According to a study conducted by the Mayo Clinic in Rochester, Minnesota, St. John’s wort is not effective for treating irritable bowel syndrome (IBS).

St. John’s wort is an herbal supplement which has been shown in several trials to be effective for treatment of depression. Antidepressants are frequently used as a treatment for IBS, however, there have been no previous studies to determine if St. John’s wort was a effective treatment for IBS.

“Several of the chemical neurotransmitters that are in the brain are also in the colon. Therefore, it’s been thought that antidepressants may affect sensation in the colon in a similar way to how they affect sensation in the brain. Our goal was to evaluate the usefulness of St John’s wort in treating IBS.” – Yuri Saito, M.D., M.P.H., gastroenterologist and study lead.

The Mayo Clinic trial included 70 Irritable Bowel Syndrome patients. Sixty of the patients were women and the average age was 42 years. During the 3 month trial half of the participants received St. John’s wort, while the other half were given a placebo.

The study participants were observed for symptoms such as constipation, diarrhea, back pain and bloating. The researchers found that the group taking the placebo had more improvement in their symptoms than the group taking St. John’s wort.

“Because people tend to struggle with IBS for several years, patients are really looking for inexpensive, over-the-counter treatments such as St. John’s wort,” says Dr. Saito. “Unfortunately, our study showed that St. John’s wort was not successful in helping IBS patients.”

Results of the study were published in the January issue of the American Journal of Gastroenterology

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According to research, adding soluble fiber such as psyllium to the diet is more likely to improve irritable bowel syndrome (IBS) symptoms than adding insoluble fiber such as bran.

The Dutch research study, a randomized trial involving 275 IBS patients, demonstrated the benefits of psyllium taken with yogurt early as one month. The test group was divided into three groups, one third received 10g psyllium, another third received 10g bran and the last third received 10g placebo (rice flour) daily.

For every four patients treated with psyllium at one month, one reported fourteen days relief from abdominal pain or discomfort.

Patients taking psyllium reported a 90-point reduction in symptom severity on a 500-point scale at three months, compared with a 49-point reduction in the placebo group and a non-significant 58-point reduction in the bran group.

Early drop-out was highest in the bran group, with the authors warning bran might worsen symptoms of IBS, especially at the beginning of treatment, and should be advised only with caution.

Writing in the British Medical Journal, the authors said those left in the trial taking bran were probably a small subset of patients who responded well to the supplement.

Psyllium was most effective in patients with a positive diagnosis of IBS based on the Rome II criteria, but it also reduced symptoms in patients whose IBS was only suspected, the study found.

Overall there was a 40% drop-out rate, which the authors said was comparable with similar trials. The main reason was that participants felt worse taking the fiber supplement, they said.

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Dr. Leonard Weinstock, a gastroenterologist at Washington University in St. Louis, recently conducted a small study on the relationship of an small intestine bacterial overgrowth (SIBO) with irritable bowel syndrome (IBS) and restless leg syndrome (RLS).

Dr. Weinstock developed the theory that there is a relationship between IBS and RLS when his cousin developed both conditions after having travelers’ diarrhea. Dr. Weinstock also said he has heard reports of IBS being associated with fibromyalgia, which, in turn, has been linked to RLS.

Dr. Weinstock found that bacterial overgrowth in the small intestine, one factor in IBS, also may play a part in RLS and that antibiotics appear to help both conditions.

The test involved 13 patients who have both IBS and RLS. The patients were given a 10-day course of the antibiotic rifaximin. All of the participants experienced improvement in IBS symptoms and 10 found significant relief from their RLS symptoms.

Rifaximin is not absorbed by the bloodstream. Participants in the study also were given long-term prescriptions for the IBS drug tegaserod, marketed under the trade name Zelnorm, and a one-month course of zinc and probiotic therapy. Dr. Weinstock, who is a consultant and speaker for Salix pharmaceuticals, marketer of rifaximin, is now starting a multicenter trial that will involve 600 patients.

Restless leg syndrome is a condition that is characterized by an irresistible urge to move one’s body to stop uncomfortable or odd sensations.

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Scientists have found that singing may help ease irritable bowel disease.

Singing in a choir may help ease the symptoms of irritable bowel disease. Sufferers who took singing sessions once a week for a year reported less pain than those who did not, according to a recent Swedish study.

Benefits: Singing in a choir can reduce the pain of irritable bowel syndrome by increasing the levels of feel-good hormone oxytocin.

The researchers believe that singing increases levels of the feel-good hormone oxytocin, which may have a painkilling effect.

