Irritable Bowel Syndrome Responds To Rifaximin

StomachIn a study presented at the annual meeting of The American College of Gastroenterology, Anthony Lembo, MD, of the Harvard Medical School and Beth Israel Deaconess Medical Center presented data that showed that the non-absorbable antibiotic Rifaximin helps control cramping and diarrhea related Irritable Bowel Syndrome (IBS). Irritable bowel cripples individuals by causing abdominal cramping and multiple loose or watery stools per day. These patients have been screened by colonoscopy and imaging studies for more serious diseases such as Crohn’s Disease and ulcerative colitis with testing ruling these entities out. They are left with severe symptoms but no objective findings on available tests.

Over 2,500 patients participated in this study and received either Rifaximin or placebo three times per week. The decision to try an antibiotic was based on the theory that some IBS patients have excessive bacteria in the gut causing the problem. The treatment was successful in a significant number of participants compared to placebo based on a reduction of pain and frequency and number of stools. The patients were then observed for four (4) weeks during which time some patients relapsed. If these patients were treated for another two (2) weeks they showed significant improvement.

Irritable bowel incapacitates millions of individuals. While this data is extremely preliminary, it gives us hope of another treatment regimen, becoming available soon, that is effective and safe.

Screening Colonoscopy

A recent study proved what physicians and scientists suspected for years – early detection of colon cancer by screening colonoscopies saves lives. The current guidelines call for asymptomatic individuals to begin having a digital rectal exam at age 40. If there are no high risk situations for the patient then it is recommended that they start having screening colonoscopies at age 50. If their screening colonoscopy is negative then they can start scheduling follow-up colonoscopies for screening purposes every ten years.

Experts are now suggesting we stop performing screening colonoscopies at age 80.  At that age, the risk of a complication from the preparation for the test, plus the risk of a complication of the test (primarily perforation of the colon) make the risks far higher than the benefits. We certainly would continue to screen with annual digital rectal exams, and fecal occult blood tests, but the decision to perform a colonoscopy would be individualized based on the patients health, quality of life and expected longevity.

For high risk individuals, those with inflammatory bowel disease (Crohn’s Disease or Ulcerative Colitis), a history of polyps or a family history of colon cancer or inflammatory bowel disease the schedule is more stringent and starts earlier. The same would apply to individuals with a family history of premalignant colon polyps.  The interval of time between colonoscopies is shortened as well. For example, if a patient had a first degree relative who developed colon cancer at age 50 we would start screening that patient at age forty.

Recent studies and evaluations of screening colonoscopies have actually shown that primary care physicians are recommending colonoscopies too frequently with too short of a time interval between studies.  If you are low risk and have no symptoms you begin at age 50 and space the colonoscopies every ten years if the studies are negative.

Within the past few years radiologists have developed the CT Colonoscopy. The prep is less arduous than a traditional colonoscopy. The films, when read by an experienced radiologist, are as detailed and accurate as a fiber-optic traditional colonoscopy. The down sides are the amount of radiation you are exposed to and the need to do a traditional colonoscopy to biopsy any suspicious lesions found on the CT Colonoscopy. Cost is a factor as well with many insurance companies refusing to use this technology for screening purposes.