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Irritable Bowel Syndrome Reading Room 

 

Irritable Bowel Syndrome Overview

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Index of Articles

New Study Shows Probiotic Strain Effective In Improving Irritable Bowel Syndrome Symptoms Suffering From The Symptoms Of Irritable Bowel Syndrome? Medical Experts Say Get Tested For Celiac Disease, Now Easier To Diagnose
Irritable Bowel Tied to Fat and Fructose Peppermint oil for irritable bowel syndrome: a critical review and metaanalysis.
Peppermint: Treating I.B.S.With Alternative Therapies
IBS Myths and Misconceptions Irritable Bowel, Pain Syndromes Linked
FDA OKs Constipation Drug for IBS What I need to Know about IBS
Fibromyalgia in patients with irritable bowel syndrome IBS Patients May Benefit From Leaving Certain Foods alone
IBS; Symptoms and Treatments. Fermentation May Be At Root Of Irritable Bowel Syndrome
IBS-specific medications Stress, psychopathology and salivary cortisol levels in IBS
Gut-directed Hypnotherapy for IBS Nerve Receptor Found to Be Key to Intestinal Inflammation
What are colonics? Hypnotherapy for IBS Works for "At Least Five Years"
Common Foods Known to Aggravate IBS. When to test patients with suspected IBS
IBS Medication Information. Increased prevalence of IBS patients with bronchial asthma.
Bacteria May Be the Cause of Irritable Bowel Syndrome Bacteria in Your Gut: Learn How to Keep the Good Kind
Family setting influences irritable bowel syndrome Management of Irritable Bowel Syndrome
IBS: Suffering in Silence Chat transcript -"What Can I eat when I have IBS?"
Inflammatory Bowel Disease and Irritable Bowel Syndrome: Separate or Unified? Menses Heighten IBS Symptoms
Diet may play role in IBS and dyspepsia Link Between Poor Sleep and Irritable Bowel Syndrome
Irritable Bowel Syndrome's Possible Genetic Link Studied by Mayo Clinic Researchers 1-866-IBS-RELIEF and http://www.ibsrelief.org (free educational materials)
Zelnorm available to U.S. patients under restricted access program

Natural Remedies for Irritable Bowel Syndrome

Eastern Medicine Offers Alternative IBS Treatments A Comparative Analysis of Clinical Outcomes in the Refractive IBS Patient vs. the Newly Diagnosed
Salix Initiates Phase 3 For Rifaximin in Non-Constipation Irritable Bowel Syndrome Prescription Medication for Diarrhea Predominant Irritable Bowel Syndrome  Barbara Bradley Bolen, Ph.D.,

 

 

 

 

Irritable Bowel, Pain Syndromes Linked

IBS Patients 60% More Likely to Suffer Fibromyalgia, Migraine, Depression
By Daniel J. DeNoon

Doctors have long suspected a link between irritable bowel syndrome, pain syndromes, and depression. New data now strongly support this theory.

The findings come from data on 97,593 people with irritable bowel syndrome enrolled in a large U.S. health plan from 1996 to 2002. J. Alexander Cole, DSc, MPH, and colleagues at Boston University compared these patients with 27,402 people seeking routine health care.

Their results show that people with irritable bowel syndrome are:

  • 80% more likely to suffer fibromyalgia

  • 60% more likely to suffer migraine

  • 40% more likely to suffer depression

  • Overall, 60% more likely to suffer fibromyalgia, migraine, or depression

  • "Perhaps what is driving the relation between irritable bowel syndrome and these other conditions is some underlying biological disorder," Cole tells WebMD. "Nobody is sure what this could be. But people suggest that there is this constellation of symptoms among people with irritable bowel syndrome, fibromyalgia, migraine, and depression that might present in different ways."

Cole and colleagues report their findings in the Sept. 28 issue of the online journal BMC Gastroenterology.

Common Cause of Pain Syndromes?

Cole, now an epidemiologist with i3 Drug Safety, is not an expert on irritable bowel syndrome. Reza Shaker, MD, is. Shaker, chief of gastroenterology and hepatology at the Medical College of Wisconsin, was not involved in the Cole study.

"Clinical observations of patients with pain syndromes indicate that we are dealing with a syndrome bigger than a single organ," Shaker tells WebMD. "These findings confirm these previous observations."

Shaker says people with irritable bowel syndrome and people with pain syndromes such as fibromyalgia and migraine have something in common. They all have nerve pathways which somehow have become vastly oversensitive to pain signals -- a process doctors call sensitization.

Perhaps, Shaker suggests, there's a common problem at the crossroads where these nerve pathways intersect.

"Is it possible that there is an event -- possibly an early life event -- that affects the crossroads of all these nerve pathways?" he asks. "In areas where these nerves cross, it could be that there is sensitization occurring, affecting different neural circuits."

Cole suggests that different doctors looking at the same underlying illness might make different diagnoses. A gastroenterologist, for example, might diagnose irritable bowel syndrome, while a rheumatologist might diagnose fibromyalgia.

This sounds a lot like the blind men who, on first encountering an elephant, declare it to be like a snake or a tree depending on whether they are touching the elephant's trunk or its leg. Shaker says this analogy is apt. But most doctors, he says, will examine the whole elephant, not just its parts.

"A professional doesn't just focus on one symptom. If we see irritable bowel syndrome along with noncardiac chest pain or fibromyalgia, then we tackle this," he says. "But we doctors need to have a more global picture of this, instead of pigeonholing our diagnosis according to our own specialty or subspecialty."

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New Study Shows Probiotic Strain Effective In Improving Irritable Bowel Syndrome Symptoms

25 Mar 2009   

A new study published in the March issue of Postgraduate Medicine found that a strain of probiotic bacteria, Bacillus coagulans GBI-30, PTA-6086 was effective in relieving abdominal pain and bloating in subjects with irritable bowel syndrome (IBS). As many as 25 percent of the U.S. population suffer from IBS, a condition characterized by a number of uncomfortable digestive symptoms and associated with a severe reduction in quality of life. Although there are two prescription drugs for IBS, doctors are limited as to the solutions they can recommend. The new study adds to the growing body of evidence that certain probiotics can help with IBS and provides hope for IBS sufferers of a new option.

The study found that subjects taking the Bacillus coagulans probiotic strain, trademarked GanedenBC30 and marketed in the over-the-counter product, Digestive Advantage Irritable Bowel Syndrome, experienced statistically significant reductions in abdominal pain and bloating versus baseline at each of the weekly measurements taken throughout the 8-week study. Subjects taking placebo experienced statistically significant reductions in just two of the weekly abdominal pain measurements and saw no statistically significant effect in bloating. "This study helps confirm that Bacillus coagulans is effective in IBS," said Larysa Hun, M.D., author of the 44 subject study. "A combination of Bacillus coagulans, Lactobacillus acidophilus, and Streptococcus thermophilus was previously shown in a clinical trial to significantly improve IBS symptoms, but it was not possible to determine what effect, if any, each strain had by itself."

IBS is associated with impaired quality of life, psychiatric problems, family disruption, impaired workplace performance, unnecessary tests and surgery, high direct and indirect costs, and even death due to IBS medications or interventions. "IBS is the most common functional gastrointestinal disorder (FGID) and represents a tremendous public health problem," noted Nicholas Talley, M.D., Ph.D., of the Mayo Clinic, an expert on IBS and author of a scientific review article about the impact FGIDs have on society.

Two drugs, alosetron and lubiprostone, are FDA-approved only for certain types of IBS: alosetron is for women with severe IBS-related diarrhea only and has serious potential side effects; lubiprostone is only for women with IBS-related constipation. Doctors commonly recommend over-the-counter medications such as laxatives, antidiarrheals, and bulking agents for IBS. But in a recent interview, Talley said, "they don't work well for most people with IBS."

"We know from consumer data that people who try Digestive Advantage Irritable Bowel Syndrome are more likely to become repeat purchasers of the product than people who try 30 other of the most popular brands of digestive products sold in stores," said Marshall Fong, vice president of marketing at Ganeden Biotech, which helped fund the study through a research grant. "This study and our other IBS studies provide scientific data to support what hundreds of thousands of satisfied consumers already tell us with their strong loyalty to our products."

The study adds to the growing amount of evidence suggesting that some probiotics are effective in relieving various IBS symptoms. Some experts would like to see continued research even if they already recommend probiotics to their patients. Maurizio Fava, M.D., a professor and researcher at Harvard and Massachusetts General Hospital, is beginning a placebo-controlled clinical trial to evaluate the efficacy of Ganeden's probiotic in patients with IBS and depression to test the hypothesis that there are common underlying factors beneath the two conditions that may be impacted by taking the Bacillus coagulans strain of probiotics. In describing a pragmatic approach to probiotics and IBS, Fava said, "While more placebo-controlled studies are necessary to determine whether giving probiotics to large populations of people, such as those with IBS, delivers a better benefit-to-cost or benefit-to-risk than doing nothing or resorting to other alternatives, it doesn't mean that individuals shouldn't take them if their doctor recommends them and they provide relief."

About Ganeden Biotech

Founded in 1996, Ganeden Biotech Inc. is a private company based in Cleveland, Ohio, and is the largest seller of over-the-counter probiotics in the U.S. through its Digestive Advantage and Sustenex brands. It also licenses its patented probiotic bacteria, GanedenBC30, for use in commercial food and beverage applications as well as in medical foods and dietary supplements. GanedenBC30 was found to be Generally Recognized As Safe (GRAS) by an independent expert panel assembled to assess its safety in use as a food ingredient. Digestive Advantage and Sustenex are available at over 40,000 retailers nationwide including Walmart, CVS/pharmacy, Walgreens, Rite-Aid, Stop & Shop, Giant, Publix, Kroger, and Target. For more information, visit http://www.digestiveadvantage.com, http://www.sustenex.com, or http://www.ganedenlabs.com.

Ganeden Biotech
http://www.digestiveadvantage.com

Article URL: http://www.medicalnewstoday.com/articles/143524.php

Main News Category: Irritable-Bowel Syndrome

Also Appears In:  Clinical Trials / Drug Trials,  

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Peppermint oil for irritable bowel syndrome: a critical review and metaanalysis.

Pittler MH, Ernst E. Department of Complementary Medicine, Postgraduate Medical School, University of Exeter, United Kingdom.

OBJECTIVE: Peppermint oil is the major constituent of several over-the-counter remedies for symptoms of irritable bowel syndrome (IBS). As the etiology of IBS is not known and treatment is symptomatic, there is a ready market for such products. However, evidence to support their use is sparse. The aim of this study was to review the clinical trials of extracts of peppermint (Mentha X piperita L.) as a symptomatic treatment for IBS. METHODS: Computerized literature searches were performed to identify all randomized controlled trials of peppermint oil for IBS. Databases included Medline, Embase, Biosis, CISCOM, and the Cochrane Library. There were no restrictions on the language of publication. Data were extracted in a standardized, predefined fashion, independently by both authors. Five double blind, randomized, controlled trials were entered into a metaanalysis. RESULTS: Eight randomized, controlled trials were located. Collectively they indicate that peppermint oil could be efficacious for symptom relief in IBS. A metaanalysis of five placebo-controlled, double blind trials seems to support this notion. In view of the methodological flaws associated with most studies, no definitive judgment about efficacy can be given. CONCLUSION: The role of peppermint oil in the symptomatic treatment of IBS has so far not been established beyond reasonable doubt. Well designed and carefully executed studies are needed to clarify the issue.

PMID: 9672344 [PubMed - indexed for MEDLINE]

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Suffering From The Symptoms Of Irritable Bowel Syndrome? Medical Experts
Say Get Tested For Celiac Disease, Now Easier To Diagnose

16 Mar 2009   

Estimates indicate that up to 20 percent of North Americans, possibly as high as 30 per cent in some countries, cope with the painful and debilitating symptoms of irritable bowel syndrome (IBS). According to the American College of Gastroenterology, all patients with symptoms of IBS should be tested for celiac disease, a lifelong hereditary disorder which has some of the same symptoms.

Celiac disease can make IBS symptoms worse. In some cases, it might even be the cause.

There is no cure for IBS. Instead the focus is on a wide variety of treatments to relieve the symptoms, and one of the treatments is a high fibre diet, which includes whole grains and certain cereals. But the only treatment for celiac disease is a gluten free diet for life. Gluten is a protein found in wheat, rye and barley. Because of its sticky characteristics, it can also be found in certain other food products and even in some medications.

At-home Test Kit Now Available

Now there's a simple, accurate way to find out if you're susceptible to celiac disease. For the first time in Canada, Health Canada has approved the Biocard™ Celiac Test Kit, an at-home test that measures gluten antibodies from a fingertip blood sample. The test gives you a high degree of certainty that you are either developing the disease or already have it, but you still need to see your doctor for a confirmation.

What is celiac disease?

Celiac disease occurs when gluten triggers an abnormal response that damages the lining of the small intestine, interfering with your absorption of nutrients. The disease is hereditary and lifelong, and affects people differently. But many of the symptoms of celiac disease are the same for IBS such as diarrhea, bloating and abdominal pain.

Left untreated, celiac disease increases the risk of malnutrition, osteoporosis (because of poor absorption of calcium and vitamin D), infertility, certain digestive cancers and other conditions such as Type 1 diabetes and thyroid disease. Research indicates that in North America, one person out of every 100 has celiac disease, and almost 97 per cent of those affected remain undiagnosed.

Celiac disease affects people differently and not all symptoms are obvious.

Classic celiac symptoms include diarrhea, stomach pain, weight loss and, in children, delayed growth. For others, the symptoms are subtler, such as such as bloating, or excess gas. Fatigue, weakness, joint pain and migraines -- symptoms typically not associated with the gut -- are also reported. Not surprisingly, the diagnosis is often irritable bowel syndrome, anemia, stress or chronic fatigue syndrome.

Average time for correct diagnosis of celiac disease - 12 years: According to a 2007 survey of the Canadian Celiac Association's more than 5000 members, the average time it took to be diagnosed was 12 years. Many reported consulting with three or more doctors before their diagnosis was confirmed.

The Process for Diagnosing Celiac Disease

With the Biocard™ Celiac Test Kit, a person can find out within 10 minutes if they have the antibodies associated with celiac disease. While the test even indicates if the disease is in its early stages, confirming the diagnosis requires a small bowel biopsy in which an endoscope is passed through the mouth into the stomach's upper intestine so that the lining can be examined and a biopsy taken.

The day your diagnosis is confirmed and you start your gluten-free diet, is the day you're on the road to recovery. It could also mark the beginning of your relief from the painful and distressing symptoms common to IBS. Celiac patients on the gluten-free diet with persisting bowel symptoms should seek medical help for other gut-related disorders such as colitis and Crohn's disease.

Information on celiac disease, the Biocard™ Celiac Test Kit, and links to key informational sites can be found at http://www.celiachometest.com. The kit can be purchased online, or at London Drugs, Rexall Pharma Plus, Price Smart, Save on Foods and other major Canadian retail chains.

About 2G Pharma Inc.

Founded by Karina Nelimarkka and Janet Monk, 2G Pharma markets the unique, patient-friendly celiac disease test kit first developed by AniBiotech in Finland. This kit has been redesigned for the Canadian market and is currently the only Health Canada approved point-of-care celiac disease test kit available. Information on celiac disease, the Biocard™ Celiac Test and links to key informational sites can be found at http://www.celiachometest.com.

