ALLERGY, RESPIRATORY
Know Your Asthma Triggers
Air Pollution May Raise Blood Pressure
Overweight Moms More Likely to Have Asthmatic Kids
ALTERNATIVE MEDICINE
Relaxation Tapes or Mozart Lower Blood Pressure
Acupuncture Eases Breast Cancer Treatment Side Effects
Alternative Treatments May Boost IVF Success
ANIMAL CARE
Rest Easy. When It Comes to Swine Flu, Your Pet Is Safe
Beware of Dog Bites
Animals Respond to Acupuncture's Healing Touch
BONES & JOINTS
B Cells Can Act Alone in Autoimmune Diseases
Fall Sports Peak Time for Lower Leg Damage
Bone Loss Stable on Restricted Calorie Diet
CANCER
Green Tea Compound Slowed Chronic Lymphocytic Leukemia
Herb May Counter Liver Damage From Chemo
Women Smokers Lose 14.5 Years Off Life Span
CAREGIVING
Medication Errors Could Be Cut: Experts
Many Hospital Patients Can't ID Their Doctors
Diabetes Epidemic Now Poses Challenges for Nursing Homes
CIRCULATORY SYSTEM
A Brisk Pace May Keep Stroke at Bay
Mercury in Fish Linked to High Blood Pressure
Varicose Veins May Mask Larger Problem
COSMETIC
Science May Banish Bad Hair Days
What to Do If You Have Unsightly Veins
Gum Chewing May Cut Craving for Snacks
DENTAL, ORAL
Good Oral Hygiene May Protect Against Heart Infections
Gum Disease May Reactivate AIDS Virus
Holistic Dentistry-My View
DIABETES
Boosting Vitamin D Can Do a Heart Good
Drug May Not Help Diabetes-Related Eye Damage
Treatment for Type 2 Diabetes Updated
DIET, NUTRITION
Low Vitamin D Levels May Initiate Cancer Development
Vinegar Might Help Keep Off Pounds
Purple Tomato Extended Lives of Cancer-Prone Mice
DISABILITIES
Review Finds Marijuana May Help MS Patients
Could Your Cell Phone Help Shield You From Alzheimer's?
ENVIRONMENTAL HEALTH
Traffic Seems to Make Kids' Asthma Worse
Exposure to 9/11 Fumes Tied to Chronic Headaches
Sunken, Unexploded Bombs Pose Cancer Risk
EYE CARE, VISION
Blood Sugar Control Helps Diabetics Preserve Sight
Poor Night Vision May Predict Age-Related Eye Disease
Retinal Gene Is Linked to Childhood Blindness
FITNESS
Be Healthy, Spend Less
Moderate Aerobic Exercise Lowers Diabetics' Liver Fat
Living With Less TV, More Sweat Boosts Weight Loss
GASTROINTESTINAL PROBLEMS
New Guidelines Issued for Management of IBS
Peppermint Oil, Fiber Can Fight Irritable Bowel
Japanese Herbals May Ease Gastro Woes
GENERAL HEALTH
For Women, Moderate Midlife Drinking Linked to Healthier Old Age
Most Women Struggle With Rising Health Care Costs
Week of Historic Senate Hearings on Integrative Medicine May Open New Doors
HEAD & NECK
Ski Helmets Encouraged for All
Many Children Will Outgrow Headaches
Zen May Thicken Brain, Thwart Pain
HEALTH & TECHNOLOGY
Subway Defibrillators Save Lives
Using Light Therapy to Silence Harmful Brain Activity
E-Mailing Your Way to Healthier Habits
HEARING
Noise Hurts Men's Hearing More, Study Shows
Summer Sounds Can Lead to Hearing Loss
HEART & CARDIOVASCULAR
Irregular Heartbeat Tied to Alzheimer's Disease
Heart Disease May Be Prevented By Taking Fish Oils, Study Shows
Research Shows Genetic Activity of Antioxidants
INFECTIOUS DISEASE
The HPV Vaccine: Preventative Medicine or Human Sacrifice?
Grapefruit Compound Inhibits Hepatitis C Virus
Bacterial Infections May Succumb to Honey
INFERTILITY
Obesity May Affect Fertility in Young Womene
KID'S HEALTH
Scary Toxins Make Halloween Face Paints Questionable
Keep Safety in Mind While Your Kids Are Cooling Off in the Water
Fussy Babys Could Be Out Of Your Control
MEN'S HEALTH
Low Iron Levels Cut Cancer Risk in Men With PAD
Lots of Sex May Prevent Erectile Dysfunction
Noise Hurts Men's Hearing More, Study Shows
MENTAL HEALTH
Meaningful Conversations Boost Kids' Language Skills
Bullying Seems to Affect Kids Years Later
Consciousness Helps the Mind and Body Work Together
PAIN
Tai Chi May Help Ease Fibromyalgia
Alleviating Rheumatoid Arthritis
'Cell Phone Elbow' -- A New Ill for the Wired Age
PHYSICAL THERAPY
PREGNANCY
Heart Defects in Newborns Linked to Antidepressants
Sugary Colas Tied to Gestational Diabetes
For Baby and Mom Alike, Breast-Feeding May Be Best
SENIORS
Want Better Health in the New Year, Add Exercise to Your Day
Many Cancer Survivors Don't Adopt Healthy Lifestyle
Money May Matter, Health-Wise, in Old Age
SEXUAL HEALTH
SLEEP DISORDERS
Sleeping Could Help Women Lose The Baby Fat
Lose Weight, Sleep Apnea May Improve
6 to 8 Hours of Shut-Eye Is Optimal for Health
WOMEN'S HEALTH
Natural Oils Help Lower Body Fat For Some
Natural Therapies for Menopause
Steady Weight Gain Boosts Late-Life 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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