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Patients with IBS are NOT more likely to develop polyps, colon cancer new
      #358578 - 05/12/10 01:18 PM
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Patients with irritable bowel syndrome not more likely to develop polyps, colon cancer

University of Michigan physician says unless other warning signs are present, colonoscopies aren't necessary for IBS patients

Ann Arbor, Mich. — Patients with irritable bowel syndrome are at no greater risk of having polyps, colon cancer or inflammatory bowel diseases than healthy people undergoing colonoscopies, according to new research published in the American Journal of Gastroenterology.

"Patients and doctors get nervous about the symptoms of irritable bowel syndrome (IBS)," says William D. Chey, M.D., professor of Internal Medicine at the University of Michigan Medical School. "They think the symptoms represent something more sinister."

"This study should reassure doctors and patients that typical IBS symptoms are not indicators of a more serious disease," he adds.

Chey was the lead author on the study, the largest prospective evaluation of the results of colonoscopies in patients with irritable bowel syndrome.

IBS symptoms include recurrent episodes of abdominal pain or cramping in connection with altered bowel habits. The condition affects 10 to 20 percent of the U.S. population and is more common among women than men. Many of those afflicted never seek treatment.

IBS patients often undergo colonoscopies because physicians are particularly concerned about missing colorectal cancer or inflammatory bowel diseases like ulcerative colitis or Crohn's disease, Chey says. Roughly a quarter of all colonoscopies performed in the U.S. are for IBS-related symptoms.

This research shows that it is unnecessary to order colonoscopies for IBS patients, unless they show other alarming symptoms like unexplained weight loss or anemia, bleeding from the GI tract, or have a family history of colon cancer, inflammatory bowel disease or celiac disease, says Chey, who also is director of U-M's Gastrointestinal Physiology Laboratory and the Michigan Bowel Control Program.

"Lay people and doctors overuse colonoscopies, which are very expensive procedures, in patients with typical IBS symptoms and no alarm features. Of course, patients over the age of 50 years or who have alarm features should undergo colonoscopy to screen for polyps and colon cancer." Chey says.

Chey's research also showed that a small percentage of IBS patients older than 35 (2.5%) had an unusual disease called microscopic colitis. Microscopic colitis can masquerade as IBS in patients with diarrhea and is important to diagnose because it is treated differently than IBS, he says.


Public release date: 9-Mar-2010

Contact: Mary Masson
University of Michigan Health System


###

March is colorectal cancer awareness month. Not counting skin cancers, colorectal cancer is the third most common cancer found in men and women in this country. The risk of a person having colorectal cancer in their lifetime is about 1 in 19.

More information about colorectal cancer can be found at http://www.cancer.med.umich.edu/cancertreat/gastro/colon_info.shtml.


http://www.eurekalert.org/pub_releases/2010-03/uomh-pwi030910.php

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Can Choir Singing Improve Irritable Bowel Syndrome? new
      #359454 - 06/24/10 01:48 PM
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A Swedish investigation has compared choir singing and group discussion in irritable bowel syndrome in the current issue of Psychotherapy and Psychosomatics.

Singing in a choir is very popular in the Nordic countries. This activity has been associated with increased longevity, and it induces feelings of relaxation and energy. Several studies have shown beneficial psychological and/or biological effects of singing. A study has shown that a singing lesson (practicing singing individually) is associated with increases in relaxation, energy and joy, as well as an elevated oxytocin concentration in serum. Low levels of oxytocin have been observed in irritable bowel syndrome (IBS) in adults.

IBS is a common gastrointestinal disorder that is influenced by psychological factors. Merely talking to IBS patients about difficult matters may influence endocrine functions of importance to the symptoms. Group-based information events, including group talk as well as behavioural therapy, have been shown to be of some benefit compared to the distribution of written IBS information. Repeated stress responses correspond to reactions that are needed in energy mobilisation.

At the same time, anabolic/regenerative processes in the body are inhibited. Anabolic/regenerative processes are reflected for instance in the blood concentration of testosterone. Recently, it has been shown that fluctuations in the 'free' blood concentration (not bound to proteins in the blood) of testosterone are closely mirrored in saliva. The anabolic/regenerative activities are of central importance to our ability to withstand adverse effects of long-lasting stress. Accordingly, processes that stimulate anabolic/regenerative processes may reduce the effects of stress. Advertisements for subjects with a verified IBS diagnosis were made in a daily newspaper and in the patient union journal.

