Gastrointestinal Illness Strikes Mostly Younger Women
By Michael Lasalandra
Beth Israel Deaconess Medical Center Correspondent
Michelle began having gastrointestinal problems around the age of 30. The problems have gotten steadily worse for the past 10 years. Like many women her age, she suffers from irritable bowel syndrome.
"The problem is that I go to the bathroom about six times a day," said Michelle, 40, a city employee from Waltham. "A lot of the time it comes on urgently. It almost controls your life. I just want some normalcy. I have to plan everything around the bathroom. Sometimes, I have to leave work and go home. That's how I live my life."
Michelle says she has tried a number of medications, but nothing has worked. She is planning to try a few more in the hopes that her chronic diarrhea can be controlled and that the other symptoms, including cramping and abdominal pain, can be minimized.
"My system is not a happy one," she says.
According to several studies, 10 to 15 percent of Americans have irritable bowel syndrome, although most cases go undiagnosed. One study found that IBS accounts for nearly one-third of all patients seen by gastroenterologists and up to 12 percent of those seen by primary care doctors. About two-thirds of patients are women.
Because tests usually show nothing physiologically wrong with these patients, some have suggested that there is nothing that can be done to help or that these intestinal problems are mostly in the heads of patients.
Michelle gets angry when she hears that. "It bugs me when I hear people say that," she says. "If they haven't lived with it, they have no right to say that. This is not all in my head. This is 110 percent real. It's a life I don't want."
Dr. Anthony Lembo, a gastroenterologist at Beth Israel Deaconess Medical Center and an expert on IBS, also dismisses the claim that IBS is only a psychosomatic illness, although he notes that like many other gastrointestinal diseases there appears to be a psychological component to it.
Unfortunately, treatment options for IBS are limited. However, Dr. Lembo and his collaborators are studying a number of different modalities including complementary and alternative therapies such as acupuncture. In a recent study, Dr. Lembo and his collaborators found that patients did slightly better with acupuncture than those receiving a sham acupuncture treatment. But those getting either real acupuncture or sham acupuncture did better than those getting no special care at all. More than that, the studies showed that those whose acupuncturists -- either real or sham -- went out of their way to be caring and compassionate did significantly better than those who conducted their treatments -- either real or sham -- in a businesslike manner.
"A large part of it had to do with the practitioner-patient interaction," Dr. Lembo says. "That's not surprising. Human interaction is important."
Some IBS patients have a different problem than Michelle is experiencing. They suffer from chronic constipation, as well as cramping, bloating and abdominal pain. A highly-touted drug for that type of IBS came on the market in 2002, but the drug, Zelnorm, was pulled off the market in 2007 because of cardiovascular concerns.
Another drug, Amitiza, was recently approved for constipation-related IBS.
There is also an approved drug for women with severe diarrhea-related IBS, Lotronex. Michelle says she and Dr. Lembo are discussing the benefits and risks of trying it.
IBS apparently stems from a disturbance in the interaction between the gut, the brain and the autonomic nervous system that regulates the digestive tract. Research is focusing on controlling diarrhea and constipation, and also on the brain-gut connection and the regulation of serotonin levels in the intestines. In some IBS patients, serotonin levels are believed to be out of whack, leaving them with gastrointestinal systems that work either too slowly or too fast.
One study estimated that IBS costs the national health care system $8 billion per year. But many sufferers haven't even sought out treatment. A 2004 survey of 1,000 Americans, conducted for the International Foundation for Functional Gastrointestinal Disorders, found 13 percent of respondents had symptoms suggestive of IBS, but 39 percent of those with symptoms had not seen a doctor about their problems.
Besides prescription drugs, some patients have turned to probiotics, which are live microorganisms such as bacteria or yeasts that are believed beneficial to the digestive system. These are contained in yogurt, for example.
Some patients have had some success with probiotics, particularly with bloating, says Dr. Lembo.
Other patients have taken antibiotics or antidepressants, with some faring better than others.
"A lot of this is trial and error," he says. "We still don't have all the answers to it. There are not any dramatic advances in therapy, but there is enough that many patients get some relief."
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Posted March 2009