Digestion, health and nutrition: Dr. Anil Minocha, a gastroenterologist and nutritionist

Cognitive behavioral therapy in irritable bowel syndrome

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Cognitive behavioral therapy or CBT appears to have a direct effect on global manifestations of irritable bowel syndrome(IBS) or spastic colon. This may not correlate with resolution of psychological distress. Improvement in IBS symptoms is associated with improvements in the quality of life and the improvement in psychological distress may be a reason for, effect of or part of it.

Scientific basis

Cognitive therapy for irritable bowel syndrome results in decrease in limbic activity and improves digestive symtoms and anxiety. Thus CBT induced symptomatic improvement in IBS may be a biologically oriented change mediated by changes in neural activity of CNS foci that relate to hypervigilance and emotions.

• Drossman (2003) conducted a randomized, comparator-controlled, multicenter trial in 431 adults to examine the clinical efficacy and safety of cognitive-behavioral therapy versus education and tricyclic antideppressant (desipramine) versus t placebo in female patients with moderate to severe functional bowel disorders including IBS. Significantly higher number of patients responded in CBT group as compared to education (70% vs 37%). Desipramine was similar to placebo in intent to treat analysis.
• Kennedy conducted randomized controlled trial of the addition of nurse administered CBT to standard general practice management of IBS (antispasmodic agent mebeverine) in in primary care. The addition of CBT was significantly superior to mebeverine-only group at 3 months. Authors concluded that specially trained practice nurses can provide effective CBT to primary care patients with a clinical diagnosis of IBS, which although effective does not reduce service or social costs although the beneficial effects of the addition of CBT to antispasmodic therapy persist for up to 6 months.
• A randomized controlled trial (Ljotsson 2010) has documented that cognitive behavior therapy based on exposure and mindfulness exercises and conducted over the internet delivered via the Internet alleviating the total burden of symptoms and increasing IBS-related quality of life in patients with IBS. The treatment group reported a 42% decrease in primary IBS-symptoms as compared to 12% in controls.
• Another randomized controlled trial (Moss-Morris 2010) found that cognitive behavioral therapy based self-management in the form of a structured manual without much contact with the therapist contact is a effective for treatment of patients with IBS in primary care.
• In contrast to studies on CBT and IBS above, Boyce (2003) reported that cognitive behavior and relaxation therapy seem not to be superior to standard care alone in IBS.             

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Irritable bowel syndrome? Peppermint oil works!

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Use of peppermint oil  for irritable bowel syndrome treatment: Irritable bowel syndrome or IBS also known as spastic colon is a type of functional bowel disorder.

IBS affects 10-20 percent of the population. IBS is more common in females. Treatment options for this chronic disorder are limited. Of note, irritable bowel syndrome is not the same thing as diverticulitis.

Study to examine effect of peppermint oil in IBS: Merat et al. from Shariati Hospital, T. University of Medical Sciences performed a  randomized double-blind placebo-controlled trial to examine the efficacy of peppermint oil in  90 patients with IBS.

Methods of irritable bowel syndrome study: Patients received one capsule of enteric-coated peppermint oil (Colpermin) or placebo three times daily for 8 weeks. Clinical symptoms and quality of life were assessed at follow up visits.

Results of IBS and perppermint: The number of patients free of abdominal pain at 8 weeks increased from 0 to 14 in the peppermint oil treatment group as compared to 0 to 6 in the placebo group (p<0.001).

There was significantly  greater reduction in the severity of abdominal pain associated with significantly better quality of life in the peppermint oil  group. No significant adverse reactions were noted due to peppermint oil.

American College of Gastroenterology in its evidence based guidelines includes use of peppermint oil as one of treatment options for treatment of irritable bowel syndrome.

Do you or someone you know has irritable bowel syndrome or IBS? What treatments have you used and have they worked for you. Please sure your thoughts.

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Toileting posture constipation

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 Wonder what toileting posture implies? Think it is important for good bowel function? While the toileting posture may be non-issue for some, it could be crucial for those with constipation.

Toileting posture is a modifiable factor that can be used as a part of an overall management strategy. The use of traditional toilet seats has potential to make recto-anal angle more acute contributing to difficult passage of stools and constipation

This is particularly an issue in kids who sit with their legs dangling the air as well as the physically challenged subjects who need to use higher chairs in order to be able to get up after defecations. Constipation as kids has potential to persist throughout life. Appropriate toilet posture coupled with abdominal exercises may help in some cases of difficult defecation and constipation.