It was explained before the start that the participants would be randomly allocated either to a choir group meeting or an information/discussion group meeting, in both cases once a week for a year. The choir group met once a week, starting in May 2006 and ending in May 2007. A professional music teacher and music therapist served as the group's paid leader. The information group also met once a week during the initial stage, but after half a year the frequency of the meetings was reduced to 3 per month. Participants in both groups received information pamphlets (7 books) 'living with IBS'.

After 6 months, there were 16 participants in both groups (corresponding to 56 and 57% in the choir and information groups, respectively). After 12 months, there were 13 participants in the choir (46%) and 14 (52%) in the information group. Saliva sampling took place before the start, and then 6, 9 and 12 months afterwards. On each test occasion, saliva specimens were collected upon awakening, half an hour later, at the end of the working day, before the event (choir and information respectively), after the event, and finally at bedtime (i.e. 6 samples in total).

The saliva testosterone concentration was assessed by means of the Spectria RIA (a coated-tube immunoassay for testosterone; Orion Diagnostica Oy, Spoo, Finland).

The ANOVA of saliva testosterone showed a significant time effect, but no difference in means between the groups. In addition, there was a strong 2-way interaction illustrating that the variations in the choir group were significantly more pronounced than those in the information group (F group = 1.36, p = 0.26; F time = 4.06 p = 0.01; F interaction (group X time) = 5.22, p = 0.003). Gender-separated analyses and exclusion of 4 female participants below the age of 50 years (premenopausal ages) made no difference to the results. Saliva testosterone concentration during the waking hours of the day from the choir singers showed an increase after 6 months, when compared to before the interventions.

The most likely interpretation is that the highly significant peak in the choir group after 6 months is associated with the intervention itself.

The findings of this study have to be replicated in larger studies. Despite the study's weaknesses there is a clear indication that choir singing once a week induces a state of stimulated regeneration during the first half-year in IBS patients, but that in this particular case this effect did not last until the end of the year.

Source: Psychotherapy and Psychosomatics

http://www.medicalnewstoday.com/articles/189153.php?nfid=79339

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Pain perception during colonoscopy higher in IBS patients than in non-IBS patients new
      #359878 - 07/21/10 03:52 PM
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J Gastroenterol Hepatol. 2010 Jul;25(7):1232-8.

Colonoscopy as an adjunctive method for the diagnosis of irritable bowel syndrome: focus on pain perception.

Kim ES, Cheon JH, Park JJ, Moon CM, Hong SP, Kim TI, Kim WH.

Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.
Abstract

BACKGROUND AND AIM: Visceral hypersensitivity is an important component of the pathophysiology of irritable bowel syndrome (IBS). In the present study, we investigated differences in pain perception during colonoscopy between IBS patients and non-IBS patients. We further assessed the sensitivity, specificity, and predictive values of pain scores to diagnose IBS.

METHODS: Patients who underwent colonoscopy for the evaluation of gastrointestinal symptoms or for screening purposes were included. All patients completed Rome III criteria questionnaires and reported pain scores on 0-100-mm visual analog scales after colonoscopy. The patients were divided into three groups: (i) IBS; (ii) other functional gastrointestinal disorders (FGID), including functional bloating, functional diarrhea, and functional constipation; and (iii) healthy controls.

RESULTS: A total of 217 patients were included. The pain scores (median, interquartile range) of IBS patients (52, 34-71) were higher than those of the healthy controls (22, 12-35) or other FGID patients (18, 10-29) (P < 0.001). Upper gastrointestinal symptoms were observed more often in the IBS group than in the non-IBS group (83.2% vs 34.5%, P < 0.001). At the pain score level of 31, the sensitivity, specificity, positive predictive value, and negative predictive value for IBS diagnosis were 86.1%, 75.9%, 75.7%, and 86.3%, respectively.

CONCLUSIONS: The degree of pain perception during colonoscopy was higher in IBS patients than in non-IBS patients. We concluded that colonoscopy can be useful in identifying IBS patients, with the additional benefit of excluding organic disorders of the lower gastrointestinal tract.

