# Dr. Salt and a Webmd chat transcript



## eric (Jul 8, 1999)

FYI: http://my.webmd.com/content/article/1700.50480 http://my.webmd.com/content/article/1700.50705 ------------------ http://www.ibshealth.com/


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## cookies4marilyn (Jun 30, 2000)

Thanks Eric...as I was reading this I thought that it was too good for anyone to miss...so here is the first one...Note the comments on mind-gut!







Excellent!Irritable Bowel Syndrome with William Salt, MDWorld Watch & Health NewsMonday, May 1, 2000 7:00 PM EDTBy William Salt II Event Date: 05/01/2000.Due to technical difficulties, member questions are missing from this transcript. We apologize for the inconvenience.Moderator: Welcome to WebMD Live's World Watch and Health News Auditorium. Today we are discussing Irritable Bowel Syndrome: The Mind-Body Brain-Gut Connection, in a special audiocast event with William B. Salt II, MD.Dr. Salt: Thank you. It's great to be with you.Moderator: I know this is your second visit to WebMD and your first audiocast!Dr. Salt: Yes, it's very exciting!Moderator: This is Blaine Baird for WebMD...I'd like to remind you that this is an audiocast, and if you cannot hear us, you should be able to now download a player.William B. Salt II, MD, is board-certified in both internal medicine and gastroenterology. He received his MD degree from The Ohio State University in Columbus, Ohio, in 1972, where he currently holds an appointment as Clinical Associate Professor in Medicine. He trained for five more years in internal medicine and gastroenterology at Vanderbilt University Hospitals in Nashville, Tennessee, where he also served as a Chief Resident in Medicine. Moderator: Dr. Salt is expressing his own opinions, and they do not necessarily reflect those of WebMD. If you suffer from Irritable Bowel Syndrome, we recommend that you consult with your personal physician. Moderator: Thank you, Doctor.Dr. Salt: Irritable bowel syndrome (IBS) is a medical diagnosis that doctors make for patients who describe abdominal pain usually with some disturbance with their bowels. The bowel symptoms are correlated with the pain or discomfort, which is often relieved following defecation. There is some correlation between the pain and discomfort and bowel function. Studies show that in the U.S., approximately one in five people have the symptoms of IBS. That doesn't mean that they all go to doctors, but the symptoms are very common and incidentally are not confined to the U.S. The condition is seen throughout the world.Moderator: Doctor, is this an ongoing problem, or a "new syndrome" of a new generation?Dr. Salt: Studies, epidemiological and historical, show that the condition and symptoms have been around for centuries, so it's only recently that we've begun to call it irritable bowel syndrome.Moderator: Thank you. Do we have any idea what causes it?Dr. Salt: Well, we would all like to see a simple answer to a question.Moderator: Makes it easier that way, doesn't it?Dr. Salt: Certainly does ! (laughs) And, we'd all like to find a simple cause for an illness or disease. Unfortunately, most things are not simply caused by something in a linear fashion, and IBS, a functional illness or condition (which means the symptoms are real, but the testing is normal), is not explainable on a linear basis.Moderator: Thanks for your question.[question missing]Dr. Salt: We have to look at the relationship between the mind and body. And, I believe the spiritual dimension is part of what we're talking about and the relationship to environment, and society, and genetics, and finally to the conscious and unconscious mind as we factor in thoughts, perceptions, beliefs, stress and emotion. It's a complex interplay, a bio-psycho-social-spiritual model, rather than a bio-psycho-social medical one.Moderator: How much do these other factors play in. You talked about psycho-social factors. How do they play into this?Dr. Salt: They're really very important. We know that depression and anxiety are not the cause of IBS, but when they are present, they can act as amplifiers, or enhance the symptoms so the individual is more likely to feel sick and consult with a doctor.[question missing]Dr. Salt: We believe you. We know that it's not psychological. Unfortunately, we cannot explain it on the basis of a disease model. When we do biopsies, X-rays and lab tests, they do not show why the distressing symptoms are occurring. So we have to look at the condition differently. And we have to examine carefully the relationship between the mind and body as we start.Moderator: Another user is asking...[question missing]Dr. Salt: Actually, the scientific studies suggest that at least a third of the patients find that their condition improves with time. The science suggests that at least these people can look forward to improvement.Moderator: That's good news!Dr. Salt: Well, the gastrointestinal tract is a long, hollow conveyor belt that moves the ingested food from the mouth to the esophagus where it goes to the stomach and digestion begins, and acid is contributed, then absorption takes place where the nutrients are brought in. Then it goes to the colon where the water comes in, and that is to make it a solid so it can be eliminated into a bowel movement to be removed from the body.