2G Pharma Inc.

Article URL: http://www.medicalnewstoday.com/articles/142395.php
Main News Category: Irritable-Bowel Syndrome
Also Appears In:  GastroIntestinal / Gastroenterology,  Medical Devices / Diagnostics,

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Peppermint: Mentha x piperita

Peppermint, Mentha Piperita comes from an easily grown herb thought to be a weed in many gardens. Once it takes root it will quickly overtake the best cared for landscape if you don't know what you are doing. There are many forms of peppermint plants, such as cinnamon or chocolate peppermint grown as herbs for tea and salads, for this topic we are refering to plain peppermint, Mentha Piperita.

The oil from the peppermint plant is best known for its role in flavoring gum, tea, breathmints, candy and tea. Perhaps a lesser known fact, is that for generations, peppermint has been used as a treatment for headaches, nausea, diarrhea, flatulence and anxiety thanks to its ability to numb, or calm the body. Antecdotal evidence suggests that it can even help with mentrual symptoms, the common cold and skin conditions. Let's take a closer look at what peppermint oil can do.

Flatulence/Bloating
Peppermint has the ability to relax digestive tract muscles, allowing for pain gas to pass.

Indigestion
Peppermint has the ability to calms stomach muscles. It can also help the body better digest fats due to its ability to stimulate bile production. Indigestion is not the same as GERD, a medically recognized disease, if you have GERD do not use peppermint as a treatment.

Irritable Bowel Syndrome
Available studies show that enteric-coated peppermint capsules can be beneficial when treating IBS symtoms, such as bloating, pain, diarrhea and gas. Studies suggest that over 79% of participants given peppermint experienced pain relief.

Why enteric capsules? Coated capsules stop the release of the oil in the stomach, which can lead to indigestion. Instead, an Enteric capsule will break down in the intestine where it can do the most good without upsetting the stomach.

Plant Description

Peppermint plants grow to about two feet tall. They bloom from July through August, sprouting tiny purple flowers in whorls and terminal spikes. Simple, toothed, and fragrant leaves grow opposite the flowers. Peppermint is native to Europe and Asia, is naturalized to North America, and grows wild in moist, temperate areas. Some varieties are indigenous to South Africa, South America, and Australia.

What's It Made Of?

Peppermint preparations start with the leaves and flowering tops of the plant. These contain a volatile oil, peppermint's primary active component, menthol.

Available Forms

Peppermint tea is prepared from dried leaves of the plant. Such teas are widely available commercially.

Peppermint spirit (tincture) in an alcoholic solution containing 10% peppermint oil and 1% peppermint leaf extract. A tincture can be prepared by adding 1 part peppermint oil to 9 parts pure grain alcohol.

Enteric-coated capsules, which are specially coated to allow the capsule to pass through the stomach and into the intestine (0.2 mL of peppermint oil per capsule)

Creams or ointments (should contain 1% to 16% menthol)

How to Take It

Pediatric

For digestion and upset stomach: 1 to 2 mL peppermint glycerite per day

Adult

Peppermint tea soothes an upset stomach and can aid digestion. It can be prepared using the infusion method of pouring boiling water over the herb and then steeping for 3 to 5 minutes. Use 1 to 2 tsp of dried peppermint leaf to 8 oz of hot water.

  • Irritable bowel syndrome: Take 1 to 2 coated capsules three times per day between meals.
  • Gallstones: Take 1 to 2 enteric-coated capsules three times per day between meals.
  • Itching and skin irritations: Apply menthol, the active ingredient in peppermint, in a cream or ointment form no more than three to four times per day.
  • Tension headaches: Using a tincture of 10% peppermint oil to 90% ethanol, lightly coat the forehead and allow the tincture to evaporate.
  •  

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a practitioner knowledgeable in the field of botanical medicine.

Peppermint tea is generally a safe way to soothe an upset stomach. However, peppermint should not be used by those with gastoesophageal reflux disease (GERD -- a condition in which stomach acids back up into the esophagus) even though some of the symptoms include indigestion and heartburn. This is because peppermint can relax the sphincter between the stomach and esophagus, allowing stomach acids to flow back into the esophagus. (The sphincter is the muscle that separates the esophagus from the stomach.) By relaxing the sphincter, peppermint may actually worsen the symptoms of heartburn and indigestion.

Pregnant or nursing mothers should drink peppermint tea only in moderation and those with a history of miscarriage should not use peppermint at all while pregnant.

Rare negative reactions to enteric-coated peppermint oil capsules may include skin rash, slowed heart rate, and muscle tremors.

Menthol or peppermint oil applied to the skin can cause contact dermatitis or other type of rash, including, possibly hives. Some have described hot flashes from the oil. It should be kept away from the eyes and other mucus membranes and should not be inhaled by or applied to the face of an infant or small child. Peppermint oil should be diluted and taken in very small amounts, since it can cause negative reactions such as those listed above, cramping and diarrhea, as well as, rarely drowsiness, tremor, muscle pain, slowed heart rate, and, in severe cases of overdose, coma. Pure menthol is poisonous and should never be taken internally. It is important not to confuse oil and tincture preparations.

Possible Interactions

5-Fluorouracil for Cancer
In an animal study, topical peppermint oil increased the absorption of 5-fluorouracil, a medication used to treat cancer that was also applied topically. It is too early to draw conclusions about the applicability of these findings to people. Therefore, it would be wise to avoid applying peppermint oil topically when using other topical medications for cancer.

Supporting Research

Abdullah D, Ping QN, Liu G. Enhancing effect of essential oils on the penetration of 5-fluorouracil through rat skin. Yao Hsueh Hsueh Pao . 1996;31(3):214–221.

Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs . Newton, MA: Integrative Medicine Communications; 2000:297-303.

Briggs CJ, Briggs GL. Herbal products in depression therapy. CPJ/RPC. November 1998;40-44.

Brinker F. Herb Contraindications and Drug Interactions . Sandy, Oregon: Eclectic medical Publications. 1998:111, 173-175.

Dew MJ, Evans BK, Rhodes J. Peppermint oil for the irritable bowel syndrome: a multicentre trial. Br J Clin Pract . 1984;(11–12):394, 398.

Gobel H, Schmidt G, Soyka D. Effect of peppermint and eucalyptus oil preparations on neurophysiological and experimental algesimetric headache parameters. Cephalalgia . 1994;14(3):228-234.

Hills J. The mechanism of action of peppermint oil on gastrointestinal smooth muscle. Gastroenterology . 1991;101:55–65.

Kline RM, Kline JJ, Di Palma J, Barbero GJ. Enteric-coated, pH-dependent peppermint oil capsules for the treatment of irritable bowel syndrome in children. J Pediatr . 2001;138(1):125-128.

Koch TR. Peppermint oil and irritable bowel syndrome. Am J Gastroenterol . 1998;93:2304–2305.

Liu JH, Chen GH, Yeh HZ, Huang CK, Poon SK. Enteric-coated peppermint-oil capsules in the treatment of irritable bowel syndrome: a prospective, randomized trial.

J Gastroenterol. 1997;32(6):765-768.

Pittler MH, Ernst E. Peppermint oil for irritable bowel syndrome: a critical review and meta-analysis. Am J Gastroenterol . 1998;93(7):1131–1135.

Pizzorno JE, Murray MT. Textbook of Natural Medicine . New York: Churchill Livingstone; 1999:827-829, 1361-1362, 1558.

Robbers JE, Tyler VE. Herbs of Choice: The Therapeutic Use of Phytomedicinals . New York, NY: The Haworth Herbal Press; 1999: 67-68.

Woolf A. Essential oil poisoning. Clinical Toxicology . 1999;37(6):721-727.

  • Review Date: 4/1/2002
  • Reviewed By: Participants in the review process include: Steven Dentali, PhD (April 1999), Senior Director of Botanical Science, Rexall Sundown, Boca Raton, FL; Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley Hospital, Harvard University and Senior Medical Editor Integrative Medicine, Boston, MA; Gary Kracoff, RPh (Pediatric Dosing section February 2001), Johnson Drugs, Natick, MA; Steven Ottariono, RPh (Pediatric Dosing section February 2001), Veteran's Administrative Hospital, Londonderry, NH; R. Lynn Shumake, PD, Director, Alternative Medicine Apothecary, Blue Mountain Apothecary & Healing Arts, University of Maryland Medical Center, Glenwood, MD; Tom Wolfe, P.AHG (March 1999), Smile Herb Shop, College Park, MD. All interaction sections have also been reviewed by a team of experts including Joseph Lamb, MD (July 2000), The Integrative Medicine Works, Alexandria, VA;Enrico Liva, ND, RPh (August 2000), Vital Nutrients, Middletown, CT; Brian T Sanderoff, PD, BS in Pharmacy (March 2000), Clinical Assistant Professor, University of Maryland School of Pharmacy; President, Your Prescription for Health, Owings Mills, MD; Ira Zunin, MD, MPH, MBA (July 2000), President and Chairman, Hawaii State Consortium for Integrative Medicine, Honolulu, HI.

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IBS Myths and Misconceptions
By Elizabeth Barker Content provided by Revolution Health Group

The more people educate themselves about irritable bowel syndrome (IBS), the better they'll be able to keep the symptoms from taking over their lives.

But many struggling with the syndrome have some serious misconceptions about how it starts and where it might lead, according to research conducted by gastroenterologist Brian E. Lacy, M.D., Ph.D., author of Making Sense of IBS (Johns Hopkins Press, 2006).

Below, we debunk the top 6 IBS myths in order to help you gain better control of your gut health.

Myth 1: IBS isn't a real medical condition.

As many as 70% of people with IBS don't seek medical help often because they're afraid that their doctors won't take the problem seriously. But, as
the American College of Gastroenterology explains, IBS is a very real gastrointestinal (GI) disorder that affects more than 58 million Americans.
It's not life-threatening, but the syndrome is second only to the common cold in causing missed days from work, according to the Food and Drug
Administration (FDA).

Myth 2: It's your food's fault.

Almost half of IBS patients surveyed in Lacy's studies felt that their sickness started with a food allergy and intolerance. "At present, we don't
believe that any foods actually cause IBS," Lacy says. However, he adds, there are a number of foods that many IBS patients may not handle well. Up to half of people with IBS may have fructose intolerance, while about 25% are lactose intolerant. (If dairy products set off your symptoms, consider trying the more easily digestible yogurt. It's loaded with probiotic bacteria that could boost your gut health and stimulate your immune system.)

Too much fiber can result in gas and bloating in some people with IBS, while others find that fiber-rich foods like beans and whole grains help to
relieve constipation. To determine which foods might make your symptoms flare up, keep a food diary and share your findings with your doctor. And since large meals can leave you prone to cramping and diarrhea, try breaking up your daily diet into 5 or 6 small meals.

Myth 3: Stress is the source.

Stress can certainly aggravate IBS, but it's not the culprit of your condition.   "It used to be taught that stress, depression and anxiety cause
IBS, but I don't believe that to be true," Lacy says. Because all 3 problems are known to worsen IBS, Lacy encourages patients to seek treatment that focuses on both their physical and psychological wellness. "Looking into specific triggers-stress at work, stress at home - can help improve symptoms in many people," he says.

To tame everyday stress, the National Institute of Diabetes and Digestive and Kidney Diseases recommends that people with IBS adopt a regular exercise routine, take up yoga or meditation and get plenty of sleep each night. Counseling also can benefit IBS patients, especially those prone to anxiety or depression. Both conditions can intensify your symptoms and  make you feel even more anxious or depressed.

Myth 4: IBS causes colon cancer.

It's a common fear among IBS sufferers, but there's no proof that the syndrome can progress into colon cancer. Although the two share a few
symptoms - diarrhea, constipation and abdominal pain - colon cancer often spurs unexplained weight loss and anemia as well. Colon cancer - the fourth most common cancer for U.S. men and women - can be caught at its earliest and most curable stages through a colonoscopy. In addition to getting screened every 10 years after you turn 50, you can lower your risk by following a low-fat, high-fiber diet.

Myth 5: IBS begets IBD.

Like colon cancer, each of the 2 types of inflammatory bowel disease (IBD) - Crohn's disease and colitis - brings on some of the same belly-centric
symptoms as IBS (such as cramping and diarrhea). "But there's no evidence that IBS can turn into Crohn's disease or ulcerative colitis," Lacy assures. Both marked by inflammation of the intestine, the two IBD forms tend to result in fever, GI bleeding and joint pain (with Crohn's even leading to kidney stones and liver inflammation in some cases).

Myth 6: You're stuck with it.

For about 75% of patients, IBS is a chronic condition. The remaining 25%, however, can eventually reclaim their gut health, Lacy says. "No one really understands what would cause IBS symptoms to resolve," he notes. "But it's quite likely that the enteric (affecting the intestines) nervous system can heal over time."

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Salix Initiates Phase 3 For Rifaximin in Non-Constipation Irritable Bowel Syndrome

IBS Affects Approximately 15% of U.S. Population   IBS U.S. Market Opportunity Exceeds $2 Billion

RALEIGH, N.C. -- Salix Pharmaceuticals, Ltd. (NASDAQ:SLXP) today announced that the Company has initiated patient enrollment in TARGET 1 and TARGET 2, its Phase 3, randomized, double-blind, placebo-controlled, multicenter studies to assess the efficacy and safety of rifaximin 550 mg, dosed three times daily, in the treatment of subjects with non-constipation irritable bowel syndrome (IBS). Two 600-subject trials will be conducted simultaneously in approximately 180 study centers throughout the United States and Canada. Subjects will receive rifaximin or placebo (1:1 randomization) for 14 days and then be followed for 10 weeks for a study duration of 12 weeks.

TARGET 1 and TARGET 2 (T-Targeted, non-systemic; A-Antibiotic; R-Rifaximin; G-Gut-selective; E-Evaluation of; T-Treatment for non-C IBS) are intended to assess the clinical efficacy and safety of a 550 mg TID dosing regimen of rifaximin (1650 mg/day) compared with placebo in subjects with IBS who are not currently experiencing symptoms of constipation, referred to as non-constipation IBS. The primary efficacy endpoint of TARGET 1 and TARGET 2 is the proportion of subjects who achieve adequate relief of IBS symptoms for at least 2 weeks during the first 4 weeks of the 10-week follow-up phase.

Salix previously announced the successful completion and outcome of its Phase 2b trial to assess the efficacy and safety of rifaximin in the treatment of patients with diarrhea-associated irritable bowel syndrome. As reported in a May 20, 2008 press release, top-line results of the 680-patient study demonstrated that a 14-day course of rifaximin at 550 mg twice-a-day provides a statistically significant improvement in both adequate relief of diarrhea-associated IBS symptoms and adequate relief of bloating, compared to placebo. Based upon an analysis of the data from the Phase 2b study, TARGET 1 and TARGET 2 are designed to evaluate rifaximin in a broad population comprised of males and females 18 years of age and older who have been diagnosed with non-constipation IBS, e.g., diarrhea-predominant IBS or alternating IBS.

