LifeCare Chiropractic

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Diarrhea / Constipation / Irritable Bowel

Public Citizen Urges FDA Not to Approve Tegaserod For IBS – (04-30-01)

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Public Citizen Urges FDA Not to Approve Tegaserod For IBS

There have been numerous attempts by the pharmaceuticals to tap into the irritable bowel syndrome market. The first attempt was pulled off the market for safety concerns (Glaxo Wellcome’s Lotronex for diarrhea-dominant IBS). Tegaserod is the latest attempt to help with constipation-dominant IBS. It’s a shame that all this money is spent on R&D when natural physicians have been doing well with IBS for years…

(article) Consumer advocacy group Public Citizen has petitioned the US Food and Drug Administration not to approve Novartis Pharmaceuticals’ drug candidate tegaserod (Zelmac) as a treatment for the constipation-predominant form of irritable bowel syndrome (IBS), citing the drug’s “questionable efficacy” and “serious safety concerns.” In August, the FDA issued the Swiss pharmaceuticals firm an approvable letter for tegaserod, with final approval conditioned on the submission of additional clinical data. FDA reviewers have estimated that tegaserod recipients were three times more likely to develop cysts than placebo recipients, Public Citizen asserts in the letter. It noted that in animal trials the compound “caused a statistically significant, dose-related increase in their incidence.” In addition, the drug has not even been proven effective, Public Citizen maintains. “Only a minority of patients ‘respond’ to the drug and the absolute benefits conferred (compared to placebo) are not clinically significant,” it said.

Corticosteroids May Protect Against Asthma-Related Irritable Bowel – (09-06-01)

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Corticosteroids May Protect Against Asthma-Related Irritable Bowel

A few things to consider here. The link between asthma and IBS is not all that surprising, except that I personally think they may have it backwards. This and previous studies suggest that patients with asthma are at increased risk of IBS. I would venture to say that it’s the opposite. Patients with GI dysfunction, whether noticed by the patient YET or not, would be more likely to develop asthma. Here’s my scenerio…patient has something happen early in life to disrupt the functional status of the GI tract (antibiotics, bottle feeding…). This ends up leading to a hyper-responsive immune system which in turn can lead to asthma. Then, later in life, the functional changes in the GI tract become noticable by the patient. As for the corticosteroids reducing risk of IBS in asthmatic patients, this gives me concern. Anti-inflammatories and steroids disrupt the integrity of the GI tract, and if the idea of using steroids to cut the risk of IBS gets out, we may be looking at a much larger problem. As the why these researchers found a reduced risk…I would like to see follow up studies confirming the results.

17th annual meeting of the International Conference on Pharmacoepidemiology Asthmatics may have a slightly increased risk of developing irritable bowel syndrome (IBS) compared with the general population. However, those who use oral corticosteroids appear to have slight protection against developing the latter disease, researchers reported here Monday. The finding comes from a study using data from the General Practice Research Database (GPRD) in the UK. The GPRD is a national computerized database of patient records from general practice. It contains more than 35 million patient-years of data and contains long-term information that can be used by researchers. In short, the study findings suggest that asthmatics are 1.3 times more likely to develop IBS than non-asthmatics. A link between the two diseases has been suggested in studies in the past. The results were presented in a poster by researchers from the Centro Español Investigación Farmacoepidemiológica in Madrid, Spain, at the 17th annual meeting of the International Conference on Pharmacoepidemiology here. The prinicipal investigator was Dr. Consuela Huerta. The researchers used information from a random sample of 50,000 database subjects who had a diagnostic code for asthma on January 1, 1994. Patients were included if they were between the ages of 10 and 79 years old. Data for a similar number of age- and sex-matched non-asthmatics were used for comparison. People who had diagnostic codes for IBS, peptic ulcers, cancer, or other confounding conditions were excluded. Both groups of patients were followed until November 1998. Subjects were excluded if during the study period they became pregnant, turned 80 years of age, developed conditions that met the initial exclusion criteria, or were diagnosed with IBS (the endpoint being sought). However, asthmatics who were regularly taking oral corticosteroids at the start of the study were slightly less likely to develop IBS during the study period, compared with other asthmatics. Other asthmatic medications were not associated with any change in IBS risk. However, the data are not strong enough to show whether or not the steroids offer any protective effect, and did not show a difference between long and short-term use of the drugs, Dr. Huerta and colleagues cautioned. Further studies in the general population are necessary to confirm whether the use of corticosteroids, regardless asthma status, has a protective effect against IBS, researchers said.

