# UPDATE ON TREATMENTS FOR IBS by Dr. Douglas Drossman



## Jeffrey Roberts (Apr 15, 1987)

UPDATE ON TREATMENTS FOR IBSDr. Douglas Drossman, Co-DirectorUNC Center for Functional GI & Motility Disorders http://www.med.unc.edu/wrkunits/2depts/med...idc/welcome.htm UPDATE ON TREATMENTS FOR IBS By Douglas A. Drossman, M.D. In the last several weeks two issues relating to new treatments for IBS have come to the attention of the general public: 1) The withdrawal of Alosetron (Lotronexï¿½) from the market only 9 months after it's release, and 2) the recent publication relating to bacterial overgrowth in IBS and the role for antibiotic treatment. To keep our readership properly advised, and because these issues have led to some differences in opinion, it might be helpful to put them into perspective. ALOSETRON WITHDRAWAL Alosetron is one of the new classes of peripheral (i.e., acting in the intestines rather than the brain) serotonin agents for treatment of IBS. It is a selective 5HT3 receptor antagonist with the primary effects being the slowing of colon transit and reduction of visceral (i.e., arising from the intestines) pain. It was produced by GlaxoWellcome (now GlaxoSmithKline), and after extensive testing of thousands of patients, it was approved on by the FDA on February 9, 2000 for use in the United States. This medication was marketed specifically for the treatment of women with diarrhea predominant IBS. The clinical trials showed significant improvement in abdominal pain and diarrhea when compared to patients taking placebo. The benefit in men was not determined from these studies, and the company was completing studies specifically designed to look at potential benefits in men. The primary side effect was constipation occurring in about 30%. However only 8% of subjects in the clinical trials found the constipation serious enough to stop treatment. In addition, about 1 in 750 individuals taking this drug were found to have ischemic colitis. This is a potentially serious condition where the wall of the colon does not get enough oxygen, and this can cause a breakdown of the intestinal lining thus producing bleeding, pain and diarrhea. In the vast majority of cases, ischemic colitis is reversible, and this appeared to be the situation for all or most all of the patients taking Alosetron both during the treatment trials and after release of the drug. On June 27, and presumably based on reports of side effects after the drug was released, the FDA convened an Advisory Committee to readdress the safety of Lotronexï¿½. They issued a warning that advised physicians to use the drug only for IBS patients with diarrhea, to stop it if they develop constipation, and to not use it in patients with inflammatory bowel disease or a history of ischemic colitis. They then met with GlaxoWellcome and required the company to: a) distribute a medication guide that warned patients about the risks,







