Source: DGNews  |  Posted 9 years ago

By Ed Susman
Special to DG News

SEATTLE, WA -- October 24, 2002 -- For the first time, the American College of Gastroenterology (ACG) issued a monograph that outlines an evidence-based approach to the management of irritable bowel syndrome -- and specifically cites two medications that appear to improve the condition in a majority of patients.

"There are drugs that significantly change peoples' lives for the better," said Lawrence Brandt, MD, professor of medicine and surgery at the Albert Einstein College of Medicine, in The Bronx, New York, United States.

Dr. Brandt said the monograph produced by the college and discussed at a press briefing here October 22 during the 67th annual scientific meeting of the ACG illustrates that tegaserod, a 5HT4 serotonin receptor agonist is more effective than placebo in relieving global irritable bowl symptoms in women who also have constipation, and that the 5HT3 serotonin receptor antagonist alosetron is more effective than placebo in similar patients who have diarrhoea.

Tegaserod is available by prescription as Zelnorm and is marketed by Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, United States. Alosetron is not presently available but is expected to return to the marketplace within the next three months following review by the Food and Drug Administration. Alosetron is expected to be marketed as Lotronex by GlaxoSmithKline, Research triangle Park, North Carolina.

"Tegaserod has a very bright future in treatment of irritable bowel syndrome," said Kevin Olden, MD, associate professor of medicine and psychiatry at Mayo Clinic, in Scottsdale, Arizona, United States. He said he expects that the drug will also find utility in other disease states as well. About 60 percent of patients with irritable bowel syndrome respond to tegaserod, he said.

The document developed by the ACG Functional Gastrointestinal Disorders Task Force reviewed clinical trials of various treatments for irritable bowel syndrome, a complaint that more often affects women than men and affects 10 percent to 15 percent of the North American population.

"Because of the prevalence of this disease it clearly deserves our attention," said Dr. Olden.

Among the findings:

---There is insufficient evidence to make a recommendation about the effectiveness of antisposmodic agents.

---Bulking agents are not more effective that placebo at relieving global irritable bowel syndrome symptoms.

---Loperamide is not more effective that placebo at relieving global irritable bowel syndrome symptoms.

---Tricyclic antidepressants improve abdominal pain in irritable bowel syndrome patients.

---Tegaserod is more effective than placebo at relieving global irritable bowel syndrome symptoms in women with constipation.

---Alosetron is more effective than placebo at relieving global irritable bowel syndrome symptoms in women with diarrhoea.

---Behavioural therapy is more effective than placebo at relieving individual irritable bowel syndrome symptoms.

The recommendations regarding tegaserod and alosetron were considered Grade A recommendations, the highest level for any of the recommendations. The researchers defined irritable bowel syndrome as abdominal discomfort associated with altered bowel habits.

Dr. Brandt noted that the document did not represent treatment guidelines. He said doctors should use the information in the monograph to answer the question: "Are the things that we do so commonly based on reasonable scientific evidence?" He said the information in the document assembled "enough evidence to support or refute what we do."

Most people with irritable bowel syndrome who seek medical help fall into three categories, the doctors said: those who have abdominal discomfort accompanied by diarrhoea; those who have abdominal discomfort accompanied by constipation, and those who have alternating constipation and diarrhea.