Re: IBS recommendations-update Jan 2009 Am Journal of Gastroenterology

[Guest guest]

Here is an update, btw.(compliments of the ever vigilant Linke

It appears they HAVE caught up.

It would be a shame to be caught unaware so I post this

Sincerely,

Michal Hogan, RD, LD, CLT

NutritionResults.com

Get a Listing: _https://therapists.net/register2.php?package=30_

(https://therapists.net/register2.php?package=30)

Get LEAP: _http://www.nutritionresultsorder.com/1657330.html_

(http://www.nutritionresultsorder.com/1657330.html)

**************************************snip************************************

*****************************

Irritable Bowel Syndrome (IBS) is one of the most common disorders managed

by gastroenterologists . There have been numerous changes in the clinical

landscape in recent years and new evidence has emerged on the benefits and risks

of drugs used for IBS. The American College of Gastroenterology today

published a new evidence-based systematic review on the management of Irritable

Bowel

Syndrome as a supplement to the January 2009 issue of The American Journal

of Gastroenterology.

The College’s evidence-based position statement on IBS offers new graded

recommendations on testing and treatment of this chronic, recurrent functional

disorder of the gastrointestinal tract that affects all aspects of daily life

for its sufferers. In order to critically evaluate the rapidly expanding

research about IBS and to assess the evidence of efficacy of new IBS drugs, the

ACG IBS Task Force performed a comprehensive meta-analysis of the evidence on

therapies for IBS.

The College’s new recommendations include expert assessments of traditional

therapies for IBS, as well as a range of new treatments, including evidence on

probiotics; the non-absorbable antibiotic rifaximin; antidepressants;

antispasmodics and peppermint oil; fiber, bulking agents and laxatives;

antidiarrheals, including loperamide; the 5-HT3 receptor antagonist alosetron;

the

5-HT4 (serotonin) receptor agonist tegaserod; the chloride channel activator

lubiprostone; psychologic therapies; herbal preparations and acupuncture. The

evidence-based review also includes new recommendations about the routine use of

diagnostic tests for patients who present with IBS symptoms, as well as food

allergy testing and diet in IBS.

“For the gastroenterologist seeing patients with IBS, the new ACG

recommendations specify whether or not the range of potential therapies are

better than

placebo for resolving IBS symptoms,†said Lawrence J. Brandt, M.D., MACG,

Chair of the ACG IBS Task Force.

“The College’s graded recommendations on IBS take into account the quality

of the evidence, such as the strength of study design, and the magnitude of

benefit of different treatments. The benefits of treatment must be balanced

against any potential risks,†explained Dr. Brandt.

“This new meta-analysis of the literature on the diagnosis and therapy of

IBS offers physicians the opportunity to make clinical decisions about IBS based

on a thorough assessment of the evidence,†explained ACG President Dr.

Eamonn M.M. Quigley, one of the contributors to the position statement.

The ACG Evidence-Based Systematic Review on IBS can be accessed as a PDF at

_http://www.acg. gi.org/media/ releases/ ajg_ibs_supp_ 0109.pdf_

(http://www.acg.gi.org/media/releases/ajg_ibs_supp_0109.pdf)

Highlights of ACG’s New Recommendations on IBS Therapies

In general, treatments for IBS are directed towards the patient’s

predominant symptoms. There are a wide variety of available therapies, many of

which

improve individual IBS symptoms. Only a small number of therapies has been

shown to be of benefit for global symptoms of IBS.

- Trials suggest psyllium, fiber, certain antispasmodics, and peppermint oil

are effective in IBS patients although the quality of the evidence is poor.

- Evidence suggests that some probiotics may be effective in reducing

overall IBS symptoms but more data are needed.

- Anti-diarrheals reduce the frequency of stools but do not affect the

overall symptoms of IBS.

- 5HT 3 antagonists are efficacious in IBS patients with diarrhea and the

quality of evidence is good. Patients need to be carefully selected, however,

because potentially serious side effects include constipation and colon

ischemia. Current use of alosetron is regulated by a prescribing program set

forth

by the FDA.

- 5HT 4 agonists are modestly effective in IBS patients with constipation

and the quality of evidence is good although the possible risk of cardiovascular

events associated with these agents may limit their utility. Currently,

there are no 5-HT 4 receptor agonists available for use in North America.

- Tricyclic anti-depressants and selective serotonin reuptake inhibitors

have been shown to be effective in IBS patients of all subtypes. The trials

generally are of good quality but the limited number of patients included in

trials implies that further evidence could change the confidence in the estimate

of effect and therefore the quality of evidence was graded as moderate.

- Non-absorbable antibiotics are effective, particularly in

diarrhea-predominan t IBS.

- The selective C-2 chloride channel activator, lubiprostone, is efficacious

in constipation- predominant IBS with a moderate quality of evidence.

- Psychological therapies also may provide benefit to IBS patients although

the quality of evidence is poor.

- While available trials of unique Chinese herbal mixtures appeared to show

a benefit in IBS, it is not possible to combine these studies into a

meaningful meta-analysis. Overall, any benefit of Chinese herbal therapy in IBS

continues to be potentially confounded by the variable components used and

their

purity. Also, there are significant concerns about toxicity, especially liver

failure, with use of any Chinese herbal mixture.

