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New Guidelines Issued for Management of IBS

Group reviews conventional and alternative therapies to treat irritable bowel symptoms
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HealthDay

Thursday, December 18, 2008

HealthDay news imageTHURSDAY, 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 Some of the breakthroughs we had have been withdrawn or are under strict control."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:

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."


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