|By PR Newswire||
|August 5, 2014 11:07 AM EDT||
BETHESDA, Md., Aug. 5, 2014 /PRNewswire-USNewswire/ -- Today, the American College of Gastroenterology (ACG) published a new systematic review of evidence about the management of irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC) to update earlier reviews from 2009 and 2005 as a supplement to the August 2014 issue of The American Journal of Gastroenterology. This analysis will allow physicians to better care for patients with IBS and CIC, and features new information for clinicians to consider when making recommendations about diet, probiotics, antibiotics and antidepressants for IBS, as well as the use of fiber, laxatives, and recently developed drugs—prucalopride, lubiprostone and linaclotide for managing constipation. This review also summarizes information about the effectiveness of other therapies, such as alosetron, lubiprostone and linaclotide, in treatment of IBS.
View the full ACG Evidence-Based Systematic Review on IBS and CIC.
IBS and CIC (also referred to as functional constipation) are two of the most common functional gastrointestinal disorders worldwide, impacting anywhere from 5 to 15 percent of the global population. These conditions affect more than 30 million Americans and are among the most common gastrointestinal disorders treated by physicians. Although there has been an increase in the number of scientific studies of these conditions, they vary in quality, making it difficult for physicians to sort out the best approaches for management.
In general, treatments for IBS are directed towards the patient's predominant symptoms. With a wide variety of available therapies, many of which improve individual IBS symptoms, only a small number of therapies have been shown to be of benefit for global symptoms of IBS.
"In order to evaluate the rapidly expanding research about IBS and CIC and to assess the evidence of efficacy of new IBS and constipation drugs, ACG sponsored an independent, systematic review, and all available studies were reviewed by the ACG Functional Bowel Disorders Task Force after a careful and systematic search of the literature in order to update the recommendations," explained Eamonn M.M. Quigley, MD, FACG, who chaired the expert task force. "Studies meeting pre-specified criteria that were selected to minimize bias were examined in detail and summarized. When possible, results were combined by a formal meta-analysis to improve the reliability of conclusions."
The quality of the evidence was graded by standard criteria and recommendations were developed based on the quality of the evidence and additional factors such as risk, cost and acceptability to patients.
The College's new recommendations include updated information and expert assessments of traditional therapies for IBS and CIC, as well as a range of new treatment approaches, including evidence on diet, 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; psychological therapies such as hypnotherapy and biofeedback; herbal preparations; and acupuncture.
Highlights of ACG's New Recommendations on IBS Therapies
- Special elimination diets may be effective, but existing evidence is weak.
- Fiber may be helpful in relieving IBS symptoms; there is better evidence in support of an effect of psyllium than of bran for IBS.
- Prebiotics and synbiotics have insufficient evidence of effect in IBS.
- Probiotics improve global symptoms, bloating and flatulence in IBS.
- Rifaxamin, a poorly absorbed antibiotic, has moderate evidence in support of effectiveness in IBS with diarrhea.
- Linaclotide and lubiprostone have strong recommendations for IBS with constipation.
- There is better evidence than in the past to support the use of antidepressants and psychological therapies in IBS.
Highlights of ACG's New Recommendations on CIC Therapies
- Fiber supplements are given a strong recommendation for use in CIC.
- Laxatives—including polyethylene glycol (PEG), lactulose, sodium picosulfate and bisacodyl—have strong recommendations for the treatment of CIC.
- Prucalopride, lubiprostone and linaclotide have been given strong recommendations for treatment of CIC.
"This new meta-analysis of the literature on the management of IBS and chronic idiopathic constipation offers physicians scientifically-based guidance to make clinical decisions about these conditions based on a thorough assessment of the evidence," said Lawrence R. Schiller, MD, FACG, who is also a member of the ACG Functional Bowel Disorders Task Force. "However, it is important that patients talk with their doctors about their treatment options, as there is no one-size-fits-all approach to managing IBS or chronic constipation. It's also vital that patients not be embarrassed to talk openly about their symptoms with their doctor in order to collaboratively determine the best treatment plan for their individual situation."
For the clinical gastroenterologist, IBS is one of the most commonly seen digestive 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.
Constipation is a symptom-based disorder defined as unsatisfactory defecation, and is characterized by infrequent stools, difficult stool passage or both. Difficult stool passage includes straining, a sense of difficulty passing stool, incomplete evacuation, hard/lumpy stools, prolonged time to pass stool, or need for manual maneuvers to pass stool. CIC is defined as the presence of these symptoms for at least 3 months.
