All Boards >> Irritable Bowel Syndrome Research Library

View all threads Posts     Flat     Threaded

On the Relationship Between Colon Ischemia, Irritable Bowel Syndrome, and Serotonergic Therapy of Irritable Bowel Syndrome
      10/24/04 07:10 PM
HeatherAdministrator

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

From Medscape Gastroenterology

Irritable Bowel Syndrome Expert Column
On the Relationship Between Colon Ischemia, Irritable Bowel Syndrome, and Serotonergic Therapy of Irritable Bowel Syndrome
Posted 09/24/2004

Lawrence J. Brandt, MD

Introduction and Context
The Problem
Colon ischemia and irritable bowel syndrome (IBS) are 2 common gastroenterologic disorders that, until recently, were thought to occur independently in very different populations. We know now, however, that there is a complex association between the 2: (1) colon ischemia appears to be more common in the IBS patient than was recognized previously; and (2) there is concern that the newly developed serotonin receptor agonists or antagonists may increase the risk of colon ischemia, and serotonergic signaling may be abnormal in patients with colitis. This review highlights some of the relationships between colon ischemia, IBS, and therapy for IBS.

IBS -- Pathophysiology and Clinical Presentation
IBS is a disorder that is diagnosed by various symptom-based criteria, such as the Manning, Rome, and Rome II criteria. IBS lacks any biologic, physiologic, structural, or serologic marker, and so diagnosis is symptom-based. Symptoms typically include abdominal discomfort or pain, bloating, diarrhea, fecal urgency, and constipation. Symptoms may change with time, and patients who have diarrhea or constipation as a major part of their illness may evolve to the opposite bowel habit or develop a pattern in which they alternate between the 2. IBS must never be considered as the explanation for rectal bleeding, bloody diarrhea, weight loss, fever, constitutional symptoms, or anemia, and in the presence of these "alarm" symptoms or signs, organic disease must be excluded using conventional stool tests, endoscopic, and radiologic examinations. For the IBS patient without alarm symptoms, the routine use of these tests is not recommended, although for patients with IBS and diarrhea, serologic testing for celiac sprue may be appropriate and cost-effective.[1,2] Of course, screening tests for colon cancer are recommended for all patients 50 years of age or older, including those with IBS.

Colon Ischemia -- Pathophysiology and Clinical Presentation
Colon ischemia generally presents in individuals older than 55 years, a population considerably older than that typically affected by IBS. The known causes of colon ischemia are many, but in the usual case, no definitive cause is found; most episodes of colon ischemia are thought to be caused by brief periods of localized nonocclusive ischemia. The acute onset of mild, lower abdominal pain accompanied or followed by diarrhea, rectal bleeding, or bloody diarrhea is typical. Most patients with colon ischemia have spontaneous resolution of symptoms within several days. Computed tomography of the abdomen usually shows segmental thickening of the colon, although this is not a specific finding. Colonoscopy, if performed within the first 24-48 hours, usually will show submucosal hemorrhage or edema in a segmental pattern (ischemic colopathy). If the examination is repeated within a few days after the onset of symptoms, it will show the disease process to have evolved into a segmental (ischemic) colitis pattern with ulceration and even pseudopolyp formation, an appearance that may mimic inflammatory bowel disease or infectious colitis; biopsy usually is nonspecific, with only infarction and ghost cells pathognomonic of ischemic injury. In general, mesenteric angiography is not used to evaluate patients suspected of having colon ischemia, because by the time of presentation, colonic blood flow usually has normalized.

It is important for primary care practitioners to be aware of colon ischemia because it is a common cause of bloody diarrhea in the elderly and can be seen in patients of all ages, especially those who have a coagulation disorder, systemic illness associated with vasculitis, or those with IBS. Moreover, colon ischemia can mimic or be mimicked by infectious colitis or inflammatory bowel disease. Most patients who develop colon ischemia do well with conservative management. For the patient who continues to have symptoms for more than 2 weeks, referral to a gastroenterologist is recommended because it is likely that these individuals will have a complicated course.




