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IBS

Irritable Bowel Syndrome Found to Be Underdiagnosed – (11-23-00)

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Irritable Bowel Syndrome Found to Be Underdiagnosed

Symptoms of IBS have been present for quite a long time, but it seems that national attention to the syndrome has been increasing over the past 2 years. Some may say that that is because there is a new drug out to treat IBS. Of course, it’s not very effective and has caused some deaths…

(article) Patients with irritable bowel syndrome (IBS) have a significantly lower quality of life than patients without IBS, according to researchers at Vanderbilt University Medical Center in Nashville, Tennessee. The research findings were released at the 65th Annual Meeting of the American College of Gastroenterology (ACG) in New York City. The data indicate that primary care physicians underdiagnose IBS. “We were somewhat surprised to learn that of the 94 patients who met the Rome criteria for IBS, only four had been diagnosed by a physician during the past year,” said Dr. Eisen. “This finding may indicate a need for greater diligence on the part of primary care physicians to diagnose these patients and commence appropriate treatment.” These data also imply that gastroenterologists need to educate primary care physicians about both the diagnosis and management of IBS in order to maximize patient satisfaction for these IBS patients. IBS is a common medical disorder usually involving abdominal pain, bloating and constipation, and/or diarrhea in alternating patterns that is diagnosed when a patient has a cluster of symptoms that cannot be attributed to a specific disease for which diagnostic tests exist.

Clinical audit of the effects of low-fibre diet on irritable bowel syndrome – (10-26-00)

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Clinical audit of the effects of low-fibre diet on irritable bowel syndrome

This study shows a benefit of low fibre diets on IBS. However, the authors did not investigate any factors that may increase discomfort from a higher fiber diet. These would include improper digestion and abnormal flora creating increased gas with digestion of carbohydrates. Lowering the fiber in the diet may just allow the patient and doctor to ignore the true cause of the symptoms.

Journal of Human nutrition & Dietetics 13 (4), 249-253 High-fibre diets are frequently advocated for the treatment of irritable bowel syndrome (IBS) although there is little scientific evidence to support this. Experience of patients on low-fibre diets suggests that this may be an effective treatment for IBS, warranting investigation. Seventy-four per cent of questionnaires were returned. A significant improvement (60–100% improvement in overall well-being) was recorded by 49% of patients. This preliminary study suggests that low-fibre diets may be an effective treatment for some IBS patients and justifies further investigation as a full clinical trial.

Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome – (03-10-03)

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Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome.

While antibiotics would not be my treatment of choice, it is wonderful for researchers to begin to focus on abnormal intestinal flora as a contributor to IBS. Unfortunately, antibiotics as a sole approach to treatment is sorely missing the boat. Elimination of pathogenic bacteria, restoration of healthy flora and avoidance of lifestyle factors leading to dysbiosis (alcohol use, refined carbs, saturated fats, low fruits and veggies….) I feel are much better approaches.

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Irritable Bowel Syndrome–A Potentially New Treatment at Last? – (06-28-00)

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Irritable Bowel Syndrome–A Potentially New Treatment at Last?

They need to rephrase the title. The authors mean a new PHARMACEUTICAL treatment, because there have been many ways to treat IBS from a natural medicine standpoint using probiotics and diet as a start.

These studies provide encouraging news that tegaserod, by accelerating orocecal transit and especially colonic transit, may prove to be a benefit in patients with constipation-predominant IBS. It is obvious that further clinical studies on intestinal transit and secretion as well as the overall clinical efficacy of tegaserod in IBS are necessary. Nevertheless, this drug seems to have promise for patients with IBS.

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.

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Classic Presentation of Celiac Disease Is Not Most Common – (11-08-01)

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Classic Presentation of Celiac Disease Is Not Most Common

This interesting portion of this article is that one third of patients in this study were originally identified as having irritable bowel syndrome. Most patients had seen three physicians before the correct diagnosis was made. Celiac disease is an allergy to one of the proteins found in certain grains, principally wheat. The take home message here is that any patient with IBS (and any GI complaints in general) needs to be put on an elimination diet devoid of the common allergens wheat, dairy, corn and soy.

66th Annual Scientific Meeting of the American College of Gastroenterology The classic presentation of celiac disease, severe malabsorption symptoms beginning in childhood, is actually not the most common presentation, according to study findings presented Monday at the 66th Annual Scientific Meeting of the American College of Gastroenterology. Dr. Robert D. Zipser, from Harbor-UCLA Medical Center in Torrance, California, and colleagues surveyed 1032 patients with biopsy-proven celiac disease to determine the most common presentations. The median age at diagnosis was 46 years and 14 patients were over 80 years when first diagnosed, the investigators note. Only 12% of patients were diagnosed before 10 years of age. Most patients had normal weights at diagnosis. While diarrhea was a common initial symptom, a few patients presented with constipation. Anemia, fatigue, flatus, bloating, and abdominal pain were also frequent presentations. Five percent of patients were asymptomatic. Most patients saw three physicians prior to being diagnosed. More than a third of patients were initially diagnosed with irritable bowel syndrome, the investigators report. The median time from initial presentation to biopsy-proven diagnosis was 1 year. However, 19% of patients had symptoms for more than 10 years before being diagnosed. “The goal of the study was to help physicians recognize celiac disease,” says Dr. Zipser. “Physicians often think of it as a rare malabsorptive disease limited to childhood,” he said. “However, the current findings indicate that celiac disease usually presents in adulthood with symptoms mimicking those of irritable bowel syndrome,” he added. While the findings indicate that adult onset is common, Dr. Zipser pointed out that for a small minority of patients the disease was probably missed during childhood. “Many symptoms which are typical of the childhood form are relatively uncommon in the adult form,” Dr. Zipser stated. For example, “weight loss is common in the childhood form, but uncommon in the adult form,” he noted. In fact, he added “some of the patients were actually obese,” he added. While all of the patients in the current study underwent small bowel biopsy, Dr. Zipser noted that it is now quite easy to diagnose celiac disease. “A simple blood test can determine whether antibodies to wheat products are being made,” he explained.