies are also diagnosed with IBS, suggesting a causal link between the two disorders.
The researchers tested their hypothesis that the lactulose breath test would be abnormal in both IBS and fibromyalgia by performing the test in 42 fibromyalgia patients, 111 IBS patients, and 15 healthy controls.
All 42 patients with fibromyalgia had an abnormal LBT, compared with 93 (84%) of IBS patients and 3 (20%) of the controls.
Hydrogen production was significantly greater in fibromyalgia patients than in IBS patients or healthy controls. Moreover, the researchers note that in 41 fibromyalgia patients, there was a significant correlation between their visual analogue pain score and the peak hydrogen level and hydrogen area under the curve seen on the LBT.
"The additional finding in our study that the degree of pain in fibromyalgia seems to correlate with the degree of hydrogen suggests a possible link between the LBT findings and hyperalgesia," the investigators write.
"This study suggests that an abnormal LBT may be a common link between subjects with fibromyalgia and IBS," the authors conclude. "Further study is needed to determine if treatment and normalization of the breath test with antibiotic treatment can produce an improvement in fibromyalgia in addition to bowel complaints."
Ann Rheum Dis 2004;63:450-452.
http://www.medscape.com/viewarticle/472635
A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing
M Pimentel, D Wallace, D Hallegua, E Chow, Y Kong, S Park and H C Lin
GI Motility Program, Divisions of Gastroenterology and Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, CSMC Burns & Allen Research Institute, Los Angeles, California 90048, School of Medicine, University of California, Los Angeles, Los Angeles, California 90024, USA
Correspondence to:
Dr M Pimentel
Cedars-Sinai Medical Center, 8635 W 3rd St, Suite 770 W, Los Angeles, CA 90048, USA; mark.pimentel@cshs.org
ABSTRACT
Background: An association between irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO) has been found.
Objective: To compare the prevalence and test results for bacterial overgrowth between IBS and fibromyalgia.
Methods: Subjects with independent fibromyalgia and IBS were compared with controls in a double blind study. Participants completed a questionnaire, and a lactulose hydrogen breath test was used to determine the presence of SIBO. The prevalence of an abnormal breath test was compared between study participants. Hydrogen production on the breath test was compared between subjects with IBS and fibromyalgia. The somatic pain visual analogue score of subjects with fibromyalgia was compared with their degree of hydrogen production.
Results: 3/15 (20%) controls had an abnormal breath test compared with 93/111 (84%) subjects with IBS (p<0.01) and 42/42 (100%) with fibromyalgia (p<0.0001 v controls, p<0.05 v IBS). Subjects with fibromyalgia had higher hydrogen profiles (p<0.01), peak hydrogen (p<0.0001), and area under the curve (p<0.01) than subjects with IBS. This was not dependent on the higher prevalence of an abnormal breath test. The degree of somatic pain in fibromyalgia correlated significantly with the hydrogen level seen on the breath test (r = 0.42, p<0.01).
Conclusions: An abnormal lactulose breath test is more common in fibromyalgia than IBS. In contrast with IBS, the degree of abnormality on breath test is greater in subjects with fibromyalgia and correlates with somatic pain.
http://ard.bmjjournals.com/cgi/content/abstract/63/4/450
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Heartburn May Not Reflect Gastroesophageal Reflux Disease Severity
Mar 12 - Particularly in the elderly, the severity of heartburn may not reflect the severity of erosive gastroesophageal reflux disease, according to a report in the March issue of Gastroenterology.
"Gastroesophageal reflux disease is common in adults of all ages, but its complications are more frequent in elderly patients," Dr. David A. Johnson, of Eastern Virginia Medical School, in Norfolk and Dr. Brian Fennerty of Oregon Health Sciences University, Portland, point out.
To investigate further, the researchers examined the relationship of age, severe heartburn symptoms, and severe erosive esophagitis. The team pooled data from five prospective, randomized, controlled trials that examined the effect of proton pump inhibitors on healing of erosive esophagitis and symptom resolution. Involved in the study were 11,945 patients with gastroesophageal reflux disease and erosive esophagitis.
The investigators observed a progressive increase in the prevalence of severe erosive esophagitis with each decade of age. In patients younger than 21 years, only 12% had severe esophagitis at baseline, compared with 37% of those older than 70 years.
Severe heartburn was present in more than 50% of patients younger than 50 years with severe esophagitis. However, severe heartburn was less common in older patients with severe esophagitis and was least likely to be found in those older than 70 years.
Given these findings, the investigators call for more aggressive diagnosis and treatment of elderly patients, "regardless of the reported severity of their presenting symptoms."
Gastroenterology 2004;126:660-664.
http://www.medscape.com/viewarticle/471671?mpid=26286
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