"Irritable bowel syndrome is the most common functional gastrointestinal disorder experienced in patients and seen by physicians in clinical practice," stated Bill Forbes, Pharm.D., Vice President, Research and Development, Salix. "Primary symptoms of IBS are recurrent abdominal pain, bloating and altered bowel function such as diarrhea. Unfortunately, the cause of IBS is not completely understood. Early investigations for the treatment of IBS focused on a relationship between psychological factors and IBS symptoms. In the 1980s, studies demonstrated that abnormal gut motility was commonly found in patients diagnosed with IBS. More recent research has investigated alterations of bacterial flora in the gut as a potential factor in IBS. To date, the use of antidepressants, serotonin mediators and systemically available antibiotics have not yielded a satisfactory treatment for IBS. Based on the most current understanding of IBS, it is thought that a broad spectrum, gut-selective antibiotic with negligible systemic absorption, minimal side effects and good efficacy for controlling bacterial overgrowth would relieve the symptoms by altering the bacteria responsible for creating the symptoms. Rifaximin, a gut-specific antibiotic, may be a strong candidate for the treatment of IBS by targeting small intestinal bacterial overgrowth. We are very pleased to now initiate these two multicenter trials - TARGET 1 and TARGET 2 - to further evaluate the efficacy of rifaximin as a treatment option in this disease which is associated with widespread prevalence, incapacitating symptoms and substantial medical costs."

About IBS

Among one of the most common chronic conditions, irritable bowel syndrome (IBS) affects approximately 15% of adults in the United States. IBS includes altered bowel habits with abdominal pain and discomfort. Among other contributors, recent science has shown that alterations in gut flora / bacteria have been identified as a potentially important contributor to the pathophysiology of IBS. Small intestinal bacterial overgrowth, a condition associated with excessive numbers of bacteria in the small intestine, may underlie some of the gastrointestinal symptoms associated with IBS.

About Rifaximin

Rifaximin is a gut-selective antibiotic with negligible systemic absorption (<0.4%) and broad-spectrum activity in vitro against both gram-positive and gram-negative pathogens. Rifaximin has a similar tolerability profile to that of placebo.

Rifaximin is under investigation in the United States as a treatment for irritable bowel syndrome. In the United States, the FDA granted marketing clearance for rifaximin tablets 200 mg (trade name: XIFAXAN([R])) indicated for the treatment of patients (12 years of age) with travelers' diarrhea caused by noninvasive strains of Escherichia coli. XIFAXAN should not be used in patients with diarrhea complicated by fever or blood in the stool or diarrhea due to pathogens other than Escherichia coli. XIFAXAN should be discontinued if diarrhea symptoms get worse or persist more than 24-48 hours and alternative antibiotic therapy should be considered. In clinical trials, XIFAXAN was generally well tolerated. The most common side effects (vs. placebo) were flatulence 11.3% (versus 19.7%), headache 9.7% (versus 9.2%), abdominal pain 7.2% (versus 10.1 %) and rectal tenesmus 7.2% (versus 8.8%).

Rifaximin has been used in Italy for 23 years and is approved in 27 countries. Salix acquired rights to market rifaximin in North America from Alfa Wassermann S.p.A. in Bologna, Italy. Alfa Wassermann markets rifaximin in Italy under the trade name Normix([R]).

About Salix

Salix Pharmaceuticals, Ltd., headquartered in Raleigh, North Carolina, develops and markets prescription pharmaceutical products for the treatment of gastrointestinal diseases. Salix's strategy is to in-license late-stage or marketed proprietary therapeutic drugs, complete any required development and regulatory submission of these products, and market them through the Company's gastroenterology specialty sales and marketing team.

Salix markets COLAZAL([R]) (balsalazide disodium) Capsules 750 mg, XIFAXAN([R]) (rifaximin) tablets 200 mg , OSMOPREP([R]) (sodium phosphate monobasic monohydrate, USP and sodium phosphate dibasic anhydrous, USP) Tablets, MOVIPREP([R]) (PEG 3350, Sodium Sulfate, Sodium Chloride, Potassium Chloride, Sodium Ascorbate and Ascorbic Acid for Oral Solution), VISICOL([R]) (sodium phosphate monobasic monohydrate, USP, and sodium phosphate dibasic anhydrous, USP) Tablets, PEPCID([R])(famotidine) for Oral Suspension, Oral Suspension DIURIL([R])(Chlorothiazide), AZASAN([R]) Azathioprine Tablets, USP, 75/100 mg , ANUSOL-HC([R]) 2.5% (Hydrocortisone Cream, USP), ANUSOL-HC([R]) 25 mg Suppository (Hydrocortisone Acetate), PROCTOCORT([R]) Cream (Hydrocortisone Cream, USP) 1% and PROCTOCORT([R]) Suppository (Hydrocortisone Acetate Rectal Suppositories) 30 mg. Vapreotide acetate, metoclopramide-ZYDIS([R]), balsalazide tablet, granulated mesalamine and rifaximin for additional indications are under development.

For full prescribing information on Salix products, please visit www.salix.com or contact the Company at 919 862-1000.

Salix trades on the NASDAQ Global Select Market under the ticker symbol "SLXP."

For more information please visit our web site at www.salix.com . Information on our web site is not incorporated in our SEC filings.

Please Note: The materials provided herein contain projections and other forward-looking statements regarding future events. Such statements are just predictions and are subject to risks and uncertainties that could cause the actual events or results to differ materially. These risks and uncertainties include, among others: clinical trials and other development activities involving pharmaceutical products; the high cost and uncertainty of the research, the unpredictability of the duration and results of regulatory review of New Drug Applications and Investigational NDAs; our need to return to profitability; market acceptance for approved products; the need to acquire new products; generic and other competition and the possible impairment of, or inability to obtain, intellectual property rights and the costs of obtaining such rights from third parties. The reader is referred to the documents that the Company files from time to time with the Securities and Exchange Commission,

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Treating I.B.S.With Alternative Therapies

There are many medical and alternative treatments available for irritable bowel syndrome, but one of the best steps you can take to help yourself is dietary and lifestyle changes.

~ According to recent studies, sixty percent of IBS sufferers reported relief from symptoms after trying hypnosis..
~ Two-thirds of IBS sufferers who utilized stress management courses reported a decrease in symptoms.
~ Studies have shown that over fifty-percent of sufferers who tried a lactose-free diet reported symptom relief. (Dairy)
~ One small study shows that IBS sufferers reported decreased bloating and a sense of well-being after acupuncture.
~ Antidotal evidence suggests IBS sufferers have found symptom relief by eliminating meat from their diet.
~ Antidotal evidence suggests symptom relief can be achieved by using biofeedback.
~ A recent study shows that seventy percent of participants found relief with the use of enteric-coated peppermint oil capsules.
~ Some believe that a colonic cleansing in the form of a plain water enema once a week is helpful.

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Natural Remedies for Irritable Bowel Syndrome (IBS)

  • Peppermint Oil

    Peppermint oil is widely used for irritable bowel syndrome. It is thought to reduce the abdominal pain and bloating of irritable bowel syndrome, possibly by blocking the movement of calcium into muscle cells in the intestines and easing excessive muscle contraction there. Peppermint is considered a carminative herb, which means that it is used to eliminate excess gas in the intestines.

    Eight out of twelve studies on peppermint for irritable bowel syndrome have found that it is more effective than a placebo.

    Although peppermint oil is available in many forms, it should only be used in enteric-coated capsules otherwise the oil can relax the lower esophageal sphincter and cause heartburn.

    Peppermint oil, especially in excessive doses, may result in nausea, loss of appetite, heart problems, nervous system disorders, and lead to kidney failure and even death.

    Peppermint oil should not be taken internally by children or pregnant or nursing women. Peppermint oil may interact with the drug cyclosporine (used to prevent organ transplant rejection and for rheumatoid arthritis and psoriasis), so they should not be combined unless under medical supervision. To read more about peppermint oil, go to my Peppermint Oil Fact Sheet1

  • Probiotics

    Probiotics are live microbial organisms that are naturally present in the digestive tract and vagina. Sometimes referred to as "friendly" bacteria, probiotics are thought to promote health include suppressing the growth of potentially harmful bacteria, improving immune function, enhancing the protective barrier of the digestive tract, and helping to produce vitamin K.

    There are over 400 species of microorganisms in the human digestive tract and the balance between beneficial bacteria and potentially harmful bacteria is important. One theory is that people with irritable bowel syndrome may have an imbalance in their normal intestinal bacteria, with an overgrowth of gas-producing bacteria.

    Studies have found that probiotics may be helpful for people with irritable bowel syndrome. For example, a fairly large study published in the American Journal of Gastroenterology examined the use of three different doses of Bifidobacterium infantis or a placebo in 362 women with irritable bowel syndrome. After four weeks, the B. infantis dose of 1 x 10(8) c.f.u. was found to be more effective than a placebo at reducing abdominal pain, bloating, bowel dysfunction, incomplete evacuation, straining, and gas.

    There are many different probiotic strains, and some may be more effective for irritable bowel syndrome. Another study compared lactobacillus salivarius, bifidobacterium infantis, or a placebo in 77 people with irritable bowel syndrome. Only people who took B. infantis had a greater reduction in abdominal pain, bloating, and bowel movement difficulty. For more information on probiotics, read my Probiotics Fact Sheet2.

  • Partially Hydrolyzed Guar Gum

    Partially hydrolyzed guar gum (PHGG) is a water soluble, non-gelling fiber that may help to reduce constipation and to a lesser extent diarrhea and abdominal pain in people with irritable bowel syndrome. PHGG also appears to increase the amount of beneficial bacteria, lactobacilli and bifidobacteria in the intestines.

    One study compared PHGG (5 grams per day), wheat bran (30 grams per day), and a placebo in 199 people with irritable bowel syndrome. After 12 weeks, both the PHGG and wheat bran resulted in an improvement in absominal pain and bowel habits, but the PHGG was better tolerated and preferred.

  • Food Intolerances

    Food intolerances may play a role in irritable bowel syndrome, possibly by triggering immune responses in the gut, leading to low-grade inflammation and an imbalance of intestinal bacteria.

    The most common food intolerances reported by people with irritable bowel syndrome are dairy and grains.

    A trained practitioner can supervise an elimination and challenge diet. Many foods are removed from the diet for a brief period of time, then re-introduced sequentially to isolate the body's reaction to the offending foods. Since grains are a common culprit, it is important to remember that carbohydrate digestion begins in the mouth and that chewing grains thoroughly allows amylase, the digestive enzyme present in saliva, to digest the grains.

  • Other Natural Remedies for Irritable Bowel Syndrome

    Pancreatic enzymes have been suggested for irritable bowel syndrome symptoms that are aggravated after a fatty meal.

    Hypnosis, or hypnotherapy, has also been used for irritable bowel syndrome. Sources
    Atkinson W, Sheldon TA, Shaath N, Whorwell PJ. Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial. Gut. 53.10 (2004): 1459-1464.

    Bausserman M, Michail S. The use of Lactobacillus GG in irritable bowel syndrome in children: a double-blind randomized control trial. J Pediatr. 147.2 (2005): 197-201.

    Drisko J, Bischoff B, Hall M, McCallum R. Treating irritable bowel syndrome with a food elimination diet followed by food challenge and probiotics. J Am Coll Nutr. 25.6 (2006): 514-522.

    Giannini EG, Mansi C, Dulbecco P, Savarino V. Role of partially hydrolyzed guar gum in the treatment of irritable bowel syndrome. Nutrition. 22.3 (2006): 334-342.

    Jun DW, Lee OY, Yoon HJ, Lee SH, Lee HL, Choi HS, Yoon BC, Lee MH, Lee DH, Cho SH. Food intolerance and skin prick test in treated and untreated irritable bowel syndrome. World J Gastroenterol. 12.15 (2006): 2382-2387.

    Lim B, Manheimer E, Lao L, Ziea E, Wisniewski J, Liu J, Berman B. Acupuncture for treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD005111.

    Miller V, Lea R, Agrawal A, Whorwell PJ. Bran and irritable bowel syndrome: the primary-care perspective. Dig Liver Dis. 38.10 (2006): 737-740.

    Niv E, Naftali T, Hallak R, Vaisman N. The efficacy of Lactobacillus reuteri ATCC 55730 in the treatment of patients with irritable bowel syndrome--a double blind, placebo-controlled, randomized study. Clin Nutr. 24.6 (2005): 925-931.

    O'Mahony L, McCarthy J, Kelly P, Hurley G, Luo F, Chen K, O'Sullivan GC, Kiely B, Collins JK, Shanahan F, Quigley EM. Lactobacillus and bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles. Gastroenterology. 128.3 (2005): 541-551.

    Parisi GC, Zilli M, Miani MP, Carrara M, Bottona E, Verdianelli G, Battaglia G, Desideri S, Faedo A, Marzolino C, Tonon A, Ermani M, Leandro G. High-fiber diet supplementation in patients with irritable bowel syndrome (IBS): a multicenter, randomized, open trial comparison between wheat bran diet and partially hydrolyzed guar gum (PHGG). Dig Dis Sci. 47.8 (2002): 1697-1704.

    Whorwell PJ, Altringer L, Morel J, Bond Y, Charbonneau D, O'Mahony L, Kiely B, Shanahan F, Quigley EM. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol. 101.7 (2006): 1581-1590.

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Eastern Medicine Offers Alternative IBS Treatments
Kelli M. Donley

There is nothing conventional about irritable bowel syndrome (IBS). For some patients, this mysterious ailment means diarrhea, while for others constipation.

Additional symptoms include gas, bloating and stomach cramps. Traditional treatments are understandably varied considering the inconsistency of the illness. Behavioral options include high fiber diets, limiting alcohol and caffeine consumption, regular exercise and some form of stress relief (yoga, meditation). Pharmaceutical treatments include the recently approved Zelnorm, for female patients suffering from constipation, and Lotronex, approved (on a special circumstance basis) for women suffering from diarrhea.

However, no pharmaceutical on the market provides relief for all IBS patients. In lieu of a chemical solution, many patients are turning to alternative methods of treatment to find relief from their nagging symptoms.

CHINESE MEDICINE

There are eight branches of Chinese medicine; each emphasize balancing a person's chi, or energy, in relation to their three realms: heaven, human and earth. These branches include: herbal therapy, acupuncture, diet, massage, exercise, mediation, cosmology and feng shui.

1According to traditional Chinese medicine, IBS is the product of an infection of heat and dampness of the gastrointestinal system. The head and dampness may be caused from external sources (weather) or internal sources (eating improper food).

2A study published in the Journal of the American Medical Association in 1998 followed 116 patients who were suffering from IBS. Participants were divided into three treatment groups: individualized Chinese herbal formulations, standard Chinese herbal formulations or a placebo. The results of the double-blind placebo-controlled trial found patients being actively treated saw significant improvement in their bowel condition. Herbal treatments tailored to the patient were no more effective than the standard treatment. Researchers concluded Chinese herbal formulations improved the conditions of IBS patients.

3Acupuncture has long been used in Eastern cultures as a method of treating a variety of ailments. There are some 2,000 acupuncture points where needles can reportedly stimulate and regulate the flow of chi. Acupuncture is a method of keeping yin, the soft and feminine qualities, in balance with yang, the dark and masculine qualities.