[question missing]Dr. Salt: Well, we know that the prevalence of the condition, that is, how common it is in a population, is dependent upon what part of the world and culture we're addressing. So, there are differences in the prevalence in various populations. What this means is not clear. We don't know if this is genetics or the culture itself. There are no clear answers to that. But we do see some differences there. We know that we can see IBS and other related digestive tract symptoms in families and the social process within the family can contribute to "clustering" within the family.[question missing]Dr. Salt: Well, we don't think that IBS is specifically caused by foods, but there are many triggers -- that's a good word, "trigger" -- which may provoke symptoms in folks that have a sensitive gastrointestinal tract, and it's enhanced, like the volume is turned up on a radio receiver. Some examples of foods would be fat, a highly stimulating substance, and lactose, the sugar in milk. Some people are troubled by wheat/grain products, also. Sometimes fruits can be a problem, perhaps related to fructose, the type of sugar in fruit. Sorbitol is a non-absorbable sugar found in certain fruits and non-sugar sweeteners found in dietetic candies and sugar-free gums, which can be a trigger even in a person who doesn't have IBS. Individuals can have triggers unique to them and their own experience as well.Moderator: Another of our users is asking....Dr. Salt: It would be very -- it would not be expected to have a dehydration state occur from IBS alone. The amount of stool and water is actually not abnormal. So, if diarrhea is present, if we were to measure the amount of stool and water lost, by collecting the bowel movement over a certain amount of days (which we do sometimes), we would not find that it's different, so we do not expect someone to become dehydrated with IBS.[question missing]Dr. Salt: Well, that is a very good question. And it provides an opportunity to talk about making a positive diagnosis of IBS. For many years, we have looked at the condition with a view that we should make absolutely certain that there is no other disease process that could be masquerading as IBS. We now try to make a diagnosis based on certain positive features of the way a person describes the symptoms to us. The pioneer of this is Dr. Douglas Drossman of the University of North Carolina, and he has lead a construct where we use certain features or criteria to recognize the symptoms as being likely related to IBS. Also in conjunction with this is to look for certain red flag types of symptoms that could mark for a disease masquerading as IBS. Difficulty with swallowing, vomiting or vomiting of blood, loss of weight, fever, or loss of blood in the bowel movement, either red in the stool or on the commode, or blood detected by the doctor. Then, we make a decision about the tests that should be conducted. An individual with mainly diarrhea would be tested differently than someone with just constipation. We do a blood count to test for anemia or the white blood cell count for infection. We test for proteins in the blood, a low protein state that might mark for something inflamed in the body. A sedimentation rate, a thyroid test, because thyroid conditions can masquerade as bowel and digestive conditions on occasion. We are looking for alarm features that might indicate something wrong in the disease process that might not be IBS, and we're trying not to overly test individuals unless it's clear that a test is needed.Moderator: Thank you doctor. We have a lot of user viewing today, and I'll present their questions shortly...Dr. Salt: Well, I believe very strongly in the importance and power of understanding the condition and the importance of leading a healthy lifestyle. One of the elements of a healthy lifestyle is understanding the benefits of healing relaxation and stress management. Hypnosis can be beneficial, but it's not necessarily widely available, might be difficult to find a practitioner in whom an individual has confidence.[question missing]Dr. Salt: I think that's a good question. A lot of work is being done to determine whether, for example, the 'clustering' of IBS or other related gastrointestinal conditions in families is genetic, or in the family relationships, or in the growing up process, something we might learn through family dynamics as we grow up. I suspect, myself, that it's a combination of genetics and socialization.[question missing]Dr. Salt: Well, it would be very important to draw a distinction between Crohn's disease and IBS cause they are quite different. The bowel, colon, small intestine, one or both are inflamed in Crohn's. But in IBS by contrast, the digestive system is not inflamed at all. So if we conduct tests, we'll find an abnormality, such as if we perform a colonoscopy, we'll find actual inflammation. But, in IBS, we would not see anything inflamed at all inside.Moderator: We have some very specific questions here, and I want to remind our users that the opinions expressed by Dr. Salt are his alone, without the benefit of having examined you, and is speaking from a theoretical perspective, and does not necessarily reflect the opinions of WebMDDr. Salt: I'm actually quite familiar with Lotronex (alosetron). It's a new drug that has just been released for use in the US within the past six to eight weeks. It is produced by Glaxo Wellcome and it is specifically released for treatment of patients who are suffering from IBS in the diarrhea predominant form. It also has been given label indications for women. It appears to be a remarkably safe drug, the main side effect appears to be constipation. It's so new that not many have received Rx's for it, but I anticipate that it will help a lot of people.Moderator: Thank you doctor...