ations for prevention, given the increasing prevalence of obesity and the morbidity and mortality association with heart defects,” Drs. Watkins and Botto conclude

Easily Treatable Condition Often Unrecognized in IBS Patients – (09-06-01)

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Easily Treatable Condition Often Unrecognized in IBS Patients

This article refers to lactose intolerance being misdiagnosed as IBS. This gives more support to alternative practitioners’ treatment methods because avoidance of dairy is always at the top of the list for almost any condition; especially so with any GI related complaints.

European Journal of Gastroenterology & Hepatology 2001;13:941-944 Prospectively, the effect of a lactose-restricted diet was evaluated among irritable bowel syndrome patients with lactose malabsorption. Lactose malabsorption was defined by a positive hydrogen breath test and a positive blood-glucose test. An analysis of symptoms was completed before, during, 6 weeks after and 5 years after starting the diet. In addition, the number of visits made by the patients to the outpatient clinic was scored during 6 years. Conclusions In a large majority of irritable bowel syndrome patients with lactose malabsorption, which was previously clinically unrecognized, a lactose-restricted diet improved symptoms markedly both in the short term and the long term. Furthermore, visits by all patients to the outpatient clinic were reduced by 75%. We conclude that diet therapy is extremely cost- and time-saving. Therefore, it is strongly recommended that lactose malabsorption, which is easily treatable, is excluded before diagnosing irritable bowel syndrome.

Read article here

Unrecognized Fructose Intolerance and Unexplained GI Symptoms – (11-08-01)

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Unrecognized Fructose Intolerance and Unexplained GI Symptoms

This is another factor to look for with IBS symptoms. Fructose is found in many fruits as well as high fructose corn syrup used as sweetener in just about every processed snack and drink.

66th Annual Scientific Meeting of the American College of Gastroenterology Many patients with unexplained gastrointestinal (GI) symptoms have fructose intolerance, according to study findings presented Monday at the 66th Annual Scientific Meeting of the American College of Gastroenterology. Unexplained bloating, flatus, and distension are common GI complaints. While much attention has been paid to lactose intolerance as a potential cause, fructose intolerance has received relatively little attention. Dr. Young K. Choi and colleagues from the University of Iowa in Iowa City administered a fructose breath test to 219 patients with unexplained GI symptoms. The patients were also given a symptom questionnaire and assessed for irritable bowel syndrome (IBS). Nearly 80% of patients had a positive breath test, the researchers note. Furthermore, the fructose given during the test reproduced the GI symptoms of 58% of patients. Based on questionnaire results, 130 of 159 patients met ROME I criteria for IBS. “We were quite surprised to find such a high prevalence of fructose intolerance,” says Dr. Choi. “The results also suggest that many people with IBS have underlying fructose intolerance,” he added. However, “the patients we studied were referred to us by outlying centers, so it is hard to know the actual prevalence of fructose intolerance.” “The fructose breath test is probably not performed at most community hospitals,” Dr. Choi noted. “The test is somewhat time-consuming, but relatively simple to perform.” Further studies are needed to better characterize the problem, he said. Until then, it is important for physicians to recognize the problem because institution of a low fructose diet may improve symptoms.

Meta-analysis of smooth muscle relaxants in irritable bowel syndrome – (03-01-01)

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Meta-analysis of smooth muscle relaxants in irritable bowel syndrome

This article describes a benefit to drugs affecting the smooth muscles of the GI tract in irritable bowel. My concern with therapies such as this are many. Primary among them is that IBS is one of those GI conditions that responds very well to functional medicine; primarily because alterations in flora and diet are major contributors to the syndrome. So, if we have a patient with unhealthy flora in the GI tract and we slow down the transit time in the gut, those bad bacteria now have even longer to act on things that they should not be acting on. Pathogenic bacteria can unconjugate estrogen that the liver is trying to get rid of and send it back into the system. They can act on undigested carbs and proteins and lead to putrefaction. Remember, fixing the problem is ALWAYS the best answer…covering up symptoms only leads to further problems.