Pam Marsh, an IBS patient in Golden, Colo., turned to acupuncture after suffering for many years.

"My internist referred me to an acupuncturist for treatment," she says. "He had seen good results with other patients with IBS and Crohn's symptoms."

Marsh receives treatment in a healthcare center that offers both Eastern and Western medicine.

"The process takes about an hour," she describes. "The acupuncturist first takes my pulse and other readings. He sometimes checks my tongue, puts pressure on certain points, etc. I lie on my back on a massage table and needles are applied. Usually the needles are left in for 20 to 30 minutes. They are placed in a variety of places: toes, foot, stomach, hands and wrist. It never hurts, but will sometimes create a burning sensation for the first couple of seconds. Breathing deeply and slowly helps reduce the sensation. Afterward, I feel a bit spacey for a half an hour or so. If I have symptoms or discomfort before a session, I most likely leave feeling much better."

Marsh says she is using this alternative treatment, along with behavioral changes, to improve the illness she has been suffering from for 20 years.

"I have used various medicines," she says, "but I have also made changes to my diet and keep to a daily exercise program."

She says while initially hesitant to trust treatment outside of the Western methodology, she recommends the procedure to others.

"I am a believer," she says. "I have been able to go off of the over-the-counter and prescriptive drugs with the acupuncture treatments. I was raised with traditional Western medicine beliefs, with my father being a pharmacist. So it was a stretch for me to trust this Eastern medicine. I believe acupuncture can help with a variety of problems. I recently had damage to the trigeminal nerve and have found relief through acupuncture. Like any other medical practice, however, I think you need to search out acupuncturists who are well-respected and recommended in the community."

OVERLAPPING IDEAS

Although Western and Eastern medical ideologies seem distinctly different, there are several treatment options both trains of thought agree on. Diet, exercise and finding a method of stress relief, possibly meditation, are three behavioral methods of treatment for IBS urged by both ideologies.

Changing a person's diet for IBS is also a conundrum based on symptoms. Flax seed is often recommended as a natural laxative for those suffering from IBS-related constipation. Chinese herbs for treating constipation include: aquilaria root, white atractylodes rhizome, szechuan pepper fruit, melia fruit, codonopsis root, torreya seeds, poria, rubia, licorice root, dried ginger, myrobalan fruit, omphalia gruiting body, nutme seed and more.

Patients suffering from diarrhea related to IBS may be advised to stay away from dairy products.

Additionally, limiting alcohol, caffeine and nicotine are recommended for all patients. Drinking at least eight glasses of water daily can also help alleviate some symptoms.

Exercise and finding a method to relieve stress are also important behavioral changes that should be made by IBS patients. Ideally, patients should try to exercise 60 minutes daily, per the new Institute of Medicine guidelines.

Methods of meditation and stress relief include: yoga, stretching, Pilates, qui gong, tai chi, other martial arts, journaling, daydreaming, walking, hiking, etc. Meditation requires mindful concentration. While a spiritual practice for some, today the practice can be applied to nearly any activity that requires focus.

Herbert Benson, MD, was one of the first Western physicians to write about the health benefits of meditation. The first article published on the topic was written by Benson in 1970 in the Journal of Transpersonal Psychology. The Harvard researcher wrote mediation could reduce heart rate, respiratory rate, blood pressure, oxygen consumption and muscle tension.5

FINDING AN ACUPUNCTURIST

The National Certification Commission for Acupuncture and Oriental Medicine has a list of acupuncturists nationally. They also have certification information for those interested in studying the practice.

NCCAOM: (703) 548-9004 www.acupuncture.com

The American Academy of Medical Acupuncture can recommend an acupuncturist who is also a physician.

AAMA: (323) 937-5514 www.medicalacupuncture.org6

With a vague cloud hanging over IBS research and treatment options, it is important to have information about other medical ideologies that may provide relief for your patients

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A Comparative Analysis of Clinical Outcomes in the Refractive IBS Patient vs. the Newly Diagnosed

By Michael Mahoney Clinical Hypnotherapist
07 February 2007  

A Comparative Analysis of Clinical Outcomes in the Refractive IBS Patient vs. the Newly Diagnosed

The successful use of clinical hypnotherapy (CHT) for the treatment of patients with irritable bowel syndrome has been established in at least 14 published studies (1) (2) where it has been shown to produce significant reduction in the cardinal IBS symptoms and associated symptoms such as anxiety. The success of this treatment method in the clinical setting is contingent upon the protocol being gut-directed or gut-specific, i.e. directly addressing the digestive tract, balancing the dismotility and restoring its proper function while allowing the patient to take part in their own healing. Sufferers who consider hypnotherapy currently tend to do so as a 'last resort' rather than a first approach after diagnosis.

In treating IBS patients since 1991, I recognised a consistent trend in therapy outcomes and decided to investigate this further with an informal observational study. From September 2003 to January 2005, I assigned 40 patients with the same primary IBS diagnostic criteria into two groups.

The first group consisted of 20 IBS patients of long-standing, termed as refractory where no previous medical interventions provided relief.   Age ranges for this group was 27 years to 66 years; average age was 42.2 years; comprised of 10 males average age 38.7 years, 10 females average age 45.6 years.

The second group included 20 newly diagnosed IBS patients with ages ranging from (24 years) to (64 years); average age (40.1 years), there were (10) males average age 40.2 years and (10) females average age 40.1years.

The newly diagnosed patients had no prior IBS treatment intervention upon their arrival to me, however, they may have presented with symptoms for varying degrees of time.

The clinical protocol (3) consisted of an initial intake consultation session, where the IBS patient discusses symptoms and concerns.

A life-style, QOL and symptom questionnaire was also completed at this time, and again upon therapy completion to assess improvement rating.

The intake session was followed by an introductory session, where the patient was apprised of the method of CHT and assurances were given. Following that, five gut-specific sessions were presented to the patient dealing with:
1)  Building a foundation of self-esteem, relaxation and familiarity with the technique,
2) IBS and related symptoms, balancing of the digestive motility, the brain-gut connection,
3) pain, discomfort, bloating issues,
4) assurance that the patient always has control over their own healing and
5) reinforcement of previous sessions and resolution.

Standard treatment would allow for patients being seen five times over a 12 - 14 week period and all participants received a recording of each session which was listened to according to a specific schedule.

Psychological State and QOL of IBS Patient Prior to receiving CHT.

The intake information of the Refractory IBS Patient presented with two findings:

1. Higher Failure Expectation after years of frustration and unsuccessful treatment resolution.
2. Patients presented with more co-morbid emotional, psychological and physical symptomology and poor QOL, in addition to "basic" IBS symptoms. (4) This finding led me to believe that in many cases, if IBS is not initially treated on the psychological level, the condition usually escalates into a multi-faceted condition.

The intake information for the Newly Diagnosed presented with two findings:

1. Less expectation for either failure or success for therapy outcome.
2. General absence of comorbid psychological, emotional and additional physical symptomology.

Outcome of CHT treatment
Improvement levels for both patient groups were within the same symptom reduction range – with an average of 90% symptom reduction overall for 20 IBS and related symptoms listed.

However, refractory IBS patients who had received other forms of treatment first, had a longer recovery and symptom reduction time frame. It was found that for these patients, the time required to move forward to the next session became extended by an average of 1 to 3 weeks (or more in some cases) depending upon severity and longevity of symptoms and the resultant psychological issues. This group's confidence and self esteem was very low, and their ability to see things in perspective was significantly reduced. When talking about the psychological elements most of these patients wept. After sometimes years of pain and discomfort, and the following of unsuccessful treatment options it was clear this group of sufferers had become emotionally drained. Having presented with, for example, such symptoms as diarrhoea, 3 or more times a day, often uncontrollable and explosive for years, it was therefore not surprising that such patients presented with anxiety or various levels of depression.

Before these sufferers could even begin to work through the IBS, the hypnotherapy sessions first provided a strong emotional base that increased self-esteem, confidence, and allowed the sufferer to begin a journey of self improvement and management, and thereby equip themselves emotionally to move away from the symptoms and the familiarity of IBS thoughts and commence recovery initially at the emotional level.

The newly diagnosed group who received CHT as a first line of treatment showed a much quicker response towards their improvement in IBS symptoms, and did not require extensions in the standard protocol time frame.

It was my observation that early intervention with CHT may reduce or eliminate the multi-faceted component of IBS, thus leading to earlier/less prolonged symptom reduction. My findings appeared to confirm this trend that was observed early on. Since the subconscious mind does not have to deal with non-present comorbid complaints with the majority of newly diagnosed patients, the IBS symptoms are dealt with initially and directly and resolved more quickly. For the refractory patient, internal and emotional energies relegated to coping with the long-standing burden of IBS usually must first be dealt with by the subconscious before IBS issues can be addressed.

Implications and Conclusion
A negative aspect in all this is that in determining if CHT for IBS should be considered as a first line of treatment, it should be noted if the patient may have underlying "true" clinical psychological conditions that may become masked by the IBS related issues, and which will still need to be addressed directly.  As assessment tools, the QOL intake session may provide an insight to this, as a pattern for onset of symptoms and onset of emotional trends may be correlated: simply put – the co-morbid psychological condition may be secondary to the ongoing, long-standing IBS. Another potential negative perspective is the availability of a trained clinical hypnotherapist whom the physician may refer the newly diagnosed patient to at the outset of diagnosis when indicated.  However, for the primary IBS patient, this observation is promising.

This bears out a real look at providing CHT concurrently as a complementary therapy as a first line of treatment upon initial IBS diagnosis, and may prove to be a good defense in treating the whole person as the method has shown to improve the IBS symptom reduction rate, and may curtail or even eliminate possible further decline in QOL and psychological issues. (4)

So what does this tell us?
Further studies using clinical hypnotherapy initially alongside traditional medical interventions (medication) may prove helpful in considering the holistic nature of the condition and its optimal treatment.   Can the experiences of the refractory IBS patient who may endure the emotional burdens of hopelessness, (5) treatment resolution frustration, elevated stress and anxiety levels secondary to IBS, negativity, reduced QOL, and other multiple areas of suffering be alleviated or even eliminated if a psychological approach such as CHT be administered in conjunction with conventional treatment recommendations upon the initial diagnosis of IBS? It is the finding of this practice that this can be achieved when hypnotherapy is delivered professionally, however further investigation should be encouraged.

Reference List
1. Tan G, Hammond DC, Joseph G. Hypnosis and irritable bowel syndrome: a review of efficacy and mechanism of action.  Am J Clin Hypn. 2005 Jan;47(3):161-78.

2. Hauser W. Medizinische Klinik I, Klinikum Saarbrucken gGmbH, Saarbrucken. Hypnosis in Gastroenterology.   Z Gastroenterol 2003 May;41 5:405-12  PMID: 12772053 

3. In 1996 Mahoney was invited to participate in a medical research study funded by the UK National Health Service which was monitored and audited by the local Health Authority Audit Commission.  Medical centre GPs and hospital gastroenterologists screened 20 IBS patients: all were long-term sufferers, had undergone all medical diagnostic tests, and had taken prescription medications without attaining significant relief from their symptoms. Each patient underwent Mahoney's original protocol of the introductory and five subsequent hypnotherapy sessions.  At the end of the project, feedback sheets from the patients indicated an overall reduction of 80% in symptom severity and frequency of presentation.    In 1997, Mahoney developed new processes for IBS clinical protocol. Patients were monitored using audio tapes both during the program and for the next three subsequent years: 1998 through 2001. The final results of this study are intended for independent publication so that they may be subject to peer review and analysis. Success rates were close to or exceeding 90% for all symptoms and patients.

4. Spiegel BM, Gralnek IM, Bolus R, Chang L, Dulai GS, Mayer EA, Naliboff B. Clinical determinants of health-related quality of life in patients with irritable bowel syndrome.  Arch Intern Med. 2004 Sep 13;164(16):1773-80.

5.Miller V, Hopkins L, Whorwell PJ. Suicidal ideation in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2004 Dec;2(12):1064-8.

6. Pinto C, Lele MV, Joglekar AS, Panwar VS, Dhavale HS. Stressful life-events, anxiety, depression and coping in patients of irritable bowel syndrome.  J Assoc Physicians India. 2000 Jun;48(6):589-93.

7. Whitehead WE, Crowell MD. Psychologic considerations in the irritable bowel syndrome. Gastroenterol Clin North Am. 1991 Jun;20(2):249-67.

8. Lackner JM, Quigley BM. Pain catastrophizing mediates the relationship between worry and pain suffering in patients with irritable bowel syndrome. Behav Res Ther. 2005 Jul;43(7):943-57. Epub  2004 Sep 25.

9. Spiller RC. Potential future therapies for irritable bowel syndrome: will disease modifying therapy as opposed to symptomatic control become a reality? Gastroenterol Clin North Am. 2005 Jun;34(2):337-54.

10. Palsson OS, Drossman DA. Psychiatric and psychological dysfunction in irritable bowel syndrome and the role of psychological treatments. Gastroenterol Clin North Am. 2005 Jun;34(2):281-303.
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Author: Michael Mahoney Clinical Hypnotherapist

Michael Mahoney is a member of various primay care societies, the Hypnotherapy Association, The British Council of Hypnotist Examiners, as well as the International Foundation for Functional Gastrointestinal Disorders, the European Association for Cancer Education and the International Functional Brain-Gut Research Group.
Serves patients through NHS, non-NHS and BUPA
He has research and patient trials experience showing success rates of 85% - 95% IBS symptom reduction using his Ongoing Progressive Session Induction Method (OPSIM).
In 2005 he was awarded the Innovation and Research award for his work with IBS patients.  In 2003 he was named first in the Independent on Sunday ‘Top Brass Section’ of leading hypnotherapists in the UK.
His hypnotherapy practice sponsored the UK’s first IBS Awareness evening at Liverpool University in 1997

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Alternative Treatments for Irritable Bowel Syndrome

Alternative treatments such as acupuncture, dietary supplements, and herbs don't always get the official scientific nod, but some patients turn to them for help with irritable bowel syndrome (IBS).

Acupuncture for IBS

Acupuncture is a popular alternative therapy for IBS and other conditions. It's proven effective for treating chronic pain, according to researchers at the National Institutes of Health (NIH). However, the studies are mixed on whether the treatments really work for IBS.

Some studies show that acupuncture helps with abdominal pain and other IBS symptoms. Other studies show that it doesn't help.

Philip Schoenfeld, MD, MSEd, MSc, investigated various IBS treatments when he co-authored the treatment guidelines published by the American College of Gastroenterology. He says the hard data showing acupuncture's effectiveness isn't very good. Yet "that does not mean that acupuncture might not be helpful," he says. Many individuals say they feel better after acupuncture. Out of all alternative options, he suspects that acupuncture may help some people with IBS.

It is not entirely clear how this traditional Chinese treatment works. Some researchers believe the acupuncture needles stimulate electromagnetic signals in the body. These signals are thought to either encourage the release of pain-killing chemicals, or nudge the body's natural healing systems into action.

Acupuncture is ideally used with other treatments, says Jeanine Blackman, MD, PhD, medical director of the University of Maryland Center for Integrative Medicine. She says even in China, the therapy is never used on its own. Talk with your doctor if you are considering acupuncture.