Regular physical activity, along with appropriate toileting posture (bending forward), support of the feet while seated on toilet and simple pelvic floor exercises, should be as part of an overall treatment plan for constipation.

Do you or someone you know have constipation? How is your toileting posture? Do you think the issue of toileting posture makes sense? Please share your thoughts.

*Further reading on kinky colon or dolichocolon

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Constipation: how to take care of business

Constipation? Is your colon kinky? Dolichocolon

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Dolichocolon causes constipation-is it true? What is dolichocolon anyway. What is the evidence to support its role in constipation?

The Dolichocolon concept was the brainchild of Arbuthnot Lane and is based on the the theory that kinking of colon leads to constipation. While colon is like a country road with its own twists and turns (and of course each "colonic country road" is different), the Lane theory suggests that gravity leads to unnatural "kinking" or twisting initially in the fixed parts of colon on the left side. It gradually progresses upward and proximally causing elongation and further kinking.

In fact, Lane was a proponent of colonic resection or a byepass. While initially colonic resection became very popular, it came into disrepute in the early 20th century and now is performed in rare selected cases only.

Lets face it-the concept of dolichocolon or kinking causing a partial bowel obstruction appears simple, straightforward, appealing and plausible (perhaps too simple and straightforward). Furthermore, theoretically speaking, the kinking along with elongation of colon has potential for increased fecal stasis in colon leading to increased water absorption from the fecal contents resulting in "drier" stool and constipation.

However, scientific data to support theoretical concepts above is lacking. At the same time, constipation does not appear to be correlated with colonic length and surgery is not beneficial in cases of colonic "kinks" unless a volvulus is present.

 And click here to read about best toilet posture.

Do you or someone close to you have constipation? What is the cause of constipation in your opinion? Does the Lane's theory of dolichocolon make sense and sound believable to you? Please share your thoughts.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger. 

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Constipation, kinky colon and fecal stasis 

Stool stasis, autointoxication due to fecal matter

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Undigested food staying in gut too long, creating toxins leading to disease--have you heard of this?

 The phenomenon is known as autointoxication and has its origins in ancient Egyptian civilization as far back as 16th century BC. Sir William Lane in the early 20th century in his treatise published in the Proceedings of the Royal Society of Medicine (1913) asserted that "autointoxication is the cause of all the chronic diseases of civilization".

Is this concept of autointoxication a fact or a myth?  The proponents argue that slowed gut transit or increased stasis of fecal matter in the colon results in greater putrefaction and production of toxins. These toxins get absorbed and cause chronic illnesses with or without low grade inflammation.

It is difficult to demonstrate such a toxin experimentally especially since such a toxin(s) may not be universally present. It is entirely possible that a multitude of toxins is involved and the disease results from individual susceptibility. Furthermore, there may not be a special toxin, but the disease may be a consequence of some normal product of bacterial putrefaction that is not necessarily absorbed but has a direct action on colonic wall affecting the gut immune cells, endocrine-neuro-immune system and ultimately the entire body system. In addition to all the above unknowns, we cannot exclude the possibility of yet unknown toxin being involved.

So what is the verdict? Is the concept of autointoxication a hard fact or just a myth perpetuated by "quacks" over the centuries. We do not have the perfect answer, atleast not yet. One thing we do know however that having a regular, efficient bowel movement pattern is essential for positive health.

What are your thoughts on autointoxication? Do you or someone you know believe in and practice any methods  to counter it? Please share your thoughts.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

 

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Constipation: Can stool stasis cause autointoxication? 

Chronic abdominal pain or IBS in kids

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Chronic abdominal pain, IBS or irritable bowel syndrome in children is a major, perplexing problem. Some have it as abdominal colic, others get termed as "irritable bowel syndrome" or "spastic colon". A recent study published in Archives of Disease in Childhood, December 2007  showed that chronic abdominal pain or tummy ache occurs in 33% girls and 13% boys of 11-14 years of age.

What works for abdominal pain in kids? Only a parents knows the magnitude of the problem of abdominal pain and how nerve-wrecking it can be for the entire family. They try all sorts of things, medicines, healers and frequently no relief. Usually no physical abnormalities are found despite extensive investigations. Now there is hope if you like to think outside of the box.