send "Dear Healthcare Professional" and "Dear Pharmacist" letters advising them of new labeling information containing these warnings, c) institute increased educational programs to inform health care professionals of the risks, and d) develop a risk management strategy to reduce the risk of the drug for IBS. The FDA also strongly emphasized that decisions about acceptability of the drug will rest on there being adequate (i.e., low) risk-benefit ratios. In other words, the risks of the drug must be balanced by its effectiveness. In the early summer, after a large number of prescriptions were written, the constipation side effect was brought to the public by the media, and this was fueled primarily by press releases from a public "watchdog" group, Public Citizen. Sidney Wolfe, M.D. one of the vocal members of this group reported to the media that there were serious side effects, specifically the constipation and ischemic colitis, which required in some cases hospitalization and surgery. The frequency of ischemic colitis remained the same, and to my knowledge was reversible and not associated with any deaths. In late October, "Public Citizen" then publicized that there were deaths directly attributed to Lotronexï¿½. The association of these deaths to the medication was to many experts not clearly established, but the concerns were evident. At about this time the Office of Post-marketing Drug Risk Assessment (OPDRA), a new FDA agency charged to evaluate the risk of approved medications made a recommendation to the FDA director that Lotronexï¿½ be withdrawn from the market.  After some discussions between GlaxoWellcome and the FDA, on November 2, 2000, GlaxoWellcome submitted a revised Risk Management Plan to evaluate the safety of Lotronexï¿½. By that time, about 350,000 individuals in the USA were prescribed 500,000 prescriptions of Lotronexï¿½, and through post-marketing surveillance the FDA reported receiving 70 cases of serious events, including 49 cases of ischemic colitis, and 21 cases of severe constipation. Of these cases, 34 resulted in hospitalization without surgery, 10 required surgical procedures and 5 resulted in death (however there is some disagreement as to how many of these 5 could be attributed to the drug; the FDA indicated that 3 could be directly linked). It should be noted that these figures over 9 months can be compared to deaths attributed to Celebrex, the new anti-arthritis drug (162 deaths, 1,055 hospitalizations) or Viagra (1009 deaths, 964 hospitalizations) over a 2 ï¿½ year period - FDA AERS 1998 - 6/2000). Finally, on November 28, the FDA and GlaxoWellcome met a final time to address the agency's concerns about complications and to consider possible risk management options. Discussions ensued regarding plans for restricted use of the drug; however, the two parties were unable to come to an agreement on how to best accomplish this. At the conclusion of the meeting the FDA suggested that GlaxoWellcome consider voluntarily withdrawing Lotronexï¿½, and the company complied. All medications were immediately removed from pharmacies and all treatment studies were discontinued. The response to this action has been notable. The International Foundation for Functional GI Disorders, Glaxo Wellcome and the IBS Self Help Group have received hundreds of phone calls and email comments each day from patients asking what could now be done, since many reported considerable benefit from the drug. Physicians were being asked to prescribe substitutes but none of the new 5HT agents currently under study will be available for at least several months. More recently there has been some effort on the part of patient groups to lobby FDA to provide limited access for Alosetron to patients who have previously benefited from the drug. What does all this mean for the future? The issue is very complex and the "ground keeps shifting", so it is not possible at this time to say whether or not the drug will come back on the market. However, there are three important lessons that can be learned from this story: 1.More education is needed to patients and physicians about IBS and its treatments. Many of the complications relating to constipation occurred because the drug was improperly prescribed, or not adequately monitored by physicians and patients. Some patients were inappropriately prescribed the drug for constipation or pain, and some did not stop it when the constipation developed. Despite an extensive educational program for physicians and patients initiated by GlaxoWellcome, it was not sufficient in some of these cases. I believe we are dealing with a disorder that is only recently being understood scientifically, and much of the new knowledge has evolved in the last 5-10 years. So there is an "educational gap" between clinical investigators (such as in our Center) working in this field, and practitioners who are prescribing these new drugs. In addition, patients have an obligation to remain fully informed of any new medication they are prescribed. 2.We need a better understanding of the serious adverse events reported and their relationship to the drug. Most of the recent information about side effects and complications came from call-ins by physicians (post-marketing data). This information is difficult to interpret because it may not be as complete or accurate as carefully designed prospective research studies. Therefore, it might help if the FDA supported the development of an advisory board charged to review the emerging adverse event data in order to: a) determine whether there is a direct link between adverse events (e.g. ischemic colitis) and the drug (association does not mean causation),