- A systematic review of trials of acupuncture for IBS was inconclusive.

Further work is needed before any recommendations on acupuncture can be made.

- Patients often believe that certain foods exacerbate their IBS symptoms.

There is, however, insufficient evidence that food allergy testing or exclusion

diets are efficacious in IBS and their routine use outside a clinical trial

is not recommended

New Recommendations on Diagnostic Testing in IBS

Because of the low likelihood of uncovering organic diseases, routine

diagnostic testing with complete blood count, serum chemistries, thyroid

function

studies, stool for ova and parasites, and abdominal imaging should not be

routinely performed in patients with typical IBS symptoms and no alarm

features.

Routine serologic screening for celiac sprue should be pursued in patients

with diarrhea predominant IBS and the mixed type of IBS. Lactose breath testing

can be considered when lactose maldigestion remains a concern despite

dietary modification.

Currently, there are insufficient data to recommend breath testing for small

intestinal bacterial overgrowth in IBS patients. Because of the low pre-test

probability of Crohn’s disease, ulcerative colitis, and colonic neoplasia,

routine colonic imaging is not recommended in patients under the age of 50

years with typical IBS symptoms and no alarm features. Colonoscopic imaging

should be performed in IBS patients with alarm features to rule out organic

diseases and in those over the age of 50 years for the purpose of colorectal

cancer screening. The College recommends that African-Americans begin

colorectal

cancer screening at age 45. When colonoscopy is performed in patients with

IBS-D, obtaining random biopsies can be considered to rule out microscopic

colitis.

About IBS

For the clinical gastroenterologist, IBS is one of the most commonly seen

problems. IBS is characterized by abdominal discomfort associated with altered

bowel function; structural and biochemical abnormalities are absent. The

pathophysiology of IBS is multi-factorial. Individual symptoms have limited

accuracy for diagnosing IBS and the disorder is considered as a symptom

complex.

IBS Prevalence and Burden of Illness

•IBS is a prevalent and expensive condition that can significantly impair

health related quality of life (HRQOL) and reduce work productivity.

•Epidemiologic studies suggest that 7-10% of people in the general

population have IBS worldwide. Community-based studies indicate that IBS-D and

IBS-M

subtypes are more prevalent than IBS-C, and that switching among subtype

groups may occur over time.

•IBS is 1.5 times more common in women than in men.

•IBS is more common in lower socioeconomic groups and more commonly

diagnosed in patients younger than 50 years.

•IBS patients make more visits to their physicians, undergo more diagnostic

tests, are prescribed more medications, miss more workdays, have lower work

productivity, are hospitalized more frequently, and account for greater

overall direct costs than patients without IBS.

•Resource utilization is highest in patients with severe symptoms, and

poorer HRQOL.

ACG IBS Expert Task Force

- Chair, Lawrence J. Brandt, M.D., MACG, Montefiore Medical Center

- D. Chey, M.D., FACG, University of Michican Medical Center

- Amy E. Foxx-Orenstein, D.O., FACG, Mayo Clinic, Division of

Gastroenterology

- Eamonn M.M. Quigley, M.D., FRCP, FACG, Cork University Hospital, National

University of Ireland at Cork

- Lawrence R. Schiller, M.D., FACG, Baylor University Medical Center

- Philip S. Schoenfeld, M.D., M.Ed., M.Sc., FACG, Veterans Affairs Ann Arbor

Healthcare System

- J. Talley, M.D., Ph.D., FACG, Mayo Clinic ville,

Department of Internal Medicine

- Brennan M. R. Spiegel, M.D. MSHS, VA Greater Los Angeles Healthcare

System, Geffen School of Medicine at UCLA

- Statistician- Epidemiologist, Moayyedi, B.Sc., M.B., Ch.B., Ph.D.,

M.P.H., FRCP (London), FRCPC, FACG, McMaster University Medical Centre,

Division of Gastroenterology

**************One site keeps you connected to all your email: AOL Mail,

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[Guest guest]

Hi Mick,

Yes, they still get it and don't get it.

" Patients often believe that certain foods exacerbate their IBS symptoms.

There is, however, insufficient evidence that food allergy testing or

exclusion diets are efficacious in IBS and their routine use outside a clinical

trial

is not recommended. "

It's clearly obvious that NONE of this review panel has ever worked with a

LEAP/MRT IBS patient.

But, what they say IS true. " allergy testing " doesn't work. Neither do

" exclusion diets. "

Thankfully, MRT/LEAP isn't either of those! ;-)

I think we should find the email addresses of every one of these reviewers

and have our IBS patients bombard them with letters. That, and a ton of case

studies as well! ;-)

Jan Patenaude, RD, CLT

-

In a message dated 12/19/2008 9:24:34 A.M. Mountain Standard Time,

NutritionResults@... writes:

Here is an update, btw.(compliments of the ever vigilant Linke

It appears they HAVE caught up.

