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Are Your Bowels Irritable? IBS Awareness Month is Here new
      #59811 - 04/09/04 07:11 PM
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Are Your Bowels Irritable? IBS Awareness Month is Here

Seattle, WA (PRWEB) April 6, 2004 -– Imagine being struck out of the blue with abdominal cramps so severe they leave you unconscious on the floor. Imagine suffering from diarrhea or constipation so unpredictable and debilitating you plan your daily life around access to bathrooms. Now imagine being told by the doctor who diagnoses you that there is no cure.

If you're one of the 50 million Americans with Irritable Bowel Syndrome, you know exactly how this feels, but odds are you're unaware of much help is now available for you. This April marks the 8th annual IBS Awareness Month, designated to publicize avenues of help for a condition so prevalent that, though rarely talked about, is the leading cause of worker absenteeism after the common cold. IBS affects 15-20 percent of the population, causing abdominal pain and bowel dysfunction. Symptoms arise from a disruption of the gut's nervous system, and that system's interaction with the brain.

For too long, IBS sufferers were dismissed by physicians, ignored by researchers, and given no alternative to suffering in silence. In recent years this situation has changed dramatically, with a rising awareness of the profound differences lifestyle modifications can make. In particular, significant patient self-help avenues such as HelpForIBS.com have been created to offer information, support, and immediate tangible help for Irritable Bowel Syndrome sufferers.

"If you have IBS, you are NOT alone," says HelpForIBS.com founder and CEO Heather Van Vorous. "Living with this disorder does not mean leading a miserable life. There are numerous strategies a person can adopt to help prevent all IBS symptoms, and a happy healthy lifestyle is absolutely possible. Though IBS is still often portrayed as simply the punch line to a joke, it's not a laughing matter to those who suffer, and these people need to hear that their suffering is completely unnecessary."

Though IBS patients report using nearly 300 different types of prescription and over-the-counter medications in unsuccessful attempts to find relief, many are now discovering that non-medical approaches to the disorder are far more effective and safer. Specifically, patients find success with:

* the groundbreaking IBS dietary guidelines and recipes from the book Eating for IBS
* a reduction of stress triggers through gut-directed hypnosis for IBS or yoga practice
* herbal and soluble fiber supplements for specific IBS symptoms and overall GI health
* emotional support via internet IBS message boards and local IBS support groups

Self-help management of IBS has proven so successful that physicians are embracing these approaches, and are referring patients to IBS internet communities such as HelpForIBS.com, hypnotherapists with IBS training, and hometown support groups.

IBS Awareness Month spreads the news that lBS patients are finally being given the lifestyle assistance they need, and not simply a diagnosis. While there is no cure for IBS on the horizon, there are now many healthy ways to successfully manage - and even prevent - all Irritable Bowel Syndrome symptoms.

About HelpForIBS.com
HelpForIBS.com is the largest IBS community on the internet, with over 2 million visits per year and a subscriber list of over 21,000 IBS patients and physicians. HelpForIBS.com is dedicated to serving people with IBS, and their mission is to offer education, support, and help that allows people with Irritable Bowel Syndrome to successfully manage their symptoms through healthy lifestyle modifications. HelpForIBS.com is owned by Heather Van Vorous, an IBS author and a sufferer since age 9. Heather's groundbreaking work in the IBS dietary field has led to her inclusion in Marquis Who's Who in Medicine and Healthcare, has been licensed by Novartis pharmaceuticals, and has been publicized worldwide by physicians, IBS organizations, and patients.

Contact:
Heather Van Vorous
heather@helpforibs.com
http://www.HelpForIBS.com

http://www.prweb.com/releases/2004/4/prweb116856.htm




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Intestinal Gas May Contribute to IBS Symptoms new
      #69120 - 05/10/04 02:29 PM
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Intestinal Gas May Contribute to IBS Symptoms

Intestinal gas and its associated symptoms (eg, bloating, distension, and flatulence) have long been trivialized and dismissed by many medical practitioners. Recent studies examining the relationship between these symptoms and the quality of life of patients with irritable bowel syndrome (IBS) report, however, that patients experience substantial distress because of these symptoms. In fact, patients with IBS often report that, even though they may be able to cope with the abdominal pain, they cannot tolerate the bloating and distension.