Oils and Supplements for IBS

To help her IBS patients, Blackman recommends a combination of treatments, including changes in diet, stress reduction, and supplements such as evening primrose oil, borage oil, fish oil, or probiotics. She says the oil supplements help calm down the gut, and probiotics restore the good balance of bacteria in the digestive system.

Evening primrose oil comes from the seed of a small yellow wildflower, and borage oil comes from the seed of a common weed. Both supplements are similar in nature. Some proponents say evening primrose oil can help improve IBS symptoms, especially in women who experience a worsening of pain, discomfort, and bloating during their menstrual period. But claims about evening primrose oil are largely unproven, reports the University of California at Berkeley Wellness Guide to Dietary Supplements. Plus, side effects reportedly include stomach upset, headaches, and rashes.

Fish oil supplements have been examined along with fish for a number of benefits, including preventing heart disease and easing autoimmune disorders. There doesn't appear to be any scientific proof, however, that they work for IBS.

Herbs for IBS

Herbs are also popular options for people with IBS. Peppermint is used to calm muscles in the colon, which may cause some of the diarrhea and abdominal discomfort suffered by people with IBS. Studies have been mixed with this herb. The Mayo Clinic advises anyone who'd like to try it to get the enteric-coated capsules, and to be aware that it may make heartburn worse.

Registered herbalists never use peppermint on its own, nor do they recommend it for an extended period of time, says Jonathan Gilbert, who has a diplomate in herbology and acupuncture from the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). He is a senior consultant for traditional oriental medicine at the Center for Integrative Medicine at the University of Maryland.

For people who are interested in true herbal therapy, Gilbert recommends a visit to an herbalist who has comprehensive training and is certified by the NCCAOM.

"In order to get a solution to a complex disorder, you need a complex formula, and in order to get that, you need to see someone who can actually prepare it," says Gilbert, noting he could combine up to 30 to 40 herbs for one formula. He says classic Chinese medicine has thousands of preset formulas for different ailments.

A lot of these formulas can't be bought on store shelves, adds Gilbert.

If you are interested in herbal therapy, dietary supplements, acupuncture, or any other treatment for your IBS, make sure you talk with your doctor. Herbs may interact with other medications you may be taking. Dietary supplements may become toxic if not used properly. Your doctor can also advise you on medicines for IBS with constipation and IBS with diarrhea.

Probiotics for IBS

On the other hand, there's some evidence that taking probiotics help IBS sufferers. Probiotics are bacteria that naturally live in the gut. Some people believe that several intestinal disorders may arise when there isn't enough good bacteria in the gut.

One study found that probiotic treatment significantly improved IBS symptoms and quality of life. In the study, researchers primarily used the bacteria Lactobacillus acidophilus and Bifidobacteria infantis. People with IBS reported fewer symptoms and, in general, a higher quality of life after taking the probiotics for four weeks.

Just as significant, the probiotic therapy did not appear to cause side effects, according to the study's author, Stephen M. Faber, MD, from Albemarle Gastroenterology Associates, PC, in Elizabeth City, North Carolina.

"These are organisms that are supposed to be in the gut. The body knows how to control them," Farber told WebMD.

Therapy and Hypnosis for IBS

Researchers have found that focusing the mind with hypnotherapy can improve the emotional and physical symptoms in those with IBS.

In one study, 20 men and 55 women received between five and seven half-hour hypnotherapy sessions over a three-month period. Afterwards, patients reported a 30% improvement in emotional quality of life and a 16% increase in overall physical health.

Two other studies conducted by one researcher included 135 people with IBS. The study participants who received 12 weekly one-hour hypnotherapy sessions focusing on their troubles with IBS showed a 52% improvement in their physical symptoms. Improvements were also maintained when researchers checked in with participants six months after the end of the study.

Cognitive behavior therapy (CBT) trains people to identify and change inaccurate perceptions they may have of themselves and the world around them. It's also been used to help IBS patients ease symptoms and improve quality of life.

Researchers gave a group of IBS patients up to 10 weekly sessions of CBT in one study. The sessions covered information on IBS, muscle relaxation training, development of a flexible set of problem-solving skills related to IBS, and ways to curb worries about the illness. Results showed that 60% to 75% of participants had improvement in their symptoms.

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FDA OKs Constipation Drug for IBS

FDA Approves Amitiza for Use in Women With Irritable Bowel Syndrome With Constipation By Miranda Hitti Reviewed by Louise Chang, MD

April 30, 2008 -- The FDA has approved the use of the constipation drug Amitiza to treat irritable bowel syndrome with constipation (IBS-C) in women aged 18 and older.

Amitiza is the first FDA-approved prescription drug therapy for IBS-C. But it isn't a new drug. The FDA approved Amitiza in 2006 to treat chronic constipation in adults. The Amitiza dose used to treat IBS-C is lower than the dose used to treat chronic constipation.

Irritable bowel syndrome is a disorder characterized by cramping, abdominal pain, bloating, constipation, and diarrhea. IBS causes a great deal of discomfort and distress to its sufferers, and it affects at least twice as many women as men. 

Amitiza works by increasing the secretion of intestinal fluid, which helps ease stool passage and constipation symptoms.

"For some people, IBS can be quite disabling, making it difficult for them to fully participate in everyday activities," Julie Beitz, MD, director for the Office of Drug Evaluation III at the FDA's Center for Drug Evaluation and Research, says in a news release. "This drug represents an important step in helping to provide medical relief from their symptoms."

Amitiza's Approval

The FDA approved Amitiza's use for treating IBS-C in women based on two studies involving 1,154 patients diagnosed with IBS-C, most of whom were women.

The patients either got Amitiza or a placebo pill. More patients in the Amitiza group than in the placebo group reported that their irritable bowel syndrome symptoms were moderately or significantly relieved over a 12-week treatment period.

The FDA didn't approve Amitiza for use in men. "The efficacy of Amitiza in men was not conclusively demonstrated for IBS-C," says an FDA news release.

Amitiza also isn't approved for use in children, and it shouldn't be given to patients who have severe diarrhea or known or suspected bowel obstructions. Amitiza's safety and efficacy haven't been established in pregnant women, nursing mothers, or patients with kidney or liver problems.

Amitiza's common side effects include nausea, diarrhea, and abdominal pain. Other rare side effects include urinary tract infections, dry mouth, fainting, swelling of the extremities, breathing problems, and heart palpitations.

The FDA recommends that Amitiza be taken with food and water twice daily in 8 microgram doses to treat IBS-C. Doctors and patients should periodically assess the need for continued therapy.

Amitiza is co-marketed by Sucampo Pharmaceuticals and Takeda Pharmaceuticals North America. Clinical trials are under way to test Amitiza for constipation in pediatric patients, people with liver problems, and treatment of opioid-induced bowel dysfunction.

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Fermentation May Be At Root Of Irritable Bowel Syndrome

LONDON, ENGLAND -- Irritable bowel syndrome (IBS) is one of the most common reasons that people go to see a gastroenterologist. People with this disorder experience intermittent bouts of abdominal pain, usually accompanied by diarrhoea or constipation. About half of patients with IBS report that certain foods make their symptoms worse. Why this might be so is unknown, but one theory is that these foods contain substances easily fermented by the bacteria normally found in the colon.

To find out, Dr. T. S. King and colleagues from Cambridge, England, recruited 12 women to participate in an experiment. The results of the study appear in this week’s issue of The Lancet.

Six of the women had IBS, and six had no gastrointestinal difficulties. All women adhered to two different diets, each for two weeks. One diet was a standard diet with normal western foods. The second was a diet often prescribed to IBS patients, which sometimes helps reduce their symptoms. This diet excludes beef, dairy products, all cereals except rice and restricts the consumption of foods with yeast, citrus fruits, caffeinated drinks and tap water.

On the last day of each two-week diet, the women spent 24 hours under a plastic canopy allowing the investigators to sample the gases they produced, such as hydrogen and methane. Breath samples, which can be used to monitor a person's gas production, were also taken every 30 minutes during waking hours. All faeces passed during the final 72 hours of the diet were collected and analysed.

Dr King and colleagues report that while on the standard diet, both groups of women produced about the same amount of gas. However, the IBS women produced more hydrogen and produced gas more rapidly, indicating an increase in fermentation.

"In four of the six [IBS] patients, symptoms occurred when gas excretion was rapid," the investigators write.

These patients were then put on the restricted diet and the rate at which they produced gas fell dramatically and their symptoms improved. Although it is unlikely that the gas alone causes discomfort, the investigators explained, it may be that other chemicals produced by fermentation are to blame, producing the symptoms either by causing local effects in the bowel, or perhaps affecting the nervous system.


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Common Foods Known to Aggravate IBS.

Some foods have been identified as "Trigger Foods" for a large segment of IBS patients. Eating these foods have been shown to trigger symptoms.
They include:

  • Alcohol

  • Carbonated drinks

  • Coffee

  • Dairy products

  • Fried foods

  • Poultry skin, chicken, turkey, duck, goose etc.

  • Red meat.

Eliminating foods from your diet can upset the balance of your dietary needs. The best way to tackle this problem would be to work with a qualified nutritionist. Knowing that the average person can not afford to do this, we suggest you find an online support group, where people who are knowledgable on this subject can help you. Check with your doctor, the internet and your local library for suggestions on getting the proper nutrition while eliminating foods from your diet.

You may also benefit from eating rice, or potatos instead of bread. Some people find relief after eliminating gluten from their diet. There are many sources for gluten free flour.

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Zelnorm available to U.S. patients under restricted access program

(July 27, 2007) The U.S. Food and Drug Administration (FDA) has approved a protocol that allows limited access to the drug Zelnorm for the treatment of chronic idiopathic constipation, or of IBS where constipation is the predominant bowel symptom. Access will be restricted to women under the age of 55 who meet special enrollment criteria administered through their doctor. Women interested in obtaining Zelnorm are encouraged to contact their doctor.

News from Novartis

(July 27, 2007) In cooperation with the US Food and Drug Administration (FDA), Novartis has established a restricted access program for Zelnorm® (tegaserod maleate) so that patients in need of this medicine can be considered for treatment.

The program, called a treatment IND, is designed to help women in the US under 55 years of age who suffer from irritable bowel syndrome with constipation (IBS-C) or chronic idiopathic constipation (CIC), and for whom no other treatment has provided satisfactory relief and/or patients who had satisfactory improvement of their symptoms with prior Zelnorm treatment for IBS-C or CIC. Novartis and the FDA are moving forward with this program because of requests from physicians and patients following the marketing suspension of Zelnorm in March 2007.

Treatment INDs are generally used to allow restricted access to medications for patients in need if no comparable alternative drug or therapy is available to treat the disease. Patients given access through a treatment IND must meet specific FDA-approved criteria for enrollment.

Through the program, appropriate female patients with IBS-C or CIC who are assessed by their physicians as being in critical need can have access to Zelnorm for relief of the often painful and disruptive symptoms associated with these conditions. The program protocol and consent materials are designed to ensure that patients and physicians are fully informed of the potential risks and benefits of Zelnorm.

To be considered for access to Zelnorm through the treatment IND, patients must have IBS-C or CIC and meet the specific criteria in the treatment IND protocol. To become part of the treatment IND, patients should contact their physicians to inquire about the protocol and evaluate if they meet the criteria. For further details of the program’s protocol, physicians can call 866-248-1348 or 888-669-6682 or go to www.zelnorm.com.

For patients who do not meet the criteria of the treatment IND but have an urgent need for Zelnorm based on a life-threatening or severely debilitating condition, there may be an alternative option available through the FDA. Physicians may inquire about this potential access option by contacting Novartis at (888-NOW-NOVA) or the FDA CDER Division of Drug Information at 301-827-4570 or www.fda.gov/cder.

Novartis suspended US marketing and sales of Zelnorm as a result of an FDA request in order to permit further discussion of its benefit/risk profile. This decision was based on a review of a new retrospective analysis of pooled clinical trial data which showed that the incidence of cardiovascular ischemic events was higher in patients taking Zelnorm than in those taking placebo. However, no causal relationship between Zelnorm and cardiovascular ischemic events has been demonstrated.

Novartis has extensively studied Zelnorm and believes that this medicine provides important benefits for appropriate patients. Novartis is in discussions with the FDA to better understand the findings and to determine appropriate next steps. 

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What are colonics?

Colonics, also known as colon hydrotherapy or colonic irrigation, involve the use of warm, sterile water which is inserted into the rectum to wash out waste products from the colon, the final section of the intestines. This process is not meant to be painful, but because IBS sufferers are often very sensitive to gut contractions it may be uncomfortable or even painful for some sufferers.

Many doctors warn against using colonics because they believe that they can alter the balance of friendly bacteria in the intestines. Colonic therapists, however, argue that while colonics can remove some friendly bacteria, they will also remove harmful bacteria and waste products from the colon, giving the good bacteria a better environment in which to live.

Many colonic therapists claim that years and years of fecal matter can become stuck in our guts and attached to the walls of our intestines. However, there is no medical or clinical evidence to suggest that this is true. Patients may of course be chronically constipated, but most people will have perfectly clean intestines, as shown by the cameras used during colonoscopies and by the observations of surgeons during intestinal surgery.

Many colonic therapists will also offer advice on diet and supplements, and this advice may in fact be more useful than the colonic itself.

What symptoms do colonics treat?

Colonics are most often associated with treating symptoms of constipation. However, therapists claim good results with other digestive disorders as well. There is no medical evidence to show that colonics can provide any long-term benefits for IBS.

What happens during a colonics session?

A medical history will be taken by the therapist, and you will then be asked to remove your clothing and put on a special gown. You will then lie down, and warm water will be inserted via a pipe into your rectum.

The therapist will use massage and pressure techniques to help dislodge old waste material from the colon, which will flow out of your body through the pipe. There should not be any odor during the treatment.

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Gut-directed Hypnotherapy for IBS

Gut-directed hypnotherapy is a special form of hypnotherapy developed for IBS and digestive disorder sufferers. It uses the therapeutic qualities of hypnotherapy, such as deep relaxation, and adds gut-specific treatments and suggestions.

Hypnotherapy is a well-established treatment for IBS and there are many scientific studies which show that it can improve IBS symptoms. This kind of hypnotherapy should not be confused with the stage hypnosis used for entertainment, as the hypnotherapist will not be able to make a patient do anything they do not wish to - you remain in control of your actions during treatment.

The exact mechanism of how hypnotherapy works is still poorly understood.

What symptoms can hypnotherapy treat?

This form of hypnotherapy is designed to treat all symptoms of IBS.

What happens during hypnotherapy?

A hypnotherapist will take some background details about your IBS experiences and symptoms. Then they will coax you into a state of extreme relaxation, and take you through a program of suggestion. For example, you may be asked to imagine that when you hold your hand over your stomach a healing warmth is flowing into your abdomen, or you may be asked to visualize a fully working digestive system.

Patients remain in complete control of their actions at all times. A therapist may record each session onto audio cassette to allow the patient to maintain their therapy between sessions and use the tape when they feel they need it.

If you are unable to attend regular sessions with a hypnotherapist or cannot afford the sessions, the IBS Audio Program 100 offers an alternative, as it is a self-hypnosis program designed to be used in the home.