[question missing]Dr. Salt: That's a good question, and I'll do my best to interpret it and reflect an answer. The term 'psychosomatic' has traditionally been used to refer to symptoms that have an origin in "mind." To a great extent, the term has become very negative. The term "psychological" refers to the mind, brain, and emotion, and certain psychological states, such as anxiety and depression. There is a powerful interplay between the mind and body, and an information exchange that is bi-directional, they both affect each other. We can't separate the mind from the body. Since the Renaissance, we have, to a great extent, split the mind from the body, since Ren Descartes first proposed that the mind and body should be split, which was in accordance with the separation of church and state at that time. But, ever since that time, the medical field has been based upon the separation of mind and body, and a form of reasoning based on reductionism, A-B, cause and effect. So, I'd conclude by saying, that I don't use the term "psychosomatic" because I feel that it's misunderstood, but I do feel that the mind is at the core of IBS and other syndromes and it's okay to talk about this connection and we all have, to some extent, symptoms that occur, some more than others. It's nothing to be ashamed about and we all ought to be able to talk about the disturbances on mind and body.Moderator: Thanks for joining us.Dr. Salt: GERD refers to Gastroesophageal Reflex Disease, the swallowing tube and stomach is weak and allows the stomach contents to return back up into the swallowing tube where the acids cause heartburn and regurgitation and other complications. We know that there is some relationship between GERD and IBS. We see more folks who have GERD in those that have IBS than we'd normally expect. So it's common to see those with IBS also have GERD.[question missing]Dr. Salt: Weight control is a very important issue for all of us. And I'd call it one of life's great struggles. I don't know that I can give a specific number as to what weight loss would be safe? It depends on the individual's body weight, how overweight they are, and how rapid the weight loss is. The best way to do it is slowly and through a combination of diet and an exercise plan.Moderator: This person should certainly contact their personal physician who is best equipped to give them specific advice...Dr. Salt: And, I think that's a very good bit of advice. Well, unwanted weight loss is not necessarily a feature of IBS per se. We'd have to mark it as a potential alarm symptom so if they are losing weight, we have to backtrack and make sure we have a correct diagnosis. Many people with IBS are gaining weight. So, unwanted weight loss would not be expected in IBS alone, in conclusion.Moderator: I want to remind our users that we're half way through this chat with Dr. Salt. His book, Irritable Bowel Syndrome, is available in bookstores now. You can also link to Barnes and Noble through the "splash page" for this event.I'd also like to remind users that while we appreciate your questions, very specific, case-sensitive questions should be referred to your personal physicians.Dr. Salt: Thank you. I completely agree with you.Dr. Salt: I'd like to mention Colon and Rectal Cancer. We've been sensitized to this because of Katie Couric and her husband dying of colon Cancer. This is a preventable and treatable condition if people would be carefully to note the warning symptoms of rectal bleeding of any type, change of bowel pattern that lasts for more than 2-3 weeks that cannot otherwise be explained (travel or diet), low blood count (anemia), and unexplained weight loss. So, it's important to be certain that a symptom related to the bowel is not, in fact, coming from a colon or rectal cancer. Most cases are diagnosed in people over age 50, but about 9 percent are in people below age 50. And, that's still 14,000 people (10 percent of that) ... so we have to be alert to all age groups.[question missing]Dr. Salt: IBS -- there are two other diseases, Crohn's disease and colitis, they have other symptoms, blood in or around the stool, or fever, or unwanted or unexplained loss of weight. A third condition that may mimic IBS is celiac sprue. This is a condition brought about by an actual allergic response to the gluten in wheat and other grain products (such as barley, oats and rye). The response in the intestine causes a damage to the lining, which leads to a malabsorption, a disturbance to the normal absorption and symptoms include anemia, cramping, bloating, loss of weight, and diarrhea. Some with this have a problem digesting or tolerating wheat products, but that's a different problem. So, one is celiac sprue, and another is more common -- those that do not digest wheat properly, a trigger problem. Celiac sprue can be diagnosed with a blood test, and an endoscopic exam of the upper digestive tract with a light to take a biopsy, and look at it under a microscope. So, I'd emphasize those three conditions specifically.Moderator: Thank you doctor, your advice is excellentDr. Salt: Clearly some people who suffer from some diarrhea conditions need help. The use of Lomotil (diphenoxylate and atropine) and Imodium (loperamide) -- there is some risk of becoming dependent on Lomotil, but it's unusual to have an abuse problem with this. I'd prefer to treat anything without a medication if I could, but for some who suffer from diarrhea that doesn't respond to other measures, this type of medication can be beneficial and can be used safely long-term.Moderator: Thank you doctor. Another question....