A recent study double blind randomized controlled trial compared usual medical treatment with gut directed hypnosis. The study titled " Hypnotherapy for children with functional abdominal pain or irritable bowel syndrome: a randomized controlled trial" was published in the prestigious journal Gastroenterology.

The investigators found that gut directed hypnosis was significantly superior to standard medical therapy. In fact the relief of chronic abdominal pain was sustained at 12 months in hypnosis group versus standard therapy (85% versus 25%) even though hypnosis sessions occurred for only 3 months.

Do you or someone in your family have chronic abdominal pain? Have you tried alternative therapies like hypnosis, cognitive behavioral therapy? If not, would you try hypnosis if other therapies are not working for you?

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What is colitis, diverticulitis and diverticulosis?

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Colitis, diverticulitis and diverticulosis are not the same

Terms like colitis, diverticulitis, diverticulosis and irritable bowel syndrome, spastic colon can be confusing. Colitis, diverticulitis, IBS, irritable bowel syndrome, spastic colon although different are often used interchangeably by some people.

Colitis

Colitis means inflammation of the colon or large intestines. Colitis may be acute or chronic and may occur due to infections, drugs, toxins, ischemia, radiation therapy etc. Colitis may also be a manifestation of chronic IBD or idiopathic inflammatory bowel disease (ulcerative colitis and Crohn’s disease).

Diverticulosis

Diverticulosis is the presence of divertculi (plural for diverticulum), usually in the colon. The colonic divertculosis is very common in the western society presumably because of lack of fiber in diet.

As many as 50% or more may have colonic diverticulosis by the age of 50 years and this number may exceed 80% by the time one reaches the age of 80 years. Usually these diverticuli are asymptomatic and an incidental finding on barium enema or colonoscopy.

In a minority of cases, they may cause complications such as diverticulitis and gastrointestinal bleeding etc which may even become life-threatening.

Diverticulitis

Diverticulitis occurs as a result of micro-perforation in the colon at the site of diverticulum. It is usually on the left side of colon and usually contained giving rise to localized infection and inflammation. This usually responds to medical measures including antibiotics. Interventional radiology techniques are sometimes used.

At times, such a perforation may form an abscess, cause bacteremia and become even become life-threatening. Surgery may be needed in severe cases.

Diverticular bleed

Diverticular bleed occurs more commonly from right sided diverticulosis. It is usually painless and massive and usually requires hospitalization and blood transfusions.

Majority of such bleeds stop spontaneously. Endoscopic and interventional radiology techniques can help stop bleeding in some cases, otherwise they may need surgery. Recurrent cases may need suregry.

Do you or someone you know has colitis or diverticulosis? What has been your experience with these terms? Please share your thoughts.

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Better clear liquid diet for Colonoscopy preparation

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Colonoscopy or endoscopy of colon (large intestine) is often dreaded by some. Colonoscopy is also called lower GI scope and is different from barium enema. Colonic cleaning and clear liquid diet is needed as part preparation as a prelude to colonoscopy. Colonoscopy as well as barium enema patients go through this misery of colonoscopy preparation on liquids like water or clear juices, carbonated beverages, electrolyte-rich sports drinks like Gatorade ®, flavored drinks e.g. Crystal-Light ®, Jello, sorbet and plain tea/coffee.

Lesser known fact is that there are clear nutritional supplements available that serve the purpose equally well and you would be less hungry since they also provide nutrition. These include Enlive ® (ww.rosstore.com), ResourceBreeze ® (ww.novartisnutrition.com) and Carnation Instant Breakfast ® juice drink (www. Nestle-nutrition.com). Do not use regular Carnation Instant breakfast as part of clear liquid diet.

Mix-and-match the clear liquids with the clear liquids nutritional supplements and try your tasty mixed drinks such as slushies, ice-pops etc.

Caution: do not use anything any red, purple liquids.

Have you or someone you know has had a colonoscopy? What was your experience with clear liquid diet prior to the exam? 

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Does botox works at both ends: check anal fissures

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You have heard about botox or botulinum toxin for skin wrinkles. Even botox parties are celebrated. Seems funny considering its use in anal fissure? By the way, botox or botulinum toxin has other uses too, like in achalasia, gastroparesis due to pyloric spasm etc.