if links are established, then it would help to identify the high risk factors, so proper guidelines for use of the drug can be established, and c) make recommendations about restrictions that should be placed in the labeling information. This issue is important not just for Alosetron, but for these classes of drugs and for the new drugs to come for treatment of IBS. Just recently, Solvay Pharmaceuticals slowed down their treatment trials of cilansetron, another 5HT3 antagonist, because of 1 report of ischemic colitis. 3.The concept of "Risk-Benefit" needs to be better understood for IBS and other functional GI disorders. This requires determining the risk of the drug, and then using a standard formula to determine its "worth". With regard to risk, since IBS has no observable pathology or clinical complications, mortality is not expected. Therefore, any deaths attributed to a new drug will be viewed with far greater concern than they would be for disorders that are associated with mortality (e.g., HIV disease, cancer) or complications possibly leading to surgery (e.g., IBD, chronic hepatitis). The problem is whether we have or have used adequate tools to understand benefit for chronic disabling disorders like IBS. The response from patients since removal of the drug suggests that the benefits of the drug may be greater than had been previously been assumed. We need to use more sensitive measures to quantify benefit. Well-designed studies on health status and quality of life in IBS can show considerable impairment with effects on work absenteeism, loss of daily function, and psychosocial effects. The assessment of risk-benefit ratios in the future will need to carefully appraise the benefits of the drug with regard to daily functional status, psychosocial effects, quality of life, and reduction in work absenteeism. One issue of concern to all of us is whether the implications of this action will go beyond the fate of this particular drug and its manufacturer. The research slowdown by Solvay Pharmaceuticals is another example where we must question whether these types of decisions, based on case report data is well-advised, and whether there may be a growing hesitancy about investigating new drugs for IBS, or whether a "double standard" is developing with regard to risk/benefit ratios in IBS relative to other medical disorders. The obvious concern is that other pharmaceutical companies might not want to invest their research dollars into an area where the likelihood of getting approval for their drug is low, or where, if a new drug is approved, it might later get withdrawn. I fear that these actions might influence a reduction in research in the FGID's in general, and reverse the rapidly growing knowledge we are accumulating about the mechanisms of IBS and its treatment. At the end of the day, I remain hopeful that caution and wisdom will prevail as this issue unfolds. In the meanwhile, it is reassuring to know that the interest of the pharmaceutical companies in IBS in the last 5 years has been growing, and the potential benefit to patients will be considerable. BACTERIAL OVERGROWTH IN IBS In the December issue of the American Journal of Gastroenterology, a relatively small study peaked the interest of news reporters, primarily because it was believed that "the answer" to understanding and treating IBS was at hand. The article entitled "Eradication of Small Intestinal Bacterial Overgrowth Reduces Symptoms of IBS" by M. Pimental, E.J. Chow and H.C. Lin found that 78% of 157 patients referred to their center for breath hydrogen testing for bacterial overgrowth were found to have bacterial overgrowth. Furthermore, over half (25 of 47) of the patients who were treated with antibiotics and came back for later testing had a reduction in their IBS symptoms. We recognize bacterial overgrowth in the small intestine to be associated with symptoms similar to IBS (bloating, abdominal pain and diarrhea), and those who have the proper equipment (as we do at our Center), can perform this test easily and painlessly. The subject drinks about a quart of a sugar solution (e.g., lactulose) that is not absorbed in the small intestine, so it usually passes to the large intestine where it is broken down by bacteria and gas is produced as a waste product which is sent to the lung as hydrogen. Because bacteria are found in very high concentration in the large, but not the small intestine, the production of the gas occurs late (after 90 minutes). So when more than the usual number of bacteria is found in the small intestine (bacterial overgrowth), they will digest the lactulose sooner, producing an earlier excretion of hydrogen in the lungs. In addition, the patients may also develop symptoms of gas, bloating and diarrhea. When bacterial overgrowth is diagnosed, it can be treated with antibiotics and this will reduce the symptoms, at least. What was different about this article was that the frequency of bacterial overgrowth in this study was far higher than clinicians and investigators had previously found. The information reported was met with a great deal of enthusiasm. To quote Reuter's press on 12/13:"Los Angeles, CA - Irritable bowel syndrome, a chronic condition believed to plague 20% of the adult populationï¿½..may be caused by too much bacteria in the small intestine, researches said Wednesday. ' It was the first time a potential cause for the disease has been identified and could lead to a radical shift in treatment', according to the lead investigator of the study. 'This is really exciting because it points to the cause of the disease. Treatments for IBS to this point have been directed at symptoms, not any cause' said Dr. Mark Pimentalï¿½..". This kind of information was communicated in newspapers, TV and the internet, and Drs. Whitehead and I were asked to comment as to whether this was indeed a major breakthrough in research. Before getting too enouraged, it would help to identify some of the limitations of this study before drawing any conclusions: 1.Patients were referred to the medical center specifically for breath hydrogen testing after being evaluated by physicians who suspected this diagnosis. This would tend to skew the proportion of persons with positive studies, simply because the doctors have already suspected the diagnosis. So the 78% figure may be higher than might occur in a better designed study. 2.This is not a placebo-controlled double-blinded study. In well-designed studies, a proportion of subjects receive a placebo, so the investigators can compare the benefits of those on the active treatment to those on placebo. In addition, usually, neither the study subjects nor the investigators know who is getting the active drug or placebo. But when there is no placebo, then all patients (and investigators) will know they are receiving the active treatment (i.e., the antibiotics), and they may do better ("placebo effect") because they expect to do better. So the level of improvement here might be higher than if the study subjects did not know which treatment they were getting. 3.Although 157 patients were tested for bacterial overgrowth, less than 1/3 were actually tested with regard to benefits from treatment. It is unclear why so few patients came back. Were the ones who didn't come back doing better or worse? Preferably, efforts need to be made to study all patients in order to know if the results are valid. 4.This was a "convenience study". It appears that the authors went back in the clinical records to report their results rather than design a prospective study where patients follow a specific protocol. For example, at least four different antibiotics were used by different physicians. So it is unknown whether one antibiotic might be better than another, and these kinds of differences in how the study is conducted will interfere with the conclusions that can be drawn from the study. So in summary I believe that while the findings being reported are not a major breakthrough, they should increase awareness of one disorder that can mimic or worsen IBS. In our experience at the UNC Center for Functional GI and Motility Disorders, the frequency is much lower (maybe <10%) of people who come to us with IBS. But when we suspect bacterial overgrowth based on certain clinical features, we then test for it, and of course, there is a greater chance the test will be positive. In those cases we treat, and many (but not all) will respond; however, the symptoms may return. Patients with IBS should consider a diagnosis of bacterial overgrowth if you have diarrhea, abdominal swelling and increased gas production within 30-45 minutes after eating. But these symptoms are also quite typical just for IBS. Your physician will work with you to determine if breath testing for bacterial overgrowth may be helpful. Or contact us at the following address: UNC Center for Functional GI & Motility Disorders CB #7080, 778 Burnett-Womack Building Chapel Hill, NC 27599-7080 (919) 966 - 0144 (phone) (919) 966 - 8929 (fax)[This message has been edited by Jeffrey Roberts (edited 07-11-2001).]