--------------------------------------------------------------------------------

Section 1 of 6 Next Page: Issues in Epidemiology


Lawrence J. Brandt, MD, Chief of Gastroenterology, Montefiore Medical Center, Bronx, New York; Professor of Medicine and Surgery, Albert Einstein College of Medicine, Bronx, New York


Disclosure: Lawrence J. Brandt, MD, has served as an advisor or consultant for Novartis, GlaxoSmithKline, Solvay, and TAP. He has also disclosed he is on the speakers bureau for AstraZeneca.

Medscape Gastroenterology 6(2), 2004. 2004 Medscape


Continue reading this article here http://www.medscape.com/viewarticle/488174_2

--------------------
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!

Print     Remind Me     Notify Moderator    

Entire thread
* Pharmaceutical
HeatherAdministrator
07/14/03 01:50 PM
* Medical Marijuana Significant for Migraines, Fibromyalgia, and IBS
HeatherAdministrator
02/16/21 01:21 PM
* Heartburn drugs that are proton pump inhibitors could trigger IBS and SIBO
HeatherAdministrator
12/07/20 01:28 PM
* For IBS Patients, Cannabis Linked to Fewer Rehospitalizations
HeatherAdministrator
05/05/20 02:14 PM
* Cannabis could help a person defecate
HeatherAdministrator
04/14/20 12:17 PM
* FDA OKs Reintroduction of Tegaserod (Zelnorm) for IBS-C in Women Under 65
HeatherAdministrator
04/04/19 02:45 PM
* Long-term cannabis use increases risk for IBS
HeatherAdministrator
10/19/17 04:04 PM
* FDA approves new drug for chronic constipation
HeatherAdministrator
01/26/17 03:05 PM
* Mixed Opioid Agent Adds to Growing List of Therapies for IBS-D
HeatherAdministrator
01/27/16 02:48 PM
* Low-dose naltreoxone for the treatment of irritable bowel syndrome
HeatherAdministrator
01/26/16 01:20 PM
* Amitiza benefited patients with chronic idiopathic constipation
HeatherAdministrator
02/10/15 04:15 PM
* Medical Marijuana for Digestive Disorders: High Time to Prescribe?
HeatherAdministrator
09/17/14 02:08 PM
* Antibiotics Early in Life May Boost Obesity Risk
HeatherAdministrator
08/18/14 03:13 PM
* Antidepressants, psychological therapies effectively treated IBS
HeatherAdministrator
07/15/14 02:49 PM
* Proton pump inhibitor (acid reflux drugs) may cause heart disease
HeatherAdministrator
09/23/13 03:22 PM
* Older drugs are better than new ones
HeatherAdministrator
06/13/13 02:00 PM
* On Anti-Depressants? Some Raise Risk of C. Diff Infection
HeatherAdministrator
05/13/13 05:51 PM
* Heartburn drugs, NSAID painkillers use linked to IBS symptoms
HeatherAdministrator
03/18/13 01:24 PM
* FDA approves Linzess to treat certain cases of irritable bowel syndrome and constipation
HeatherAdministrator
08/31/12 11:25 AM
* 3-month FDA delay for potential IBS drug linaclotide
HeatherAdministrator
04/23/12 01:45 PM
* Latest FDA watch list includes GI drugs
HeatherAdministrator
04/23/12 01:42 PM
* Antibiotics that reduce gut bacteria linked to obesity
HeatherAdministrator
05/06/11 12:25 PM
* Rifaximin: a unique gastrointestinal-selective antibiotic for enteric diseases
HeatherAdministrator
02/10/11 10:23 AM
* Antacids increase risk of pneumonia
HeatherAdministrator
01/14/11 04:35 PM
* Editorial - Antibiotic Rifaximin (Xifaxan) Therapy for the Irritable Bowel Syndrome
HeatherAdministrator
01/07/11 03:01 PM