In an article in the December 2003 issue of Gut, Eamonn Quigley, MD, discusses the role of intestinal gas in IBS and its relationship to IBS symptoms. Patients with IBS do not appear to produce more gas than do individuals not suffering from IBS. They do appear, however, to suffer from abnormal gas transit, which result in gas retention in the small intestine. This gas retention, combined with visceral hypersensitivity, is likely to cause symptoms (ie, gas retention causes bloating and distension, whereas hypersensitivity causes patients with IBS to experience greater discomfort than is experienced by persons without IBS at the same level of retention). Gas content and transit appear to conspire with the motor and sensory responses of the gut to produce gas-related symptoms in patients with IBS as well as in individuals not suffering from IBS, according to Dr. Quigley.

http://www.mdlinx.com/GILinx/thearts.cfm?artid=939367&specid=13&ok=yes

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Natural History of Irritable Bowel Syndrome new
      #69123 - 05/10/04 02:36 PM
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Natural History of Irritable Bowel Syndrome

H. B. El-Serag; P. Pilgrim; P. Schoenfeld

Background: The natural history of irritable bowel syndrome is unclear, including the likelihood that these patients will be diagnosed with an alternative organic or functional gastrointestinal disorder. Understanding the stability of an irritable bowel syndrome diagnosis may limit repeated diagnostic evaluation among these patients.

Methods: The inclusion criteria included observational longitudinal studies of clinic-based samples of adult patients with irritable bowel syndrome. Only studies published in the English language in full manuscript form were included. Literature searches, selection and review of eligible articles, and data abstraction were performed in a duplicate, independent manner.

Results: Fourteen studies met study selection criteria. In six studies with relevant information, 2-5% of irritable bowel syndrome patients were diagnosed with an alternative organic GI disorder after 6 months to 6 years of follow-up. Long-term follow-up indicated that 2-18% of patients developed worse irritable bowel syndrome symptoms, approximately 30-50% of patients had unchanged symptoms, and the rest either improved or had symptoms disappear. Prior surgery (one study), higher somatic scores (one study), higher baseline anxiety (two studies), depression scores (one study) were predictive of worsening of symptoms during long-term follow-up.

Conclusions: Irritable bowel syndrome, a chronic disorder, is a stable diagnosis. Once initial investigations are negative, fewer than 5% are diagnosed with an alternative organic GI disorder. Repeated diagnostic evaluations of patients with recurrent or persistent symptoms similar to their baseline symptoms are not warranted.

http://www.medscape.com/viewarticle/473351?src=mp

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Moms with Bowel Symptoms Take Baby to Doctor More new
      #73255 - 05/25/04 11:53 AM
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Moms with Bowel Symptoms Take Baby to Doctor More

Tue 25 May, 2004 16:19

By Amy Norton

NEW YORK (Reuters Health) - Mothers with irritable bowel syndrome (IBS) may be more likely than other women to seek a doctor's help when their babies have colds or other common ills, a UK study suggests.

The findings, according to researchers, suggest that learned responses to bodily symptoms early in life could help explain why the children of people with IBS tend to be more affected by bowel symptoms later in life.

IBS is a common disorder in which normal colon function is disrupted, causing symptoms such as abdominal pain, bloating, constipation and diarrhea. Its underlying cause is unclear, and studies show that only some people with symptoms of the condition are affected severely enough to seek treatment.

Why people differ in their reactions to IBS symptoms, and why symptoms interfere with daily life in some individuals but not in others, is unknown, according to Dr. Catherine Crane of the University of Oxford, the new study's lead author.

Previous research has suggested that children whose parents have IBS are both more likely to be taken the doctor as kids and more likely to complain of bowel symptoms as adults, Crane told Reuters Health.

One theory is that these individuals may be particularly sensitive to such symptoms because of the influence of their parents.