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## Joyce123 (Oct 8, 2004)

I have recently been diagnosed with IBS. I am 50, a jogger, and otherwise in good health. In June I was in Hawaii on vacation and got ill. I have seen a gastroenteronlogist in Michigan for 2 months now, been through a number of tests, and then diagnosed with IBS. I'd like to be able to rule out the possibility of bacterial overgrowth, but my doctor's attitude is just learn to live with your condition. Any suggestions for how to find a doctor in Southeast Michigan (Detroit area) who may be willing to work with me in getting control of the condition?


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## Guest (Sep 15, 2001)

Hello Joyce:I am from the Detroit area and have been living with the condition for 7 years. I ran into the same problems as you, not getting real advice from doctors and basically being told that there is nothing they can do. I may have a suggestion from somebody that could help, not a doctor, but a nutrition specialist that believes in combining exercise with the right diet and the right life style. If you are interested, why don't you post your email address so that I can sent this information to you.


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## Guest (Sep 18, 2001)

My name is Kristy, I live on the west coast. I recieved the same treatment from r's as you both. It wasn't quite so bad (tolaratable) untill last year. thats when my life as I knew it ended.. I had had a couple of test done and a small surgery. And since then I have been in agony. I was sent to see a specialist...I was told to live with it! (cold) She wasn't the one having to TRY to live with it. My Dr at home wasn't much more help, he just didn't know what to do...Iv'e been in for more testing and to see other dr's but I get the same attitude from them all! This condition has devistated my life. I can't even get out of bed for months sometimes because of the effect the pain has on me and my emotions. I think Dr's should be more simpithetic. I now suffer alone and without help. Any adivice???? Please help


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## Guest (Oct 3, 2001)

I can certainly sympathise with you. I have had this for 15 months and it's getting worse as time goes on. In the last 2 1.2 weeks I've been absent from work on 5 days. I found the specialist cold just as you did -the old "live with it" routine and am going to see my family doctor again tomorrow afternoon. I can be in pure agony (such as yesterday when this attack of worsened IBS started) and have watery stools up to 20 times a day. My family doctor has been fantastic but has already told me there is nothing more he can do. I find searching the web is helping - I'm making a list of items to take to him to see what he thinks. This is becomming a real handicap and if this continues I can't see myself working on a regular basis and I only have myself and no savings to rely on. I was on disability for a year and a half approx 3 1/2 years ago and hated being home with just the TV for company - I want to work. I don't even know if Canada considers this a disability as my insurance only covers me for 2 years. There really has to be a concerted effort to teach doctors about this syndrome so they are more knowledgeable and sympathetic. I live in what is supposed to be one of the best medical cities in Canada but I know this is not the only illness you cannot get "real" help for - a friend is trying to get help for her anorexic daughter and there is no help here to speak of. I also feel tired all the time, don't feel like going anywhere (partly because you want to make sure there's a loo nearby). All you can do is just keep trying to find a doctor who understands and try to keep up your spirits. Does your doctor have you on an anti-depressant? They used to think this was caused by depression but I think they now realize the depression is caused by the horrible effects of THIS disease! They may help. Good luck in your search. Keep searching the net - I found an article about a doctor in Australia and am interested in his treatment - Dr. Tom Borody - tests for a specific parasite our labs don't normally find - D.Fragilis - then treats his patients with 20 days of anitbiotics. Within 3 days their cramps have disappeared with within 20 days they have mostly normal bowels. I'm hoping this may be an option for me.Good Luck and keep remembering there are millions of us suffering from this - you are not alone!!