It would be a shame to be caught unaware so I post this

Sincerely,

Michal Hogan, RD, LD, CLT

NutritionResults.Nut

Get a Listing: __https://therapists.https://theraphttps://therhtt_

(https://therapists.net/register2.php?package=30_)

(_https://therapists.https://theraphttps://therht_

(https://therapists.net/register2.php?package=30) )

Get LEAP: __http://www.nutritiohttp://www.nuthttp://www.nhttp:_

(http://www.nutritionresultsorder.com/1657330.html_)

(_http://www.nutritiohttp://www.nuthttp://www.nhttp_

(http://www.nutritionresultsorder.com/1657330.html) )

*****************************************************************************

*****************************

Irritable Bowel Syndrome (IBS) is one of the most common disorders managed

by gastroenterologists . There have been numerous changes in the clinical

landscape in recent years and new evidence has emerged on the benefits and

risks

of drugs used for IBS. The American College of Gastroenterology today

published a new evidence-based systematic review on the management of

Irritable Bowel

Syndrome as a supplement to the January 2009 issue of The American Journal

of Gastroenterology.

The College’s evidence-based position statement on IBS offers new graded

recommendations on testing and treatment of this chronic, recurrent

functional

disorder of the gastrointestinal tract that affects all aspects of daily

life

for its sufferers. In order to critically evaluate the rapidly expanding

research about IBS and to assess the evidence of efficacy of new IBS drugs,

the

ACG IBS Task Force performed a comprehensive meta-analysis of the evidence

on

therapies for IBS.

The College’s new recommendations include expert assessments of traditional

therapies for IBS, as well as a range of new treatments, including evidence

on

probiotics; the non-absorbable antibiotic rifaximin; antidepressants;

antispasmodics and peppermint oil; fiber, bulking agents and laxatives;

antidiarrheals, including loperamide; the 5-HT3 receptor antagonist

alosetron; the

5-HT4 (serotonin) receptor agonist tegaserod; the chloride channel activator

lubiprostone; psychologic therapies; herbal preparations and acupuncture.

The

evidence-based review also includes new recommendations about the routine

use of

diagnostic tests for patients who present with IBS symptoms, as well as food

allergy testing and diet in IBS.

“For the gastroenterologist seeing patients with IBS, the new ACG

recommendations specify whether or not the range of potential therapies are

better than

placebo for resolving IBS symptoms,†said Lawrence J. Brandt, M.D., MACG,

Chair of the ACG IBS Task Force.

“The College’s graded recommendations on IBS take into account the quality

of the evidence, such as the strength of study design, and the magnitude of

benefit of different treatments. The benefits of treatment must be balanced

against any potential risks,†explained Dr. Brandt.

“This new meta-analysis of the literature on the diagnosis and therapy of

IBS offers physicians the opportunity to make clinical decisions about IBS

based

on a thorough assessment of the evidence,†explained ACG President Dr.

Eamonn M.M. Quigley, one of the contributors to the position statement.

The ACG Evidence-Based Systematic Review on IBS can be accessed as a PDF at

__http://www.acg._'>http://www.acg._ (http://www.acg./) gi.org/media/ releases/ ajg_ibs_supp_

0109.pdf_

(_http://www.acg.http://www.achttp://wwhttp://www.achttp://w_

(http://www.acg.gi.org/media/releases/ajg_ibs_supp_0109.pdf) )

Highlights of ACG’s New Recommendations on IBS Therapies

In general, treatments for IBS are directed towards the patient’s

predominant symptoms. There are a wide variety of available therapies, many

of which

improve individual IBS symptoms. Only a small number of therapies has been

shown to be of benefit for global symptoms of IBS.

- Trials suggest psyllium, fiber, certain antispasmodics, and peppermint oil

are effective in IBS patients although the quality of the evidence is poor.

- Evidence suggests that some probiotics may be effective in reducing

overall IBS symptoms but more data are needed.

- Anti-diarrheals reduce the frequency of stools but do not affect the

overall symptoms of IBS.

- 5HT 3 antagonists are efficacious in IBS patients with diarrhea and the

quality of evidence is good. Patients need to be carefully selected,

however,

because potentially serious side effects include constipation and colon

ischemia. Current use of alosetron is regulated by a prescribing program set

forth

by the FDA.

- 5HT 4 agonists are modestly effective in IBS patients with constipation

and the quality of evidence is good although the possible risk of

cardiovascular

events associated with these agents may limit their utility. Currently,

there are no 5-HT 4 receptor agonists available for use in North America.

- Tricyclic anti-depressants and selective serotonin reuptake inhibitors

have been shown to be effective in IBS patients of all subtypes. The trials

generally are of good quality but the limited number of patients included in

trials implies that further evidence could change the confidence in the

estimate

of effect and therefore the quality of evidence was graded as moderate.

- Non-absorbable antibiotics are effective, particularly in

diarrhea-predominan t IBS.

- The selective C-2 chloride channel activator, lubiprostone, is efficacious

in constipation- predominant IBS with a moderate quality of evidence.

- Psychological therapies also may provide benefit to IBS patients although

the quality of evidence is poor.

- While available trials of unique Chinese herbal mixtures appeared to show

a benefit in IBS, it is not possible to combine these studies into a

meaningful meta-analysis. Overall, any benefit of Chinese herbal therapy in

IBS

continues to be potentially confounded by the variable components used and

their

purity. Also, there are significant concerns about toxicity, especially

liver

failure, with use of any Chinese herbal mixture.

- A systematic review of trials of acupuncture for IBS was inconclusive.

Further work is needed before any recommendations on acupuncture can be made.

- Patients often believe that certain foods exacerbate their IBS symptoms.