Synergy Abstract

Read entire article here

Common Disorder May Underlie Asthma and IBS – (06-25-01)

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Common Disorder May Underlie Asthma and IBS

Hey!! We’re getting closer to the mark!! One of these days it may occur to the medical powers that be that the GI tract has a major impact on our overall health. Antibiotics, poor lifestyle habits, acid blockers, stress, NSAIDs can all alter the flora of the GI tract and lead to IBS symptoms. Antibiotics have shown to increase risk of asthma and this risk is most likely mediated through alterations in the flora. So of course a common disorder may underlie–destruction of normal, healthy flora!

Am J Gastroenterol 2001;96:1511-1516 Asthma appears to be more prevalent among patients with irritable bowel syndrome (IBS) than among individuals without IBS, which suggests that there are pathophysiological processes common to both conditions, according to Turkish researchers. Dr. Aziz Yazar and colleagues, from the Mersin University Faculty of Medicine, in Mersin, performed pulmonary function tests and noted respiratory symptoms in 133 men and women with IBS and 137 controls. In the IBS group 33.8% of patients had respiratory symptoms, significantly more than in the control group, 5.8%. In addition, 15.8% of the IBS patients but only 1.45% of controls were diagnosed with asthma, Dr. Yazar’s group found. Compared with controls, IBS patients had impaired pulmonary function, including significantly lower forced expiratory volume in 1 second, flow after 50% of vital capacity had been exhaled, peak expiratory flow rate, and maximal midexpiratory flow rate. In a previous study, the research team notes, patient responses to a questionnaire showed that & quot;IBS, gastroesophageal reflux symptoms, and symptomatic bronchial hyper-responsiveness occur together more often than expected and that the conditions are independently associated with each other.” Some of the lines of evidence for an association between IBS and asthma, according to the researchers, are that in both disorders there is an altered contractility and smooth muscle tone, the autonomic nervous system is involved, and inflammation probably has an etiologic role.

Probiotics Significantly Reduce Symptoms of IBS, Ulcerative Colitis – (06-17-03)

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Probiotics Significantly Reduce Symptoms of IBS, Ulcerative Colitis

It’s nice to see that probiotics are finally making it into the limelight. Sadly, this is about a decade behind the research and probably another decade before it makes it into clinical practice. Currently, most docs that have some inkling that certain bacteria may benefit the GI tract tell their patients to eat yogurt–which is usually laden with sugar or aspartame and has relative minute levels of probiotics compared to supplemental usage.

DDW 2003: Abstract M1582, presented May 19, 20003; Abstract W1523, presented May 21, 2003.