[question missing]Dr. Salt: Yes. Since IBS seems to be focused on the colon and rectal area, in terms of where it's actually coming from in an organ sense from the body, the pain and discomfort is usually experienced in the lower abdomen, so if we drew a line at the belly button, we'd be talking about the area below that line, and the area to the left of that line, the Sigmoid colon and that's where most people who have IBS pain experience their symptoms. But, it's not exclusive. Some people refer the pain, can feel it up into the chest and shoulder and into their backs as well.[question missing]Dr. Salt: Prevacid (lansoprazole) is a drug that is used to turn down the acid secretion mechanism of the stomach, so we use this along with AcipHex (rebeprazole) and another to treat ulcer and hyperacidity conditions as well as GERD.Moderator: I again remind our users that Dr. Salt's advice is based on theory only, and not having examined you, is offering information only, not a specific diagnosis or recommendation of treatment for your specific conditionDr. Salt: Crohn's disease, again, is associated with inflammation in either the small intestine, colon, rectum or all of those areas. So, we would diagnose this by visualizing or examining those parts of the digestive tract. The test could include a small X-ray done by drinking barium, which passes through the stomach down into the intestine and films are taken. And a lower GI, the barium is put up into the colon through the anus and rectum and an X-ray is taken. And, a colonoscopy. A short version of this is a flexible sigmoidoscopy, but colonoscopy permits us to examine the entire colon to the end and even to get into the small intestine of most people, with a light and a little camera on the end.Moderator: Thank you doctor...Dr. Salt: That's an appropriate question from mommy. I'd say that, per se, IBS would not be associated with having a large baby.Moderator: ...only if you gave birth to the baby out of your behind.....Dr. Salt: But, any trauma of any sort, including passing a large baby or delivering a large baby could be a trigger or something that activates the condition. Some people tell us they've had an episode of gastroenteritis, and thereafter they've had IBS symptoms. Stress, and something like this can be a stress as well, so it may be the trigger of IBS. Or the provocative event.[question missing]Dr. Salt: Yes. Definitely. And, that's a very important question and observation. IBS is common. Fifteen to 20 percent of all of us experience the symptoms of it, so we commonly see it co-exist with other conditions. We may have, for example, very mild Crohn's disease, but a whole lot of associated IBS along with it. So, if we are using strong and heavy drugs to treat the Crohn's disease and not getting a response, we have to look at the very real probability that most of the symptoms are related to the IBS.[question missing]Dr. Salt: Lotronex is the new Glaxo Wellcome drug that is now released and is now available in the US for the past month and a half for the treatment of diarrhea predominant form of IBS in women. Comes in a 1 mg tablet taken twice daily. It seems to be a remarkably safe drug and I look forward to it being a definite benefit to many suffering from this. It's not for people who are having constipation though, because it can actually aggravate this. There are two other relatives of this drug that will be released for folks who have the constipation form of IBS Within the next 12 months.Moderator: We've got around fifteen minutes left. I'd like to thank our viewers for their questions today. If you're just joining us, we're discussing Irritable Bowel Syndrome with Dr. William B. Salt IIDr. Salt: Yes. I am an investigator in the Columbus and Central Ohio area for Glaxo Wellcome on the drug, Lotronex. They're conducting a study on the impact of quality of life and the outcome to determine if it improves the quality of life on those that take it.Moderator: I'll try to present as many of your questions to the doctor as time permits.Dr. Salt: No findings yet, the study was initiated here in the last two months. The alternatives are the current and conventional drugs. Again, I prefer to treat and find a way to deal with the symptoms without prescription meds, if at all, possible by changes in lifestyle and diet, but if that is not effective, we do have Lomotil and other drugs, as we've mentioned earlier.Moderator: You mentioned your recommendations of changes in diet and lifestyle. Could you