PMID: 20594249 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/pubmed/20594249

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Irritable Bowel Syndrome Is Not In Your Head new
      #361089 - 09/24/10 02:42 PM
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Source: Technische Universitaet Muenchen

Copyright: Medical News Today

Article URL: http://www.medicalnewstoday.com/articles/198444.php

Main News Category: Irritable-Bowel Syndrome

EXCERPT:

Professor Michael Schemann's research team at the TUM Department for Human Biology has managed to demonstrate that micro-inflammations of the mucosa cause sensitization of the enteric nervous system, thereby causing irritable bowel syndrome. Using ultrafast optical measuring methods, the researchers were able to demonstrate that mediators from mast cells and enterochromaffin cells directly activate the nerve cells in the bowel. This hypersensitivity of the enteric nervous system upsets communication between the gut's mucosa and its nervous system.

http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=198444

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Subtypes of Irritable Bowel Syndrome Based on Abdominal Pain/Discomfort Severity and Bowel Pattern new
      #363405 - 02/10/11 10:14 AM
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Subtypes of Irritable Bowel Syndrome Based on Abdominal Pain/Discomfort Severity and Bowel Pattern

Margaret Heitkemper, Kevin C. Cain, Robert Shulman, Robert Burr, Anne Poppe and Monica Jarrett

Digestive Diseases and Sciences
DOI: 10.1007/s10620-011-1567-4

Abstract
Introduction
Irritable bowel syndrome (IBS) has traditionally been classified by stooling pattern (e.g., diarrhea-predominant). However, other patterns of symptoms have long been recognized, e.g., pain severity. Our objective was to examine the utility of subtyping women with IBS based on pain/discomfort severity as well as predominant bowel pattern.
Methods
Women (n = 166) with IBS completed interviews, questionnaires, and kept a diary for 28 days. Rome II questionnaire items eliciting the past year recall of hard and loose stools, and frequency and severity of abdominal pain or discomfort were used to classify participants into six subtypes—three bowel pattern categories by two pain/discomfort severity categories. Concordance of these subtypes with corresponding diary items was examined. Analysis of variance (ANOVA) tested the relationship of bowel pattern and pain categories to measures of quality of life and symptoms.
Results
There is moderate congruence of the retrospective classification of bowel pattern and pain/discomfort severity subtypes with prospectively reported stool frequency and consistency and pain severity. Quality of life, impact of IBS on work and daily activities, and cognitive beliefs about IBS differed significantly based on abdominal pain/discomfort category but not on predominant bowel pattern. There is evidence of an interaction, with the effect of pain severity being strong in the IBS-diarrhea and IBS-mixed groups, but this was absent in the IBS-constipation group. Similar results hold for most diary symptoms, except for those directly related to bowel pattern.
Conclusions
Overall, the distress of IBS is more strongly related to the severity of abdominal pain/discomfort than is the predominant stool pattern in patients with IBS. Categorizing IBS patients by abdominal pain/discomfort severity in conjunction with predominant bowel pattern may be useful to clinicians and researchers in developing more effective management.


http://www.springerlink.com/content/m75576l610uu1018/

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Factors associated with co-morbid irritable bowel syndrome and chronic fatigue new
      #363408 - 02/10/11 10:21 AM
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Factors associated with co-morbid irritable bowel syndrome and chronic fatigue-like symptoms in functional dyspepsia

1. L. Van Oudenhove1,2,
2. J. Vandenberghe2,
3. R. Vos1,
4. L. Holvoet1,
5. J. Tack1

Article first published online: 24 JAN 2011

DOI: 10.1111/j.1365-2982.2010.01667.x

Abstract

Background&#8194; It is unclear which factors explain the high co-morbidity between functional dyspepsia (FD) and other functional somatic syndromes. The aim of this study is to investigate the association between gastric sensorimotor function, psychosocial factors and 'somatization' on the one hand, and co-morbid irritable bowel syndrome (IBS) and chronic fatigue (CF)-like symptoms on the other, in FD.

