Irritable Bowel Syndrome Reading Room
Bowel, Pain Syndromes Linked
IBS Patients 60% More Likely to Suffer
Fibromyalgia, Migraine, Depression
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:
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."
25 Mar 2009
Article URL: http://www.medicalnewstoday.com/articles/143524.php
Main News Category: Irritable-Bowel Syndrome
Also Appears In: Clinical Trials / Drug Trials,
Peppermint oil for irritable bowel
syndrome: a critical review and metaanalysis.
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]
16 Mar 2009
Article URL: http://www.medicalnewstoday.com/articles/142395.php
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.
Irritable Bowel Syndrome
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.
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.
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
For digestion and upset stomach: 1 to 2 mL peppermint glycerite per day
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.
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.
5-Fluorouracil for Cancer
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):214221.
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;(1112):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;101:5565.
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;93:23042305.
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):11311135.
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
IBS Myths and
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."
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.
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]).
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,
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..
Eastern Medicine Offers
Alternative IBS Treatments
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.
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."
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
By Michael Mahoney Clinical Hypnotherapist
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:
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.
The intake information for the Newly Diagnosed presented with two findings:
1. Less expectation for either failure or success for
Outcome of CHT treatment
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
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?
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.
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
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.
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."
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.
Fermentation May Be
At Root Of Irritable Bowel Syndrome
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 weeks issue of The Lancet.
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.
Common Foods Known
to Aggravate IBS.
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.
(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 programs 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.
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.
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.
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.
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:
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.
When to conduct
testing in patients with suspected irritable bowel syndrome.
Nerve Receptor Found
to Be Key to Intestinal Inflammation
of irritable bowel syndrome in patients with bronchial asthma.
Bacteria in Your Gut: Learn How to Keep the Good Kind There.
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 dont 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
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"
patients with irritable bowel syndrome An association with the severity of the intestinal
Link Between Poor
Sleep and Irritable Bowel Syndrome Studied by ImmuneSupport Staff
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.
Symptoms Among Women With Irritable Bowel Syndrome GUT 2002; 50: 471-4.
By Harvey McConnell
~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®
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
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
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
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.
Fat, Fructose May Worsen Gastric Upset By
Disease and Irritable Bowel Syndrome: Separate or Unified?
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Page Updated: April 02, 2009