Archive for the ‘Testing’ Category

 

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John Libonati

New IBS Guidelines Include Screening for Celiac Disease

December 20th, 2008 by John Libonati


New guidelines for the treatment of IBS published by the American College of Gastroenterology include screening for celiac disease...

New IBS Guidelines Offer Treatment Ideas

American College of Gastroenterology Updates Recommendations for Irritable Bowel Syndrome By Bill Hendrick

WebMD Health NewsReviewed by Louise Chang, MDDec. 19, 2008 -- New guidelines have been issued by the nation's gastroenterologists that are aimed at easing the abdominal pain, diarrhea, and other symptoms of irritable bowel syndrome (IBS), which afflicts millions of Americans.

The guidelines, issued by the American College of Gastroenterology, also offer hope to patients who've struggled with the condition and found satisfactory treatments lacking.

IBS is diagnosed in people whose symptoms include abdominal pain, bloating, gas, diarrhea, and constipation, or a combination of these symptoms. Though sometimes confused with inflammatory bowel disease, which includes Crohn's disease and ulcerative colitis, IBS is a separate condition.

IBS care uses up more than $20 billion a year in direct and indirect expenditures, according to William Chey, MD, professor of medicine and director of the Gastrointestinal Physiology Laboratory at the University of Michigan Health System. He developed the guidelines in conjunction with Philip Schoenfeld, MD.

"The last time the American College of Gastroenterology published guidelines for the management of IBS was in 2002, and the College recognized that in the span of five to six years there has been a remarkable explosion in knowledge that's become available that's helped us to understand the cause and management of IBS," Chey says in a news release.

Tests and Treatments for IBS According to the new guidelines:

Patients with symptoms typical for IBS -- and without alarm features like rectal bleeding, low blood count due to iron deficiency, weight loss, or a family history of colon cancer, IBD, or celiac disease -- do not need extensive testing before being diagnosed.

IBS patients with diarrhea, or a combination of constipation and diarrhea, should be screened with blood tests for celiac disease, a disorder in which patients can't tolerate the gluten protein found in wheat or other grains.

When IBS patients have alarm features or are over 50 years old, they should have further tests (such as colonoscopy) to rule out other bowel disease such as IBD and colon cancer. IBS patients and their doctors should consider treatments involving antidepressants, which have been shown to offer relief.

The drug Amitiza helps with women who have IBS with constipation; the non-absorbable antibiotic rifaximin can ease IBS and bloating as a short-term treatment. And Lotronex, a drug that affects serotonin receptors, can be considered for patients with severe IBS with diarrhea.

Certain anti-spasm treatments may offer short-term help with abdominal pain from IBS. These include hyoscine, cimetropium, and peppermint oil.

A probiotic called Bifidobacteria may help some IBS patients.

According to the guidelines, women are twice as likely as men to suffer from IBS, which often begins in young adulthood. Gastroenterologists have found that dietary changes have proved helpful, including the addition of dietary fiber supplements such as psyllium.

Chey says IBS can be managed in most patients with counseling, dietary and lifestyle interventions, and use of both over-the-counter and prescription medications.

The guidelines suggest many treatments might be tried, though the authors concede no single magical answer has yet been found to eliminate symptoms in IBS patients. But the guidelines offer hope for people with IBS that their doctors can try a number of methods to reduce discomfort, and that some of the steps that can be taken seem to work.

ARTICLE SOURCE: http://www.webmd.com:80/ibs/news/20081219/new-ibs-guidelines-offer-treatment-ideas


The news release below is timely because anti-gliadin antibody blood tests are losing ground while the reality of gluten sensitivity looms far larger than is now appreciated by many doctors!  These blood tests are absolutely necessary to investigate health problems caused by gluten itself, yet they are being dismissed by doctors who look only to diagnosing celiac disease.

Positive anti-gliadin antibody tests show undigested gluten peptides in the bloodstream.  This abnormal finding tells the story that gluten has passed through the tight barrier defenses of the small intestinal lining into the body where it can wreak havoc, with or without celiac disease.  Gluten is a food protein in wheat, barley, rye and oats.

In screening for celiac disease, an inherited immune response to gluten entering the small intestinal lining, doctors rely on the celiac specific antibody tests, anti-endomysium and anti-tissue transglutaminase.  However, the investigation to find these auto-antibodies must not exclude the anti-gliadin antibodies. 

Doctors Slow To Recognise Gluten Harm.” Dr. Rodney Ford, Leading New Zealand Paediatrician And Allergist Challenges Medical Stalwarts With Revolutionary Gluten Thinking

There is more to gluten problems than just coeliac disease. Gluten sensitivity is ten times more prevalent than celiac disease in New Zealand and mostly undiagnosed. This is the message that Christchurch-based paediatrician, allergist and author, Doctor Rodney Ford wants to get across to the public and the ever conservative medical fraternity.

The practice of medicine is restricted to the knowledge, experience, attitudes and politics of the society it functions in. Medicine is an inexact but evolving science, thus current standard medical practices are often disproved. The validity of medical opinion, long held to be the gold standard of diagnosis and treatment, are constantly challenged. This is a healthy dynamic, one that enables the pursuit of excellence and the evolution of better forms of practice, resulting in better outcomes for patients. Why, then asks Dr Ford, is there such resistance to his new Gluten Syndrome hypothesis recently published in a book and supported by years of clinical experience and research.

In the absence of coeliac disease, his latest research shows that the simple gluten test (IgG-gliadin antibody) is a sensitive indicator to detect those people who get sick eating gluten but who have tested negative to Celiac Disease. However, this test is rarely ordered by general practitioners or specialists. He says “This is because of an illogical rejection of gluten sensitivity as a valid diagnosis. Ignoring gluten flies in the face of all of the evidence and is also alienating doctors from their patients.”

Picture this, if you will: a six year old girl, Elizabeth, small for her age, a distended stomach, gas and suffering from gastric reflux. Her teachers reported a lack of attention at school and early learning problems. Elizabeth had been thoroughly investigated by the medical profession: blood tests, bowel biopsies, colonoscopy, endoscopy. Celiac Disease had been ruled out, various medications had been tried and doctors had started to question her mother’s parenting skills. Elizabeth’s parents had gone beyond frustration and fear for their child, they were at the point of desperation.

This is a common story in Dr Ford’s practice. It is also one of the many success stories he has to share. After seeing Dr Ford, a positive IgG-gliadin antibody test and being put on a gluten free diet, Elizabeth improved within a few days. Within weeks she made a remarkable recovery and was in essence cured. Gluten was no longer a choice for her and accidental intake still causes her a reoccurrence of symptoms. Adhering to a gluten free diet has enabled Elizabeth to grow into the healthy, happy and successful young woman that she is today.

Common stories such as this, along with the increasing research and evidence of gluten based harm, should be enough to spur the medical profession into action in an effort to save the current generation of children from the long term health, social and financial consequences of what is an easily diagnosed and treatable condition.

The shocking truth is that this terrible scourge of gluten is being ignored by most medical practitioners. Even worse, the blood tests that can diagnose it are being abandoned by many medical laboratories. For instance, Medlab Diagnostics in Auckland no longer offers gliadin antibody tests.

The medical professions reluctance to act on the gluten problem is costing New Zealand billions of dollars each year with long term and far reaching consequences. From a dollars and cents point of view it makes no economic sense. From a patient care point of view it is bordering on negligence.

Source: Scoop Independent News, New Zealand, Thursday, 19 June 2008, 9:49 am You can find this news release at http://www.scoop.co.nz/stories/GE0806/S00059.htm

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