May 21, 2003 (Orlando) — Probiotic therapy, primarily in the form of Lactobacillus acidophilus and Bifidobacteria infantis, significantly improves symptoms and quality of life in patients with irritable bowel syndrome (IBS) and other bowel disorders, researchers reported in a number of presentations here at Digestive Disease Week 2003.In a study designed to assess the efficacy of probiotics alone or in combination with antibiotics in patients with IBS, Stephen M. Faber, MD, from Albemarle Gastroenterology Associates, PC, in Elizabeth City, North Carolina, evaluated treatment in 44 patients with IBS. Twenty patients received probiotics alone and 24 received ciprofloxacin 500 mg twice daily for one week and two probiotic formulations, Lactobacillus (NCFM) 10 billion/g and Bifidobacteia infantis (Bifdo), 10 billion/g for four weeks. Patients completed the IBS-Quality of Life (IBS-QOL) questionnaire and the Symptom Frequency Index (SFI) before and after treatment. For the study group as a whole, IBS-QOL scores averaged 66.2 before treatment and 84.6 after treatment. SFI scores before treatment averaged 38, decreasing to 18 after treatment. In patients who received both probiotics and antibiotics, IBS-QOL scores averaged 67.6 before and 87.8 after treatment. SFI scores averaged 35 at baseline, decreasing to 18 after treatment.In the probiotic-only group, baseline IBS-QOL scores were 69.3, increasing to 86.4 after treatment. SFI scores were 39 at baseline and 17 after treatment.Differences in IBS-QOL and SFI scores between probiotic plus antibiotic treatment and probiotic-only treatment were statistically insignificant, Dr. Faber reported.A retrospective look at IBS patients treated with probiotics indicates that there is a deficiency of Lactobacillus in the gut flora in patients with IBS, Dr. Faber noted, “but we’re not ready to call IBS an infectious disease.”Probiotic therapy also improved symptoms of ulcerative colitis (UC) in a separate study presented by Richard N. Fedorak, MD, professor of medicine and director of the division of gastroenterology at the University of Alberta in Edmonton, Canada. In a safety and efficacy study of the probiotic formulation VSL3 (VSL Pharmaceuticals, Inc., Ft. Lauderdale, FL), which contains eight lactic acid bacterial species, Dr. Fedorak and colleagues evaluated 30 patients with active mild-to-moderate UC with recent flares. Patients continued with previous treatment that included mesalamine, corticosteroids, and/or azathiaprine, as long as the treatment regimen was stable prior to the study. Patients took two VSL3 sachets twice a day for six weeks. Ulcerative Colitis Clinical Scores were measured and sigmoidoscopy performed at baseline and after the six-week treatment period. Dr. Fedorak reported that remission occurred in 63% (19 patients) and there was a clinical response in an additional 23% (seven patients). There was no response in 13% (four patients). Worsening of symptoms occurred in one patient.Dr. Fedorak said that probiotic therapy was not associated with any adverse clinical or biochemical events. “I haven’t heard of getting into trouble with probiotics,” Dr. Faber told Medscape. “These are organisms that are supposed to be in the gut. The body knows how to control them, so it doesn’t seem that you can overtreat.”While probiotics have been recognized as beneficial components of food, Dr. Fedorak pointed out that “we don’t use it as a food product anymore but as a treatment.”Infantile diarrhea can be shortened by about a day from the usual three- to four-day course. That is very important in infants. Probiotics are effective with rotavirus symptoms, with antibiotic-induced diarrhea, in pseudomembranous colitis, and perhaps in radiation-induced diarrhea,” he said.But Dr. Fedorak cautioned that “we don’t know how they work. They appear to strengthen the mucosal barrier of the bowel and improve immune function. And we don’t know which probiotics to use or in what combination.”

 

H. Pylori May Protect Against Diarrheal Disease in Children – (12-14-00)

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H. Pylori May Protect Against Diarrheal Disease in Children

I still remain on the fence about H. pylori. The is too much evidence both pro and con for the presence of this organism. A few questions need to be answered before we indiscriminantly eradicate H. pylori in every patient. Is H. pylori normal flora? How does transmission/infection take place? What percentage of healthy persons have H. pylori and no conditions associated w/ it? Current standard of care is to eradicate whenever found. It may be that in 20 or 30 years we will find that H. pylori protects against some GI cancers and may even act as a sentry for infection from other organisms. We just don’t have enough data yet.

J Infect Dis 2000;182:1446-1449 An inverse relationship has been observed between Helicobacter pylori colonization and diarrheal disease in children. According to the results of a population-based study published in the November issue of the Journal of Infectious Diseases, these findings suggest that H. pylori may protect against gastrointestinal infection. The results of previous studies have suggested that H. pylori infection protects against colonization by other bacteria by inducing the production of immunoglobulin A and secreting its own antibacterial peptides, Dr. Dietrich Rothenbacher, from the University of Ulm, Germany, and colleagues explain. Dr. Rothenbacher’s group points out that “although certain H. pylori strains are associated with increased risk of illnesses…in adult Western populations, it may well be that the benefits of colonization in most carriers outweigh the costs, since only a small proportion of H. pylori carriers develop clinically related diseases during any time during their life.” The investigators believe the findings, if confirmed, “could substantially change management and prevention strategies, especially for children in the developing world, where both diarrheal illnesses and H. pylori are highly prevalent.”