# has anyone



## eric (Jul 8, 1999)

Has anyone ever looked through the IBS resource center on medscape, you have to register, but its free and there is a ton of IBS information there, a lot of it Continuing medical education for docs, but a lot of information there. For exampleFrom Medscape GastroenterologyViewpointsEfficacy of Rifaximin vs Placebo in Reducing Symptoms in Adults With IBSPosted 11/10/2006David A. Johnson, MD, FACG, FACP The Effect of a Nonabsorbed Oral Antibiotic (Rifaximin) on the Symptoms of the Irritable Bowel Syndrome: A Randomized TrialPimentel M, Park S, Mirocha J, Kane SV, Kong YAnn Intern Med. 2006;145:557-563SummaryIrritable bowel syndrome (IBS) is a prevalent condition that has been labeled as a "functional bowel disorder." By this delineation, its cause has been thought to be indefinable. The primary symptoms of this disorder include constipation, diarrhea, abdominal bloating, and cramping. Recent attention has focused on a potential infectious component of IBS.In this study, Pimental and colleagues investigated the use of rifaximin in patients diagnosed with IBS as defined by the Rome I criteria. Rifaximin is a nonabsorbable, gut-selective antibiotic derived from the rifamycin family that may reduce bacterial overgrowth due to its broad-spectrum activity in vitro against gram-positive, gram-negative, aerobic, anaerobic, and microaerophilic bacteria.This was a prospective, double-blind randomized controlled trial that involved 43 patients who received 400 mg of rifaximin 3-times daily and 44 who received placebo for 10 days. Patient symptom and stool diaries were completed prior to entry, during the study, and the week following treatment.Global improvement was found to vary widely across weeks for most patients, and the data were reported as an averaging of the symptoms over all 10 weeks of the study. This percentage was significant as a function of group (P = .020), but not as a function of week (P = .78) or group-by-week (P = .96). The patients in the rifaximin group had a 36.4% improvement in global symptoms compared with 21.0% for the placebo group.The rifaximin group also reported significantly less bloating on a visual analog scale compared with the placebo group (P = .010), a difference that persisted after controlling for differences between groups in baseline pain scores (P = .001). Besides bloating, none of the secondary endpoints improved with treatment compared with placebo on the visual analog scale: abdominal pain (P = .32), diarrhea (P = .67), and constipation (P = .069).ViewpointRifaximin is currently US Food and Drug Administration-approved for the treatment of traveler's diarrhea, although these study findings suggest a more expanded potential role for this antibiotic. However, before recommending widespread globalized use of this medication for all patients with IBS, healthcare providers should be aware of several limitations of this study. First, although this was a "multicenter study," there was a considerable imbalance between enrollment from the 2 study sites (83 participants vs 3 participants). Second, because the global measure includes pain, it is important to note that there was an imbalance in baseline pain scores between the 2 patient groups at entry. The imbalance (higher baseline pain scores in the rifaximin group) potentially favors the reduction in the global scores. Additionally, this primary outcome measure is unique in the spectrum of the recent treatment intervention evaluations for IBS trials, and therefore makes comparisons with other trials somewhat difficult. Third, the study authors relied solely on the use of the lactose breath test to define small bowel bacterial overgrowth. Future tests in this area should evaluate the use of other breath tests to define bacterial overgrowth in the small intestine. Fourth, the data suggest that rifaximin may be of more help in the subset of patients with bloating. In IBS, abdominal bloating is reported in more than 50% of patients, and a recent study suggests that changes in abdominal girth can reach 12 cm in more than 50% of patients.[1]Clearly, this study highlights a new concept in the potential pathogenesis of IBS. An infectious cause may offer a tremendous opportunity to manage an otherwise somewhat frustrating disease -- both for patients and their treating physicians.AbstractReferencesHoughton LA, Lea R, Agrawal A, Reilly B, Whorwell PJ. Relationship of abdominal bloating to distention in irritable bowel syndrome and effect of bowel habit. Gastroenterology. 2006;131:1003-1010. Related LinksResource CentersIBS and Chronic ConstipationDavid A. Johnson, MD, FACG, FACP, Professor of Medicine, Chief of Gastroenterology, Eastern Virginia School of Medicine, Norfolk, VirginiaThis is really important."Besides bloating, none of the secondary endpoints improved with treatment compared with placebo on the visual analog scale: abdominal pain (P = .32), diarrhea (P = .67), and constipation (P = .069).as well as the testing they used itself lactolose."However, the accuracy of the LHBT in testing for the presence of SIBO has been questioned.[73] Sensitivity of the LHBT for SIBO has been shown to be as low as 16.7%, and specificity approximately 70%.[74] Additionally, this test may suboptimally assess treatment response.[75] The glucose breath test has been shown to be a more reliable tool,[76] with a 75% sensitivity for SIBO[77] vs 39% with LHBT for the "double-peak" method of SIBO detection.[74] In a recently conducted retrospective study involving review of patient charts for the presence of gastrointestinal-related symptoms (including IBS) in patients who were referred for glucose hydrogen breath tests for SIBO, of 113 patients who met Rome II criteria for IBS, 11% tested positive for SIBO.[78] *Thus, results demonstrated that IBS symptoms are often unrelated to the presence of SIBO. "*http://ibsgroup.org/groupee/forums/a/tpc/f...322/m/620106842"Unfortunately, the diagnosis of bacterial overgrowth presents several difficulties and limitations, and as yet there is not a widespread agreement on the best diagnostic test. "http://ibsgroup.org/groupee/forums/a/tpc/f...322/m/620104662http://www.medscape.com/resource/ibs