re-emphasize those again for us please?Dr. Salt: I think that we all need to take a careful look at how we are living our lives. We all underestimate our own power to heal and to live a healthy life. It is very easy to get caught up in, for example, very bad eating patterns. A lot of the fast foods currently available are unhealthy, particularly when eaten on a regular basis. It'd be a whole discussion in and of itself, on what we should eat, I have to think about this myself. Most of us do not take nearly enough fiber in our diet. The average American takes about 12-15 grams of fiber in their diet and the US guidelines call for us to take about 25 grams. I think we should take about 35-40 grams. I take a fiber supplement to assure that I achieve that goal.I think we eat too much fat and the wrong kinds of fats and too much carbs are bad for us relative to a concept called the glycemic index. And I believe strongly in two other dimensions of a healthy lifestyle; aerobic exercise and resistance or strength training exercise.Moderator: Again, Dr. Salt is offering his own personal advice and recommendations, and does not necessarily reflect the opinions of WebMDDr. Salt: And, stress management -- meditation, trying to elicit the relaxation response, like Yoga for example. We really have to work hard at health because it is not passive, not simply something that we can stand by and say we're entitled to have it. We have to make an investment to be healthy. And when we have a condition such as IBS, we can use that to change the way we live our lives and look for improvement.Moderator: Thank you doctor. We have a few responses from our audience regarding fiber.Dr. Salt: I still believe that fiber is at least worth a try for most people who have IBS because I believe it's healthy for most people in general. Let's look more carefully at fiber. There's no doubt that some people are aggravated by it when they first take it. So, you can add it slowly, add three to six grams to the diet every week or two. I don't think it's a good idea to suddenly bump it from 12 grams a day to 40 grams a day. We need to be patient, because we can have symptoms even without IBS. I, myself, had IBS-like symptoms that lasted four a few days until they passed and now I've become totally committed to fiber as a healthy way of living. As we talk about specific fiber products, Metamucil (psyllium hydrophilic mucilloid) is a Proctor & Gamble formulation of psyllium, and that's found in other brands as well. It can be purchased in health food stores. It's an excellent form of fiber. I find it to be useful in helping with the symptoms of IBS, particularly when there's an element of constipation. If you dump some Metamucil or psyllium into a glass, it will solidify if you do not drink it right away, so it helps in diarrhea as well. You can achieve the fiber goal without a fiber supplement, but we lead hectic and busy lives and it's hard to get the fruits, veggies, and grains everyday. So I advocate the fiber supplements myself.Moderator: We have time for a few brief questions....Dr. Salt: Well, we have divided gastrointestinal tract symptoms into twenty-four diagnoses, the Rome Criteria .. and one of the symptoms is Globus, and that's a sense of a lump or fullness or thickness or tightness in the center of the front of the throat where the Adam's apple is. It's a constant sensation present there which is often improved when we are eating something. It's a functional condition, which means when we put a scope down there, we do not find a cause of it. It can be associated with IBS or seen with it, or it can be independent of it.Moderator: Thank you doctor. And one last question.....[question missing]Dr. Salt: I'm wondering if that question refers to diagnosis, treatment, or both?Moderator: I'm not sure. Do you have any general comments on that issue?Dr. Salt: I think that that's a bit of a tricky area, isn't it? Managed care and the health environment. The relationship between the doctor and patient is a sacred one and important to the healing process. The healing process is in part related the patient's beliefs that the doctor can help and vice versa. I have to admit that most doctors and many patients find that the managed care environment is interfering with the relationship between doctor/patient. And, I probably should confine my comments to that.[question missing]Dr. Salt: Most people and patients with IBS are able to lead normal lives. In some, the condition can be distressing and in occasional patients, it can be disabling. There can be ups and downs, and missing work and such, but for the most part, if the individual has an understanding of what this is and isn't, and a good relationship with a health care professional, I think we can look at this with great optimism.Moderator: Thanks so much for joining us today,,,,again, we've left a lot of your questions unanswered, but we recommend you read Dr. Salt's book, Irritable Bowel Syndrome. We remind our users to seek as much information online as possible, but the ultimate best decision regarding care is up to them personally and their own physician.Dr. Salt: Thank you, Blaine. Related documents... Printer-friendly version... Email This To A Friend Physician | Nurse | Corporate Contact Us | Terms and Conditions | Privacy Statement