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## Margaret Staples (Mar 30, 2002)

I too have suffered for a long time - I was on holiday in Hawaii in 1993 when I had the severest attack of diarohea ever - in the lift in the hotel ! Since then i get these attacks with absolutely no warning except about two minutes of sweating, heart rate increase and cramps which if I let go for the pain, there is the obvious pool of you know what !This is the only bugbear I have in my life and I am sick to death of it. There is no indication that is is caused by anything - I have eliminated some things in my diet that seemed to be present in the attack days, but it has not worked. I am no more stressed than the next person.I honestly don't know how my husband can cope with my constant preoccupation with where the neaarest public toilets are wherever we go especially on holidays in other countries. McDonalds is my saviour ! I have heard of a new treatment call psychosamatic healing - has anyone else heard of it. It is available here in Australia from March 2002, but no one has heard of it - my doctor says it could possibly be a type of hypnosis treatment, but he is not sure. I am convinced that part of the problem with my IBS is mind over matter. I can get into a meeting at work, say and way back in my mind think, Oh God I hope I don't need to go to the toilet, and then presto - thats what I have to do ! Does anyone else feel like this ?


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## sueby (Jul 10, 2002)

My IBS profile is quite similar to yours. I live in SA, Australia. I have probably been living with it for about 5 years. Recent visit to Gastointerolgist confirmed that I probably did have IBS.Funnily enough







, my IBS started after a trip to Hawaii with my 2 sisters. While there I had some acute D attacks. Since then, my IBS has restricted what I will comfortably tackle. Long trips in the car, walking around a shopping mall or even doing a big grocery shop are my big anxiety and D triggers. I too have become aware of those "thoughts". Mine go something like this. "I hope I'll be fine on the trip ... why am I thinking about it ...Oh no I'm thinking about it again .... Stop the car NOW!" A classic example is getting only 2kms down the road and having to use a roadhouse loo







. I carry tissues and clean knickers in my handbag.I want desperately to get back to my morning walks, which I was happily managing at our previous home (there were 4 sets of public toilets along the way - and as "murphy" would have it, rarely had to use them). But now I'm living in a more urban setting. I guess we should go and discover all the possible Pub.Toilets. Although I hate bowing to IBS like that! What I have tried recently though (2 weeks so far) is Metamucil, and my BM's are tolerable, more solid and regular (akthough I must be home between 8-8.30am). I am starting to tell myself messages like "Come on, you completely emptied your B's this morning, so put those shoes on and go walking!"







.I really don't think many people appreciate the level of insecurity IBS can generate. Like you, my husband is very sympathetic and understands when I have to go "again" and "now". Squatting behind a bush comes quite easily to me now!I am, in all other respects, fit and healthy. Ideal body weight and very conscious about eating well. Would welcome any replies.


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## Dibbur (Jul 28, 2002)

I was wondering if I was not normal or something. I have been having similar problems like you people. I can get excited or anxious about something and bring it on. Or so it seems. I too, when going on a trip or to some function HAVE TO first locate where all the bathrooms are and how close to where I'm going to be. And if I am on a road trip and I think I may not be able to get to a bathroom, that is a sure sign I'm going to have to go in a hurry. I have been told you bring it on yourself. Just thinking about it makes it happen so it has to be all in my mind. And I get mad and say no, not in my mind, maybe in my pants. People don't understand something that they don't have problems with. I wish there were solutions. Thanks for listening


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## CMB (Jul 26, 2001)

Please read the book "Eating for IBS" by Heather Van Vorous. The first part of the book is most important to those of us that have IBS-D......