----------



## Rick (never give up) (Oct 7, 2005)

Thanks a lot eric for this info. I have also read several of your posts and it looks like you had already evolved into the best species of all the ones among us IBS sufferers: The informed IBS sufferer.In the past years, especially when my IBS started, I got scammed several times with products like Molocure, Primal Defense, etc, etc, etc... And I mean scammed because I followed their guidelines to the letter and got no results. Then I learned that IBS is more than just a simple word.In fact, now that I'm more prone into science and clinically proven methods, I think that IBS might actually be not one single problem, but several "undefined" conditions that having no explanation yet, are grouped together based on symptoms and labeled as IBS







.Again, thanks for bringing this kind of information to this forum, hopefully it will help many people realize that despite our intrinsic need for hope and get cured, IBS is in its essence kind of like the UFO phenomena, and we should approach it with a little bit of salt.


----------



## Moises (May 20, 2000)

Eric,I too appreciate the effort you make to encourage all to decide on treatments based on the evidence.In this thread the evidence suggests that rifaximin offers a low probability of symptom improvement beyond that offered by a placebo.You also highlight as important the fact that pain, diarrhea, and constipation were significantly improved. But bloating was. Personally, this is what attracted me to Pimentel's thesis. (Of course, I agree with you that what I am attracted to has no bearing on the truth or falsity of his thesis.) Pimentel gives more emphasis to bloating and distension than do other researchers. Pimentel recognizes that this flies in the face of Rome II criteria. You have been posting some great stuff in the "News, Research, and Abstracts" forum about bloating and distension. What is often repeated is that many patients report bloating or distension as their most problematic symptom. If Pimentel had an effective treatment for bloating (a very big "if", I concede), that would be a significant contribution to the field.When you get down in the trenches of science, it's a muddy, mucky mess.


----------



## eric (Jul 8, 1999)

If you both email me I will send you some valuable information on this subject. I cannot post it yet.Rick what your saying is basically true.For example this is a major expert on Post Infectious IBS on motility and D. I believe Pimental calls this a "harolding event" or something like that no?Neurogastroenterol Motil. 2006 Dec;18(12):1045-1055. Role of motility in chronic diarrhoea.Spiller R.Wolfson Digestive Diseases Centre, University Hospital, Nottingham, UK.Patients complaining of 'chronic diarrhoea' usually mean the passage of loose, urgent stools. Chronic diarrhoea is a feature of malabsorption; it may also be seen in the 'dumping syndrome' which follows gastric surgery, small intestinal bacterial overgrowth, bile salt malabsorption and in malabsorption of simple sugars including most commonly lactose, fructose and sorbitol. Excessively rapid entry of chyme into the small or large intestine generates propulsive motor patterns leading to accelerated transit. Inflammation is associated with decreased normal mixing motor patterns but increased propulsive motility including high amplitude propagated contractions (HAPCs). Evidence for abnormal small intestinal motility in the diarrhoea associated with irritable bowel syndrome (IBS) is conflicting and any difference appears small. Increased colonic HAPCs with increased propulsion is seen in IBS with diarrhoea (IBS-D). Stress-induced colonic motility is increased in IBS-D with hyper-responsiveness to corticotrophin releasing factor (CRF). Long-lasting increases in mucosal serotonin availability may contribute to the chronic diarrhoea seen in IBS-D and coeliac disease. Treatments for abnormal motility in chronic diarrhoea include those designed to correct specific underlying abnormalities including octreotide, antibiotics, colestyramine, specific food avoidance and anti-inflammatory agents. There are also treatments aimed primarily at altering motility directly including opiates, 5HT3 receptor antagonists and amitriptyline.PMID: 17109687Something important here I believe in regards to all this is pain and discomfort. Some normal people bloat but to them it may not even register that much and small gas bublles can cause a lot of pain and discomfort. Altered gas flow dynamics as well. I use to get true distension every time I went swimming after I got out of the water?Rarely but sometimes I would get bloating and distension together.I also noticed with the distension some times my rectum would seem to tighen up and I would get distended. That to me was interesting as it made some sense to me that if you tighted the retum muscle while the above was relaxed it may distend a person. Mosises, I am happy there is more awareness of SIBO and look forward to other research centers studying SIBO in regards to IBS. You want to treat SIBO if you have it for sure of course.I personally don't want to take antibiotics though, especially if I have to take them long term. Other treatments like probiotics may help some of these issues as well, but they are studying that at the moment.I have personally also found a ton of relief with HT which has reduce all my symptoms greatly, bloating is almost gone very rarely now and I can remember the last time I had distension. Pain is greatly reduced and so are the rest of my symptoms, including non gi ones I had, sleep, back pain, muscle tension etc., and I am not the only one.Have you guys watched this yet?Integrated Approach to Irritable Bowel SyndromeThis is an online CME course featuring Dr. Drossman http://www.ja-online.com/dukeibs/#Another aspect of this is the narrower focus of SIBO and IBS as opposed to the global picture of IBS through all the research and there has been quite a bit lately.Have you seen these.Integrated Approach to Irritable Bowel SyndromeThis is an online CME course featuring Dr. Drossman http://www.ja-online.com/dukeibs/#alsoEvaluation of Visceral Sensation in IBS Patients Using Subliminal Stimulationhttp://ibsgroup.org/groupee/forums/a/tpc/f...261/m/988101652Study shows link between IBS and painhttp://www.channelnewsasia.com/stories/hea.../239806/1/.html


----------