The new findings, according to Crane, suggest that differences in how parents respond to their children's illnesses could be part of this learning process.

The study involved 73 mothers who were on medication for bowel symptoms -- mainly IBS -- and 154 mothers with current or past stomach ulcers. The women were asked about their children's illnesses and health problems during their first 18 months of life, and whether they responded by taking the child to the doctor.

The findings are published in the American Journal of Gastroenterology. The researchers found that moms with IBS were more likely than those with stomach ulcers to seek care when their babies had a stuffy nose, cough or accident. Their children did not, however, have higher rates of health problems.

Some past studies have suggested that, as a group, people being treated for problems with bowel function tend to be particularly concerned about the underlying cause of their symptoms, Crane said.

So it's possible that moms with IBS are especially cautious when it comes to their babies' symptoms, she speculated.

But this attention to illness, according to Crane and her colleagues, may be translated to children in such a way that they later become more vulnerable than average to so-called functional disorders, such as chronic back pain and IBS.

"Social learning seems to play a part in the transmission of IBS from one generation to the next," Crane said, "and this study suggests that differences in parental responses to symptoms may be part of this social learning."

That doesn't mean, however, that parents should refrain from taking children to the doctor out of fear of teaching them "illness behavior."

"It is always wise for a parent to seek medical advice if they are concerned about their child's health," Crane noted.

However, she said, this study does suggest there should be more research into how parents' responses to their young children's physical symptoms influence them as they get older.

SOURCE: American Journal of Gastroenterology, April 2004.

http://www.reuters.co.uk/newsArticle.jhtml?type=healthNews&storyID=5251222&section=news

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Biases Affect Treatment of IBS new
      #76356 - 06/04/04 06:45 PM
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Reported June 1, 2004

Biases Affect Treatment

(Ivanhoe Newswire) -- Doctors' stereotypes about certain diseases may keep patients from receiving effective treatment, according to a new study in the British Medical Journal.

Researchers in London gathered 46 general practitioners to discuss treating chronic fatigue syndrome and irritable bowel syndrome. The study's authors say they chose these conditions because both have complex, poorly understood causes and these patients often have symptoms that are difficult to characterize.

The doctors admit they tend to view patients with CFS as having undesirable traits, such as a weaker work ethic or a refusal to play the "sick role," meaning they are seen as not making every effort to get better as quickly as possible. On the other hand, doctors view patients with IBS in a more positive light, giving them credit for "battling through it" or rarely missing work because of the condition.

The researchers say many of the doctors were frustrated by a clear treatment option for chronic fatigue syndrome. One doctor went so far as to say, "I would rather treat a whole surgery full of people with irritable bowel syndrome than people with chronic fatigue."

Previous research has indicated that mental health interventions may be effective for patients with both chronic fatigue syndrome and irritable bowel syndrome who do not respond to symptom management by their primary care doctor. The authors of this study conclude many physicians say they do not consider a referral to a mental health provider because they are unfamiliar with these interventions or they think they're either unnecessary or unavailable.

The researchers suggest these set of beliefs are keeping patients from receiving effective treatment. They write, "To overcome these barriers, doctors must recognize their deeply held beliefs that mediate their understanding of complex disease mechanisms." Such a change in perception, they say, must be supplemented by the establishment of locally available effective interventions.

This article was reported by Ivanhoe.com, who offers Medical Alerts by e-mail every day of the week. To subscribe, go to: http://www.ivanhoe.com/newsalert/.

