Highlights From Digestive Disease Week: An Expert Interview With Lawrence R. Schiller, MD
Laurie Barclay, MD
June 4, 2003 — Editor's Note: Recent advances and new directions in functional bowel disorders highlighted during Digestive Disease Week (DDW) 2003, held from May 17 through May 22 in Orlando, Florida, may clarify the pathophysiology of these chronic, highly prevalent disorders while offering different treatment options. (To read news articles about the studies discussed below, click on the link to DDW 2003 conference coverage at the bottom of this article.)
Altered mechanisms of coping with pain and stress may help explain the interplay of psychological factors with symptoms of irritable bowel syndrome (IBS). Based on patterns of brain activation revealed with positron emission tomography (PET), individuals with IBS may differ in their perception of pain from healthy controls, reported Bruce D. Naliboff, PsyD, and colleagues from the University of California in Los Angeles (UCLA).
These individuals also tend to have submissive, unassertive, introverted personalities, according to a presentation by Jeffrey M. Lackner, PsyD, from the University at Buffalo School of Medicine in New York. With behavior modification designed to reduce negative thinking and related mindsets, about 70% of IBS patients report reduction in gastrointestinal (GI) symptoms by at least half.
An alternative approach to treatment of IBS is probiotic therapy, based on ingestion of Lactobacillus acidophilus and Bifidobacteria infantis. Stephen M. Faber, MD, from Albemarle Gastroenterology Associates, PC, in Elizabeth City, North Carolina, reported that probiotics alone or in combination with antibiotics significantly improved symptoms and quality of life.
Given the interplay between psychological factors and GI symptoms, it is perhaps not surprising that antidepressants may be effective in IBS and other functional bowel disorders. However, efficacy at low dosage — about half that required for depression — suggests a different mechanism at work. Douglas A. Drossman, MD, from the University of North Carolina in Chapel Hill, reported the results of a randomized trial in 216 patients with functional bowel disorders. After adjustment for study dropouts, desipramine relieved GI symptoms in nearly three quarters of patients compared with nearly half of patients who received placebo. However, drawbacks with tricyclic antidepressants include late onset of action and high incidence of adverse effects.
To learn more about these and other new developments in functional bowel disorders, Medscape's Laurie Barclay interviewed Lawrence R. Schiller, MD, a gastroenterologist from the Baylor Health Care System in Dallas, Texas. Dr. Schiller is immediate past president of the Texas Society for Gastroenterology and Endoscopy. At DDW, he taught an AGA postgraduate course entitled "Chronic Diarrhea: Logical and Cost-Effective Approach." He is a consultant for Novartis, the maker of tegaserod, but he has no other pertinent financial disclosures.
[And the rest of this interesting article can be found at Medscape.
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