How successful is hypnotherapy in clinical studies?

There have been a range of clinical studies which show that hypnotherapy can help IBS.

The pioneer for this kind of treatment was Dr Peter Whorwell, a UK doctor who published his first study in the journal The Lancet in 1984. The placebo-controlled study consisted of 15 IBS patients who received seven hypnotherapy sessions, and 15 patients who received seven sessions of psychotherapy and placebo pills.

The patients who received psychotherapy showed a small improvement in their abdominal pain and general well-being, but not in their typical IBS symptoms such as diarrhea and constipation. The patients who had received hypnotherapy showed a major improvement in all main symptoms, and remained well during the three-month period of follow-up research.

Conclusion: In 1997 the American Journal of Gastroenterology published a study (Gonsalkorale WM, Houghton LA, Whorwell PJ) which looked at 250 patients, who were given 12 hypno sessions plus home practice sessions. Overall, the severity of IBS symptoms was reduced by half, and there were also marked improvements in quality of life, anxiety and depression.

Conclusion: Hypnotherapy can greatly reduce IBS symptoms.

A review of 14 previous clinical studies was published in the American Journal of Clinical Hypnosis  (Tan G, Hammond DC, Joseph G) in 2005. Eight of the studies had used a control group, and six studies had no control group.

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Bacteria May Be the Cause of Irritable Bowel Syndrome

09-10-2004 A USC researcher considers new ways to treat a gastrointestinal condition that affects millions of Americans. The approach represents a reversal in thinking, offering hope for patients.

By Alicia Di Rado

The enigmatic-but-common condition known as irritable bowel syndrome, or IBS, is caused by an overgrowth of bacteria in the small intestine, a USC researcher has proposed in the Journal of the American Medical Association.

Researchers have suggested numerous theories to explain IBS, which affects as many as 36 million Americans. But according to gastrointestinal motility specialist Henry C. Lin, associate professor of medicine in the Keck School of Medicine of USC, the idea of a bacterial origin of IBS represents a major change in thinking.

Writing in the Aug. 18 issue of JAMA, Lin proposed that ordinary bacteria normally confined to the large intestine may expand into the small intestine, prompting uncomfortable bloating and gas after meals, a change in bowel movements as well as an immune response that may account for the flu-like illness so common in the IBS patient, including such debilitating symptoms as headaches, muscle and joint pains and chronic fatigue.

"IBS has long been a frustrating diagnosis for both patients and their physicians," Lin said. "The bacterial hypothesis of IBS offers new hope for suffering patients by providing a new framework for understanding the symptoms of this disorder, pointing to new strategies for treatment."

Physicians frequently diagnose a patient with IBS when ongoing symptoms - including diarrhea, constipation, bloating, gas and abdominal pain - are not explained by medical tests such as gastrointestinal endoscopies.

For more than a dozen years, Lin has searched for a common thread to account for the symptoms in IBS. Studies indicate 92 percent of IBS patients report bloating after they eat, a symptom he saw again and again in his patients.

While many physicians believe that IBS-related bloating is perceived and not real, Lin noted that recent studies of IBS patients show that their abdomens do become measurably more distended than those of healthy patients.

With the symptom of post-meal bloating in mind, Lin began the quest for the cause of IBS by considering the problem of increased intestinal gas.

Gas comes about when gut bacteria ferment food in the intestinal tract. There are plenty of organisms in the gut, where bacteria may number 100 trillion.

Bacteria perform a variety of valuable services in the large intestine, according to Lin. "But we believe problems may start when bacteria set up shop in the small intestine where they are normally scarce. Usual medical tests such as endoscopy cannot detect this problem in most patients," he said.

However, a breath test can be used to indirectly tell if too many bacteria are in the small intestine. In this test, the patient ingests a syrup containing the sugar lactulose. Over the next three hours, the gaseous products of bacterial fermentation of this sugar may be measured in the exhaled breath.

In a 2003 paper authored by Lin and his research partner Mark Pimentel of Cedars-Sinai Medical Center, 84 percent of IBS patients were found to have abnormal breath test results suggesting small intestinal bacterial overgrowth.

In this double-blind, placebo-controlled study, patients received either antibiotic therapy or a sugar pill. Patients whose small intestinal bacterial overgrowth was eradicated by antibiotics reported a 75 percent improvement in symptoms.

Small intestinal bacterial overgrowth allows gut bacteria to cross the mucosal barrier, which is the lining of the gut, and enter the body. This activates the patient's immune system as evidenced by increased numbers of inflammatory cells in tissues of IBS patients.

"The immune response to bacterial antigens may then explain the flu-like symptoms that can greatly diminish the quality of life such as chronic fatigue and pain," Lin said.

The Jill and Tom Barad Family Fund supports Lin's current bacterial overgrowth research. His other research projects are supported by the National Institutes of Health.

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Hypnotherapy for Irritable Bowel Syndrome Works for "At Least Five Years"

Long term benefits of hypnotherapy for irritable bowel syndrome 2003; 52: 1623-9

Hypnotherapy seems to be an effective long term treatment for irritable bowel syndrome (IBS), lasting for "at least five years," conclude researchers in this month's edition of Gut.

IBS is a very common disorder and makes up half a gastroenterologist's workload. Conventional treatment of IBS often does not work very well.

The researchers base their findings on questionnaires regularly completed by over 200 patients with IBS. These patients scored their symptoms, quality of life, and levels of anxiety and depression before, immediately after, and up to six years after being given hypnotherapy. Sessions lasted one hour for up to 12 weeks.

Almost three quarters of the patients responded well to hypnotherapy (71%), and most of these did not deteriorate over time, while the remainder claimed their deterioration had been slight. Women were more likely to respond than men

Among those who responded, all registered a significant improvement in symptoms compared with what these had been like before treatment, and there was very little difference in how these were rated for more than five years after treatment.

Scoring for quality of life and levels of anxiety and depression also significantly improved, but did begin to tail off slightly over time. But patients also said they took fewer drugs and did not need to see their doctors as often after they had had a course of hypnotherapy.

The researchers say that the sustained improvements in most of the patients seen cannot be attributed to other treatments as fewer than one in 10 patients attempted alternatives after completing their hypnotherapy sessions.

The researchers, who work at the first NHS hypnotherapy unit to be established in the UK, say that previous research has found that hypnotherapy for IBS works in the short term, but their study shows that it also works in the long term.

Critics have complained that the number of sessions needed for hypnotherapy to be effective make it a costly option, but the authors contend that its sustained effects, with the accompanying reduction in use of prescription drugs and consultations with doctors, more than offset these costs.

Click here to view the full paper:
http://press.psprings.co.uk/gut/november/1623_gt17244.pdf
[Please note this link will remain live for one month only after issue]

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Actual stress, psychopathology and salivary cortisol levels in the irritable bowel syndrome (IBS).

J Endocrinol Invest 2001 Mar;24(3):173-7 Patacchioli FR, Angelucci L, Dellerba G, Monnazzi P, Leri O. Department of Physiology and Pharmacology V. Erspamer, Medical Faculty, University of Rome La Sapienza, Italy.

Although irritable bowel syndrome (IBS) can be considered a biopsychological disorder in which an association between life stress and physiological changes leading to bowel irregularity is present, there is a lack of data concerning possible modifications of the adrenal function during the disease. The aim of the present study was to measure biological and psychological variables related to the activity of the hypothalamo-pituitary-adrenal axis in IBS patients compared to healthy subjects. Cortisol was measured in the saliva (obtained by a stress-free, non invasive collection procedure) of 55 IBS outpatients and 28 matched controls. Moreover, each subject completed the following self-administered questionnaires: the Rome Burnout Inventory (RBI) in its physical (RBI-PE) and emotional-mental exhaustion (RBI-EME) components, Beck Depression Inventory, State and Trait Anxiety Inventory (STAI), Perceived Social Support Scale (PSSS) and a Scale for the Assessment of Perceived Actual Work-Non Work Stress. Compared with controls, IBS subjects showed significantly higher levels of cortisol in the morning and lower in the evening, while they maintained the physiological circadian fluctuation (i.e. cortisol morning level higher than in the evening). Moreover, IBS patients presented a significant difference from controls in RBI-PE scores, which confirms the presence of fatigue, a symptom frequently reported by the patients. Compared with controls, no differences were found in IBS patients with respect to other psychological parameters. These findings suggest a dysregulation of the adrenal activity in IBS patients. The results may be relevant considering that changes in cortisol levels have been shown to be sensitive indicators of psychosocial stress and coping patterns in both laboratory and life situations.

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When to conduct testing in patients with suspected irritable bowel syndrome.

Rev Gastroenterol Disord. 2003;3 Suppl 3:S18-24. Talley NJ. Center for Enteric Neurosciences and Translational Epidemiologic
Research, Mayo Clinic, Rochester, MN.

Patients who have abdominal discomfort or pain plus disturbed defecation warrant a careful history taking and physical examination. The presence
of positive symptom criteria for irritable bowel syndrome (IBS) usually correctly identifies the underlying IBS diagnosis. The clinical
evaluation may uncover findings that cause concern about underlying organic disease ("alarm features" or "red flags"). Traditional alarm
features include bleeding, obvious anemia, weight loss, and older age at onset. Although the diagnostic utility of most of these red flags has
not been tested, patients with these symptoms should be investigated promptly. In the primary care setting, most patients who have alarm
symptoms will have a negative further evaluation, and the original IBS diagnosis will be confirmed. In the past, numerous tests (eg, complete
blood cell count, flexible sigmoidoscopy) were considered routine for patients with suspected IBS in the primary care setting. However,
available data do not support this approach; these patients do not have an increased likelihood of most organic diseases compared with control
populations without IBS. Although celiac disease may occur more frequently in persons with IBS, the yield of serologic testing is likely
to be low. Testing is generally not required in patients with positive symptom criteria for IBS and an absence of alarm features.

PMID: 14502113

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Nerve Receptor Found to Be Key to Intestinal Inflammation
By Duke Researchers

DURHAM, N.C. -- Researchers at Duke University Medical Center have found that a specific nerve cell receptor appears to be necessary to initiate the
development of inflammatory bowel disease (IBD), findings they believe could change how physicians treat this disorder.
The results of their studies, which were carried out in rats, could point toward a potential therapy aimed at blocking the receptor, known as
vanilloid receptor type 1 (VR-1). Interestingly, they said, VR-1 is the receptor on sensory neurons that receives and transmits the "heat" and
"pain" impulses felt when eating raw chili peppers.

The results of the Duke study were reported today (May 1, 2003) in the May 2003 issue of the journal Gut.

IBD is a general term given to a constellation of chronic disorders in which the intestine becomes inflamed, typically resulting in recurring abdominal
cramps, pain and diarrhea, in some cases bloody. The cause of IBD is unknown, and it is believed that up to 2 million Americans suffer from this
disorder, the researchers said.

"We know that immune modulators known as cytokines are responsible for the inflammation that is the hallmark of the disease, so research has focused on
discovering a viral or bacterial trigger," said Christopher Mantyh, M.D., colorectal surgeon and senior member of the Duke team.

"However, our studies have shown that by blocking the VR-1 receptor, we can halt the development of IBD in an animal model," he continued. "So it would
appear that the activation of the VR-1 receptor is the signal, or trigger, that 'revs up' the release of cytokines."

It has long been appreciated that sensory neurons within the intestinal system can play a role in the development of inflammation. Key to this
process is Substance P, a neurotransmitter found in minute quantities in the human nervous system and intestines. It is primarily involved in the
transmission of pain impulses and is also a potent pro-inflammatory mediator in the intestines.

"Studies have shown that using Substance P antagonists as well as denervation -- either surgical or chemically -- can block some forms of
intestinal inflammation," Mantyh said. "However, what is missing is that trigger. What was not known was how the nerve cells in the intestine were
stimulated to begin the inflammatory process."

In their experiments, the Duke team focused on the newly cloned VR-1 receptor, which can be activated by heat, acid and capsaicin, the ingredient
that gives chili peppers their "heat."

Capsaicin stimulates the pain and heat response by binding, like a lock-and-key, to the VR-1 receptors on neurons. Just as long-time chili
eaters find that prolonged consumption renders them immune to the peppers' effects, over-stimulation of VR-1 receptors can cause them to become
desensitized.

The researchers used three groups of rats. The first group was administered capsaicin at birth, which chemically denervated them by "overstimulating'
the VR-1 receptors to the point of inactivating them permanently. They were allowed to reach adulthood. The second group, which were adults, were given
the agent capsazepine (CPZ), a VR-1 antagonists which blocks the receptor. The third group, the control, received no additional treatments.

The team then induced colitis, or intestinal inflammation, in all three groups of rats by giving them dextran sulphate sodium (DSS) in their water
for a week. The animals' reactions to the treatment were carefully monitored and after one week, detailed studies were made of their intestinal tracts.

"In the control rats, DSS caused active colitis with its trademark ulceration of the intestinal lining," Mantyh said. "However, the two other
groups showed significantly lower levels of disease. The treated rats were protected from the damaging effects of DSS administration. This data
provides strong evidence that an animal model of colitis requires neurons containing VR-1.

"Inhibition of the VR-1 receptor in humans -- either by small doses of CPZ or other antagonists -- may represent a novel therapeutic pathway to prevent
IBD," Mantyh continued.

The research was supported by grants from the National Institutes of Health, the American Surgical Association and the Department of Veterans Affairs.

Other members of the Duke team were Naoki Kihara, M.D., Sebastion de la Fiente, M.D., Kazunori Fujino, M.D., Toku Takahashi, D.M.D., and Theodore
Pappas, M.D.

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Increased prevalence of irritable bowel syndrome in patients with bronchial asthma.

Roussos A, Koursarakos P, Patsopoulos D, Gerogianni I, Philippou N.

9th Department of Pulmonary Medicine, SOTIRIA Chest Diseases Hospital, Athens, Greece. roumar26@yahoo.com

Irritable bowel syndrome (IBS) is one of the most common diseases of the gastrointestinal tract. IBS may represent a primary disorder of gastrointestinal motility accompanied with motor dysfunction in various extraintestinal sites. Recent studies suggest that IBS is associated with bronchial hyper-responsiveness and bronchial asthma might be more prevalent in IBS patients than in control subjects. The aim of our study was to assess the prevalence of IBS in a cohort of asthmatic patients. We evaluated 150 patients with bronchial asthma (71 males and 79 females, aged 45.1+/-14.9 years) and two control groups including 130 patients with other pulmonary disorder and 120 healthy subjects. All subjects enrolled (asthmatic and controls) completed the Greek version of the Bowel Disease Questionnaire (BDQ). BDQ is a, previously validated, self-report instrument to measure gastrointestinal symptoms. Diagnosis of IBS was based on Rome II criteria. The IBS prevalence was significantly higher in asthmatics (62/150, 41.3%) than in subjects with other pulmonary disorders (29/130, 22.3%, P<0.001) and healthy ones (25/120, 20.8%, P<0.001). For all subjects studied, the prevalence of IBS was significantly higher in females (78/214, 36.4%) than in males (38/186, 20.4%, P<0.001). The IBS prevalence in asthmatic males was 29.5% vs. 15.2% in male patients with other pulmonary disorders (P=0.002) and 14.2% in male healthy subjects (P=0.002). The IBS prevalence in asthmatic females was 51.8% vs. 28.1% in females patients with other pulmonary disorders (P<0.001) and 26.5% in females healthy subjects (P<0.001). None of the asthma medications were associated with increased or decreased likelihood of IBS. We conclude that patients with bronchial asthma have an increased prevalence of IBS. Further studies are needed to clarify the potential pathogenetic mechanisms underlying the association between IBS and asthma.
Publication Types:

  • Clinical Trial

  • Controlled Clinical Trial

  • PMID: 12556015

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100 Trillion Bacteria in Your Gut: Learn How to Keep the Good Kind There.
By Dr. Joseph Mercola with Rachael Droege

You probably don't think about your gut very often but this may make you start--the bacteria in your bowels outnuber the cells in your body by a factor of 10 to one. This gut flora has incredible power over your immune system, which, of course, is your body's natural defense system that keeps you healthy. In other words, the health of your body is largely tied into the health of your gut, and it's hard to have one be healthy if the other is not.