ACG Expert Task Force on the Management of Functional Bowel Disorders
- Chair, Eamonn M.M. Quigley, MD, FRCP, FACG, Houston, Methodist Hospital and Weill Cornell Medical College
- Brian E. Lacy, MD, PhD, FACG, Dartmouth-Hitchcock Medical Center
- Anthony J. Lembo, MD, Harvard Medical School, Beth Israel Deaconess Medical Center
- Paul Moayyedi, BSc, MB, ChB, PhD, MPH, FRCP (London), FRCPC, FACG*, McMaster University Medical Centre
- Yuri Saito, MD, MPH, Mayo Clinic, Rochester
- Lawrence R. Schiller, MD, FACG, Baylor University Medical Center
- Edy E. Soffer, MD, FACG, Keck School of Medicine, University of Southern California
- Brennan M. R. Spiegel, MD, MSHS, UCLA School of Medicine
*Dr. Moayyedi conducted the systematic reviews with support from Alexander C. Ford, MD, ChB, MD, FRCP, and carried out the technical analyses of the data independent of the Task Force.
About the American College of Gastroenterology
Founded in 1932, the American College of Gastroenterology (ACG) is an organization with an international membership of more than 12,000 individuals from 80 countries. The College's vision is to be the pre-eminent professional organization that champions the evolving needs of clinicians in the delivery of high quality, evidence-based, and compassionate health care to gastroenterology patients. The mission of the College is to advance world-class care for patients with gastrointestinal disorders through excellence, innovation and advocacy in the areas of scientific investigation, education, prevention and treatment. www.gi.org
About The American Journal of Gastroenterology
The American Journal of Gastroenterology is published on behalf of the American College of Gastroenterology by Nature Publishing Group. As the leading clinical journal covering gastroenterology and hepatology, The American Journal of Gastroenterology provides practical and professional support for clinicians dealing with the gastroenterological disorders seen most often in patients. Published with practicing clinicians in mind, AJG devotes itself to publishing timely medical research in gastroenterology and hepatology. The Co-Editors-in-Chief are William D. Chey, MD, AGAF, FACG, FACP of the University of Michigan and Paul Moayyedi, BSc, MB ChB, PhD, MPH, FRCP, FRCPC, FACG of McMaster University.
SOURCE American College of Gastroenterology
CIOs and those charged with running IT Operations are challenged to deliver secure, audited, and reliable compute environments for the applications and data for the business. Behind the scenes these tasks are often accomplished by following onerous time-consuming processes and often the management of these environments and processes will be outsourced to multiple IT service providers. In addition, the division of work is often siloed into traditional "towers" that are not well integrated for cro...
Feb. 13, 2016 04:00 PM EST Reads: 511
SYS-CON Events announced today that FalconStor Software® Inc., a 15-year innovator of software-defined storage solutions, will exhibit at SYS-CON's 18th International Cloud Expo®, which will take place on June 7-9, 2016, at the Javits Center in New York City, NY. FalconStor Software®, Inc. (NASDAQ: FALC) is a leading software-defined storage company offering a converged, hardware-agnostic, software-defined storage and data services platform. Its flagship solution FreeStor®, utilizes a horizonta...
Feb. 13, 2016 02:30 PM EST
With an estimated 50 billion devices connected to the Internet by 2020, several industries will begin to expand their capabilities for retaining end point data at the edge to better utilize the range of data types and sheer volume of M2M data generated by the Internet of Things. In his session at @ThingsExpo, Don DeLoach, CEO and President of Infobright, will discuss the infrastructures businesses will need to implement to handle this explosion of data by providing specific use cases for filte...
Feb. 13, 2016 02:00 PM EST Reads: 253
SYS-CON Events announced today that Avere Systems, a leading provider of enterprise storage for the hybrid cloud, will exhibit at SYS-CON's 18th International Cloud Expo®, which will take place on June 7-9, 2016, at the Javits Center in New York City, NY. Avere delivers a more modern architectural approach to storage that doesn’t require the overprovisioning of storage capacity to achieve performance, overspending on expensive storage media for inactive data or the overbuilding of data centers ...
Feb. 13, 2016 01:30 PM EST Reads: 141
SYS-CON Events announced today that Pythian, a global IT services company specializing in helping companies adopt disruptive technologies to optimize revenue-generating systems, has been named “Bronze Sponsor” of SYS-CON's 18th Cloud Expo, which will take place on June 7-9, 2015 at the Javits Center in New York, New York. Founded in 1997, Pythian is a global IT services company that helps companies compete by adopting disruptive technologies such as cloud, Big Data, advanced analytics, and DevO...