Methods&#8194; In 259 tertiary care FD patients, we studied gastric sensorimotor function with barostat (sensitivity, accommodation). We measured psychosocial factors (abuse history, alexithymia, trait anxiety, depression, panic disorder) and 'somatization' using self-report questionnaires, and presence of IBS and CF-like symptoms. Hierarchical multiple logistic regression was used to determine which of these factors were independently associated with co-morbid IBS and CF-like symptoms, including testing of potential mediator effects.

Key Results&#8194; Co-morbid IBS or CF-like symptoms respectively were found in 142 (56.8%) and 102 (39.4%) patients; both co-morbidities were not significantly associated (P = 0.27). Gastric accommodation (&#946; = 0.003, P = 0.04) and 'somatization' (&#946; = 0.17, P = 0.0003) were independent risk factors for IBS (c = 0.74, P < 0.0001); the effect of adult abuse (&#946; = 0.72, P = 0.20) was mediated by 'somatization'. Depression (&#946; = 0.16, P = 0.008) and 'somatization' (&#946; = 0.18, P = 0.004) were overlapping risk factors for CF-like symptoms (c = 0.83, P < 0.0001); the effects of alexithymia and lifetime abuse were mediated by depression and 'somatization', respectively.

Conclusions & Inferences&#8194; 'Somatization' is a common risk factor for co-morbid IBS and CF-like symptoms in FD and mediates the effect of abuse. Gastric sensorimotor function and depression are specific risk factors for co-morbid IBS and CF-like symptoms, respectively.

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2982.2010.01667.x/abstract;jsessionid=B10B73DFA073FA4885354C9A93B23267.d03t04

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Stress May Alter Gut Bacteria and Hurt Immune System new
      #364161 - 04/06/11 04:31 PM
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New York, 21 March 2011 – Stress can change the balance of bacteria that naturally live in the gut, according to research published this month in the journal Brain, Behavior, and Immunity.

"These bacteria affect immune function, and may help explain why stress dysregulates the immune response," said lead researcher Michael Bailey.

Exposure to stress led to changes in composition, diversity and number of gut microorganisms, according to scientists from The Ohio State University. The bacterial communities in the intestine became less diverse, and had greater numbers of potentially harmful bacteria, such as Clostridium.

"These changes can have profound implications for physiological function", explained Dr Bailey. "When we reduced the number of bacteria in the intestines using antibiotics, we found that some of the effects of stress on the immune system were prevented", he added. "This suggests that not only does stress change the bacteria levels in the gut, but that these alterations can, in turn, impact our immunity."

"This is the first evidence that the gut microorganisms may play a role in innate immunological stress responses," said Monika Fleshner, Professor of Integrative Physiology at the University of Colorado, Boulder. "The study reveals the dynamic interactions between multiple physiological systems including the intestinal microbiota and the immune system."

Because gut bacteria have been linked to diseases like inflammatory bowel disease, and even to asthma, a future goal of the study is to determine whether alterations of gut bacteria is the reason why these diseases tend to be worse during periods of pressure.

The research was conducted with colleagues from the Texas Tech University Health Sciences Center and the Research and Testing Laboratories, and was funded by the National Institute of Health.

http://www.elsevier.com/wps/find/authored_newsitem.cws_home/companynews05_01905

About Brain, Behavior, and Immunity
External link Brain, Behavior, and Immunity, founded in 1987, is the official journal of the Psychoneuroimmunology Research Society (PNIRS). This innovative journal publishes peer-reviewed basic, experimental, and clinical studies dealing with behavioral, neural, endocrine, and immune system interactions in humans and animals. It is an international, interdisciplinary journal devoted to investigation of the physiological systems that integrate behavioral and immunological responses. The journal welcomes original research in neuroscience, immunology, integrative physiology, behavioral biology, psychiatry, psychology, and clinical medicine and is inclusive of research at the molecular, cellular, social, and organismic levels. The journal features online submission and review, leading to timely publication of experimental results. There are no submission fees or page charges for Brain, Behavior, and Immunity, which is published eight times a year.


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Gut Bacteria Falls Into Three Major Types new
      #364636 - 05/05/11 11:13 AM
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Gut Bacteria Falls Into Three Major Types

By Jenifer Goodwin
HealthDay Reporter

THURSDAY, April 21 (HealthDay News) -- Just like eye color or blood type, the bacteria that flourish in the gut can also be used to categorize humans, new research finds.

