# Found today on OB-GYN News: IBS Patients May Find Relief With High-Fiber Diet and Par



## JenS (Dec 18, 2000)

IBS Patients May Find Relief With High-Fiber Diet and ParoxetineBruce JancinDenver Bureau SEATTLE — One in four patients with irritable bowel syndrome will experience marked improvement after bringing intake of dietary fiber closer to levels recommended for the general population. Moreover, placing dietary nonresponders on paroxetine while continuing the dietary intervention results in symptomatic improvement in nearly two-thirds of them, Dr. George L. Arnold reported at the annual meeting of the American College of Gastroenterology. The benefits of these interventions are seen regardless of whether a patient has constipation-predominant or diarrhea-predominant irritable bowel syndrome (IBS), said Dr. Arnold of the University of Pittsburgh. His two-tiered clinical trial earned a 2002 ACG Governors Award for Excellence in Clinical Research. Dr. Arnold reported on 110 IBS patients, none of whom had a history of depression. Baseline dietary evaluation indicated 98 of them consumed less than 25 g/day of water-soluble and insoluble dietary fiber combined; this group averaged 11 g/day of dietary fiber, a typical intake for U.S. adults. These 98 patients were assigned to a high-fiber diet aimed at boosting fiber intake to more than 25 g/day. (That dietary goal for fiber is not far from the current U.S. Dietary Reference Intakes for daily total fiber: 25 g for women up to the age of 50 years, 21 g for women over aged 50, 38 g for men up 50, and 30 g for men over 50.) The patients received counseling and close follow-up by a dietitian to promote adherence. After 5 weeks in the high-fiber program, 25 patients (26%) were so improved that they requested no further treatment. They showed significant reductions in abdominal pain and bloating along with improvement in overall well-being as assessed on a standardized IBS quality of life questionnaire. Those who succeeded on the diet averaged 26 g/day of fiber at 5 weeks, compared with 21 g/day among nonresponders. Four patients found the high-fiber diet so disagreeable they dropped out of the study altogether. The remaining 69 nonresponders to the high-fiber diet next moved on to a 12-week randomized double-blind trial of paroxetine versus placebo. Joining them were the 12 patients who got to skip the 5-week dietary trial because their baseline fiber intake exceeded 25 g/day. Patients in this phase of the study remained on the high-fiber diet. The daily dose of the selective serotonin reuptake inhibitor was titrated up to 40 mg. Eight patients in the paroxetine arm and seven on placebo withdrew from the trial because of minor possible side effects or lack of time. Among completers of the 12-week study, 63% in the paroxetine arm demonstrated significant improvement in overall well-being on the IBS quality of life measure, compared with 26% of those on placebo. The number needed to treat with paroxetine for one patient to achieve significant improvement in overall well-being was three. Paroxetine-treated patients also reported significant improvement in anxiety as well as ease of stool passage. They showed nonsignificant trends toward reduced bloating and abdominal pain. Analysis of serial Beck Depression Inventory scores showed that improvement on paroxetine occurred independent of the drug's antidepressant effect. Dr. Kevin W. Olden, a psychiatrist and gastroenterologist at Mayo Clinic Scottsdale (Ariz.), told this newspaper that he views Dr. Arnold's trial as “a wonderful study” that points to a valuable primary care clinical pathway for the management of IBS. He predicted that the results would be even more impressive, at least in patients with constipation-predominant IBS, if tegaserod (Zelnorm) were substituted for paroxetine. Tegaserod is a recently approved selective serotonin 5HT4 receptor agonist indicated for treatment of IBS with constipation. It is substantially more effective in this population than anything else to date, Dr. Olden said. Copyright ï¿½ 2002 by International Medical News Group. Click for restrictions.


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## trbell (Nov 1, 2000)

where did you find the original article? I showed this to my psychiatrist but he didn't think paxil would help IBS-C so wouldn't prescribe it.tom


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