* Antiobiotic Rifaximin (Xifaxan) for Patients with Irritable Bowel Syndrome without Constipation
HeatherAdministrator
01/07/11 02:59 PM
* Proton Pump Inhibitor Drugs Tied to 80% Increase in Clostridium difficile Risk
HeatherAdministrator
11/10/10 11:29 AM
* Phase 3 clinical trials of linaclotide for IBS constipation
HeatherAdministrator
10/13/10 02:44 PM
* An over-the-counter drug for constipation offers superior symptom relief compared with a commonly used prescription agent
HeatherAdministrator
07/16/10 03:17 PM
* Benefit/risk ratio of Renzapride not sufficient to warrant further study in IBS-C
HeatherAdministrator
04/07/10 01:32 PM
* Adverse effects of drugs on small intestine and colon
HeatherAdministrator
03/16/10 11:23 AM
* Children's Belly Aches Don't Disappear With Antidepressant
HeatherAdministrator
03/11/10 01:14 PM
* Survey: Marijuana Use In Patients With IBS
HeatherAdministrator
01/12/10 03:17 PM
* FDA Approves Amitiza for IBS-C
HeatherAdministrator
05/23/08 10:59 AM
* Zelnorm no longer available except for emergency use
HeatherAdministrator
04/11/08 12:05 PM
* Clinical trial: phase 2 trial of lubiprostone for irritable bowel syndrome with constipation.
HeatherAdministrator
02/15/08 11:20 AM
* Role of Antibiotics vs Conventional Pharmacotherapy in Treating Symptoms of Irritable Bowel Syndrome
HeatherAdministrator
01/03/08 04:45 PM
* FDA permits the restricted use of Zelnorm
HeatherAdministrator
08/09/07 11:41 AM
* Antidepressant Therapy (Imipramine and Citalopram) for Irritable Bowel Syndrome
HeatherAdministrator
06/20/07 01:56 PM
* Neuromuscular Dysfunction and IBS: Clinical Implications for Drug Use
HeatherAdministrator
02/04/07 04:30 PM
* Enteric Bacteria and IBS
HeatherAdministrator
11/26/06 02:51 PM
* Rifaximin vs Placebo in Reducing Symptoms in Adults With IBS
HeatherAdministrator
11/26/06 02:39 PM
* Antibiotic Rifaximin Appears Safe and Effective for Irritable Bowel Syndrome
HeatherAdministrator
10/26/06 10:29 AM
* Citalopram (Celexa) Improves Symptoms of Irritable Bowel Syndrome
HeatherAdministrator
10/14/06 12:57 PM
* Marijuana eases chronic pain
HeatherAdministrator
07/17/06 11:49 AM
* Doctors group launches war on drug ads
HeatherAdministrator
07/17/06 11:17 AM
* New IBS drug in development in Japan
HeatherAdministrator
07/05/06 05:13 PM
* Marijuana and the gastrointestinal tract
HeatherAdministrator
06/12/06 03:38 PM
* Zelnorm Rejected Again in Europe
HeatherAdministrator
04/02/06 03:25 PM
* Antidepressants for IBS
HeatherAdministrator
03/16/06 12:31 PM
* Takeda Laxative Wins U.S. Approval for Adults
HeatherAdministrator
02/18/06 01:36 PM
* Cilansetron: ; Solvay Pharmaceuticals suspends registration activites in the U.S.,
HeatherAdministrator
01/18/06 04:15 PM
* Hearburn Drugs Cause Diarrhea
HeatherAdministrator
01/08/06 05:10 PM
* Zelnorm fails to win EU panel backing
HeatherAdministrator
12/21/05 11:25 AM
* Non-steroidal anti-inflammatory drugs and gastrointestinal damage
HeatherAdministrator
12/08/05 12:51 PM
* Octreotide May Be Effective in Treatment of Nonconstipated IBS
HeatherAdministrator
12/08/05 12:31 PM
* Lack of Lasting Effectiveness of Miralax Laxative Treatment of Constipation.
HeatherAdministrator
08/07/05 04:18 PM
* Acute Hepatitis Associated With Lotronex
HeatherAdministrator
07/24/05 02:37 PM