Irritable bowel syndrome affects ten to 15 per cent of the population, causing symptoms such as abdominal pain and cramping, bloating and diarrhea.

It is three times more common in women, there is no cure and treatment includes dietary changes, medication to treat the spasms, and even antidepressants.

Although its cause is unknown, there is evidence that psychological factors, such as stress, play an important role in irritable bowel syndrome.

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People who suffer from constipation due to irritable bowel syndrome may get relief from their symptoms by participating in regular exercise. This is the finding of a study published in the International Journal of Sports Medicine in September, 2008.

Previous studies have shown that regular exercise can relieve constipation and feelings of bloating. Therefore, it seems plausible that regular exercise could help IBS sufferers find relief from these symptoms.

This 12 week study was conducted with 56 adult participants, most of whom were women. This group was randomly assigned to usual care or to an exercise program. The exercise program consisted of two 40-minute one-on-one exercise consultations designed to provide exercise skills, knowledge, confidence and motivation with the goal of performing 30 minutes of moderate intensity exercise 5 days a week.

After 12 weeks, the group that did regular exercise reported significantly greater declines in symptoms of constipation.

The study was conducted by Dr. Amanda J. Daley of the University of Birmingham in the UK. The fact that this brief, pragmatic exercise intervention led to a significant increase in the amount of exercise IBS patients engaged in is “encouraging,” Daley and her colleagues say, especially considering that people with IBS may avoid participating in exercise because of their abdominal symptoms.

In conclusion, the report emphasizes the potential for exercise to be an effective way for people to manage their IBS symptoms, particularly constipation.

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The American College of Gastroenterology (AGC, www.gi.com) announced Wednesday that it will unveil two new online, interactive patient tools for people with irritable bowel syndrome (IBS). “The IBS Test” and “The IBS Treatment Matrix” are based on recently published ACG analysis and offers graded recommendations on the full range of options for testing and treatment of IBS. These new tools will be revealed on May 29 in recognition of World Digestive Health Day.

IBS is a chronic functional gastrointestinal disorder which for many sufferers is marked by abdominal discomfort, bloating, constipation and/or diarrhea. It is estimated that between 10% and 15% of the U.S. adult population suffers from IBS symptoms, yet only 5% to 7% of adults have been diagnosed with the disease. According to studies, IBS patients make more visits to their physicians, undergo more diagnostic tests, are prescribed more medications, miss more workdays, have lower work productivity, are hospitalized more frequently, and account for greater overall direct healthcare costs than patients without IBS.

The IBS Treatment Matrix for patients was built based on a new ACG systematic review of the evidence on IBS treatments. Published in the January 2009 issue of The American Journal of Gastroenterology, the review offers graded recommendations on the full spectrum of options for testing and treatment of IBS, addressing everything from new IBS drugs to alternative therapies including psychotherapy and acupuncture.

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Irish Pharmaceutical AGI Therapeutics has announced that they are discontinuing development of their Irritable Bowel Syndrome candidate, Rezular, after showed disappointing results in Phase III trials.

Analysis from the trial, which involved 711 participants from 123 clinics in the U.S., South America and Europe, showed the drug did not significantly relieve the symptoms of diarrhea-predominant IBS (IBS-D), which include pain/discomfort or change in severity of pain.

The trial utilized four different regimens which included three different dosage levels of Rezular as well as placebo. This was a double-blind trial that was conducted over a period of 12 weeks. Results of the trial included:

• The study did not show statistically significant differences between treatments in the primary endpoint of patient reported adequate relief of IBS symptoms
• Statistically significant evidence favoring Rezular treatment was achieved in a number of secondary endpoints, particularly those relating to aspects of diarrhea (e.g. stool form as assessed by the Bristol Stool Scale), stool frequency and in the majority of sub-categories of quality-of-life (IBS-QOL) scores and in the overall IBS-QOL score
• There were no statistically significant differences between treatments in adequate relief of pain/discomfort or change in severity of pain

AGI said it didn’t believe the drug would meet regulatory requirements as an effective therapy for the broad IBS-D population.

AGI’s CEO, John Devane Ph.D., said that while AGI is disappointed with results, it would not be a prudent use of resources to continue development of Rezular as a treatment for IBS-D. “A safe and effective therapy for patients with IBS-D remains elusive. We will now focus on prioritizing our pipeline and plan how best to move these forward.”