European researchers have determined that there are three distinct types of microscopic ecosystems that exist in the human intestine. What differentiates each type is which species of microbes are present and which are the most abundant, researchers said.

Although there's far more to learn about what those microbes do, researchers say your bacterial type may tell a whole lot about you, including how you metabolize food, how you synthesize vitamins and how you might respond to certain medications.

"We think humans can be categorized based on the micro-composition in their gut," said study co-author Manimozhiyan Arumugam, a research scientist at the European Molecular Biology Laboratory in Heidelberg, Germany. "We also have reasons to believe these are not specific to any continent, country, ethnicity or any other obvious factor."

The human gut is host to an estimated 500 to 1,000 species of bacteria, Arumugam said. Those species compete and cooperate with each other in microscopic ecosystems that remain relatively stable in a balanced, symbiotic relationship with the host -- the human body.

"They are not working alone, they have to work as a community," Arumugam said. "And they have to adapt to the host, such as what we eat."

In the study, published in the April 20 issue of Nature, researchers took stool samples of 22 people from four European countries (Denmark, France, Italy and Spain), extracted the DNA and determined which species of bacteria resided there. They combined their data with the results of earlier data on the gut microbes of 13 people from Japan and two Americans. They then added data from another 85 Danish people and 154 Americans.

Their analysis showed that the microbiota could be grouped into three categories. People with type 1, for example, had high levels of the bacteria Bacteroides. In type 2, Bacteroides levels were lower, but the Prevotella was prevalent. Ruminococcus was a big factor in the third enterotype.

"In the data sets we looked at, we found three types. Would it remain only three if you sampled 100,000 people? We don't know," Arumugam said. "It could also be that maybe these enterotypes could be refined more and that there are subtypes."

Since researchers began to understand that gut microbes play a significant -- and underestimated -- role in human health, one question that's been vexing the field is just how many versions of intestinal microbiota there are, said Justin Sonnenburg, an assistant professor of microbiology and immunology at Stanford University School of Medicine.

If there were an infinite number of variations, then using the information in the real world would be impossibly complex, Sonnenburg added.

"There's been this increasing realization over the past several years that the microbes that live in and upon us are wired into many facets of our biology, and it's also becoming clear that these microbes are going to be a major determinant of variation between individuals, both in relationship to our health, predisposition to disease, progression of diseases and how they should be treated therapeutically," he said.

But by identifying the three types, the new research represents a significant breakthrough, he added.

"This paper really makes a huge leap in establishing that this variation is not a continual and infinite, but that there these finite enterotypes," Sonnenburg said.

Think of it like eye color, Sonnenberg added. There's brown, green, blue, hazel and a perhaps a few other variations, but there is no purple, chartreuse or other colors.

The researchers said they had found no evidence that such characteristics as age, gender or body weight correlated to the gut microbe types.

However, looking across the entire sample, age, gender and body weight did correlate with certain genetic markers in the bacteria, hinting that it may be possible to eventually use such information to diagnose disease or determine who is likely to get diseases, Arumugam said.

More information

The U.S. National Institutes of Health has more on human microbiota.
SOURCES: Manimozhiyan Arumugam, Ph.D, research scientist, European Molecular Biology Laboratory, Heidelberg, Germany; Justin Sonnenburg, Ph.D., assistant professor, microbiology and immunology, Stanford University School of Medicine, Palo Alto, Calif,; April 20, 2011, Nature
Copyright © 2011 HealthDay. All rights reserved.
This is a story from HealthDay, a service of ScoutNews, LLC.

http://generic.e-healthsource.com/index.php?p=news1&id=652138

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Colon Cleansing Not Backed by Science and Can Be Dangerous
      #365731 - 08/03/11 03:45 PM
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Colon Detox Not Backed by Science
By Nancy Walsh, Staff Writer, MedPage Today
Published: August 01, 2011

Colon cleansing has no evidence to support its use, and can lead to pain, vomiting, and fatal infections, according to a new report.

"A search of the literature using the terms 'colon cleansing,' 'herbal colon cleanse,' 'colon detoxification,' and 'colon irrigation,' yielded no scientifically robust studies in support of this practice," wrote Ranit Mishori, MD, of Georgetown University in Washington, D.C., and colleagues, in the August Journal of Family Practice.