There is, however, insufficient evidence that food allergy testing or

exclusion

diets are efficacious in IBS and their routine use outside a clinical trial

is not recommended

New Recommendations on Diagnostic Testing in IBS

Because of the low likelihood of uncovering organic diseases, routine

diagnostic testing with complete blood count, serum chemistries, thyroid

function

studies, stool for ova and parasites, and abdominal imaging should not be

routinely performed in patients with typical IBS symptoms and no alarm

features.

Routine serologic screening for celiac sprue should be pursued in patients

with diarrhea predominant IBS and the mixed type of IBS. Lactose breath

testing

can be considered when lactose maldigestion remains a concern despite

dietary modification.

Currently, there are insufficient data to recommend breath testing for small

intestinal bacterial overgrowth in IBS patients. Because of the low pre-test

probability of Crohn’s disease, ulcerative colitis, and colonic neoplasia,

routine colonic imaging is not recommended in patients under the age of 50

years with typical IBS symptoms and no alarm features. Colonoscopic imaging

should be performed in IBS patients with alarm features to rule out organic

diseases and in those over the age of 50 years for the purpose of colorectal

cancer screening. The College recommends that African-Americans begin

colorectal

cancer screening at age 45. When colonoscopy is performed in patients with

IBS-D, obtaining random biopsies can be considered to rule out microscopic

colitis.

About IBS

For the clinical gastroenterologist, IBS is one of the most commonly seen

problems. IBS is characterized by abdominal discomfort associated with

altered

bowel function; structural and biochemical abnormalities are absent. The

pathophysiology of IBS is multi-factorial. Individual symptoms have limited

accuracy for diagnosing IBS and the disorder is considered as a symptom

complex.

IBS Prevalence and Burden of Illness

•IBS is a prevalent and expensive condition that can significantly impair

health related quality of life (HRQOL) and reduce work productivity.

•Epidemiologic studies suggest that 7-10% of people in the general

population have IBS worldwide. Community-based studies indicate that IBS-D

and IBS-M

subtypes are more prevalent than IBS-C, and that switching among subtype

groups may occur over time.

•IBS is 1.5 times more common in women than in men.

•IBS is more common in lower socioeconomic groups and more commonly

diagnosed in patients younger than 50 years.

•IBS patients make more visits to their physicians, undergo more diagnostic

tests, are prescribed more medications, miss more workdays, have lower work

productivity, are hospitalized more frequently, and account for greater

overall direct costs than patients without IBS.

•Resource utilization is highest in patients with severe symptoms, and

poorer HRQOL.

ACG IBS Expert Task Force

- Chair, Lawrence J. Brandt, M.D., MACG, Montefiore Medical Center

- D. Chey, M.D., FACG, University of Michican Medical Center

- Amy E. Foxx-Orenstein, D.O., FACG, Mayo Clinic, Division of

Gastroenterology

- Eamonn M.M. Quigley, M.D., FRCP, FACG, Cork University Hospital, National

University of Ireland at Cork

- Lawrence R. Schiller, M.D., FACG, Baylor University Medical Center

- Philip S. Schoenfeld, M.D., M.Ed., M.Sc., FACG, Veterans Affairs Ann Arbor

Healthcare System

- J. Talley, M.D., Ph.D., FACG, Mayo Clinic ville,

Department of Internal Medicine

- Brennan M. R. Spiegel, M.D. MSHS, VA Greater Los Angeles Healthcare

System, Geffen School of Medicine at UCLA

- Statistician- Epidemiologist, Moayyedi, B.Sc., M.B., Ch.B., Ph.D.,

M.P.H., FRCP (London), FRCPC, FACG, McMaster University Medical Centre,

Division of Gastroenterology

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[Non-text portions of this message have been removed]

Jan Patenaude, RD, CLT

Consultant, Writer, Speaker

Director of Medical Nutrition

Signet Diagnostic Corporation

(Mountain Time)

Fax:

DineRight4@...

Mediator Release Testing and LEAP Diet Protocol for Irritable Bowel

Syndrome, Migraine, Fibromyalgia and more. Co-developer of Certified LEAP

Therapist

Training.

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[Guest guest]

Hi Mick,

Yes, they still get it and don't get it.

" Patients often believe that certain foods exacerbate their IBS symptoms.

There is, however, insufficient evidence that food allergy testing or

exclusion diets are efficacious in IBS and their routine use outside a clinical

trial

is not recommended. "

It's clearly obvious that NONE of this review panel has ever worked with a

LEAP/MRT IBS patient.

But, what they say IS true. " allergy testing " doesn't work. Neither do

" exclusion diets. "

Thankfully, MRT/LEAP isn't either of those! ;-)

I think we should find the email addresses of every one of these reviewers

and have our IBS patients bombard them with letters. That, and a ton of case

studies as well! ;-)

Jan Patenaude, RD, CLT

-

In a message dated 12/19/2008 9:24:34 A.M. Mountain Standard Time,

NutritionResults@... writes:

Here is an update, btw.(compliments of the ever vigilant Linke

It appears they HAVE caught up.