AGI is currently developing several other treatments for gastro-intestinal disorders:

• A proof-of-concept Phase II trial with AGI-004, a controlled release transdermal mecamylamine patch, in the treatment of chemotherapy-induced diarrhoea (CID)
• AGI-006, which contains the pure r-isomer form of the racemic CNS disorder drug, baclofen, and is in development for a number of GI and related conditions.
• The ulcerative colitis candidate AGI-022 is being developed as an improved, once-daily form of aminosalicylic acid (ASA), formulated in a colon-targeted delayed-release/controlled-release delivery system
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A new study suggests that adults with allergy symptoms have a higher risk of developing irritable bowel syndrome. The link is between atopic disorders, which is an allergic hypersensitivity, and IBS.

The study involved 125 patients and was conducted by Rush University Medical Center. The research team found that patients with seasonal allergic rhinitis were more than 2 ½ times as likely to have IBS and those with allergic eczema were nearly 4 times as likely to have IBS.

According to the researchers: “The reported presence of allergic dermatitis was highly correlated to the presence of IBS in our population. In atopic disease, allergic dermatitis is the first step of the ‘atopic march.’ In early childhood, AE (allergic eczema) is frequently associated with gastrointestinal dysfunction and food allergy. A clinical history of AE may be a useful marker for patients with gut hypersensitivity and atopic IBS.”

In addition, the study shows that 29% of asthma patients also had irritable bowel syndrome, a finding that correlates with previous studies.

The results of this, as well as previous related studies, led the researchers to suggest that “this subgroup of IBS (atopic IBS) be considered separately from patients with IBS without atopic symptoms, because they may have distinct pathophysiologic features and may benefit from specific therapeutic interventions.”

The findings of this study were published in the January, 2009 issue of Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology.

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In the last two posts I wrote about some of the recognized onset events for irritable bowel syndrome (IBS). Those included genetics, gender, infection and inflammation, and environment. The remaining two factors include bacterial overgrowth, and abuse.

Bacterial overgrowth

The part that bacterial overgrowth plays in the development of irritable bowel syndrome is contentious.

A research project conducted several years ago reported that the eradication of bacterial overgrowth completely eliminated the symptoms of IBS in 48% of the study participants. Subsequent analysis of the study itself found that this uncontrolled study had several flaws. First, there was a significant patient drop out rate. Second, there were several different antibiotics used and the dosages were not controlled. And third, the short follow-up period of only 7 to 10 days.

Another study, this one randomized, double-placebo, and placebo-controlled, found that patients with IBS were more likely than people without IBS to have an abnormal lactulose breath test and they were more likely to report an improvement in their IBS symptoms if their small intestine bacterial overgrowth (SIBO) was eradicated.

However, two other large studies of patient records did not determine that there was any link between the prevalence of SIBO to IBS symptoms. It is generally accepted that bacterial overgrowth has a significant role in the severity of IBS symptoms.

Abuse

There have been quite a few studies which have shown that there is a higher prevalence of abuse in patients with IBS than with other diseases. Physicians have been urged to bring up the subject of abuse with IBS patients to determine if there is any history of it. If a history of abuse is identified it is important that the patient is referred to professional who has experience in dealing with this issue.

Regardless of how the condition started, most people who have been newly diagnosed with IBS are concerned with learning what it is and how to treat it. More in my next post.

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In my last post I wrote about a couple of the recognized onset events for irritable bowel syndrome (IBS). Those included genetics and gender. Additional factors include infection and inflammation, and environmental factors.

Infection and inflammation

Four decades ago researchers recognized that some of their patients developed IBS symptoms after an
an enteritis, or small intestine inflammation. In more recent years, studies have shown that people who experience digestive system infections have an increased risk of developing IBS. For some of these patients the symptoms of abdominal pain, bloating and diarrhea continue after the infection has been resolved. And for most of these patients, the symptoms will disappear over time. However, data suggests that from 4% to 32% of patients will suffer from persistent IBS symptoms after a digestive system infection.

It is not understood why IBS symptoms continue after the infection is cleared. One theory is that the infection may permanently damage the enteric nervous system, which is the part of the nervous system that controls the gastrointestinal system. Another hypothesis is that the infection impacts the immune system leading to chronic inflammation of the bowel. This in turn leads to changes in the motility, or movement of stool through the intestines, intestinal sensitivity.
Another possibility may be damage to tissue in the intestines which alters it’s functioning.
Patients who have a longer intestinal illness and those who do not vomit generally have IBS symptoms longer due to toxin exposure
Environmental factors
Genetic factors do not complexly explain why some people develop IBS. It is believed that environmental factors also play a role. There have been several studies that support the view that parental history of IBS is a risk factor for IBS development in children. Parental modeling may also be a factor in development of IBS. As an example, a study of 81 children showed that parental rejection of a child is linked to the development of physical illness.

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