One of the reasons why your gut has so much power has to do with the 100 trillion bacteria--about three pounds worth--that line your intestinal tract. This is an extremely complex living system that aggressively protects your body from outside offenders.

However, if you are eating as many sugars as the typical American (about 175 pounds per year) then you are feeding the "bad" bacteria, which are more likely to cause disease than promote health, rather than promoting the "good" bacteria that help protect you from disease. Exposure to chemicals will also contribute to this disruption in your gut microflora, and over time the imbalance will lead to illness.

A large part of the influence of the "bad" bacteria is on the intestinal lining (mucousal barrier) that is over 300 square meters, or about the size of a tennis court.

Beneficial bacteria in your gut can help to boost the immune system, prevent allergic inflammation and food allergy, clear up eczema in children and heal the intestines from a variety of ailments.

Fortunately, you can influence the composition of the good and bad bacteria in your gut by optimizing your diet and supplementing it with a high-quality probiotic, or good bacteria. As written in a report in the October 2003 American Journal of Clinical Nutrition, “probiotics can act as partners of the defense system of the intestine.”

The typical American diet is so full of sugar and grains that--although I don’t often recommend supplements--nearly everyone can benefit from probiotics. You should look for a high potency, multi-strain variety, which can be found in most health food stores. Since the best type of probiotic to use can become highly specific, you may want to discuss the varieties with an experienced health food store employee.

I recommend probiotics to nearly all of our new patients, as it is a helpful start for their health recovery. This is not a lifetime recommendation, however. Once you are eating the right foods it is generally possible to maintain a healthy bacterial balance in your gut without the use of probiotics.

On a side note, probiotics are especially helpful when you are traveling in the event you get an infectious diarrhea. Typically, large doses of a high-quality probiotic--about one-half to one full bottle in one day--are quite useful for a rapid resolution of the diarrhea.

Management of Irritable Bowel Syndrome American Family Physician 12/04/2002 By Elda Hauschildt

Irritable bowel syndrome (IBS) is a benign condition, despite the concerns patients present about their symptoms, researchers in the United States point out.

Investigators from the US Naval Hospital in Jacksonville, Florida, say IBS is the most common functional disorder reported of the gastrointestinal tract. It is also the most common diagnosis made in gastroenterological practices.

Family doctors frequently treat patients with IBS, which accounts for up to 3.5 million doctor visits each year in the US. At the same time, only 10 to 30 percent of patients with IBS seek medical care, the researchers note.

They say at five-year follow-up 5 percent of IBS patients report complete recovery and up to 30 percent report partial recovery.

"Diagnosis should be made using standard criteria after red flags that may signify organic disease have been ruled out," the researchers suggest.

They also say an effective doctor-patient relationship is vital to successful management of the condition. "A good doctor-patient relationship has also been shown to reduce repetitive office visits. The patient may need to be reassured repeatedly of the positive diagnosis, and specific patient concerns and fears will need to be addressed."

The investigators point out that while no specific dietary advice has been shown to be efficacious in research, it has been suggested that patients limit alcohol, caffeine, sorbitol and fat intake.

Lactose elimination is only recommended when patients prove to have lactase deficiency.

They add that if a patient believes a particular dietary substance exacerbates symptoms, an elimination trial is warranted. But, "In general, there is no association between IBS and food intolerance."
American Family Physician, 2002; 66: 1867-1874. "Management of Irritable Bowel Syndrome"

Transcript of a WebMD Live Chat on "What Can I eat when I have IBS?". The speaker was Elaine Magee, MPH, RD. Elaine has a degree in nutrition and a master's from the University of California at Berkeley in public health nutrition, she is a registered dietician and her job, so to speak, is helping people make better food choices. She has written 18 books so far, and has a national column called the Recipe Doctor. (You will have to register at this website to be able to access the articles. Registry is free and only take a minute) Once you register, just do a search for the article by typing in "Tell Me What to Eat if I Have Irritable Bowel Syndrome: Nutrition You Can Live With"

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Fibromyalgia in patients with irritable bowel syndrome An association with the severity of the intestinal disorder
International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery
ISSN: 0179-1958 (printed version) ISSN: 1432-1262 (electronic version) Abstract Volume 16 Issue 4 (2001) pp 211-215 DOI 10.1007/s003840100299 Ennio Lubrano (1), Paola Iovino (2)(3), Fabrizio Tremolaterra (4), Wendy J. Parsons (5), Carolina Ciacci (4), Gabriele Mazzacca (4) (1) Physical Medicine and Rehabilitation Department, University Federico II, Naples, Italy (2) Endoscopic Unit, University Federico II, Naples, Italy E-mail: piovino@unina.it Phone: +39-81-7462759 Fax: +39-81-7462759
(3) Via del Rione Sirignano 10, 80121 Naples, Italy (4) Gastroenterology Unit, University Federico II, Naples, Italy (5) Research and Development Department, Leeds General Infirmary, Leeds, UK
Accepted: 14 February 2001 / Published online: 27 April 2001

Abstract. Fibromyalgia (FM) syndrome and irritable bowel syndrome (IBS)
are functional disorders in which altered somatic and or visceral perception thresholds have been found. The aim of this study was to evaluate the prevalence of FM in a group of patients with IBS and the possible association of FM with patterns and severity of the intestinal
disorder. One hundred thirty consecutive IBS patients were studied. The
IBS was divided into four different patterns according to the predominant
bowel symptom and into three levels of severity using a functional severity index. All patients underwent rheumatological evaluation for number of positive tender points, number of tender and swollen joints, markers of inflammation, and presence of headache and weakness. Moreover,
patients' assessments of diffuse pain, mood and sleep disturbance, anxiety, and fatigue were also measured on a visual analogue scale. The diagnosis of FM was made based on American College of Rheumatology classification criteria. Nonparametric tests were used for statistical
analysis. Fibromyalgia was found in 20% of IBS patients. No statistical association was found between the presence of FM and the type of IBS but a significant association was found between the presence of FM and severity of the intestinal disorder. The presence of FM in IBS patients
seems to be associated only with the severity of IBS. This result confirms previous studies on the association between the two syndromes

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Link Between Poor Sleep and Irritable Bowel Syndrome Studied by ImmuneSupport Staff

Researchers have documented a link between poor sleep and subsequent gastrointestinal disturbances, both common problems for people with chronic fatigue syndrome (CFS) and fibromyalgia (FM). The University of Washington study followed women with IBS and found that more gastrointestinal disturbances occurred after a night of poor sleep. This news is the most recent supporting the possibility of a casual relationship between the two.

Over the course of the 2-month analysis, 82 women with IBS and 35 women without used a combination of 7-day recall and a daily diary to test the relationship between the two ailments. Approximately 25% of the IBS women suffered from sleep disturbances. The severity of the disturbance correlated strongly with the severity of gastrointestinal symptoms.

Although the relationship between IBS and gastrointestinal symptoms remained significant even after researchers adjusted for psychological stress, they noted that this adjustment weakened the possibility of a definitive relationship.

A brief analysis of the data showed that poor sleep on a single night leads to significantly increased symptoms on the following day, while increased symptoms on a particular day do not appear to cause sleep disturbances that night. Original report published in Digestive Diseases and Sciences.

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Menses Heighten Symptoms Among Women With Irritable Bowel Syndrome GUT 2002; 50: 471-4. By Harvey McConnell

Women with irritable bowel syndrome (IBS) have significantly worse symptoms during their menses and this is allied with a lower rectal pain threshold.

This has been found among 29 women with IBS whose rectal responses were
measured during four phases of their menstrual cycle in a study by Dr Lesley Houghton and colleagues at the Department of Medicine, University Hospital of South Manchester, Manchester, England.

The clinicians postulate that the guts of women with IBS, which are already acutely sensitive, may be further sensitised by other triggers such as fluctuating hormone levels.

Clinicians note that healthy women have looser, and more frequent, stools during menses, but firmer during the luteal phase. This may be related to cycling female sex hormones. At the same time, they found in an earlier study that the menstrual cycle does not appear to alter their rectal
motility or sensitivity.

Sex hormones also may be implicated in the pathogenesis IBS: more women than men suffer from the condition and patients often report exacerbation of symptoms at the time of menses.

All of the women's symptoms met the Rome criteria I for the diagnosis of IBS: normal hematology, biochemistry, and sigmoidoscopy, together with a normal colonoscopy or barium enema if they were aged over 40. Their menstrual cycles were a mean normal of 27 days, and none resorted any .
gynecological symptoms, taking the oral contraceptive or a drug known to effect gastrointestinal motility.

Clinicians measured their responses to serial inflation of a balloon catheter inserted into the unprepared rectums during days one to four (menses), eight to 10 (follicular phase), 18 - 20 (luteal phase), and 24 - 28 (premenstrual phase) of the menstrual cycle. Insertions were done
during the same time of day. In addition, the women kept a diary of symptoms to assess abdominal pain and bloating and bowel habits. Any anxiety or depression were assessed by a hospital questionnaire.

Dr Houghton found the women reported that abdominal pain and bloating were significantly worse during menses. Bowel habits became more frequent and, while the women said they felt less well, clinicians found no allied evidence that they were more depressed or anxious.

The clinicians found that rectal sensitivity among the women increased at menses compared with all other phases of the cycle. Balloon distension needed to induce urge and discomfort were all lower. However, there were no differences in motility or rectal tension and pressure, suggesting
that the increased sensitivity was independent of any other bowel changes.

Dr Houghton and colleagues conclude: "Women with IBS appear to be predisposed to fluctuations in visceral sensitivity associated with the menstrual cycle. Understanding the pathogenesis behind these changes should help to unravel some of the mechanisms of visceral sensitization."

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IBS Medication Information.

~NuLev relaxes the muscles of the intestine and slows down their movement. NuLev helps ease the pain of intestinal cramps and spasms associated with IBS and helps bowel habits return to normal.

~Hyoscyamine. Brand Names-: Anaspaz®, Cystospaz®, Cystospaz-M®, Levbid®, Levsin®, Levsinex® Timecaps, Levsin S/L®
Why Is Hyoscyamine (Levsin) Prescribed?

Hyoscyamine is used to treat bladder spasms, colic, peptic ulcers, IBS (Irritable Bowel Syndrome), pancreatitis, cystitis, diverticulitis. Hyoscyamine works by decreasing the secretion of stomach fluids including acid.
How Is Hyoscyamine (Levsin) Supplied?

Hyoscyamine comes in tablet, capsule, or liquid form and is taken by mouth. It is usually taken 2-4 times daily. Follow the directions carefully, and ask your doctor or pharmacist if you have any questions.

Precautions of Hyoscyamine (Levsin)

Always consult your doctor if you experience any allergic reactions to Hyoscyamine or other drugs.

Side Effects of Hyoscyamine (Levsin)

The following side effects are common symptoms that you may experience with this drug. Tell your doctor if they are severe or do not go away: dry mouth, constipation, drowsiness, headache, difficult urination, blurred vision, flushing, increased sensitivity to light.

Warnings of Hyoscyamine (Levsin)

Call your doctor immediately if you experience any of the following: diarrhea, eye pain, skin rash, rapid or irregular heart rate.

For more information on Hyoscyamine, please visit MEDLINEplus.

~Levsin Pronounced: LEV-sin
Generic name: Hyoscyamine sulfate
Other brand names: Anaspaz Levbid Levsinex NuLev. Levsin is an antispasmodic medication given to help treat various stomach, intestinal, and urinary tract disorders that involve cramps, colic, or other painful muscle contractions.

~Hyoscyamine
Generic Name: Hyoscyamine (HYE-oh-SYE-a-meem)
Drug Class: Anticholinergic

~Levsin. Warnings, interactions, precautions.

Zelnorm (tegaserod maleate) was approved for the short-term treatment of women with IBS marked primarily by constipation.

2002-07-25 11:00:40 -0400 (Reuters Health)

WASHINGTON (Reuters Health) - The US Food and Drug Administration (FDA) said on Wednesday it has approved the first drug for women with one form of irritable bowel syndrome (IBS).

Novartis Pharmaceuticals' Zelnorm (tegaserod maleate) was approved for the short-term treatment of women with IBS marked primarily by constipation. Novartis said it plans an early fall launch for the drug.

The FDA stressed that Zelnorm doesn't cure IBS or treat diarrhea-prominent IBS. But it has been shown to reduce constipation, bloating and abdominal discomfort, the agency said.

GlaxoSmithKline recently won US approval for a limited re-introduction of Lotronex (alosetron) for the treatment of women with severe IBS characterized by diarrhea. That drug was pulled off the market in late 2000 due to safety concerns.

Novartis originally expected FDA approval of Zelnorm in 2001, but the FDA requested additional information to resolve safety concerns and conflicting efficacy data. A Novartis spokesperson noted on Wednesday that Zelnorm will not have to be sold under the marketing restrictions that are in place for Lotronex.

The FDA said its decision to approve Zelnorm was based on results from three studies in which more patients on the drug than on placebo reported alleviation of symptoms during a 3-month period. The agency noted that effects appeared greater after one month than after 3 months, which it said suggests the benefits may decrease over time. The effects of Zelnorm beyond 3 months were not studied.

Zelnorm is the first in a new class of drugs called serotonin-4 receptor agonists, Novartis said. The drug activates these receptors to stimulate the peristaltic reflex, which helps normalize the gastrointestinal tract's motility.

The most common side effects in clinical studies were headaches and diarrhea, according to the firm. The company noted that the majority of patients who reported diarrhea had only one episode and that the side effect generally resolved itself without discontinuation of Zelnorm therapy.

More patients in the treatment group than in the placebo group had abdominal surgeries, but there is no proof of a causal relationship, according to the FDA.

The Novartis spokesperson estimated the potential US patient population for Zelnorm at about 10 million women and said the drug will be priced comparably to other gastrointestinal therapies.

Zelnorm's effect on men has not been established.

The drug is already approved in about 30 other countries, including Australia, Switzerland, Canada and Brazil. Novartis is investigating its use in other gastrointestinal disorders, such as chronic constipation and indigestion.

