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'Safe' Ozone Levels May Not Be for Some
Air Quality Better in Northeast, Midwest
Obesity May Raise Kids' Allergy Risk
ALTERNATIVE MEDICINE
Meditation May Boost Short-Term Visual Memory
Holistic Treatment for Candida Infection
Health Tip: Anticipating Acupuncture
ANIMAL CARE
'Comfort Dogs' Come to Emotional Rescue
Animals Respond to Acupuncture's Healing Touch
Beware of Dog Bites
BONES & JOINTS
Varicose, Spider Veins May Be Inevitable for Some
For All Their Plusses, Pets Pose a Risk for Falls, Too
Childhood Dairy Intake Boosts Bone Health Later On
CANCER
HPV Vaccine Has Higher Allergic Reaction Rate
Women Smokers Lose 14.5 Years Off Life Span
Healthy Behaviors Slow Functional Decline After Cancer
CAREGIVING
High Rate of Rehospitalizations Costing Billions
Hospital Volume Imperfect Gauge of Cancer Surgery Outcomes
Simpler Sleep Apnea Treatment Seems Effective, Affordable
CIRCULATORY SYSTEM
Review Confirms Links Between Diet, Heart Health
An Apple a Day May Help Keep Heart Disease Away
Bad Marriages Harder on Women's Health
COSMETIC
New Genetic Links to Baldness Discovered
Health Tip: After Liposuction
Study Evaluates Laser Therapies for Hair Removal
DENTAL, ORAL
Gum Care Helps Control Type 2 Diabetes and Its Complications
Good Oral Hygiene May Protect Against Heart Infections
Gum Disease Might Boost Cancer Risk
DIABETES
Patients' Photos Help Boost Radiologists' Accuracy
Study Shows Turmeric May Prevent Type 2 Diabetes
24 Million Americans Had Diabetes in 2007
DIET, NUTRITION
Research Confirms How Valuable A Healthy Lifestyle Can Be
Decline of Underweight Children in U.S. Continue to Fall
Cinnamon Breaks Up Brain Plaques, May Hold Key to Fighting Alzheimer’s
DISABILITIES
Could Your Cell Phone Help Shield You From Alzheimer's?
Review Finds Marijuana May Help MS Patients
ENVIRONMENTAL HEALTH
Bed Bugs Bring No Disease Danger
Preparing for a Chlorine Gas Disaster
Pollution Particles Impair Blood Vessel Function
EYE CARE, VISION
'Blind' Man Navigates Obstacle Course Without Error
Antioxidant-Rich Diet May Protect Against Eye Disease
Certain Diabetes Drugs May Pose Eye Risk
FITNESS
Diet, Exercise May Slow Kidney Disease Progression
Maximize Your Run
Go To Work But Skip The Car
GASTROINTESTINAL PROBLEMS
Bowel Prep Harder on Women Than Men
Gum Chewing May Speed Colon Surgery Recovery
New Yogurt May Ease Stomach Ulcers
GENERAL HEALTH
Standard IQ Test May Underestimate People With Autism
Winter's Bitter Cold Poses Health Dangers
Asparagus May Ease Hangover
HEAD & NECK
Many Children Will Outgrow Headaches
Zen May Thicken Brain, Thwart Pain
Ski Helmets Encouraged for All
HEALTH & TECHNOLOGY
Save Your Aging Brain, Try Surfing The Web
Combating Myths About Seasonal Allergies
'Comfort Dogs' Come to Emotional Rescue
HEARING
Noise Hurts Men's Hearing More, Study Shows
Summer Sounds Can Lead to Hearing Loss
HEART & CARDIOVASCULAR
Walk Long, Slow and Often to Help the Heart
Review Confirms Links Between Diet, Heart Health
Estrogen May Help Men's Hearts
INFECTIOUS DISEASE
Swine Flu Loves a Crowd
Poor Restroom Cleaning Causes Cruise-Ship Sickness
Viral Infection Might Trigger High Blood Pressure
INFERTILITY
Obesity May Affect Fertility in Young Womene
KID'S HEALTH
Obesity May Raise Kids' Allergy Risk
Health Tip: Back Pain in Children
Obese Children More Likely to Suffer Lower Body Injuries
MEN'S HEALTH
Countdown to Hair Loss
Whole Grains, Bran May Fight Hypertension in Men
Noise Hurts Men's Hearing More, Study Shows
MENTAL HEALTH
Positive Brain Changes Seen After Body-Mind Meditation
Environmental Chemicals May Affect Male Reproduction
Man's Best Friend Helps Mend Broken Hearts
PAIN
Alleviating Rheumatoid Arthritis
'Cell Phone Elbow' -- A New Ill for the Wired Age
Are We Exercising Pain Away? Not So Much.
PHYSICAL THERAPY
PREGNANCY
Breast-Feeding May Protect a Woman's Heart
Yoga's Benefits Outweigh Risks for Pregnant Women
Music of Mozart Soothes the Preemie Baby
SENIORS
Exercise Helps Reduce Falls in Young and Old
Healthy Diet Could Cut Alzheimer's Disease Risk
Daily dose of beet juice promotes brain health in older adults
SEXUAL HEALTH
SLEEP DISORDERS
Exercising Throat Muscles May Relieve Sleep Apnea
Sleeping Could Help Women Lose The Baby Fat
Pay Attention to Signs That Say You're Too Fatigued to Drive
WOMEN'S HEALTH
Prenatal Stress May Boost Baby's Asthma Risk
Lifting Weights Can Ease Arm Swelling in Breast Cancer Survivors
Green Tea May Help Treat Uterine Fibroids
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New Guidelines Issued for Management of IBS

THURSDAY, Dec. 18 (HealthDay News) -- A leading organization of gastroenterologists has released new guidelines on the management of irritable bowel syndrome (IBS).