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## cookies4marilyn (Jun 30, 2000)

Wasn't the comment "only if you gave birth to the baby out of your..." a hoot??? Such a spunky moderator.








Okay, now this is the second one...has the questions as well. My computer was acting weird on the site...hope this helps everyone a bit.. Thanks again, Eric







Defining Irritable Bowel Syndrome with William B. Salt IIHealth FocusMonday, April 17, 2000 6:00 PM EDTBy William Salt II Moderator: Welcome everyone! Today's guest is William B. Salt II, MD. He will be answering your questions about Irritable Bowel Syndrome. Welcome Dr. Salt. Thank you for joining us this evening. We have a lot of questions, so let's begin.William B. Salt II, MD: Good evening. Itï¿½s nice to be with you. I appreciate the opportunity to discuss Irritable Bowel Syndrome and related functional gastrointestinal disorders.funky_craigviv: What is IBS?William B. Salt II, MD: IBS is a medical diagnosis that doctors give to patients to describe a diagnosis for symptoms of abdominal pain and discomfort associated with changes of bowel function, including diarrhea, constipation or an alternation between diarrhea and constipation.strickland_lands: Is this hereditary?William B. Salt II, MD: IBS is not hereditary in a genetic sense. The condition is commonly found in families so we do look for other family members who may have it as a clue to support a diagnosis in a given patient.almostjena: Is it true that you should limit your caffeine consumption if you have IBS?William B. Salt II, MD: I think that is generally a wise recommendation for the following reason. Caffeine stimulates the intestine and can aggravate the symptoms of IBS, particularly diarrhea. Furthermore, caffeine is a stimulant and can aggravate any anxiety that may be present, thus a worsening of anxiety could in turn amplify the symptoms of IBS in a vicious cycle.leopeg53: What tests do they use to diagnose IBS?William B. Salt II, MD: We, as physicians, are working harder to make a positive diagnosis of IBS. Previously, we would attempt to rule out or exclude many disease processes that might be mimicking IBS. Now we are attempting to identify the typical symptoms that are characteristic of IBS and look for alarm or "red flag" symptoms that could indicate the presence of serious disease processes that are masquerading as IBS. These red flag/alarm symptoms include unexplained weight loss, vomiting, fever, awakening from sleep due to symptoms and blood in the bowel movement. Tests can be done which include blood tests, digestive x-rays, and either flexible sigmoidoscopy or colonoscopy.kew396: Are the symptoms of a twisted colon similar to irritable bowel?William B. Salt II, MD: We should attempt to clarify what the term "twisted" means. It may be the doctor who described a twisted bowel on x-ray. There are some rare medical conditions (such as volvulus) in which there is a true anatomic twisting of the bowel or intestine, which is not IBS. The doctors may describe an x-ray finding as twisted or tortuous, but this does not really correlate with symptoms and is not relevant to the diagnosis of IBS. nicole9999_1999: I'm interested in hypnosis and meditation to deal with my IBS. Do you recommend this?William B. Salt II, MD: I definitely recommend this. Most people and doctors underestimate the patient's power potential and ability to heal. A very good way to manage IBS or another functional GI illness is to use some type of relaxation technique on a regular basis. Hypnosis and meditation are excellent examples of this.Xile98: My girlfriend suffers with bleeding and mucus when going to the toilet. Is there any help?William B. Salt II, MD: The most important step to take would be to obtain a clear diagnosis because we must never assume that bleeding is related in any way to IBS. Probably the most common explanation would be IBS and bleeding from hemorrhoids or a tear in the anal lining called a fissure. However, it is very important to make certain that the bleeding is not related to a growth, polyp, cancer, tumor, inflammation or infection.leopeg53: What new medications are there for IBS?William B. Salt II, MD: There is one new drug just introduced in the US by Glaxo Wellcome called Lotronex. This drug is approved for the treatment of the diarrhea predominant form of IBS in women. It is still being studied for use in men. There are two other drugs that will most likely be released within the next 6 to 12 months for the treatment of the constipation predominant form of IBS.brook_lyn_grl2000: What is involved in a colostomy, and when would it be permanent or temporary?William B. Salt II, MD: A colostomy is a surgery that brings out part of the colon to the abdomen's front and skin surface so the waste is eliminated into a bag. It would never be necessary in IBS and is not often necessary at all now. In some situations, where there is blockage and an emergency situation, a colostomy may be required at least temporarily. There are occasional rectal cancers that are located so low in the rectum that a colostomy is needed to surgically treat with the best chance