It would be a shame to be caught unaware so I post this

Sincerely,

Michal Hogan, RD, LD, CLT

NutritionResults.Nut

Get a Listing: __https://therapists.https://theraphttps://therhtt_

(https://therapists.net/register2.php?package=30_)

(_https://therapists.https://theraphttps://therht_

(https://therapists.net/register2.php?package=30) )

Get LEAP: __http://www.nutritiohttp://www.nuthttp://www.nhttp:_

(http://www.nutritionresultsorder.com/1657330.html_)

(_http://www.nutritiohttp://www.nuthttp://www.nhttp_

(http://www.nutritionresultsorder.com/1657330.html) )

*****************************************************************************

*****************************

Irritable Bowel Syndrome (IBS) is one of the most common disorders managed

by gastroenterologists . There have been numerous changes in the clinical

landscape in recent years and new evidence has emerged on the benefits and

risks

of drugs used for IBS. The American College of Gastroenterology today

published a new evidence-based systematic review on the management of

Irritable Bowel

Syndrome as a supplement to the January 2009 issue of The American Journal

of Gastroenterology.

The College’s evidence-based position statement on IBS offers new graded

recommendations on testing and treatment of this chronic, recurrent

functional

disorder of the gastrointestinal tract that affects all aspects of daily

life

for its sufferers. In order to critically evaluate the rapidly expanding

research about IBS and to assess the evidence of efficacy of new IBS drugs,

the

ACG IBS Task Force performed a comprehensive meta-analysis of the evidence

on

therapies for IBS.

The College’s new recommendations include expert assessments of traditional

therapies for IBS, as well as a range of new treatments, including evidence

on

probiotics; the non-absorbable antibiotic rifaximin; antidepressants;

antispasmodics and peppermint oil; fiber, bulking agents and laxatives;

antidiarrheals, including loperamide; the 5-HT3 receptor antagonist

alosetron; the

5-HT4 (serotonin) receptor agonist tegaserod; the chloride channel activator

lubiprostone; psychologic therapies; herbal preparations and acupuncture.

The

evidence-based review also includes new recommendations about the routine

use of

diagnostic tests for patients who present with IBS symptoms, as well as food

allergy testing and diet in IBS.

“For the gastroenterologist seeing patients with IBS, the new ACG

recommendations specify whether or not the range of potential therapies are

better than

placebo for resolving IBS symptoms,†said Lawrence J. Brandt, M.D., MACG,

Chair of the ACG IBS Task Force.

“The College’s graded recommendations on IBS take into account the quality

of the evidence, such as the strength of study design, and the magnitude of

benefit of different treatments. The benefits of treatment must be balanced

against any potential risks,†explained Dr. Brandt.

“This new meta-analysis of the literature on the diagnosis and therapy of

IBS offers physicians the opportunity to make clinical decisions about IBS

based

on a thorough assessment of the evidence,†explained ACG President Dr.

Eamonn M.M. Quigley, one of the contributors to the position statement.

The ACG Evidence-Based Systematic Review on IBS can be accessed as a PDF at

__http://www.acg._'>http://www.acg._ (http://www.acg./) gi.org/media/ releases/ ajg_ibs_supp_

0109.pdf_

(_http://www.acg.http://www.achttp://wwhttp://www.achttp://w_

(http://www.acg.gi.org/media/releases/ajg_ibs_supp_0109.pdf) )

Highlights of ACG’s New Recommendations on IBS Therapies

In general, treatments for IBS are directed towards the patient’s

predominant symptoms. There are a wide variety of available therapies, many

of which

improve individual IBS symptoms. Only a small number of therapies has been

shown to be of benefit for global symptoms of IBS.

- Trials suggest psyllium, fiber, certain antispasmodics, and peppermint oil

are effective in IBS patients although the quality of the evidence is poor.

- Evidence suggests that some probiotics may be effective in reducing

overall IBS symptoms but more data are needed.

- Anti-diarrheals reduce the frequency of stools but do not affect the

overall symptoms of IBS.

- 5HT 3 antagonists are efficacious in IBS patients with diarrhea and the

quality of evidence is good. Patients need to be carefully selected,

however,

because potentially serious side effects include constipation and colon

ischemia. Current use of alosetron is regulated by a prescribing program set

forth

by the FDA.

- 5HT 4 agonists are modestly effective in IBS patients with constipation

and the quality of evidence is good although the possible risk of

cardiovascular

events associated with these agents may limit their utility. Currently,

there are no 5-HT 4 receptor agonists available for use in North America.

- Tricyclic anti-depressants and selective serotonin reuptake inhibitors

have been shown to be effective in IBS patients of all subtypes. The trials

generally are of good quality but the limited number of patients included in

trials implies that further evidence could change the confidence in the

estimate

of effect and therefore the quality of evidence was graded as moderate.

- Non-absorbable antibiotics are effective, particularly in

diarrhea-predominan t IBS.

- The selective C-2 chloride channel activator, lubiprostone, is efficacious

in constipation- predominant IBS with a moderate quality of evidence.

- Psychological therapies also may provide benefit to IBS patients although

the quality of evidence is poor.

- While available trials of unique Chinese herbal mixtures appeared to show

a benefit in IBS, it is not possible to combine these studies into a

meaningful meta-analysis. Overall, any benefit of Chinese herbal therapy in

IBS

continues to be potentially confounded by the variable components used and

their

purity. Also, there are significant concerns about toxicity, especially

liver

failure, with use of any Chinese herbal mixture.

- A systematic review of trials of acupuncture for IBS was inconclusive.