Anal fissure

Anal fissure (different from hemorrhoids) can really be a pain the rear (no pun intended). Although acute anal fissures can be managed by conservative measures alone, the optimal medical treatment for chronic anal fissure is still lacking.

Surgery is effective for treatment of chronic anal fissure but has significant morbidity.

Botox or botulinum toxin for anal fissures 

Recently, Brisinda and colleagues (Br J Surg 94:162-7) from Italy compared the efficacy of local nitroglycerin ointment versus botulinum toxin (botox).

Results

Botox group had superior healing rates at both 4 and 8 weeks. Adverse events were more likely to be due to nitroglycerin.

Bottomline

This finding of a comparison between two medical treatments must be interpreted in the context of data on comparison with placebo where nitroglycerin has only been marginally superior. In contrast, the efficacy of botox was similar to placebo.

Until long term studies can show superiority of botox over placebo, its use for routine treatment of chronic anal fissure may not be prudent.

Have you used botox for any reason? Do you or someone you know has chronic anal fissures? Please share the remedies that have or have not worked for you.

Here is info on botox or nitroglycerine for anal fissures

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Acetaminophen, arthritis drugs and constipation

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Constipation is a widely prevalent disorder. Similarly acetaminophen and other NSAIDs or arthitis drugs are also commonly used. Constipation is more likely to occur in women and the elderly. The causes of constipation are not fully understood. A variety of medications including many heart, blood pressure drugs as well as anti-depressants may contribute to this problem.

Acetaminophen, NSAIDs and constipation

Now comes a study from the Mayo Clinic showing that commonly used nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin and aspirin-like medications commonly used for arthritis increase the risk for constipation.

Dr. Chang and colleagues found that subjects who chronically consume over 7 tablets of acetaminophen per week had 2.7 times increased risk for constipation. The risk due to aspirin and other NSAIDs was increased almost two times as compared to those who did not.

Be advised that NSAIDs, both OTC and prescription strength have potential for side-effects and as this study demonstrates they also increase the potential for constipation.

Do you take acetaminophen, aspirin or other NSAIDs regularly. Do you suffer from constipation? Do you take any OTC or prescription remedy for constipation? Please share your thoughts.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

IRRITABLE BOWEL SYNDROME

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IBS and how to manage it medically or by complimentary and alternative medicine

Irritable bowel syndrome (IBS) or spastic colon affects 5-20 percent population. It is likely that you or someone you know has irritable bowel syndrome. But what is this irritable bowel syndrome or spastic colon or IBS?

Irritable bowel syndrome

IBS is a symptom based diagnosis of unclear etiology. It should not be confused with diverticulosis or diverticultis. Irritable bowel syndrome is probably is not a single disease. More likely, IBS is comprised of multiple diseases, all lumped into one at the present time for lack of understanding its pathogenesis. Infantile colic is considered by many to be a variant of IBS in infants and kids.

Features of irritable bowel syndrome and Rome criteria

Irritable bowel syndrome is a functional disorder characterized by chronic (at least three months in the preceding one year) abdominal pain and a disturbance of bowel habit. The disturbed bowel habit of IBS may manifest as diarrhea, constipation or alternating diarrhea with constipation. Pain frequently improves with defecation.

A waxing and waning pattern of symptoms is seen in most patients. The precise conglomeration of symptom complex is defined under ROME III criteria.

What causes irritable bowel syndrome?

• The pathogenesis of irritable bowel syndrome remains an enigma and no single etiology fits all cases. IBS is predominantly seen in young females but can be seen in adults of any age and either sex. It is more prevalent among Caucasian Americans than African Americans.
• Motility disorder has been frequently implicated; however no consistent motility pattern can be demonstrated.
•  Visceral hypersensitivity (pain with a stimulus not severe enough to cause pain in healthy subjects) is seen in many patients.
• Autonomic dysregulation has also been implicated. A dysfunction of 5-HT system is supected in many cases. Stress does not cause it but does tend to exacerbate symptoms. Food allergy or intolerance may be present in some cases.
• Many patients attribute the onset of disease to a bout of flu-like illness e.g. viral gastroenteritis, travelers diarrhea.
• Low grade inflammation in the gut can be documented in many cases.
•  Several authors claim small intestinal bacterial overgrowth to be the cause in most cases of IBS although these observations have not been confirmed by others.

