How to Manage Vague Bowel Irr... Video Transcript

Participants

, Lin Chang MD, John Johanson MD, MS, Brian E. Lacy MD, PhD

Summary

Some people with vague digestive symptoms needlessly suffer in silence believing there is no treatment. Abdominal discomfort, bloating, and either diarrhea, constipation or a combination of both, can be a sign of irritable bowel syndrome (IBS). Recent advances in the treatment of IBS make seeing a doctor the first step toward relief. Learn the many medical strategies used to treat this common intestinal disorder.

Webcast Transcript

BRIAN LACY, MD: I think one of the interesting things about irritable bowel syndrome is there's really no true typical patient and we see so many different patients they all have different stories. That being said, a typical presentation for a patient is that they may have had symptoms for many months or years of pain, bloating, constipation, diarrhea. They may have tried to solve those problems on their own using a variety of over-the-counter agents and realize that they don't help and they finally bring this problem to the attention of their physician.

LIN CHANG, MD: The diagnosis of IBS has to be based on the symptoms. So there is actually standard diagnostic criteria that have been developed. These are based on expert opinion on symptoms that are commonly seen in patients with IBS.

JOHN JOHANSON, MD: The therapy of IBS needs to be tailored to individual patients, I think that we try to break down patients into groups of symptoms and treat them a little bit differently.

ANNOUNCER: Initiating treatment means helping a patient understand the diagnosis.

JOHN JOHANSON, MD: Really the first step in treatment of irritable bowel syndrome is reassurance and connecting with the patient and saying, "You don't have anything serious."

ANNOUNCER: The further treatment of Irritable Bowel Syndrome depends on whether the patient's IBS manifests as IBS with constipation or IBS with diarrhea

LIN CHANG, MD: Fiber is a good treatment for constipation. It may help ease of stool passage, but it doesn't really help any other symptoms, such as pain. Sometimes you can have side effects such as bloating or cramps. So I think it can help constipation, but it doesn't really help the multiple symptoms of IBS.

LIN CHANG, MD: For the treatment of IBS with constipation, patients typically take some type of laxative. There are many different types of laxatives that a patient could take, either over-the-counter or prescribed, for their constipation, but it doesn't really help their pain.

JOHN JOHANSON, MD: The next step in treating someone with IBS and constipation is -- is something that's exciting to me. It's because of a drug called Zelnorm. Zelnorm works to treat the constipation and so people's bowel frequency increases like laxatives. But the advantage, compared to laxatives, is that it also treats the abdominal pain and the bloating.

ANNOUNCER: Treatment for a person who has IBS with diarrhea may be more difficult to treat.

LIN CHANG, MD: In treating patients with IBS and diarrhea, many of the patients will take anti-diarrheal agents, such as loperamide or Imodium.

JOHN JOHNANSON, MD: Anti-spasm medications tend to slow the gut down by relaxing the smooth muscle of the colon. And, to some extent, by reducing the contractility of the colon, they also reduce the discomfort.

Antispasmodic medicines are also an attempt to treat the pain.

Patients who have diarrhea but predominantly pain as a complaint; we might even use antidepressant medications that have some pain modulating effects.

ANNOUNCER: Another drug to treat IBS with diarrhea is called Lotronex, or alosetron. It's use is restricted to patients with IBS with severe diarrhea because there is a risk of serious side effects.

BRIAN LACY, MD: Actually for the first time in FDA history, a drug that was withdrawn for the market was brought back to the market. And now alosetron or Lotronex is available under a limited-use program for patients with severe IBS and diarrhea.

ANNOUNCER: Finally, treatment for IBS can involve changes in lifestyle, to lessen the frequency or severity of symptoms.

LIN CHANG, MD: I think lifestyle changes are important.