Thursday, June 4, 2009
DDW: Managing IBS
CHICAGO--Because physicians are unlikely to cure irritable bowel syndrome (IBS), their most important interventions are to listen to the patient, explain a little of the pathophysiology of IBS so the patient knows she's not crazy, set appropriate expectations, and establish an effective patient-physician relationship, said Philip Schoenfeld, MD, during "New and Emerging Approaches to the Management of IBS" at Digestive Disease Week.
Instead of just writing a prescription for Prozac when he feels it's necessary, he shows the patient an image of the body that clarifies a brain-gut connection to validate that there may be a defect in how the gut communicates with the brain. Then he says, "And here's a medicine to modify how the brain receives it." In those circumstances he said the vast majority of his patients are willing to give the medication a try.
After walking attendees through the pros and cons of currently used medications, Dr. Schoenfeld offered his take on other treatments:
Peppermint oil: This "has pretty darn good data" showing 60% of patients' symptoms are likely to improve compared with placebo. His warning: Be sure the patient doesn't bite the tablet. "It tastes horrible and gives incredible heartburn," he said.
Probiotics: Evidence isn't that good for probiotics because it's a "mishmash of information" using different strains, although he emphasized that he's not saying it is ineffective--just that data don't show effectiveness. The only one that showed efficacy, Dr. Schoenfeld said, and that he uses is Align's bifidobacterium infantis 35624.
Isphagula husk: He called this moderately effective, but urged caution because patients can get more bloated.
--By Paula S. Katz, special to ACP Internist
Labels: digestive disease week, IBS
posted by Janet Colwell at
12:00 PM
ACP Internist hosted Grand Rounds on June 16, wrapping up the best of the medical blogosphere. Click here for the complete wrap-up.
Contact ACP Internist
Send comments to ACP Internist staff at acpinternist@acponline.org.
Previous Posts
- DDW: Fecal incontinence
- DDW: Point-of-care Web sites
- DDW: Who are your IBS patients?
- DDW: Signs of the times
- DDW: Beyond drugs for IBS
- DDW: Nonalcoholic steatohepatitis
- News from Digestive Disease Week: PPIs and CAT
- News from Digestive Disease Week: Crohn's disease
- News from Digestive Disease Week: Patients often i...
- Digestive Disease Week: Colorectal cancer detectio...
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American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
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