Further work is needed before any recommendations on acupuncture can be made.

- Patients often believe that certain foods exacerbate their IBS symptoms.

There is, however, insufficient evidence that food allergy testing or

exclusion

diets are efficacious in IBS and their routine use outside a clinical trial

is not recommended

New Recommendations on Diagnostic Testing in IBS

Because of the low likelihood of uncovering organic diseases, routine

diagnostic testing with complete blood count, serum chemistries, thyroid

function

studies, stool for ova and parasites, and abdominal imaging should not be

routinely performed in patients with typical IBS symptoms and no alarm

features.

Routine serologic screening for celiac sprue should be pursued in patients

with diarrhea predominant IBS and the mixed type of IBS. Lactose breath

testing

can be considered when lactose maldigestion remains a concern despite

dietary modification.

Currently, there are insufficient data to recommend breath testing for small

intestinal bacterial overgrowth in IBS patients. Because of the low pre-test

probability of Crohn’s disease, ulcerative colitis, and colonic neoplasia,

routine colonic imaging is not recommended in patients under the age of 50

years with typical IBS symptoms and no alarm features. Colonoscopic imaging

should be performed in IBS patients with alarm features to rule out organic

diseases and in those over the age of 50 years for the purpose of colorectal

cancer screening. The College recommends that African-Americans begin

colorectal

cancer screening at age 45. When colonoscopy is performed in patients with

IBS-D, obtaining random biopsies can be considered to rule out microscopic

colitis.

About IBS

For the clinical gastroenterologist, IBS is one of the most commonly seen

problems. IBS is characterized by abdominal discomfort associated with

altered

bowel function; structural and biochemical abnormalities are absent. The

pathophysiology of IBS is multi-factorial. Individual symptoms have limited

accuracy for diagnosing IBS and the disorder is considered as a symptom

complex.

IBS Prevalence and Burden of Illness

•IBS is a prevalent and expensive condition that can significantly impair

health related quality of life (HRQOL) and reduce work productivity.

•Epidemiologic studies suggest that 7-10% of people in the general

population have IBS worldwide. Community-based studies indicate that IBS-D

and IBS-M

subtypes are more prevalent than IBS-C, and that switching among subtype

groups may occur over time.

•IBS is 1.5 times more common in women than in men.

•IBS is more common in lower socioeconomic groups and more commonly

diagnosed in patients younger than 50 years.

•IBS patients make more visits to their physicians, undergo more diagnostic

tests, are prescribed more medications, miss more workdays, have lower work

productivity, are hospitalized more frequently, and account for greater

overall direct costs than patients without IBS.

•Resource utilization is highest in patients with severe symptoms, and

poorer HRQOL.

ACG IBS Expert Task Force

- Chair, Lawrence J. Brandt, M.D., MACG, Montefiore Medical Center

- D. Chey, M.D., FACG, University of Michican Medical Center

- Amy E. Foxx-Orenstein, D.O., FACG, Mayo Clinic, Division of

Gastroenterology

- Eamonn M.M. Quigley, M.D., FRCP, FACG, Cork University Hospital, National

University of Ireland at Cork

- Lawrence R. Schiller, M.D., FACG, Baylor University Medical Center

- Philip S. Schoenfeld, M.D., M.Ed., M.Sc., FACG, Veterans Affairs Ann Arbor

Healthcare System

- J. Talley, M.D., Ph.D., FACG, Mayo Clinic ville,

Department of Internal Medicine

- Brennan M. R. Spiegel, M.D. MSHS, VA Greater Los Angeles Healthcare

System, Geffen School of Medicine at UCLA

- Statistician- Epidemiologist, Moayyedi, B.Sc., M.B., Ch.B., Ph.D.,

M.P.H., FRCP (London), FRCPC, FACG, McMaster University Medical Centre,

Division of Gastroenterology

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[Non-text portions of this message have been removed]

Jan Patenaude, RD, CLT

Consultant, Writer, Speaker

Director of Medical Nutrition

Signet Diagnostic Corporation

(Mountain Time)

Fax:

DineRight4@...

Mediator Release Testing and LEAP Diet Protocol for Irritable Bowel

Syndrome, Migraine, Fibromyalgia and more. Co-developer of Certified LEAP

Therapist

Training.

IMPORTANT - This e-mail message is intended only for the use of the

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[Guest guest]

Hi Mick,

Yes, they still get it and don't get it.

" Patients often believe that certain foods exacerbate their IBS symptoms.

There is, however, insufficient evidence that food allergy testing or

exclusion diets are efficacious in IBS and their routine use outside a clinical

trial

is not recommended. "

It's clearly obvious that NONE of this review panel has ever worked with a

LEAP/MRT IBS patient.

But, what they say IS true. " allergy testing " doesn't work. Neither do

" exclusion diets. "

Thankfully, MRT/LEAP isn't either of those! ;-)

I think we should find the email addresses of every one of these reviewers

and have our IBS patients bombard them with letters. That, and a ton of case

studies as well! ;-)

Jan Patenaude, RD, CLT

-

In a message dated 12/19/2008 9:24:34 A.M. Mountain Standard Time,

NutritionResults@... writes:

Here is an update, btw.(compliments of the ever vigilant Linke

It appears they HAVE caught up.