Feb. 13, 2016 01:30 PM EST Reads: 280
SYS-CON Events announced today that Commvault, a global leader in enterprise data protection and information management, has been named “Bronze Sponsor” of SYS-CON's 18th International Cloud Expo, which will take place on June 7–9, 2016, at the Javits Center in New York City, NY, and the 19th International Cloud Expo, which will take place on November 1–3, 2016, at the Santa Clara Convention Center in Santa Clara, CA. Commvault is a leading provider of data protection and information management...
Feb. 13, 2016 12:45 PM EST Reads: 470
SYS-CON Events announced today that Interoute, owner-operator of one of Europe's largest networks and a global cloud services platform, has been named “Bronze Sponsor” of SYS-CON's 18th Cloud Expo, which will take place on June 7-9, 2015 at the Javits Center in New York, New York. Interoute is the owner-operator of one of Europe's largest networks and a global cloud services platform which encompasses 12 data centers, 14 virtual data centers and 31 colocation centers, with connections to 195 ad...
Feb. 13, 2016 12:00 PM EST Reads: 449
The Quantified Economy represents the total global addressable market (TAM) for IoT that, according to a recent IDC report, will grow to an unprecedented $1.3 trillion by 2019. With this the third wave of the Internet-global proliferation of connected devices, appliances and sensors is poised to take off in 2016. In his session at @ThingsExpo, David McLauchlan, CEO and co-founder of Buddy Platform, will discuss how the ability to access and analyze the massive volume of streaming data from mil...
Feb. 13, 2016 12:00 PM EST
SYS-CON Events announced today that Alert Logic, Inc., the leading provider of Security-as-a-Service solutions for the cloud, will exhibit at SYS-CON's 18th International Cloud Expo®, which will take place on June 7-9, 2016, at the Javits Center in New York City, NY. Alert Logic, Inc., provides Security-as-a-Service for on-premises, cloud, and hybrid infrastructures, delivering deep security insight and continuous protection for customers at a lower cost than traditional security solutions. Ful...
Feb. 13, 2016 12:00 PM EST Reads: 473
SYS-CON Events announced today that Column Technologies will exhibit at SYS-CON's @DevOpsSummit at Cloud Expo, which will take place on June 7-9, 2016, at the Javits Center in New York City, NY. Established in 1998, Column Technologies is a global technology solutions provider with over 400 employees, headquartered in the United States with offices in Canada, India, and the United Kingdom. Column Technologies provides “Best of Breed” technology solutions that automate the key DevOps principal...
Feb. 13, 2016 12:00 PM EST
In most cases, it is convenient to have some human interaction with a web (micro-)service, no matter how small it is. A traditional approach would be to create an HTTP interface, where user requests will be dispatched and HTML/CSS pages must be served. This approach is indeed very traditional for a web site, but not really convenient for a web service, which is not intended to be good looking, 24x7 up and running and UX-optimized. Instead, talking to a web service in a chat-bot mode would be muc...
Feb. 13, 2016 11:45 AM EST Reads: 312
SYS-CON Events announced today that Men & Mice, the leading global provider of DNS, DHCP and IP address management overlay solutions, will exhibit at SYS-CON's 18th International Cloud Expo®, which will take place on June 7-9, 2016, at the Javits Center in New York City, NY. The Men & Mice Suite overlay solution is already known for its powerful application in heterogeneous operating environments, enabling enterprises to scale without fuss. Building on a solid range of diverse platform support,...
Feb. 13, 2016 11:45 AM EST Reads: 273
When building large, cloud-based applications that operate at a high scale, it’s important to maintain a high availability and resilience to failures. In order to do that, you must be tolerant of failures, even in light of failures in other areas of your application. “Fly two mistakes high” is an old adage in the radio control airplane hobby. It means, fly high enough so that if you make a mistake, you can continue flying with room to still make mistakes. In his session at 18th Cloud Expo, Lee...
Feb. 13, 2016 11:45 AM EST
SYS-CON Events announced today that AppNeta, the leader in performance insight for business-critical web applications, will exhibit and present at SYS-CON's @DevOpsSummit at Cloud Expo New York, which will take place on June 7-9, 2016, at the Javits Center in New York City, NY. AppNeta is the only application performance monitoring (APM) company to provide solutions for all applications – applications you develop internally, business-critical SaaS applications you use and the networks that deli...
Feb. 13, 2016 11:30 AM EST Reads: 445
Fortunately, meaningful and tangible business cases for IoT are plentiful in a broad array of industries and vertical markets. These range from simple warranty cost reduction for capital intensive assets, to minimizing downtime for vital business tools, to creating feedback loops improving product design, to improving and enhancing enterprise customer experiences. All of these business cases, which will be briefly explored in this session, hinge on cost effectively extracting relevant data from ...
Feb. 13, 2016 11:30 AM EST Reads: 156