* FDA revisions to safety labeling for Lotronex (alosetron )
HeatherAdministrator
05/22/05 06:46 PM
* Clinical pharmacology of new motility promoting agents
HeatherAdministrator
05/22/05 06:33 PM
* Rationale for Using Serotonergic Agents to Treat Irritable Bowel Syndrome
HeatherAdministrator
05/08/05 06:21 PM
* Zelnorm Associated With Rare Cases of Severe Diarrhea, Ischemic Colitis
HeatherAdministrator
04/24/05 03:48 PM
* Clinical Response to Tricyclic Antidepressants in Functional Bowel Disorders not Related to Dosage
HeatherAdministrator
03/28/05 01:32 PM
* Efficacy and Safety of Alosetron in Men with Diarrhea-Predominant IBS
HeatherAdministrator
02/19/05 05:56 PM
* Irritable Bowel Syndrome Medications Side Effects Survey
HeatherAdministrator
11/09/04 02:04 PM
* On the Relationship Between Colon Ischemia, Irritable Bowel Syndrome, and Serotonergic Therapy of Irritable Bowel Syndrome
HeatherAdministrator
10/24/04 07:10 PM
* New Risk Information on Zelnorm for IBS for Women
HeatherAdministrator
07/11/04 02:18 PM
* The Relationship among Previous Antimicrobial Use and H. Pylori Infections
HeatherAdministrator
06/27/04 01:33 PM
* Therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome
HeatherAdministrator
06/04/04 03:54 PM
* Pharmaceutical companies funding a number of studies into IBS in the UK
HeatherAdministrator
05/25/04 12:00 PM
* Irritable bowel syndrome helped by Paroxetine, a drug for depression
HeatherAdministrator
05/10/04 02:15 PM
* Fears cause low sales of Lotronex
HeatherAdministrator
05/10/04 01:46 PM
* Zelnorm Warning Issued by FDA
HeatherAdministrator
05/10/04 01:01 PM
* Renzapride Improves Symptoms in Constipation-Predominant Irritable Bowel Syndrome
HeatherAdministrator
12/01/03 06:14 PM
* Clinical Trial Guidelines for Pharmacological Treatment of IBS - Pharmacological Options
HeatherAdministrator
12/01/03 05:55 PM
* SOLVAY presses ahead with cilansetron, a new IBS drug
HeatherAdministrator
11/18/03 03:43 PM
* Measuring Treatment Effects in IBS Trials
HeatherAdministrator
10/20/03 03:30 PM
* FDA Orders Novartis To Pull Zelnorm Ads
HeatherAdministrator
10/07/03 11:25 PM
* Step-down dosage of PPI drugs for hearburn
HeatherAdministrator
09/30/03 01:26 PM
* Evaluation of drug treatment in irritable bowel syndrome
HeatherAdministrator
09/30/03 12:52 PM
* Pain Relievers and Intestinal Disorders
HeatherAdministrator
09/16/03 04:20 PM
* Hypersensitivity and hyperreactivity in IBS: opportunity for drug discovery
HeatherAdministrator
07/18/03 12:39 PM
* Antidepressants in the Treatment of IBS and Other Functional GI Disorders
HeatherAdministrator
07/18/03 12:20 PM
* Use of Antidepressants in the Treatment of IBS?
HeatherAdministrator
07/14/03 03:58 PM
* Combined use of SSRIs and NSAIDs increases the risk of GI adverse effects
HeatherAdministrator
07/14/03 03:15 PM

Extra information
0 registered and 1 anonymous users are browsing this forum.

Moderator:  Heather 



Permissions
      You cannot post until you login
      You cannot reply until you login
      HTML is enabled
      UBBCode is enabled

Thread views: 414269

Jump to

| Privacy statement Help for IBS Home

*
UBB.threads™ 6.2


McAfee SECURE sites help keep you safe from identity theft, credit card fraud, spyware, spam, viruses and online scams

HelpForIBS.com BBB Business Review