It would be a shame to be caught unaware so I post this

Sincerely,

Michal Hogan, RD, LD, CLT

NutritionResults.Nut

Get a Listing: __https://therapists.https://theraphttps://therhtt_

(https://therapists.net/register2.php?package=30_)

(_https://therapists.https://theraphttps://therht_

(https://therapists.net/register2.php?package=30) )

Get LEAP: __http://www.nutritiohttp://www.nuthttp://www.nhttp:_

(http://www.nutritionresultsorder.com/1657330.html_)

(_http://www.nutritiohttp://www.nuthttp://www.nhttp_

(http://www.nutritionresultsorder.com/1657330.html) )

*****************************************************************************

*****************************

Irritable Bowel Syndrome (IBS) is one of the most common disorders managed

by gastroenterologists . There have been numerous changes in the clinical

landscape in recent years and new evidence has emerged on the benefits and

risks

of drugs used for IBS. The American College of Gastroenterology today

published a new evidence-based systematic review on the management of

Irritable Bowel

Syndrome as a supplement to the January 2009 issue of The American Journal

of Gastroenterology.

The College’s evidence-based position statement on IBS offers new graded

recommendations on testing and treatment of this chronic, recurrent

functional

disorder of the gastrointestinal tract that affects all aspects of daily

life

for its sufferers. In order to critically evaluate the rapidly expanding

research about IBS and to assess the evidence of efficacy of new IBS drugs,

the

ACG IBS Task Force performed a comprehensive meta-analysis of the evidence

on

therapies for IBS.

The College’s new recommendations include expert assessments of traditional

therapies for IBS, as well as a range of new treatments, including evidence

on

probiotics; the non-absorbable antibiotic rifaximin; antidepressants;

antispasmodics and peppermint oil; fiber, bulking agents and laxatives;

antidiarrheals, including loperamide; the 5-HT3 receptor antagonist

alosetron; the

5-HT4 (serotonin) receptor agonist tegaserod; the chloride channel activator

lubiprostone; psychologic therapies; herbal preparations and acupuncture.

The

evidence-based review also includes new recommendations about the routine

use of

diagnostic tests for patients who present with IBS symptoms, as well as food

allergy testing and diet in IBS.

“For the gastroenterologist seeing patients with IBS, the new ACG

recommendations specify whether or not the range of potential therapies are

better than

placebo for resolving IBS symptoms,†said Lawrence J. Brandt, M.D., MACG,

Chair of the ACG IBS Task Force.

“The College’s graded recommendations on IBS take into account the quality

of the evidence, such as the strength of study design, and the magnitude of

benefit of different treatments. The benefits of treatment must be balanced

against any potential risks,†explained Dr. Brandt.

“This new meta-analysis of the literature on the diagnosis and therapy of

IBS offers physicians the opportunity to make clinical decisions about IBS

based

on a thorough assessment of the evidence,†explained ACG President Dr.

Eamonn M.M. Quigley, one of the contributors to the position statement.

The ACG Evidence-Based Systematic Review on IBS can be accessed as a PDF at

__http://www.acg._'>http://www.acg._ (http://www.acg./) gi.org/media/ releases/ ajg_ibs_supp_

0109.pdf_

(_http://www.acg.http://www.achttp://wwhttp://www.achttp://w_

(http://www.acg.gi.org/media/releases/ajg_ibs_supp_0109.pdf) )

Highlights of ACG’s New Recommendations on IBS Therapies

In general, treatments for IBS are directed towards the patient’s

predominant symptoms. There are a wide variety of available therapies, many

of which

improve individual IBS symptoms. Only a small number of therapies has been

shown to be of benefit for global symptoms of IBS.

- Trials suggest psyllium, fiber, certain antispasmodics, and peppermint oil

are effective in IBS patients although the quality of the evidence is poor.

- Evidence suggests that some probiotics may be effective in reducing

overall IBS symptoms but more data are needed.

- Anti-diarrheals reduce the frequency of stools but do not affect the

overall symptoms of IBS.

- 5HT 3 antagonists are efficacious in IBS patients with diarrhea and the

quality of evidence is good. Patients need to be carefully selected,

however,

because potentially serious side effects include constipation and colon

ischemia. Current use of alosetron is regulated by a prescribing program set

forth

by the FDA.

- 5HT 4 agonists are modestly effective in IBS patients with constipation

and the quality of evidence is good although the possible risk of

cardiovascular

events associated with these agents may limit their utility. Currently,

there are no 5-HT 4 receptor agonists available for use in North America.

- Tricyclic anti-depressants and selective serotonin reuptake inhibitors

have been shown to be effective in IBS patients of all subtypes. The trials

generally are of good quality but the limited number of patients included in

trials implies that further evidence could change the confidence in the

estimate

of effect and therefore the quality of evidence was graded as moderate.

- Non-absorbable antibiotics are effective, particularly in

diarrhea-predominan t IBS.

- The selective C-2 chloride channel activator, lubiprostone, is efficacious

in constipation- predominant IBS with a moderate quality of evidence.

- Psychological therapies also may provide benefit to IBS patients although

the quality of evidence is poor.

- While available trials of unique Chinese herbal mixtures appeared to show

a benefit in IBS, it is not possible to combine these studies into a

meaningful meta-analysis. Overall, any benefit of Chinese herbal therapy in

IBS

continues to be potentially confounded by the variable components used and

their

purity. Also, there are significant concerns about toxicity, especially

liver

failure, with use of any Chinese herbal mixture.