SOURCE: British Medical Journal, doi:10.1136/bmj.38078.503819.EE, published online May 29, 2004

http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=8784

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Irritable Bowel Syndrome - An Evidence-Based Approach to Diagnosis new
      #83741 - 06/27/04 01:14 PM
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From Alimentary Pharmacology & Therapeutics

Irritable Bowel Syndrome - An Evidence-Based Approach to Diagnosis

Posted 06/21/2004

B.D. Cash; W.D. Chey

Summary and Introduction
Summary
Irritable bowel syndrome (IBS) represents one of the most common reasons for primary care visits and consultation with a gastroenterologist. It is characterized by abdominal discomfort, bloating and disturbed defecation in the absence of any identifiable physical, radiologic or laboratory abnormalities indicative of organic gastrointestinal disease. IBS is a costly disorder, responsible for significant direct and indirect costs to patients and society. Much of the cost attributed to IBS arises from the time and resources used to establish the diagnosis. Historically IBS has been viewed by many as a diagnosis of exclusion rather than as a primary diagnosis, and many patients with typical symptoms will undergo an extensive array of diagnostic tests and procedures prior to the eventual diagnosis of IBS.

Recent reviews addressing the management of such patients have cast doubt on the necessity for this degree of testing. Current best evidence does not support the routine use of blood tests, stool studies, breath tests, abdominal imaging or lower endoscopy in order to exclude organic gastrointestinal disease in patients with typical IBS symptoms without alarm features. Serological testing for celiac sprue in this population may eventually prove useful but validation of studies indicating an increased prevalence of this disease in patients with suspected IBS is needed.

The development and refinement of symptom-based criteria defining the clinical syndrome of IBS has greatly facilitated the diagnosis of this condition, which can be confidently diagnosed through the identification of typical symptoms, normal physical examination and the exclusion of alarm features. The presence of alarm features or persistent non-response to symptom-directed therapies should prompt a more detailed diagnostic evaluation dictated by the patient's predominant symptoms.

Introduction
Irritable bowel syndrome (IBS) is a chronic gastrointestinal condition characterized by abdominal discomfort, bloating and disturbed defecation. It is considered one of a group of functional gastrointestinal disorders in which a variety of factors including altered motility, abnormal visceral sensation and psychosocial factors interplay to cause symptoms. By definition, IBS is characterized by the absence of any identifiable physical, radiologic or laboratory abnormalities indicative of organic disease. IBS is a common condition, with prevalence estimates ranging between 7 and 24% in women and between 5 and 19% in men in the United States and Britain.[1-3] The symptoms of IBS represent one of the most common reasons for primary care visits, and consultation with a gastroenterologist accounting for 2.4-3.5 million physician visits per year.[1,4] Patients with IBS visit their physicians more frequently than those without IBS for both GI-related and non-GI-related problems, reflecting the increased likelihood of a variety of other conditions such as migraine headache, fibromyalgia and chronic pelvic pain.[5,6]

Based upon these observations, it should come as no surprise that the annual economic consequences of IBS in the United States are substantial. It has been estimated that IBS accounts for $1.7-10 billion in annual direct medical costs in the USA.[7,8] Perhaps more importantly, an additional $10-20 billion in indirect costs, largely resulting from work absenteeism and decreased productivity, has been attributed to IBS.[8,9] These estimates do not include prescription or over the counter-medications for IBS, so it is likely that a substantial portion of these costs may be attributed to the diagnostic testing that is frequently conducted as part of the evaluation of patients with suspected IBS. This paper will examine the current recommendations for the diagnostic evaluation of patients with suspected IBS and will critically review the evidence regarding the yield of various diagnostic tests and procedures that are routinely performed in this group of patients in order to exclude organic disease.




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Section 1 of 5 Next Page: Evidence-Based Medicine Approach to Diagnosis

Click here to read this entire article http://www.medscape.com/viewarticle/481182


B.D. Cash* & W.D. Chey†

*Division of Gastroenterology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; †Division of Gastroenterology, University of Michigan School of Medicine, Ann Arbor, MI, USA



Aliment Pharmacol Ther 19(12):1235-1245, 2004. © 2004 Blackwell Publishing


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Drug-Free Ways to Treat IBS new
      #88757 - 07/11/04 01:47 PM
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Drug-Free Ways to Treat IBS

DIGESTIVE HEALTH Article Archive

By Greg Arnold, May 4, 2004, Abstracted from "Relieve IBS
Holistically" in the May 2004 edition of Taste for Life Magazine

Irritable bowel syndrome (IBS) is a condition that affects 10 - 25% of the general population. Along with pain and suffering coupled with medical expenses, IBS exacts a toll on social and job-related activities. IBS can be the result of dysfunction in any part of the brain-gut axis in the central nervous system caused by psychological or other factors, abnormal gastrointestinal motility, or heightened
visceral sensations (1).

