ALLERGY, RESPIRATORY
Traffic, Dust Linked to Asthma in Kids
Air Quality Better in Northeast, Midwest
Keep Asthma, Allergies at Bay for the Holidays
ALTERNATIVE MEDICINE
Acupuncture May Trigger Natural Painkiller
When Healing Becomes a Commodity
Acupuncture May Not Help Hot Flashes
ANIMAL CARE
Animals Respond to Acupuncture's Healing Touch
Rest Easy. When It Comes to Swine Flu, Your Pet Is Safe
'Comfort Dogs' Come to Emotional Rescue
BONES & JOINTS
Vitamin D Plus Calcium Guards Against Fractures
New Clues to How Fish Oils Help Arthritis Patients
Fruits and Veggies May Strengthen Bones
CANCER
Adding Garlic Might Cut Cancer Risk
Method for Treating Cervical Lesions May Pose Pregnancy Risks
Strenuous Daily Workout May Keep Cancer at Bay
CAREGIVING
Flu Strikes a Milder Blow This Season
Memory Loss Help from Brain Supplement Prevagen
What Moms Learned May Be Passed to Offspring
CIRCULATORY SYSTEM
Tai Chi and Qigong Offer Many Health Benefits: Review
Mercury in Fish Linked to High Blood Pressure
Laughter Can Boost Heart Health
COSMETIC
With Psoriasis, the Internet May Offer Hope
Health Tip: After Liposuction
Study Evaluates Laser Therapies for Hair Removal
DENTAL, ORAL
Hormones May Be to Blame for Women's Cavity Rates
An Oral Approach to Heart Disease
Amino Acid May Be Key to Strong Teeth
DIABETES
Spices, Herbs Boost Health for Diabetics
Exercise Protects Black Women From Type 2 Diabetes
Brown Rice Bests White for Diabetes Prevention
DIET, NUTRITION
Adding Garlic Might Cut Cancer Risk
Atkins Diet Tougher on Heart After Weight Loss
Low Vitamin D Levels May Initiate Cancer Development
DISABILITIES
Review Finds Marijuana May Help MS Patients
Could Your Cell Phone Help Shield You From Alzheimer's?
ENVIRONMENTAL HEALTH
Improved Fungicides May Be Easier on Environment
What's Cookin'? It Could Be Air Pollution
Seasons Arriving 2 Days Earlier, Study Says
EYE CARE, VISION
Clues Found to Brain Mechanism Behind Migraines
Eye Problems, Hearing Loss May Be Linked
Omega-3 Foods May Lower Eye Disease Risk
FITNESS
Consciousness Helps the Mind and Body Work Together
Be Healthy, Spend Less
Being Active an Hour a Day Puts Brakes on Weight Gain
GASTROINTESTINAL PROBLEMS
Peppermint Oil, Fiber Can Fight Irritable Bowel
Soothing Imagery May Help Rid Some Kids of Stomach Pain
Gum Chewing May Speed Colon Surgery Recovery
GENERAL HEALTH
6 to 8 Hours of Shut-Eye Is Optimal for Health
When Clocks Change, Body May Need Time to Adjust
Pesticides and How to Affordably Eat Organic or Reduce Pesticide Consumption
HEAD & NECK
Ski Helmets Encouraged for All
Zen May Thicken Brain, Thwart Pain
Many Children Will Outgrow Headaches
HEALTH & TECHNOLOGY
Imaging Sheds Light on How Acupuncture Works
Subway Defibrillators Save Lives
The Internet Is Becoming One-Stop Shopping for Health Help
HEARING
Summer Sounds Can Lead to Hearing Loss
Noise Hurts Men's Hearing More, Study Shows
HEART & CARDIOVASCULAR
Cocoa in Chocolate May Be Good for the Heart
Toothbrushing May Stave Off Heart Woes
Fish Oil Supplements Help With Heart Failure
INFECTIOUS DISEASE
Swine Flu Now Reported in All 50 States
Swine Flu Closes Three Schools in NYC
Chinese 'Devil Dung' Plant Could Be a Swine Flu Fighter
INFERTILITY
Obesity May Affect Fertility in Young Womene
KID'S HEALTH
Plastics Chemical Tied to Aggression in Young Girls
Fussy Babys Could Be Out Of Your Control
Family Medicine Cabinet Top Source Of Kid's Poisonings
MEN'S HEALTH
Soy Linked to Low Sperm Count
Vigorous Exercise Cuts Stroke Risk for Men, Not Women
Strenuous Daily Workout May Keep Cancer at Bay
MENTAL HEALTH
Musicians' Brains Tuned to Emotions in Sound
Meditation May Boost College Students' Learning
A Simple 'Thank You' Brings Rewards to All
PAIN
Tai Chi May Help Ease Fibromyalgia
Are We Exercising Pain Away? Not So Much.
Acupuncture, Real or Fake, Eases Back Pain
PHYSICAL THERAPY
PREGNANCY
Alternative Treatments May Boost IVF Success
Heart Defects in Newborns Linked to Antidepressants
Acupuncture May Relieve Acid Indigestation In Pregnancy
SENIORS
15-Point Test Gauges Alzheimer's Risk
Exercise Helps Reduce Falls in Young and Old
Daily dose of beet juice promotes brain health in older adults
SEXUAL HEALTH
SLEEP DISORDERS
Better Sleep, Grades Seem to Go Up
6 to 8 Hours of Shut-Eye Is Optimal for Health
Meditation May Help Put Primary Insomnia to Bed
WOMEN'S HEALTH
Steady Weight Gain Boosts Late-Life Breast Cancer Risk
Bitter Melon Extract May Slow, Stop Breast Cancer
Supplements Might Reduce Breast Cancer Risk
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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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