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## KATHLEENE (Nov 14, 2002)

HI EVERYONEIVE POSTED ON A FEW IBS TODAY.I'M FINDING THAT ALMOST ANYTHING I EAT CAN TRIGGER THE ATTACKS, DAIRY, VEGS, FRUIT. AND WHEN I DO EAT IT HAS TO BE FULLY COOKED, T.V DINNERS ( LIKE HEATHY CHOICE IS GOOD). BUT ITS LIKE I HAVE TO MAKE MYSELF EAT, OR MY HUBBY NAGGES ME INTO EATING. BUT ITS SCARY WHEN I KNOW WHATS GOING TO HAPPEN. AND ITS LIKE 10 OR SO MINS. AFTER EATING IM RUSHING TO THE BATHROOM.MY DR. HAS GIVEN ME A COUPLE OF MEDS BUT THEY NEVER WORKED. IN FACT I THINK IT MADE IT WORSE. KATHLEEN


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## dallasred (Oct 5, 2002)

Very Interesting discussion. I have had IBS-D DX for 10 years, but suffered more years than that. I lived in Hawaii for three years, 76-79. I have recently discovered Heather Von Vorus book, Eating for IBS. It has helped a lot. My GI has IBS also and can relate to my problems. I have been on Elavil for 10 years and it helps, but nothing like Lotronex did. I keep hoping it will be released soon as I am in the middle of a very bad flare of IBS.


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## becky d (Dec 3, 2002)

I have also been diagnosed with IBS. Although I have suffered for many years. I was also told to figure it out for myself. I searched on the internet for books and also found Heather Van Vorous. The First Year and Eating for IBS. To sum up what I have learned I stay away from dairy products, low or no fat products and red meat. I have tried several of her receipts and they are really good. You just have to get use to living without the fat taste in your diet. I also take Zelnorm and Buspar for anxiety. I feel much much better. I would recommend anyone with this problem to read her books and to try her diet.


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## Georgine (Jan 21, 2003)

I had IBS diagnosed in my early 30's. I am now 68 years old and have controlled this with taking metamucil every am & pm, exercise(walking, step class at the gym, body toning classes) and a prescription of donnatal which i usually take at bedtime when I'm having trouble. My attacks come on from not having enough to do usually and I do better when I'm busiest.I have never figured out how food effects me. I can go for months with no trouble at all but I always take the metamucil and exercise. When I do get into trouble with it, I never let it stop me from functioning even tho I feel miserable.My husband gives me space and knows that I need to take care of things after breakfast before we can go anywhere. I always allow enough time so I won't miss anything.My big problem being an old RN is I worry about it being something worse than IBS like Cancer. Then I usually get a headache worrying about it. I'm hoping reading everyone elses problems will give me some comfort. Hang in everyone, there are worse things!


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## dogmom5 (Mar 5, 2003)

I am a 43 year old female and I have had IBS since I was in college, I was 20 when diagnosed. I have put up with the bloating and constipation these many years, taking metamucil before bed and hoping it will work. Last November things changed. For the first time I experienced the unbelievably painful intestinal cramps and diarrhea. The cramping/spasms are worse than labor pains. I have been to a GI Doc, he performed all of the necessary tests and said I have mild diverticulosis and IBS. He is giving me Bentyl, Kristalose and Miralax for the cramping and frankly I don't understand why. Two of the meds are laxatives. I had to stop, because I couldn't make it to work on time each morning. Most of you know what I mean. I have reached the point of not wanting to eat for fear of what's to come. I have lost the desire for food. I have lost 15 pounds in the past 6 weeks. I am so tired of this.


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## Joycemae (May 3, 2003)

I have had IBS for over 40 years. Hard to believe myself.Just today I have an appt with the "gut dr."He really hasn't been a whole lot of help but now he found something else Barrets Esophagus. Anyone had any experience with the Barrets. All I know it is cellular changes in esopphagus that could turn to cancer YIKES! But very small chance.but I am not the kind of person who takes things as they come without a lot of nerves.thanks


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## danners55 (Dec 29, 2003)

Hi. I'm 19 years old from Ontario Canada...what i have my family calls what i have "The Aarssen Bowel" aka. IBS...alot of people in my family have it. It has amost been 3 years since it first started and I'm not even sure what brought it on, and I've tried everything! And I've also been told that there may be a underline cause. Depression and Axiety...but I've got for treatment for both but I still have IBS which i think caused some axiety on its own..I'm on Dicetel right now and it's not working. Is there a secret to getting rid of it?!