for cure. In some diseases such as Ulcerative Colitis and Crohn's disease, it can be necessary to completely remove the colon and rectum surgically. At least with Ulcerative Colitis, an operation is available which includes the construction of a pouch in the pelvis made from lower small intestine. This allows the person to eliminate liquid bowel movement out of the anus. It is currently widely available at tertiary institutions. But remember that we are talking about IBS tonight, and surgery with colon removal and these surgical procedures is not applicable. rkt45we: Are there any foods that I shouldnï¿½t be eating?William B. Salt II, MD: Exploring the matter of foods either aggravating or triggering symptoms is always important in the management of IBS. First, many people are lactose intolerant and are unable to digest the sugar (lactose) in milk, ice cream and other dairy products. Next, fat is very stimulating to the digestive tract even in someone that is healthy. We should all be striving to eat less fat anyway. Then, it becomes a matter of trial and error. Some people have difficulty digesting wheat and grain products and can benefit from their reduction/removal from the diet.foxygrrl87: Is there a way to control or totally get rid of it?William B. Salt II, MD: IBS is a chronic condition, but I believe very strongly in the patient's power and ability to control the condition and heal from it. As Dr. Koop, the former Surgeon General of the US, has said, "knowledge is often more important than medicine." I firmly believe that most people, armed with a true understanding of what IBS is and is not, can be clearly helped. This is the reason that I wrote Irritable Bowel Syndrome and the Mind-Body/Brain/Gut Connection for my patients and others who suffer from the illness. It is available in bookstores or can be directly ordered from www.parkviewpub.com or you can call 1-888-599-6464.insatiable44_99: I've been living off of Imodium AD. Am I doing damage to myself?William B. Salt II, MD: The medication in this is remarkably safe and is available over the counter without a prescription. If the diagnosis of IBS is correct and if the medication is beneficial, then I do not see any risk. It is important that a proper diagnosis has been established.skydog9952: Can alcohol cause IBS?William B. Salt II, MD: Alcohol is not the cause of IBS, but it certainly can be a trigger of symptoms in some patients. brook_lyn_grl2000: Can relaxation and stress management help with IBS?William B. Salt II, MD: Definitely. Stress and emotional stress can intensify and/or aggravate the symptoms of IBS, and treatment and management directed to stress and psychological distress such as anxiety/depression can clearly be of benefit.baloobaloo98: If hemorrhoids bleed, is that something to really to be concerned with?William B. Salt II, MD: Rectal bleeding must always be considered to be an important symptom that requires an accurate diagnosis. The only way a doctor can be somewhat certain that rectal bleeding is from hemorrhoids from the patients description is if the blood actually drips into the commode, such as a leaky faucet would drip. As long as an accurate diagnosis has been made, then a little bleeding that is coming from hemorrhoids is not dangerous.outspokn2: How can you tell the difference between IBS and Ulcerative Colitis or Crohnï¿½s?William B. Salt II, MD: Ulcerative Colitis and Crohn's are quite different than IBS because the bowel and intestine are inflamed. There is no inflammation or abnormality of the bowel or intestine in IBS. Symptoms of Ulcerative Colitis and Crohn's disease can mimic IBS since abdominal pain and diarrhea occur in all of these conditions, but bleeding, rectal bleeding, fever, and weight loss point to a diagnosis of Ulcerative Colitis or Crohn's disease.brook_lyn_grl2000: I've heard that religion and spirituality can heal a lot of illnesses. Does it have any effect on IBS?William B. Salt II, MD: The matter of religion/spirituality in IBS has not been formally studied to my knowledge. However, I believe very strongly in the Mind-Body-Spirit connection and in the healing power of spirituality and religious practice.nicole9999_1999: What about herbs to treat IBS?William B. Salt II, MD: As far as herbal treatments, the only herbal formulation that has been scientifically tested was a recent article showing the benefit of Chinese herbal medicine in IBS. One natural treatment that I regularly recommend, because it has been used for centuries, is peppermint. A good way to purchase it is to find an enteric coated peppermint so that the peppermint is not released in the stomach after it has been swallowed but is protected until it reaches the intestine and colon where it can then do its work.jfranklin65: Sometimes when I eat, I immediately have to go to the bathroom. There is no waiting. I have never really been able to pinpoint any certain type of food and it is always a very loose stool with a pretty good amount of force. Does this sound like IBS?William B. Salt II, MD: That symptom is what we call a hyperactive gastrocolic reflex. In other words, a strong signal is sent from