Otilonium Bromide Confirmed As More Effective Than Placebo For Irritable Bowel Pain
   
European Journal of Gastroenterology and Hepatology, 2002;14: 1331-1338.
"Extended analysis of a double-blind, placebo-controlled, 15-week study with otilonium bromide in irritable bowel syndrome." 12/23/2002 10:15:32 AM By Elda Hauschildt

Otilonium bromide is more effective than placebo in relieving pain and discomfort in patients with irritable bowel syndrome (IBS), Italian research confirms. Investigators from the University of Bologna, SS Giovanni e Paolo Hospital in Venezia and Menarini Ricerche spa in Firenze did an efficacy
assessment of a large clinical trial of otilonium bromide therapy in 378 patients. Trial participants were treated with either 40 milligrams of otilonium bromide or placebo three times a day for 15 weeks. Data on 12 single efficacy endpoints were assessed. The new efficacy evaluation of the
double-blind, parallel-group study was based on information reported by
patients. Investigators used an assessment that integrated key IBS symptoms.
These included pain frequency and intensity as well as the presence of
meteorism and distension. The primary efficacy outcome measure was the rate
of response within two to four months of therapy. Results indicate response
within two to four months was significantly higher in patients in the
otilonium bromide group (36.9 percent) than in the placebo group (22.5percent). "In each month of treatment, the rate of monthly response was
higher in the otilonium bromide group as compared with the placebo group,"
the researchers report. Differences in total monthly and weekly responses to
individual endpoints were also significantly more frequent in the otilonium
bromide group. These endpoints were: intensity/frequency of pain/discomfort,
meteorism/abdominal distension, diarrhoea/constipation severity and mucus in
the stool. Patients with diarrhoea had an additional benefit, the investigators add

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Irritable Bowel Tied to Fat and Fructose  Steven Reinberg HealthDay Reporter

MONDAY, Oct. 13 (HealthDayNews) -- Two new studies suggest fat and fructose, a sugar found in many fruits and honey, play key roles in causing gastrointestinal disorders.

Both studies were presented Oct. 13 at the American College of Gastroenterology annual meeting in Baltimore.

In the first report, Nancy Kraft, a clinical dietitian from the University of Iowa, and her colleagues say patients with irritable bowel syndrome (IBS) who are fructose-intolerant can achieve a significant improvement in symptoms by following a diet that restricts fructose intake.

Kraft says fructose intolerance is an often overlooked component of IBS.

Her colleague, Dr. Young Choi, adds in a statement that "a fructose-restricted diet significantly improved symptoms in patients with IBS and fructose intolerance. Fructose intolerance is yet another piece of the IBS puzzle, whose treatment when adhered to confers significant benefit."

In the study, the researchers looked at 80 patients with suspected IBS. Of these they found 30 were fructose-intolerant. Kraft's team taught these patients how to eliminate fructose from their diet. After one year, 26 patients were interviewed to assess their symptoms.

Among the 14 patients who stuck to the diet, there was a significant reduction in symptoms such as abdominal pain, bloating and diarrhea. In addition, there was a decline in IBS in this group.

However, bowel symptoms remained the same for the 12 patients who did not stick with the diet, the researchers report.

Kraft believes these results are encouraging, since "people who limit their intake of fructose see their symptoms improve or disappear," but that further study is needed.

In the second study, researchers from the Mayo Clinic in Rochester, Minn., led by Dr. Yuri Saito, collected data on the diets of 221 adults, aged 20 to 50. Of these patients, 102 had gastrointestinal disorders and 119 were healthy.

The research team found patients with IBS or dyspepsia reported eating more monounsaturated fats compared to healthy patients. These patients also ate fewer carbohydrates than their healthy counterparts.

The Mayo investigators conclude that "future studies are needed to determine whether fat intake causes gastrointestinal symptoms."

Dr. Theodore M. Bayless, a professor of medicine at Johns Hopkins University, finds both reports of value. He is not surprised fat and fructose are linked with IBS and dyspepsia.

He notes that both fat and fructose are hard to digest and can aggravate both conditions. Bayless, however, does not believe that restricting fructose cures IBS; it only relieves the symptoms.

Bayless says "anyone who is gassy with or without IBS will benefit by decreasing the intake of fructose."

He advises his patients to avoid fatty foods and foods that contain high levels of fructose such as grapes, dates, nuts, honey and apple or pear juice.

He also advises patients to increase fiber intake to make their bowels perform regularly.

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IBS Patients May Benefit From Leaving Certain Foods Out of Their Diet

Fat, Fructose May Worsen Gastric Upset By Charlene Laino

Oct. 13, 2003 (Baltimore) -- Can avoiding certain foods help to relieve thebloating, tummy aches and general misery associated with irritable bowel
syndrome?

That's the intriguing possibility raised by two new studies that show thatfat and fructose, the simple sugar found in honey, fruits, and some soft
drinks, may contribute to symptoms of the misunderstood gastrointestinalsyndrome that affects more than 1 in 10 Americans.

The research was presented here this week at the 68th Annual ScientificMeeting of the American College of Gastroenterology. Young K. Choi, MD, of
the University of Iowa in Iowa City, studied people with irritable bowelsyndrome, or IBS, whose bodies cannot absorb fructose properly.

Irritable bowel syndrome is one of the most common gastrointestinaldisorders, affecting almost 58 million Americans. People who suffer from it
have symptoms of abdominal discomfort or pain, and they can alternatebetween diarrhea and constipation.

In this study, those who were able to eliminate fruit and otherfructose-rich foods from their diet were rewarded with an improvement in
symptoms, Choi says.

While not as well known as lactose intolerance, fructose intolerance isquite common, affecting one-third to one-half of patients with symptoms of
IBS, Choi says.

The researchers tested 80 patients with suspected IBS; 30 were found to be fructose intolerant. The patients were taught what foods are high in
fructose and urged to avoid them.

After one year, interviews with 26 of the patients showed that only one-half stuck to the fructose-restricted diet, Choi says. But those who did stick
with the program reported significantly less abdominal pain, bloating, and diarrhea than before changing their diets, he says. Not surprisingly, those
who cheated on their diets showed no improvement in symptoms.

Avoiding fructose is no easy task, says Kevin W. Olden, MD, associate professor of medicine in the division of gastroenterology at the Mayo Clinic
in Scottsdale, Ariz. High-fructose corn syrup is a hidden ingredient in everything from cola to lemonade, he says.

Richard G. Locke III, also of the Mayo Clinic, says he wonders whether patients in the study really had IBS. Fructose intolerance can cause pain,
bloating, and diarrhea -- the same symptoms associated with irritable bowel syndrome.

"We used to think people who were intolerant to milk had IBS, but now we know they have lactose intolerance," Locke says. "The same thing could be
happening here. It's a matter of labeling."

The important thing is to know that fructose can cause these symptoms, says Yuri A. Saito, MD, MPH, also of the Mayo Clinic. "Most people are not even
aware of this."

In the second study, Saito and colleagues in the division of gastroenterology and hepatology found that people with IBS tend to reach for
high-fat, low-carb foods. These dietary factors may contribute to some of the symptoms suffered by gastrointestinal disorders such as IBS.

They are also significantly more likely to suffer from food allergies than people who don't have gastric woes, the study suggests.

The researchers studied 221 Minnesotans, about half of whom suffered from IBS or other gastrointestinal problems. All the participants filled out
detailed questionnaires that asked about their diet, and about half of those in each group also kept a diet diary for one week itemizing exactly what
they ate and when.

The study showed that fat comprised a greater proportion of the total calories taken in by people with IBS each day for healthy people.
Carbohydrates, on the other hand, accounted for a lower proportion of their total caloric intake.

No significant differences were found for protein, fiber, iron, calcium, niacin, or vitamins B, C, D, or E.

Saito says further studies are needed to look at whether fat causes gastrointestinal symptoms in people with IBS.

In the meantime, she does not recommend any blanket change in diet recommendations. Instead, people who suffer from IBS should work with a
doctor, nurse, or nutritionist to uncover any foods that make them feel worse.

Olden, who was not involved with the study, agrees. "I advise my patients to eat what they enjoy. If they identify a food that makes them feel sicker,
they should not eat that food. "But you can't tell everyone not to eat cornflakes."

SOURCES: The 68th Annual Scientific Meeting of the American College of Gastroenterology, Baltimore, Oct. 12-15, 2003. Young K. Choi, MD, University
of Iowa, Iowa City. Richard G. Locke III, associate professor of medicine, Mayo Clinic, Rochester, Minn. Kevin W. Olden, MD, associate professor of
medicine, Mayo Clinic, Scottsdale, Ariz. Yuri A. Saito, MD, MPH, Mayo Clinic, Rochester, Minn.

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Irritable Bowel Syndrome's Possible Genetic Link Studied by Mayo Clinic Researchers
ROCHESTER, Minn., Dec. 10 (AScribe Newswire) -- Researchers at Mayo Clinic studying irritable bowel syndrome say their study of people with this disorder suggests genetic factors may play a role.

Irritable bowel syndrome is a common problem affecting about one in 10 adults. However, many people don't talk about irritable bowel syndrome, which causes abdominal cramping, constipation and diarrhea. The study, which is published in the December issue of Gut, an international journal in gastroenterology, shows that the risk of having irritable bowel syndrome is nearly double in the families of people with the disorder.

"The next challenge is determining nature versus nurture," said G. Richard Locke, M.D., a Mayo Clinic gastroenterologist and one of the authors of the study. "Is this due to a gene or genes or is it due to a shared environmental factor? Our group is active in investigating these issues."

In developing the study, researchers noted that people with irritable bowel syndrome often report family members with similar symptoms. The researchers hypothesized that if there is a familial connection, there would be an increased frequency of irritable bowel syndrome in direct relatives of irritable bowel syndrome patients compared to relatives of people without irritable bowel syndrome.

Others who conducted the study include Jamshid Kalantar, M.D., Alan Zinsmeister, Ph.D., Christopher Beighley, and Nicholas Talley, M.D., Ph.D. Dr. Kalantar was a research fellow at Mayo Clinic during the study, but is now with the Department of Medicine, University of Sydney, Australia. Mr. Beighley now works in West Virginia. The others are with Mayo Clinic in Rochester.

In the study, patients with irritable bowel syndrome seen at Mayo Clinic and their spouses filled out a bowel disease questionnaire and provided the names and addresses of their direct relatives. Researchers then sent a bowel disease questionnaire to 355 relatives of the patients and their spouses, and 71 percent responded. Irritable bowel syndrome occurred in 17 percent of the patients' relatives compared with 7 percent in spouses' relatives.

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Diet may play role in IBS and dyspepsia
Studies link fructose and fat to IBS symptoms

Contact: Malaika Hilliard
mhilliard@porternovelli.com
202-973-5896
American College of Gastroenterology
BALTIMORE (October 13, 2003)-- Two recent studies released today attempt to unravel the role that diet plays in gastrointestinal disorders such as irritable bowel syndrome (IBS) and dyspepsia. The preliminary findings suggest that both fructose and fat contribute to symptoms of IBS, a disorder affecting about 10 to 15 percent of the American population. The findings will be presented at the 68th Annual Scientific Meeting of the American College of Gastroenterology.
For several years, University of Iowa researchers have been investigating how fructose, the simple sugar found in honey and many fruits, may play an important role in some of the symptoms of IBS, a leading cause of referral to a gastroenterologist. IBS is characterized by abdominal discomfort, bloating, and change in bowel habits (constipation and/or diarrhea).

Although lactose intolerance is well-known, fructose intolerance is just beginning to be recognized. Young K. Choi, M.D., and colleagues from the University of Iowa Hospitals and Clinics (Iowa City, IA) found previously that one-third to one-half of patients with IBS symptoms are fructose intolerant.

"A fructose-restricted diet significantly improved symptoms in patients with IBS and fructose intolerance," said Dr. Choi. "Fructose intolerance is yet another piece of the IBS puzzle, whose treatment -- when adhered to -- confers significant benefits."

For this study, the University of Iowa researchers tested 80 patients with suspected IBS and found that 30 were fructose intolerant. Patients were taught about eliminating fructose from their diet, and after one year, 26 were interviewed to assess their symptoms. Only one-half of the patients complied with the fructose-restricted diet.

For those who were compliant, symptoms (such as abdominal pain, bloating, and diarrhea) declined significantly (P .LT. 0.05) from their reported symptoms before the diet modification. Also, the prevalence of IBS in this group declined. For the group that did not comply with the diet modification, bowel symptoms stayed the same over the study period. Given the modest number of patients, additional confirming studies would be an important prerequisite to consideration of a modification in general disease management strategies in IBS.

In the second study, Yuri A. Saito, M.D., M.P.H., and colleagues of the Division of Gastroenterology and Hepatology at Mayo Clinic and Foundation (Rochester, MN) attempted to tease out the dietary factors that may explain some of the symptoms of functional gastrointestinal disorders, such as IBS and dyspepsia. Their population-based study provides the framework for establishing whether dietary components are the causative factors in the development of symptoms.

The investigators mailed a questionnaire to an age- and gender-stratified random sample of Minnesotans aged 20 to 50 years old. Those who reported IBS or dyspepsia or who claimed no GI symptoms had a physical exam and completed a survey on diet. Of the 221 participants who completed the diet survey, 53 cases and 58 controls were asked to record their diet for one week.

Dr. Saito and colleagues found that those with IBS or dyspepsia reported consuming a significantly higher proportion of fat in their diet (33.0 percent for those with GI disorders, 30.7 percent for controls, P .LT. 0.05). No significant differences were found for protein, fiber, iron, calcium, niacin, or vitamins B1, B2, B6, B12, C, D, or E.

"Future studies are needed to determine whether fat intake causes gastrointestinal symptoms," said Dr. Saito.

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Inflammatory Bowel Disease and Irritable Bowel Syndrome: Separate or Unified?

Posted 07/15/2003
Sylvie Bradesi, PhD, James A. McRoberts, Ph.D, Peter A. Anton, MD, Emeran A. Mayer, MD

Abstract and Introduction
Abstract
Both irritable bowel syndrome and inflammatory bowel diseases share symptoms of altered bowel habits associated with abdominal pain or discomfort. Irritable bowel syndrome has been referred to as a functional bowel disorder, which is diagnosed by a characteristic cluster of symptoms in the absence of detectable structural abnormalities. Inflammatory bowel disease is a heterogeneous group of disorders characterized by various forms of chronic mucosal and/or transmural inflammation of the intestine. In this review, the authors discuss recent evidence suggesting several potential mechanisms that might play a pathophysiologic role in both syndromes. Possible shared pathophysiologic mechanisms include altered mucosal permeability, an altered interaction of luminal flora with the mucosal immune system, persistent mucosal immune activation, alterations in gut motility, and a role of severe, sustained life stressors in symptom modulation. It is proposed that similarities and differences between the two syndromes can best be addressed within the framework of interactions between the central nervous system and the gut immune system. Based on recent reports of low-grade mucosal inflammation in subpopulations of patients meeting current diagnostic criteria for irritable bowel syndrome, therapeutic approaches shown to be effective in inflammatory bowel disease, such as probiotics, antibiotics, and antiinflammatory agents, have been suggested as possible therapies for certain patients with irritable bowel syndrome.

Complete article here: http://www.medscape.com/viewarticle/457728_1
Curr Opin Gastroenterol 9(4):336-342, 2003. © 2003 Lippincott Williams & Wilkins

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