The guidelines, issued by the American College of Gastroenterology and published in the January issue of The American Journal of Gastroenterology, essentially replace a 2002 document.

"The world of IBS is changing quickly because of more therapies and an increased awareness. It is considered a 'real disease,'" said Dr. Lawrence Brandt, chairman of the group's IBS task force and chief of gastroenterology at Montefiore Medical Center in New York City. "A lot of new drugs are being developed, and a lot of work still needs to be done, but there's enough new information since the last time."

"From the practitioner's standpoint, this doesn't change much about practice and there's not that much information that's new, although it is thorough and helpful," said Dr. Benjamin D. Havemann, an assistant professor of internal medicine at the Texas A&M Health Science Center College of Medicine and director of gastroenterology for the Round Rock University Medical Campus of Scott & White Hospital. "It shows what little has transpired [in terms of new treatments] in the last few years. Some of the breakthroughs we had have been withdrawn or are under strict control."

"One powerful piece of information is that extensive work-ups are unhelpful," Havemann said. "It makes sense to me that in the absence of alarm symptoms, the benefit of even basic blood work and other tests is in doubt."

An estimated 7 percent to 10 percent of people have IBS, which can involve abdominal pain, bloating and other discomfort, including constipation and diarrhea. IBS affects both quality of life and productivity for millions of people.

Most IBS treatments relieve symptoms rather than resolve the condition itself.

The new guidelines encompass existing evidence on conventional treatments for IBS as well as new therapies (probiotics, for example) and alternative therapies (acupuncture and more). In summary, the updated guidelines say:

* Fiber products -- including psyllium, anti-spasmodic medications and peppermint oil -- may be effective, at least in some people. "The evidence is poor, but some patients say they feel better," Brandt said. He cautioned that fiber should be used carefully in people with narrowed colons.
* More data is needed on probiotics, live microorganisms (usually bacteria) similar to the "good" organisms found normally in the gut. "This is a very hot topic but an exceedingly complicated subject," Brandt said. Researchers and practitioners need to consider the species of bacteria used, how many species, and dosages.
* Non-absorbable antibiotics -- those targeted to the gut only, such as rifaximin (Xifaxan) -- also seem to help some people, especially those who have "diarrhea-predominant IBS." Brandt said that "the data is not great, but some patients swear they're helping them dramatically."
* Tricyclic antidepressants as well as the antidepressants known as selective serotonin reuptake inhibitors (SSRIs) benefit a broad range of people with IBS. This is backed up by quality studies, although with small numbers of participants, and could change as research on larger numbers of people is evaluated. Psychological counseling may also provide some relief.
* Selective C-2 chloride channel activators, notably lubiprostone (Amitiza), are effective for "constipation-predominant IBS."
* 5HT 3 antagonists such as alosetron (Lotronex) relieve symptoms of diarrhea but can cause constipation and colon ischemia, a restriction of blood flow.
* 5HT 4 agonists, though effective against constipation, are not available in North America because of a heightened risk of cardiovascular problems.
* There is yet to be conclusive evidence on Chinese herbal mixtures, and the mixtures run the risk of causing liver failure and other problems. Differences in the content of compounds and the purity of ingredients complicate evaluation of benefits.
* Similarly, the evidence on acupuncture remains inconclusive.
* There is no evidence at this point that testing for food allergies or following diets that exclude certain foods alleviates IBS symptoms.
* Routine diagnostic testing for IBS is not recommended, although some testing should be performed in certain subgroups of patients.

Though comprehensive, the guidelines were criticized for not explaining what outside funding was used for in the development process. The document does disclose that support was received from Takeda Pharmaceutical Co. and Salix Pharmaceuticals, which make products targeted to IBS.

Dr. Mark Ebell, deputy editor of American Family Physician, said he would feel more comfortable if the guidelines had been "very clear about what support was provided and what they needed the support for: paying for literature searches, for staff. … It's common to have support for guidelines. … I think it's generally unintentional, but when we have a relationship, it creates the potential for problems."

Ebell said that Brandt had relationships with pharmaceutical companies.

Brandt had a different view. "I don't have any ties to industry that would have any relevance to this publication," he said. "I don't receive money directly from any company. I own no stock and, nor does my family, so this is a totally unbiased thing. I have no conflict of interest whatsoever, and I think that does it."

Anne-Louise B. Oliphant, a spokeswoman for the American College of Gastroenterology, said: "No company was involved in any way in either structuring or completing the meta-analysis that forms the basis for the College's evidence-based recommendations on IBS. Furthermore, no company was in any way involved in deciding who served on the task force or in any of its work."

More information

To learn more about IBS, visit the U.S. National Institute of Diabetes and Digestive and Kidney Diseases online.



SOURCES: Lawrence J. Brandt, M.D., chief, division of gastroenterology, Montefiore Medical Center, and professor of medicine and surgery, Albert Einstein College of Medicine, New York City; Mark H. Ebell, M.D., deputy editor, American Family Physician; Anne-Louise B. Oliphant, spokeswoman, American College of Gastroenterology, Bethesda, Md.; Benjamin D. Havemann, M.D., assistant professor, internal medicine, Texas A&M Health Science Center College of Medicine, and director, gastroenterology, Round Rock University Medical Campus, Scott & White Hospital; January 2009 The American Journal of Gastroenterology

Last Updated: Dec. 18, 2008

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