The most popular method of dealing with IBS is through prescription drugs. Popular prescription drugs include anti-diarrhea drugs, anticholinergic (antispasmodic) drugs, and Tricyclic antidepressants (to provide antidepressive and analgesic properties) (2). But these drugs can take a heavy toll on the liver, with risks outweighing the benefits.

Alternative therapies for IBS have increased in recent years, and the following treatment have demonstrated considerable success:

ACUPUNCTURE. Research on acupuncture's role in alleviating IBS symptoms has shown promise, with one studying showing acustimulation to "significantly increased the threshold of rectal sensation of gas, desire to defecate and pain" as well as reducing rectal sensitivity in IBS patients (3).

HYPNOTHERAPY. Another increasingly popular treatment, hypnotherapy reduces the sensory and motor component of the gastrocolonic response in patients with irritable bowel syndrome. These effects may be involved in the clinical efficacy of hypnotherapy in IBS (4).

PROBIOTICS. One of the most effective ways to help treat IBS is by strengthening the environment where IBS flourishes: the intestines. Probiotics are live, microbial food supplements that benefit the host animal by improving intestinal microbial balance. Their major role in
preventing and treating gastrointestinal disease appears to be from their effect on the immune process, protection against abnormal invasive bacteria, and in the production of short-chain fatty acids from starch and non-starch polysaccharides (5). By introducing healthy
bacteria into the digestive tract, such as acidophilus and bifidus, IBS has less of a chance of being a threat. Although sold as powders and capsules, Probiotics can be found in a variety of foods, including yogurt and kefir.

References:

1. Farhadi A. rritable bowel syndrome: an update on therapeutic modalities. Expert Opinion on Investigational Drugs 2001; 10(7): 1211-22

2. Emedicine website: "Irritable Bowel Syndrome" posted
November 19 , 2003.

3. Xing J. Transcutaneous electrical acustimulation can reduce visceral perception in patients with the irritable bowel syndrome: a pilot study. Alternative Therapy and Health in Medicine 2004; 10(1): 38-42.

4. Simren M. Treatment with hypnotherapy reduces the sensory and motor component of the gastrocolonic response in irritable bowel syndrome. Psychosomatic Medicine 2004; 66(2): 233-8

5. Floch MH. Probiotics, Irritable Bowel Syndrome, and
Inflammatory Bowel Disease. Current Treatment Options in
Gastroenterology 2003; 6(4): 283-288

Contact Mary Tevis [mailto;weeklynews@nowfoods.com]
Visit Citizens for Health, the Consumer Voice for Natural Health.

Copyright 2004 NOW Foods
Physical Address:
395 South Glen Ellyn Rd
Bloomingdale, IL 60108



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Irritable Bowel Syndrome Linked to High Rates of Various Surgeries new
      #88760 - 07/11/04 02:15 PM
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NEW YORK (Reuters Health) - People with irritable bowel syndrome (IBS) -- a disease of unknown origin involving abdominal pain and diarrhea -- are more likely than other people to undergo several types of surgery, including gallbladder removal and appendectomy, a new study shows.
Many of these operations are probably unnecessary, according to a related editorial.

The findings, which appear in the medical journal Gastroenterology, are based on a study of nearly 90,000 subjects who completed medical and lifestyle questionnaires.

Of the six surgeries studied, gallbladder removal, appendectomy, hysterectomy, and back surgery were all significantly more common among IBS patients than among other subjects, note Dr. George F. Longstreth, from Kaiser Medical Center in San Diego, California, and Dr. Janis F. Yao, from the Permanente Medical Group in Pasadena, California.

The strongest link was with gallbladder removal, which was twice as common among patients with IBS as those without the condition.

By contrast, rates for coronary artery surgery and peptic ulcer surgery were similar for subjects with and without IBS, the report indicates.

