Asthmatics Who Quit Smoking May Reverse Lung Damage
Folic Acid Might Offer Allergy Relief
Air Quality Better in Northeast, Midwest
Supplement Hampers Thyroid Cancer Treatment
Acupuncture Eases Breast Cancer Treatment Side Effects
Massage Fosters Healing in Bereaved Relatives
Separation Anxiety, Canine-Style
'Comfort Dogs' Come to Emotional Rescue
Beware of Dog Bites
Many Americans Fall Short on Their Vitamin D
Active Young Women Need Calcium, Vitamin D
Childhood Dairy Intake Boosts Bone Health Later On
Papaya Could Be a Cancer Fighter
Vitamin E, Selenium and Soy Won't Prevent Prostate Cancer
Many Cancer Survivors Don't Adopt Healthy Lifestyle
Study Links Pesticides to Birth Defects
Late-Life Fatherhood May Lower Child's Intelligence
Few Hospitals Embracing Electronic Health Record Systems
Review Confirms Links Between Diet, Heart Health
Obesity Linked to Heart Failure Risk
Secondhand Smoke Quickly Affects Blood Vessels
Contact Lenses Boost Kids' Self-Image
Mouse Study Finds Molecule That Tells Hair to Grow
Health Tip: After Liposuction
Holistic Dentistry-My View
Acupuncture May Ease Anxiety Over Dental Work
Rheumatoid Arthritis May Harm Gums
Chamomile Tea May Ward Off Diabetes Damage
Strict Blood Sugar Lowering Won't Ease Diabetes Heart Risk
Lifestyle Factors Tied to Older Adults' Diabetes Risk
The High-Fructose Corn Syrup (HFCS) Debate
Pesticides on Produce Tied to ADHD in Children
Vinegar Might Help Keep Off Pounds
Could Your Cell Phone Help Shield You From Alzheimer's?
Review Finds Marijuana May Help MS Patients
Accumulated Lead May Affect Older Women's Brains
Dementia Underestimated in Developing Countries
Ozone Pollution Taking Toll on American Lives
Cases of Age-Related Farsightedness to Soar
High Temps Degrade Contact Lens Solution: Study
Kids' Eye Injuries From Golf Clubs Rare But Severe
Tai Chi: An Ideal Exercise for Many People with Diabetes
Avoiding a Holiday Season of Discontent
After a Stroke, Light Exercise Gets Hands, Arms Working Again
Bowel Prep Harder on Women Than Men
New Yogurt May Ease Stomach Ulcers
Peppermint Oil, Fiber Can Fight Irritable Bowel
Time to Remind Teens About Sun Protection
Surgical Masks Could Prevent Flu, Maybe
Spot light on Dani Antman New Lionheart teacher
Zen May Thicken Brain, Thwart Pain
Ski Helmets Encouraged for All
Many Children Will Outgrow Headaches
'Comfort Dogs' Come to Emotional Rescue
E-Mailing Your Way to Healthier Habits
Airport Full Body Scanners Pose No Health Threat: Experts
Noise Hurts Men's Hearing More, Study Shows
Summer Sounds Can Lead to Hearing Loss
Kids With Vitamin D Deficiency Linked to Heart Trouble
Brown Rice Tied to Better Heart Health in Study
Vitamin B3 May Help Repair Brain After a Stroke
Poor Restroom Cleaning Causes Cruise-Ship Sickness
Chinese 'Devil Dung' Plant Could Be a Swine Flu Fighter
Swine Flu Is Now a Pandemic Says W.H.O.
Obesity May Affect Fertility in Young Womene
Should Your Child Be Seeing a Chiropractor?
Guard Kids' Eyes Against Long-Term Sun Damage
Pregnant Women Exposed To Certain Pollutants Could Lower Childs IQ
Vigorous Exercise Cuts Stroke Risk for Men, Not Women
Could Chinese Herb Be a Natural Viagra?
Lots of Sex May Prevent Erectile Dysfunction
Vitamin C Protects Some Elderly Men From Bone Loss
Meditation May Boost College Students' Learning
Chocolate a Sweet Pick-Me-Up for the Depressed
Alleviating Rheumatoid Arthritis
Tai Chi May Help Ease Fibromyalgia
'Cell Phone Elbow' -- A New Ill for the Wired Age
Expectant Mom's Exercise Keeps Newborn's Birth Weight Down
Breast-Feeding Benefits Moms and Babies
Mom's Extra Pregnancy Pounds May Raise Child's Heart Risks
Money May Matter, Health-Wise, in Old Age
Seniors Who Volunteer May Live Longer
As You Age, Better Health Means Better Sex
Sleeping Could Help Women Lose The Baby Fat
Lose Weight, Sleep Apnea May Improve
Better Sleep, Grades Seem to Go Up
Flame-Retardant Chemical Linked to Conception Problems
Natural Relief for Painful Menstrual Cramps
Women Smokers Lose 14.5 Years Off Life Span
Add your Article

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

Copyright 2008 ScoutNews, LLC. All rights reserved.

Licensed by