the stomach to the colon to squeeze or contract. This is a common symptom in IBS. Consider talking to your doctor about taking a bile acid sequestrant medication since some people who suffer with this symptom pattern have a disturbance of bile circulation and absorption that can be corrected.TheRoaringGirl: Sometimes I get IBS spasms during or right after sex. Is there a known connection, or could something else be wrong?William B. Salt II, MD: There could be something else wrong. Many factors can trigger the symptoms of IBS including medications, diet, and physical activity including sex, stress, and the hormonal female cycle. It can sometimes be difficult to sort out bowel problems from gynecologic ones.nita_vick: Do you recommend a colonoscopy for a nine-year-old boy with a megacolon?William B. Salt II, MD: It would be important that a consultation be obtained with a pediatric gastroenterologist. I am an adult gastroenterologist, and children have some unique diagnostic considerations that are not necessarily the same as in adults. An important diagnosis to consider in a child with a megacolon, which means enlarged colon, is a rare condition called Hirschsprung's Syndrome.ncdude_32: At what age do you first see IBS? William B. Salt II, MD: IBS most commonly occurs in the teens and 20ï¿½s but can occur at any age.mjudylou: Do you support the use of charcoal tablets for intestinal cramps?William B. Salt II, MD: Charcoal is an over-the-counter non prescription based product that can be tried for gas and crampy symptoms for which we have little scientific basis to recommend.docholiday202: I've had a total colectomy with illiostomy. Are my chances higher now of other gastro problems?William B. Salt II, MD: To some extent it depends on what underlying disease process led to the necessity for the surgery. Crohn's disease, for example, can return or recur in the intestine after the colon has been removed. Adhesions can cause intestinal blockage after surgery as another consideration.ToffeeSpice: You mentioned that the female hormonal cycle affects IBS. Can you tell me a little more about how this is?William B. Salt II, MD: The most common pattern that we see is the woman who has IBS with constipation predominance and who notes that the constipation is relieved around the time of menstruation or that diarrhea occurs then. This is an example of how the female hormonal cycle is a "stress" and influences bowel function.FlameKurve: I drink peppermint tea all the time. Does it work as well?William B. Salt II, MD: The use of peppermint tea is always worthwhile as a trial. Theoretically the tea would be absorbed in the stomach/upper GI before it reached the colon which is why enteric-coated peppermint might be better. However, the peace and relaxation associated with the leisurely consumption of a pleasantly flavored peppermint tea could lead to beneficial effects. Enteric coated peppermint is available at health food stores and can also be purchased online.dorna19: What are the symptoms of colon cancer?William B. Salt II, MD: The main symptom of colon cancer is rectal bleeding. The other symptom would be a change of bowel habit lasting more than 2 weeks that cannot be explained otherwise by travel, change of diet or medications.nygirltoday: Can you sum up steps to take to live a normal life with IBS?William B. Salt II, MD: There is no simple sound bite summation of managing IBS, which explains why I was motivated to write a book for my patients and the public. I think I would say that I believe very strongly in the patientï¿½s own healing potential, particularly when he or she has the knowledge that they need. We can help as doctors, but everyone should recognize how powerful they really are. The step by step approach that I recommend is outlined in the book Irritable Bowel Syndrome and the Mind-Body-Brain-Gut Connection. The book is available at www.parkviewpub.com, and you can call toll free at 888-599-6464. It is also available in bookstores.Moderator: Dr. Salt, thank you so much for all of the information you covered during this chat, not only onIBS but with other GI problems. We welcome you back at any time as a guest speaker. Thank you all for joining us tonight. We hope the information you received tonight answers a lot of your questions. Thank you again, Dr. Salt, for joining us, and thanks to all of you in the auditorium. Have a wonderful evening. Related documents... Printer-friendly version... Email This To A Friend Physician | Nurse | Corporate Contact Us | Terms and Conditions | Privacy Statement Copyright ï¿½ 1996-2000 WebMD, Inc. - All rights reserved. We subscribe to the HONcode principlesof the Health On the Net Foundation [This message has been edited by cookies4marilyn (edited 09-29-2000).]


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## Guest (Sep 30, 2000)

Eric,Thank you for posting the articles. They were very informative.Everyone needs to read them too.


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## JeanG (Oct 20, 1999)

HI Eric:Thanks for posting these!







You too, cookies.







JeanG


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