"Although it is impossible to know how much of the surgical predisposition we identified resulted from misdiagnosis, consideration of our findings with those of other studies suggests that diagnostic error is an important factor," the researchers note.

In a related editorial, Dr. Nicholas J. Talley, from the Mayo Clinic in Rochester, Minnesota, comments that follow-up "data on the indications and outcomes of surgery in IBS is now needed."

He adds that "whether the excess surgery in IBS is cause or effect, unnecessary surgery must be avoided and gastroenterology (doctors) should take responsibility for actions to protect the public."

SOURCE: Gastroenterology, June 2004.

© Reuters 2004. All Rights Reserved.


http://www.reuters.com/newsArticle.jhtml?type=healthNews&storyID=5546266

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Bacillary dysentery as a causative factor of irritable bowel syndrome and its pathogenesis new
      #92809 - 07/24/04 01:42 PM
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Gut 2004;53:1096-1101
© 2004 by BMJ Publishing Group Ltd & British Society of Gastroenterology

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IRRITABLE BOWEL SYNDROME

Bacillary dysentery as a causative factor of irritable bowel syndrome and its pathogenesis

L-H Wang, X-C Fang and G-Z Pan
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China


Correspondence to:
Professor G-Z Pan
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Beijing 100730, The People's Republic of China; pangz2@btamail.net.cn


ABSTRACT
Background and aims: The incidence of irritable bowel syndrome (IBS) or functional bowel disorders (FBD) after bacillary dysentery (BD) has not been extensively evaluated, and little is known of the pathogenesis of post-infective (PI) IBS. Therefore, we investigated the incidence of IBS and FBD in a Chinese patient population who had recovered from BD. To further elucidate its pathogenesis, neuroimmunological changes, including interleukins (IL), mast cells, neuropeptides, and the relationship between mast cells and intestinal nerves, were investigated.

Methods: A cohort study of 295 patients who had recovered from BD (shigella identified from stool in 71.4%) and 243 control subjects consisting of patient siblings or spouses who had not been infected with BD were included in the study. All subjects were followed up using questionnaires for 1–2 years to explore the incidence of FBD and IBS, as defined by the Rome II criteria. In 56 cases of IBS (PI and non-PI) from another source, the number of mast cells in biopsy specimens from the intestinal mucosa were stained with antitryptase antibody and counted under light microscopy. Also, the relationship of mast cells to neurone specific enolase (NSE), substance P (SP), 5-hydroxytryptamine (5-HT), or calcitonin gene related peptide positive nerve fibres was observed using double staining with alcian blue and neuropeptide antibodies. In 30 cases of IBS (PI-IBS, n = 15) taken at random from the 56 cases, expression of interleukin (IL)-1, IL-1ß, and IL-1 receptor antagonist (IL-1ra) mRNAs in intestinal mucosa were identified using reverse transcription-polymerase chain reaction. The above results were compared with 12 non-IBS controls.

Results: In the BD infected cohort, the incidences of FBD and IBS were 22.4% and 8.1% (in total)–10.2% (among those in who shigella were identified) respectively, which were significantly higher (p<0.01) than the incidences of FBD (7.4%) and IBS (0.8%) in the control cohort. A longer duration of diarrhoea (7 days) was associated with a higher risk of developing FBD (odds ratio 3.49 (95% confidence interval 1.71–7.13)). Expression of IL-1ß mRNA in terminal ileum and rectosigmoid mucosa was significantly higher in PI-IBS patients (p<0.01). The number of mast cells in the terminal ileum mucosa in PI-IBS (11.19 (2.83)) and non-PI-IBS patients (10.78 (1.23)) was significantly increased compared with that (6.05 (0.51)) in control subjects (p<0.01). Also, in the terminal ileum and rectosigmoid mucosa of IBS patients, the density of NSE, SP, and 5-HT positively stained nerve fibres increased (p<0.05) and appeared in clusters, surrounding an increased number of mast cells (p<0.01 compared with controls).