- A systematic review of trials of acupuncture for IBS was inconclusive.

Further work is needed before any recommendations on acupuncture can be made.

- Patients often believe that certain foods exacerbate their IBS symptoms.

There is, however, insufficient evidence that food allergy testing or

exclusion

diets are efficacious in IBS and their routine use outside a clinical trial

is not recommended

New Recommendations on Diagnostic Testing in IBS

Because of the low likelihood of uncovering organic diseases, routine

diagnostic testing with complete blood count, serum chemistries, thyroid

function

studies, stool for ova and parasites, and abdominal imaging should not be

routinely performed in patients with typical IBS symptoms and no alarm

features.

Routine serologic screening for celiac sprue should be pursued in patients

with diarrhea predominant IBS and the mixed type of IBS. Lactose breath

testing

can be considered when lactose maldigestion remains a concern despite

dietary modification.

Currently, there are insufficient data to recommend breath testing for small

intestinal bacterial overgrowth in IBS patients. Because of the low pre-test

probability of Crohn’s disease, ulcerative colitis, and colonic neoplasia,

routine colonic imaging is not recommended in patients under the age of 50

years with typical IBS symptoms and no alarm features. Colonoscopic imaging

should be performed in IBS patients with alarm features to rule out organic

diseases and in those over the age of 50 years for the purpose of colorectal

cancer screening. The College recommends that African-Americans begin

colorectal

cancer screening at age 45. When colonoscopy is performed in patients with

IBS-D, obtaining random biopsies can be considered to rule out microscopic

colitis.

About IBS

For the clinical gastroenterologist, IBS is one of the most commonly seen

problems. IBS is characterized by abdominal discomfort associated with

altered

bowel function; structural and biochemical abnormalities are absent. The

pathophysiology of IBS is multi-factorial. Individual symptoms have limited

accuracy for diagnosing IBS and the disorder is considered as a symptom

complex.

IBS Prevalence and Burden of Illness

•IBS is a prevalent and expensive condition that can significantly impair

health related quality of life (HRQOL) and reduce work productivity.

•Epidemiologic studies suggest that 7-10% of people in the general

population have IBS worldwide. Community-based studies indicate that IBS-D

and IBS-M

subtypes are more prevalent than IBS-C, and that switching among subtype

groups may occur over time.

•IBS is 1.5 times more common in women than in men.

•IBS is more common in lower socioeconomic groups and more commonly

diagnosed in patients younger than 50 years.

•IBS patients make more visits to their physicians, undergo more diagnostic

tests, are prescribed more medications, miss more workdays, have lower work

productivity, are hospitalized more frequently, and account for greater

overall direct costs than patients without IBS.

•Resource utilization is highest in patients with severe symptoms, and

poorer HRQOL.

ACG IBS Expert Task Force

- Chair, Lawrence J. Brandt, M.D., MACG, Montefiore Medical Center

- D. Chey, M.D., FACG, University of Michican Medical Center

- Amy E. Foxx-Orenstein, D.O., FACG, Mayo Clinic, Division of

Gastroenterology

- Eamonn M.M. Quigley, M.D., FRCP, FACG, Cork University Hospital, National

University of Ireland at Cork

- Lawrence R. Schiller, M.D., FACG, Baylor University Medical Center

- Philip S. Schoenfeld, M.D., M.Ed., M.Sc., FACG, Veterans Affairs Ann Arbor

Healthcare System

- J. Talley, M.D., Ph.D., FACG, Mayo Clinic ville,

Department of Internal Medicine

- Brennan M. R. Spiegel, M.D. MSHS, VA Greater Los Angeles Healthcare

System, Geffen School of Medicine at UCLA

- Statistician- Epidemiologist, Moayyedi, B.Sc., M.B., Ch.B., Ph.D.,

M.P.H., FRCP (London), FRCPC, FACG, McMaster University Medical Centre,

Division of Gastroenterology

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)

[Non-text portions of this message have been removed]

Jan Patenaude, RD, CLT

Consultant, Writer, Speaker

Director of Medical Nutrition

Signet Diagnostic Corporation

(Mountain Time)

Fax:

DineRight4@...

Mediator Release Testing and LEAP Diet Protocol for Irritable Bowel

Syndrome, Migraine, Fibromyalgia and more. Co-developer of Certified LEAP

Therapist

Training.

IMPORTANT - This e-mail message is intended only for the use of the

individual or entity to which it is addressed, and may contain information that

is

privileged, confidential and exempt from disclosure under applicable law. If

you have received this message in error, you are hereby notified that we do not

consent to any reading, dissemination, distribution or copying of this

e-mail message. If you have received this communication in error, please notify

the sender immediately by e-mail and telephone ( toll free) and

destroy the transmitted information.

E-mail transmission cannot be guaranteed to be secure or error-free as

information could be intercepted, corrupted, lost, destroyed, arrive late,

incomplete, or contain viruses. The sender therefore does not accept liability

for

any errors or omissions in the contents of this message, which arise as a

result of e-mail transmission.

**************One site keeps you connected to all your email: AOL Mail,

Gmail, and Yahoo Mail. Try it now.

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