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## Piaffe (Jan 12, 2004)

Hi, I'm 43 years old and have been living with IBS since at least 9 years old. I've been through every test in the book until I refused to take anymore because I knew they weren't going to help me. I typically have the "C" type which suddenly goes violent on me (usually right after supper). I get body shakes, super hot, then cold sweats, loud buzzing in the ears and pass out and vomit from the pain of the spasm, then diarrahea several times until it works it's way through. I have never found any food in particular triggers it but lately I have found some relief from taking Metronidazole/Flagyl for a few months although it eventually starts coming back. I found out about this in the National Enquirer and begged my doctor to let me try it. I find it upsetting to read about so many people experiencing this as I too live in terror of the next painful attack. I also don't want to go out after dinner (or FOR dinner) or travel much or go anywhere without a bathroom close by in case this happens in a public place. I too am afraid to eat at times, always wondering in the back of my mind if I will have an attack afterwards. My husband is pretty understanding about it to the point where he will come looking for me to make sure I didn't pass out and hit my head if I get up in the middle of the night and don't return to bed in a few minutes. Yes, it is depressing, but I refuse to let it rule my life totally and view it merely as my lot in life. There are a lot worse things out there is the way I look at it, i.e. little kids dying of cancer, etc. I try to make the best of it. A friend of mine from South Africa recently had me try a med called "Colofac" which I have been unable to find in Canada or the U.S. (We are allowed to legally import a one month supply of medication for personal use in the U.S. and Canada.) It is an anti-spasmodic which helped me a great deal as my entire digestive system often goes on the "fritz" for weeks after and I cannot eat properly and lose a lot of weight. I was finally able to order Colofac from an online pharmacy based in the U.K.; here is the link: http://www.mastersmarketing.com This med is available without prescription in South Africa and it does not give me bad side effects such as I got with Buscopan. Last night, I took one pill with my dinner, and although I had an attack anyway, it was without that devastating cramp, and much more just like normal diarrahea although I still felt sick with a sore abdomen afterwards. Maybe next time I'll try TWO pills with dinner. I'm hoping I will be able to go out to a restaurant armed with this stuff, and in the meantime, I'm going to take another round of antibiotic as it seems to help for a few months anyway. I also wanted to post here that for people with vomiting problems, if your doctor has you on calcium supplements, I recently found out from my pharmacist that some people (including my mother and myself) are extremely sensitive to Calcium CARBONATE. My mother was told to take this to avoid osteoporosis and had been having "inexplicable" vomiting binges for several years that were ruining her life and making her very unhappy. My pharmacist sold me a new product which is calcium CITRATE my mother switched to it and she no longer gets sick at all! I myself can now take calcium supplements without stomach pains so if you have this problem and are on calcium supplements switch to the CITRATE compound and see if it makes a difference for you. The name brand I bought in Canada is OsteoCit. There should be something similar in the U.S. and it causes NO VOMITING or stomach pain. Sorry to say, I don't much believe in doctors anymore. Know yourself and figure out what's best for you. A lot of doctors these days are far more concerned with dishing out pills than figuring out what the problem is.


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## carolann (Jul 29, 2004)

Hi, I've had IBS for 20 years or more. In the last 5-6 years it has become much worse. I can go from horrible constipation to raging D within minutes. Being nervous about it happening just makes it worse. I have been using a natural supplement from New Zealand called Ibsacol. It's helped tremendously. It's a bit expensive in the beginning but eventually you can dose down to a very few pills a day. I would recommend it to anyone. If you have any questions, please feel free to email me.


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## yvonne (Aug 11, 2004)

hi ive had ibs for 12 years now,where do i get ahold of these pills?


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## enjoy life now (Aug 18, 2004)

I've had D-IBs for over 40 years and now have relief with taking pancreatic enzymes with the "triggering meals" like spicy, Italian, garlic, onions, BBQ sauces, Chinese, etc. The enzymes are Viokase tablets 8000 units of lipase. I take 1 before I eat the first bite, and a second one 1/3 of the way through the meal. It's a prescription drug, but it's working like a charm.


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