Conclusions: BD is a causative factor in PI-IBS. The immune and nervous system may both play important roles in the pathogenesis of PI-IBS.



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Abbreviations: BD, bacillary dysentery; FBD, functional bowel disorder; IBS, irritable bowel syndrome; IL, interleukin; IL-1ra, interleukin 1 receptor antagonist; PI, post-infective; RT-PCR, reverse transcription-polymerase chain reaction; NSE, neurone specific enolase; SP, substance P; CGRP, calcitonin gene related peptide; 5-HT, 5-hydroxytryptamine; SA-HRP, streptavidin-horseradish peroxidase; PBS, phosphate buffered saline

http://gut.bmjjournals.com/cgi/content/abstract/53/8/1096

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Irritable Bowel Syndrome Remains a Difficult Condition to Manage new
      #92816 - 07/24/04 02:09 PM
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Irritable Bowel Syndrome Remains a Difficult Condition to Manage

Posted 07/08/2004

Nicholas J. Talley, MD, PhD

Abstract and Introduction
Abstract
Irritable bowel syndrome (IBS) remains challenging to manage, with no universally agreed treatment protocol. Complicating the treatment picture is the placebo response, which can vary from 20% to 70% and can be sustained long term. Results of the most recent meta-analysis on fiber intake suggest that soluble fiber (psyllium, ispaghula, and calcium polycarbophil) is of benefit in alleviating IBS symptoms, while insoluble fiber (corn and wheat bran) is not. A meta-analysis of antispasmodic agents suggests that the use of this class of drugs improves global symptoms in IBS and reduces abdominal pain, but the anticholinergic drugs available in the United States have limited efficacy. Opioid agonists are effective antidiarrheal agents; loperamide is superior to placebo for IBS-associated diarrhea but not other symptoms. Meta-analyses support the efficacy of tricyclic antidepressants, but the efficacy of the selective serotonin reuptake inhibitors is unclear. Tegaserod is efficacious in constipation-predominant IBS in women. Alosetron is efficacious in women with diarrhea-predominant IBS, but side effects limit its use. A number of newer agents are being tested, but which of these will reach the clinical setting remains uncertain.

Introduction
Irritable bowel syndrome (IBS) represents a symptom complex comprising abdominal discomfort or pain associated with disturbed defecation, often coexisting with bloating.[1,2] A number of pathophysiologic abnormalities have been identified in IBS, but the exact cause remains unknown and treatment is largely empirical.[1] IBS is a highly prevalent condition, affecting approximately 10% of US adults, and it can be disabling.[1,2] In part, the disability results from the inability of patients to predict when their symptoms will occur; they may often experience unplanned interruptions to work and home activities because of physical discomfort and shame.

Specific symptom-based criteria, such as the Rome criteria, have been developed for IBS that allow clinicians to make a positive diagnosis, particularly in the absence of red flags, or alarm features, such as weight loss, GI bleeding, or vomiting.[1,2] The American College of Gastroenterology (ACG) Functional Gastrointestinal Disorders Task Force concluded that patients with IBS who present for care typically have impaired quality of life and deserve to be offered treatment; the goal, then, is to improve global symptoms of the condition.[3]

IBS symptoms tend to come and go, which may account for some of the relatively high–and varied–placebo responses observed in clinical trials, ranging from 20% to 70%.[2] Furthermore, in a 12-month trial of alosetron versus placebo, it is striking that the placebo response was maintained for at least 12 months, which is as yet unexplained.[4] However, a clinical trial represents an artificial setting. The efficacy of the placebo response in IBS in clinical practice is unknown and is likely to be substantially lower than that which has been reported in the trials.

Some drugs have a significant place in the management of IBS, although evidence that many of the therapies used are superior to placebo remains lacking.

Dr Talley is professor of medicine and co-director of the Clinical Enteric Neuroscience Translational and Epidemiological Research Program, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn.



Drug Benefit Trends 16(6):313-322, 2004. © 2004 Cliggott Publishing, Division of CMP Healthcare Media

http://www.medscape.com/viewarticle/482425?src=mp

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