My opinion: IBS occurs when there is a perfect storm of combination of increased intestinal permeability (Leaky gut) and low grade inetestinal inflammation,  altered gut bacteria and some harmful factor in gut lumen in a patient with genetic predisposition. The role of diet in at least affecting the IBS manifestations can not be emphasized enough.

Note: The leaky gut, inflammation and altered bacteria can affect not only the gut but also systems far away including the brain.

IBS medical consensus

Overall, in the absence of clear cut cause, a bio-psychosocial model for pathogenesis for irritable bowel syndrome has been proposed. This model emphasizes the role of mind-body interactions with the environment.

In this context, it should be noted that there is an increased prevelance of certain chronic pain disorders in IBS patients, e.g. functional dyspepsia, fibromyalgia, chronic fatigue syndrome, interstitial cystitis, chronic back pain etc.

Diagnostic strategy for irritable bowel syndrome

While the diagnosis of irritable bowel syndrome should be positive, physicians frequently perform studies to exclude any treatable cause. The work up for IBS should be individualized and may include complete blood count (CBC), routine chemistries and stool studies. Flexible sigmoidoscopy or colonoscopy may be performed depending upon age and risk for colon cancer and suspicion for alternative diagnosis like inflammatory bowel disease (Crohn's disease and ulcerative colitis).

Celiac sprue should be excluded by antibody testing for anti-tissue transglutaminase antibody. The use of anti-gliadin antibody has recently seen a resurgence with the identification that many IBS patients get relief from gluten free diet.

Lactose hydrogen breath test may be done to exclude lactose intolerance. Small bowel bacterial overgrowth can be excluded by hydrogen breath test or cultures of small bowel aspirate.

Treatment of irritable bowel syndrome

The management of IBS patients follows a step-wise fashion and is largely symptom based. Realistic goals need to be established. Reassurance with a lot of hand-holding goes a long way in helping patient cope with the symptoms of IBS.

Placebo response rate in irritable bowel syndrome may be as high as fifty percent. 

Role of Diet: An often an forgotten factor in management

• High fiber diet and fluid are frequently prescribed as first line of treatment for IBS of all types. Much of positive data about fiber in IBS pertains to Isubghulla type.
• Patients with diarrhea may be helped by lactose-avoidance.
• Patients can frequently identify provoking factors and need to abstain
• Gluten-free diet helps many patients.
• Other exclusion diets are also helpful including the  FODMAP diet.

Role of GI medications

Over the counter laxatives or  prescription medication Zelnorm are used in cases with constipation predominant IBS. Of note, Zelnorm was withdrawn from US market on March 30, 2007 because of unacceptable side-effects. Lubiprostone is available.

Constipating agents like Imodium and Lomotil may be needed in patients with diarrhea predominant IBS. Lotronex is useful for diarrhea-predominant IBS but has high risk for ischemic colitis. Its availability is limited and its use in IBS has largely been abandoned by most physicians in the US.  Its is not to be used for irritable bowel syndrome of constipation type.

Antispasmodic agents e.g. Bentyl are frequently prescribed for abdominal pain associated with irritable bowel syndrome but provide only limited benefit at best.

Peppermint oil, A time proven remedy:

Peppermint oil is effective based on literataure as stated in guidelines by the American College of Gastroenterology.

Probiotics: Multiple studies have now documented beneficial effects of probiotics in IBS. Note, that all probiotics are not created equal and results depend on the species/strain used.

Treat SIBO if present: Small bowel bacterial overgrowth is treated with antibiotics. Rifaximin, a gut selective antibiotic is frequently used. Probiotics have also been shown to heal small bowel bacterial overgrowth and may have less adverse effects overall as compared to antibiotics.

Role of antidepressents in irritable bowel syndrome

Low dose tricyclic antidepressants (e.g. imipramine, desipramine) raise the pain threshold and are frequently prescribed to IBS patients not responding to above strategies; however their side-effects can be problematic.  Although frequently prescribed, there is less data about the use of newer antidepressant agents like SSRIs for management of IBS.

CAM therapies

Several trials have documented positive impact of probiotics in IBS patients. Cognitive behavioral therapy, hypnosis, IBS classes, yoga, Chinese herbal medicine etc have  also been used successfully in irritable bowel syndrome. Limited data points to efficacy of melatonin (over-the-counter sleep-aid) in IBS. A Mayo Clinic (Rochester) study showed that St John's wort does not have beneficial effect.

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Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

Botox is good for constipation too!