Colon cleansing has been practiced since antiquity as a means of enhancing health through ridding the body of toxins. These procedures are similar to enemas, except that volumes in excess of 50 liters sometimes are used, and the procedure may be done repeatedly.

The liquids used often contain herbal extracts such as cat's claw, burdock, and milk thistle, or other substances such as coffee, enzymes, and probiotics.

Among the benefits touted for colon cleansing are improvements in circulation, immune function, and alleviation of ailments such as headache and fatigue.

Users can perform the procedure themselves, but many visit hydrotherapists or colon hygienists. These providers may be certified by groups such as the International Association for Colon Hydrotherapy, but are not necessarily licensed healthcare providers.

They are required to have little more than a high school diploma and certification in cardiopulmonary resuscitation, according to Mishori and colleagues.

In their report, Mishori and colleagues outlined three cases of colon cleansing sessions that led to adverse outcomes. They also scanned published literature on colon cleansing and found case reports of air embolism, septicemia, and fatal parasitic infections.

The liquid preparations used for colon cleansing are classified as food supplements and are not approved as safe or effective by the FDA, the authors explained.

However, the devices, such as irrigation systems, are FDA Class III. If these devices are used in ways beyond what is medically accepted, such as in preparation for gastrointestinal procedures, the manufacturer must seek FDA approval.

"During the past decade the FDA has issued numerous warning letters to manufacturers for unapproved use of the devices for colon cleansing," the authors noted.

They advised that clinicians caution patients as follows:

Colon cleansing is not medically advisable, particularly for patients who have had any gastrointestinal disorder or other health problems.
Many adverse events have been linked to these procedures including serious infections and heart failure.
The devices are not FDA approved and if sanitary precautions are inadequate, infections can result.
Organizations of these practitioners, and the training they receive, are not scientifically regulated.

The authors reported no conflicts of interest.


Primary source: Journal of Family Practice
Source reference:
Mishori R, et al "The dangers of colon cleansing" J Family Pract 2011; 60: 454-457.

http://www.medpagetoday.com/PrimaryCare/AlternativeMedicine/27820


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Gut analysis with smart pill could be new key to IBS treatment
      #366226 - 10/06/11 06:58 PM
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Gut analysis 'key to IBS treatment'

(UKPA) – 1 day ago

A new "smart pill" could offer hope to thousands of people with irritable bowel syndrome (IBS) by delivering accurate information about the gut.

The capsule is swallowed and travels through the system analysing details such as how quickly food moves along the colon, acidity, pressure and temperature.

This is relayed to a monitor worn on the patient's waist for several days as they go about their daily activities.

Experts hope the pill will lead to much more accurate treatment for people with IBS and other long-term unexplained but frequently painful digestive problems.

Doctors at the private Princess Grace Hospital in central London have become the first in Europe to use the SmartPill. While other swallowed devices can take images of a patient's gut, this is the first to assess information on how it is functioning.

Gastro-physiologist Dr Anthony Hobson said : "This is a real breakthrough and gives many people real hope of a better quality of life by obtaining a more definitive diagnosis. Camera-based pills are good for looking at things like inflammation or blockages but this pill tells us about the function of the gut. We are looking at how the gut works and empties, and for the first time we are able to look at the different components of the gut.

Elizabeth Lynch, from Bishop's Stortford in Hertfordshire, has suffered from bloating, pain and other problems for more than 10 years and is thought to be the first UK patient to try the pill.

The SmartPill was able to rule out a range of potential problems of gut transit and helped doctors identify that Ms Lynch was suffering from an allergy or food intolerance type of condition.

"What it showed was that my system was working within the normal range and that gave a clue about a new form of treatment which has helped me a great deal," she said. "I am now feeling a lot better and it meant I didn't have to undergo another unpleasant endoscopy investigation."

The SmartPill GI Monitoring System at the Princess Grace costs £1,750, including all consultation fees.

Copyright © 2011 The Press Association. All rights reserved.

http://www.google.com/hostednews/ukpress/article/ALeqM5hgoO2SsROE6X40n21hFSkTt8qyew?docId=N0776831317819724036A

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