# Irritable Bowel Syndrome: Examining New Findings & Treatments



## JeanG (Oct 20, 1999)

This is on the Medscape webpage and is an educational program. It says:"Online CME from industry-supported events.This online program, certified for credit by Johns Hopkins School of Medicine, was not prepared by Medscape's editors, but is made available on our site as a service to our audience. Authors are routinely instructed by the CME provider to disclose financial conflicts of interest and mention of investigational drugs and unapproved indications. Medscape has received a fee for posting this program."For you chart lovers, there are a lot of charts to examine. You'll have to go to the Medscape site to see the whole article. (JeanG)The URL for this article is: http://gastroenterology.medscape.com/CMECi.../2000/CME01/pub lic/toc-CME01.html[/URL] Irritable Bowel Syndrome (IBS): Examining New Findings and TreatmentsAuthors: Marvin M. Schuster, MD; Michael D. Crowell, PhD; Nicholas J. Talley, MD, PhDRelease Date: October 26, 2000Valid for CME until October 26, 2001Copyright 2000 by Johns Hopkins School of Medicine Table of ContentsIntroductionDefining and Diagnosing IBSThe Role of Serotonin in the Pathophysiology of IBSTreatment Options for Patients With IBS: A Focus on SerotoninConclusionsReferences[This message has been edited by JeanG (edited 10-27-2000).]


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## Mike NoLomotil (Jun 6, 2000)

Observation:It is a very well done sophisticated marketing piece for physicians on ZELMAC structured as a CME course from Johns Hopkins, paid for by grant from Novartis, developer of ZELMAC. It describes the mode of action and rationale for for interventional pharmacotherapy with LOTRONEX vs. ZELMAC, as to the sites of action and effects of these drug types on specific serotonergic receptors (5HT-3 antagonist vs 5-HT-4 agonist). These are the only treatment options presented (see course objectives), discussed, and rationalized to the participating practitioner in the CME course (pharmacotherapy with these drugs). Which, of course, makes perfect sense.MNL_________________ www.leapallergy.com


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## JeanG (Oct 20, 1999)

This was part of an educational grant to Johns Hopkins. The sidebar reads:"The Johns Hopkins School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The Johns Hopkins University takes responsibility for the content, quality and scientific integrity of this CME activity.The Johns Hopkins School of Medicine designates this continuing medical education activity for up to 1.5 credit hours in Category 1 of the Physician's Recognition Award of the American Medical Association. Each physician should claim only those hours of credit that he/she actually spends in the educational activity.Supported by an unrestrictededucational grant to The Johns Hopkins School of Medicine from Novartis".


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## Mike NoLomotil (Jun 6, 2000)

...and this is one of the many standard and sophisticated methodologies used to put pharmaceutical product in front of physicinas to encourage prescriptive use. It's an observation of fact. That is what the "grant" was for...to do this CME program on this subject. Johns Hopkins is no different than any of the medical centers and universities nationwide that receive large amounts of funding to perform this kind of work. It's what makes the world go round in American medicine and influences how medicine is practiced. Its no different than a CME program at the Palm Springs Golf Resort over a long weekend sponsored and paid for by a drug company, or DME company etc. It is not restricted to the pharmaceutical companies. This is where a chunk of the $2.8 Billion a year Novartis spends on marketing. You have publicly-held for profit hospital corporations for example putting tens of millions directly into medical university operating budgets to support and providing affiliate medical centers for internships and residencies as well.This is merely an observation of fact.MNL_____________ www.leapallergy.com


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## moldie (Sep 25, 1999)

This is the page that I found the most interesting: http://gastroenterology.medscape.com/CMECi...1/CME01-02.html It was interesting to see the graphic of motility in the sigmoid after eating for an IBS individual as opposed to a "normal" individual.Sometimes I think that some of this "abnormal" activity could be a direct result of an irritant (allergen, bacterium, fungal agent, or parasite) that could be stimulating this result. In this case would this be another case of trying band-aid treatments instead of confronting the real problem for some patients who have been diagnosed with "IBS" that may have other or additional problems? Perhaps they would be more helpful for those who do have a "true" case of IBS that involves disrupted signals in the brain, but would not be as effective for those individuals with sensitivities of certain substances or infected by microbrials as mentioned above. Just a thought.


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## JeanG (Oct 20, 1999)

For "true" IBS I'll stick to the disrupted brain gut connections causing problems with the receptors, rather than other irritants.Who knows! In the end they may find out it's something alltogether different than anything any of us could ever imagine.







JeanG


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## Mike NoLomotil (Jun 6, 2000)

NOTE:The presence of inflammatory mediators and localized low-level and nondescript inflammatory reactions in the gut demonstrate that localized abnormal immunologic responses have occurred. These are mechanisms and pathways that are not triggered by the CNS.The blood-brain barrier is permeable to certain of these mediators either released or synthesized within the plasma by the circulating immune cells, starting in the gut microcirculation when presented first with an allergen. Hence the observations of the effects of the inflammatory mediators (cytokienes, leukotriens, etc) within that locale as a primary response-effect site. The systemic effects of these mediators are well documented in other organ systems to which they are delivered by the plasma as the circulting immune cells react on an ongoing basis to "allergen". The blood-brain barrier is not impermeable to these mediators and they effect nerve tissue structures as well as blood vessel and GUT smooth muscle as well. Observations of GIT hypereactivity and CNS hyperreactivity are interestingly similar, and the connectivity inclusive of the conductive system, circulatory and lymphatic system, and the "tissue" immune system (and tissue immune system changes seen in IBS...ie: increased mast cell density in the ceacum) can be viewed as the "strings which tie the bag".The observation of the activity of specific neurologic sites (serotonergic receptors) and chemicals of transmission is a study of a mechanism that is evoked, not an etiology. Pharmacotherapy can be used to intervene or attenuate that mechanism, but does not address the underlying cause of what IS evoking or provoking that mechanism into excessive action.The question to be answered is what is the underlying CAUSE of abnormal reactivity or sensitivity of the nerve pathways. The brain does not tell granulocytes to degranulate, for example. But allergenic substances ingested do, and can now be observed and quantified.So the next severqal years will be of particular interest, as investigation of the basis is hopefully added to simply observing, quantifiying and devising chemical means of attenuating portions of the reactive mechanism.MNL_____________ www.leapallergy.com


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