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Botulinum toxin or botox has been gaining increasing popularity as a cosmetic intervention for wrinkles in recent years. Even botox parties and get-togethers are held!

Now comes a study demonstrating that botox is good for constipation due to dysfunction of muscles of the pelvic floor.

Normally, such muscles are supposed to relax to facilitate dysfunction. In affected patients there is paradoxical contraction. This disorder is fairly common cause of constipation especially among females.

Study

Dr. Maria and colleagues studied studied 24 women with functional outlet obstruction or functional obstructive defecation. Treatment involved injection of type A botulinum toxin. They published their findings in the American Journal of Gastroenterology .

Results

At 2-month follow-up, 19 of the 24 patients had improved defecation.

Conclusions

The authors concluded that botox is simple, safe and effective treatment for such patients with constipation.  

Are you familiar with botox? Do you or someone you know has had botox treatments? By the way, botox is used as a treatment for treatment of anal fissures also.

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Botox and constipation written by Anil Minocha of Shreveport, La

Time from food to feces

How much time does it take from ingestion of food to the time it is expelled in stool? I was recently asked by one of the print media regarding this question raise by one of its readers. This may be not a question for dinner table, but if you want to know, read on.

The time it takes for food to travel from mouth through the gastrointestinal tract and come out through anus is known as bowel transit time. This time depends on multiple factors including person's diet and medications as well as diseases he/she may be having.

There is a great deal of person to person variability and in fact, even when tested in same person, the results can vary from day to day. Persons ingesting high fiber diet may have quicker transit while patients taking medications that slow down gut are likely to have longer duration. A variety of tests are employed to look at bowel or gastrointestinal transit time.

One of the tests involves ingestion of non-absorbable radio-opaque markers. These markers start appearing in stool about 15 to 24 hours after ingestion. In the simplest form of this test, the markers are given only once. An x ray is done before ingestion, and then on the fifth day to look for any residual markers.

In most normal healthy subjects, the markers are usually completely evacuated by about 48-72 hours. If however by the fifth day, over 20% of the markers are still in the gastrointestinal system (gut), that is considered definitely abnormal.

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Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

Irritable bowel syndrome (IBS) and chinese herbal medicine

Irritable bowel syndrome is a common functional bowel disorder and there has been a great  need for good effective treatments.

Chinese herbal medicine has been suggested as treatment for Irritable bowel Syndrome. Randomized controlled trials have yielded conflicting results. The main reason for the conflicting reasons may be due the differences in patient populations and the herbs studied. We will review two such studies here.

Bensoussan and colleagues from Australia published their findings in the prestigious Journal of American Medical association.  They conducted a double-blind  randomized placebo controlled trial. A total of 116 patients based on Rome criteria were recruited. They were divided into three groups.  Patients were randomly assigned to individualized Chinese herbal formulations, a standard Chinese herbal formulation, or placebo for 16 weeks.

The authors found that as compared to placebo, the patients in the active treatment groups (standard and individualized chinese herbs) had significant improvement in bowel symptom scores as rated by patients and by gastroenterologists. Similarly, there was significant global improvement as rated by patients and by gastroenterologists. There was a decrease in degree of interference with life caused by IBS symptoms as assessed by patients themselves. Chinese herbal formulations individually tailored to the patient was as effective as the standard treatment. However, at 14 weeks after completing the therapy, the effects were sustained only in the individualized treatment group.

A more recent study by Leung and colleagues from the Chinese University of Hongkong studied only patients with diarrhea predominant IBS. In their study titled, "Treatment of diarrhea-predominant irritable bowel syndrome with traditional Chinese herbal medicine: a randomized placebo-controlled trial" , they demonstrated that Chinese medicine does not have any benefit over placebo.

These investigators studied the effectiveness an ancient herbal Chinese formula in patients with diarrhea-predominant IBS. Patients were recruited based on the established Rome II criteria and confirmation by a herbalist. 119 Patients received a standard preparation of TCM extracts containing 11 herbs or a placebo for 8 weeks. Patients were followed for further 8 weeks after the treatment.

The authors found no significant difference in the proportion of patients with global symptom improvement between the Chinese medicine and placebo groups at week 8 as well as at week 16. There was also no difference in individual symptom and the quality-of-life scores between the two groups. The authors concluded that the use of this herbal formulation for diarrhea-predominant IBS did not lead to symptom improvement.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger