RxPG News : IBS

Exercise, eating right could ease IBS, diarrhea and constipation

Tue, 04 Oct 2005 00:31:38 PST

( from http://www.rxpgnews.com ) Physical activity may help reduce gastrointestinal (GI) symptoms in people who are obese. In a study published today in the American Gastroenterological Association (AGA) journal Clinical Gastroenterology and Hepatology, researchers found that a high body mass index (BMI) and lack of physical activity were associated with an increase in GI symptoms such as stomach pain, diarrhea, constipation and irritable bowel syndrome (IBS).

Obesity is a chronic disease that has become a major health problem in the United States and around the world. In fact, many patients who are seen by gastroenterologists are overweight or obese. Over the last 20 years, obesity has emerged as the most important nutrition problem in the United States.

Researchers from the University of Washington in Seattle and the University of Minnesota in Minneapolis found that obese people who incorporated some form of physical activity into their routine suffered less from GI symptoms than others who were inactive. High BMI was associated with an increase in symptoms of IBS, abdominal pain and diarrhea and binge eating was associated with an increase in abdominal pain, constipation and bloating. Of those participating in the study, more than 13 percent had IBS and nearly 6 percent were binge eaters. On average, participants in this study were classified as obese, with an average BMI of 33.

"It is well-documented that maintaining a healthy diet and regular physical activity can benefit GI health," said Rona L. Levy, PhD, lead study author and professor at the University of Washington in Seattle. "Our study is the first to show the benefit of maintaining these healthy habits and staving off the occurrence of GI symptoms in obese people. These findings have future implications for the treatment of both obesity and various GI disorders and symptoms that are more prevalent in this population."

Data collected from 1,801 men and women enrolled in a 24-month randomized trial evaluating telephone- and mail-based interventions for weight loss was used in this study. Participants were members of a Managed Care Organization and were randomized to one of three groups: a mail-based weight intervention using prepared lessons that gave nutrition and physical activity tips; a telephone-based weight intervention with a trained counselor that also used prepared lessons; or a usual care group who did not receive specific weight loss instructions, but were allowed access to telephone and clinic-based weight loss counseling at modest cost. Study participation was based on eligibility factors, such as age, gender, smoking status, amount of physical activity, BMI and binge eating status.

The average body weight of Americans has increased by approximately 10 percent during the last 20 years, with more than half the adult population being overweight and nearly one in every three adults diagnosed as obese. Adopting a diet rich with fruits and vegetables and increasing physical activity are two simple ways to control weight and lead a healthier lifestyle.

"Potential reduction of GI symptoms is yet another reason for obese people to consider engaging in physical activity," said Levy. "It could mean the difference between leading a normal life or leading one filled with constant discomfort."

Budesonide Prolongs Remission of Crohn's Disease

Wed, 14 Sep 2005 01:58:38 PST

( from http://www.rxpgnews.com ) In a study published in The American Journal of Gastroenterology, researchers found that budesonide capsules are an effective treatment to prolong and maintain the period of remission of Crohns Disease. Previous studies have demonstrated that budesonide is effective for inducing remission of Crohns disease.

Four double-blind, placebo-controlled trials were conducted with identical protocols in which patients with Crohns Disease, and medically induced remission, received a treatment of oral budesonide for 12 months. Results showed that budesonide taken at 6 mg/day is effective for prolonging time to relapse and for significantly reducing rates of relapse.

Long-term treatment with budesonide is well-tolerated and the frequency and types of adverse events are similar to placebo, states lead researcher,William J. Sandborn, MD. Safety of a long-term medication is obviously important, but how well a patient tolerates their medication is also important and can affect patient adherence to therapy.

Crohns disease is a long-term disease that results from inflammation of the digestive tract. It is a debilitating sickness, even for patients who are classified as having mild to moderate disease. Currently, there are no treatment options available that prevents recurrence of symptoms.

As stated, this disease is recurring in nature, so extending the time a patient can be symptom-free or with diminished symptoms is an important feature of treatment. Budesonide capsules are a treatment option for Crohns disease that has been shown in studies not only to be very effective in relieving symptoms, but also in extending the time before patients experience a recurrence.

Genome wide approach to pinpoint gene activations in IBD

Tue, 23 Aug 2005 21:01:38 PST

( from http://www.rxpgnews.com ) In a paper published in PLoS Medicine researchers from the German Genome Research Network have analysed the expression of thousands of genes from patients with inflammatory bowel disease (ulcerative colitis and Crohn disease) using a genome wide approach to produce a comprehensive picture of which genes are activated in these conditions.

Using microarrays¡Xa technique in which thousands of markers for genes are placed together on a silicon chip¡Xthe researchers led by Stefan Schreiber were able to assess whether genes from patients with these two diseases were switched on or off in samples taken from the affected gut. What they found was that 650 genes differed in how active they were between normal individuals and patients with either of the diseases. Interestingly, down-regulation leading to a lack of function was the prevailing pattern the researchers found. In Crohn disease, approximately 84% of differentially expressed genes were found to be less active compared with 42% of the differentially expressed genes in ulcerative colitis. However, none of the 122 differentially expressed genes in Crohn Disease and ulcerative colitis was overexpressed in one disease and underexpressed in the other, which supports the idea of a shared underlying inflammatory process going on in both diseases. This notion is also supported by recent clinical developments that demonstrate that therapies are often applicable to both diseases.

In a second part of the study, the team looked closely at what patterns of gene expression there were; they found that there were changes in many genes associated with abnormal immune response in both diseases; and in ulcerative colitis they found changes in genes responsible for cell growth and proliferation.

Ulcerative colitis and Crohn disease are common chronic relapsing diseases; in the UK, for example, together they affect about one person in every 400, amounting to a total of 120,000 cases of ulcerative colitis and 60,000 of Crohn disease, with 6,000 new cases of ulcerative colitis and 3,000 new cases of Crohn disease every year. Current estimates are of more than 1 million cases each in the US and Europe.

This study highlights how complex the underlying disease process is in these two diseases, but also indicates some possible future avenues for research of such diseases in general.

Certolizumab Shows Significant Benefit in Moderate to Severe Crohns Disease

Wed, 27 Jul 2005 14:10:38 PST

( from http://www.rxpgnews.com ) UCB today announced significant positive results for the two pivotal phase III trials (PRECISE 1 and 2) of CIMZIATM (certolizumab pegol, CDP870) in the induction and maintenance of clinical response in moderate to severe active Crohns disease. The PRECiSE trials assessed the safety and efficacy of CIMZIA compared to placebo over a 26 week period, in a total of 1330 patients with active Crohns disease.

The primary endpoints in both the PRECiSE 1 and PRECiSE 2 trials were met with statistical significance, irrespective of C-reactive protein (CRP, a marker of inflammation) status or prior exposure to anti-TNF therapy. In addition, data from both trials suggest CIMZIATM is well-tolerated.

CIMZIATM is therefore the first subcutaneously-administered anti-TNF biologic to successfully meet the primary endpoints in a phase III clinical trial programme in Crohn's disease.

A regulatory submission for CIMZIATM in the treatment of Crohns disease is scheduled to be submitted in both the US and Europe within the next six to nine months.

These results are highly encouraging, showing a significant potential to address the considerable unmet medical need in the treatment of Crohns disease and to bring new hope to the hundreds of thousands of patients affected by this debilitating disease, commented Prof. William Sandborn, Mayo Clinic College of Medicine, Rochester, Minnesota, USA, principal investigator on the PRECiSE 1 trial. The results from the PRECiSE trials suggest CIMZIA to be highly effective at reducing the symptoms associated with Crohns disease.

Dr. Stefan Schreiber, principal investigator on the PRECiSE 2 trial, and Professor of Medicine and Gastroenterology at the Christian-Albrechts University, Kiel, Germany, further highlighted the advantages of CIMZIATM in offering highly convenient dosing with a patient-friendly, subcutaneous route of administration, having the potential to improve the long-term management of this lifelong disease.

Data from PRECiSE 1 and 2 will be presented in more detail at the major forthcoming gastroenterology congresses.

The findings of the PRECiSE trials are consistent with our vision of changing patients lives for the better, said Roch Doliveux, CEO, UCB. With the robust clinical results and its subcutaneous administration, CIMZIATM has the potential to have a significant impact on the treatment of Crohns disease.

About Crohns disease

Crohns disease is a chronic inflammatory disease of the gastrointestinal tract with the disease typically localized in the terminal part of the ileum and right colon. Crohns disease affects almost 1 million patients worldwide, with the disease typically appearing early in life.

About CIMZIATM

CIMZIATM is a unique anti-TNF biologic. CIMZIATM is a PEGylated Fab fragment of a humanised anti-TNF ? monoclonal antibody, with high affinity for both soluble and membrane-bound TNF ?. CIMZIATM is currently the subject of phase III clinical trials in both Crohns disease and rheumatoid arthritis.

Pediatric Researchers Collaborate to Build Largest Inflammatory Bowel Disease Registry

Fri, 18 Feb 2005 17:39:38 PST

( from http://www.rxpgnews.com ) As part of a multi-center consortium, Emory University pediatric researchers have created the largest shared patient registry of children suffering from inflammatory bowel disease (IBD) reported to date. The IBD registry and associated study will help doctors understand the characteristics of IBD in children of all age groups, particularly very young patients, and improve treatment for children suffering from IBD.

To build the registry, Emory researchers joined others involved in the National Pediatric IBD Consortium, to collect uniform data from January 2000 to November 2003 from a cohort of 1370 young IBD patients. The results, published in an article in the January issue of the Journal of Pediatrics, show that 54 percent of IBD patients were male and 86 percent were white. The largest percentage of IBD diagnosis (48 percent) was made in children ages six to 12, and more than 63 percent of children younger than eight had isolated colonic disease -- a disease limited to the large bowel or colon. Researchers also found that 29 percent of everyone in the registry had at least one family member with IBD.

The results also show that the age diagnosis of IBD can be younger than previously believed, notes Dr. Benjamin D. Gold, MD, director of the Division of Pediatric Gastroenterology and Nutrition, Emory University School of Medicine. The study has the largest cohort of children under the age of two ever reported, the youngest patient at diagnosis being six months of age.

"This is the largest registry of children with inflammatory bowel disease reported in the world. It's even larger than most, if not all, adult registries," says Dr. Gold. "The exciting aspect of this registry and the data it provides is that the more we understand about diagnosing IBD in young children, the earlier parents and doctors can treat this painful disease."

Dr. Gold attributes the large number of patients entered from the Atlanta sites to Emory's collaboration with Children's Healthcare of Atlanta and the private practice community through the Children's Center for Digestive Healthcare, where Stanley Cohen, MD, an adjunct professor of pediatrics at Emory, served as a co-principal investigator.

"Many of the fundamental questions about IBD regarding age of presentation, disease phenotype, epidemiology and risk factors for acquisition can only be answered with large multi-center collaborations," Dr. Gold says. "This registry and data can be used in follow up studies to look at the natural history of the disease or develop ways to predict who will have recurrence or complications. The consortium represents a wonderful platform by which new and improved therapies as well as more established therapies for IBD can be critically evaluated and assessed."

IBD is a group of intestinal disorders that causes inflammation of the digestive system. Crohn's disease and ulcerative colitis are two major diseases classified as IBD. Inflammation or destruction of the bowel wall, as a result of IBD, can lead to deep ulcerations (sores) and narrowing of the intestines. In children, IBD can cause growth failure including malnourishment, severe weight loss, a delay of puberty and overall stunted growth when an adult.

According to the American Gastroenterological Association, 15-30 percent of patients with IBD have a relative with the disease. Although the causes of IBD are unknown, one theory suggests a genetic basis.

Dr. Gold notes that several Pediatric IBD Consortium participants have received National Institutes of Health grants, and they will continue ongoing collection of data by enrolling more patients into the registry.

Irritable bowel syndrome, frequent indigestion common in people with insomnia

Sat, 11 Dec 2004 18:15:38 PST

( from http://www.rxpgnews.com ) Mayo Clinic researchers report in the current issue of Mayo Clinic Proceedings an association between gastrointestinal disorders and sleep disturbances. The association is important because these problems cause significant health issues including greater need for general medical and mental health treatment.

It's estimated that nearly one-half of American adults experience one or more symptoms that indicate sleep disturbances or insomnia, at least a few nights a week.

The authors of the study note that this is the first population-based study, to their knowledge, that assesses the association between sleep disturbances and irritable bowel syndrome, frequent indigestion and frequent heartburn. In the past, studies have reviewed patients, not the general population. Assessing the general population helps physicians better understand an overall cause-and-effect relationship between the various problems.

The researchers looked at the responses to a detailed questionnaire (previously tested and found to be reliable) from 2,269 people. After they adjusted their findings for age, sex and other factors, they determined that irritable bowel syndrome was significantly more common in people with sleep disturbances than those without sleep disturbances. It's uncertain whether GI disturbances and sleep disturbances cause one another or they are caused by another underlying problem.

"We think the findings will generate further research to understand the interactions between emotional or psychological distress and sleep disturbances and GI disturbances," says Santhi Swaroop Vege, M.D., a Mayo Clinic physician and lead author of the study.

The National Sleep Foundation has defined insomnia as any of the following: difficulty falling asleep, waking a lot during the night, waking too early with inability to get back to sleep or waking up feeling tired. Using this broad definition, the 2003 Sleep in America poll, which included 1,506 adults ages 55 to 84 from various parts of the United States, found a prevalence of insomnia in 48 percent.

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Researchers who co-authored this report are: G. Richard Locke III, M.D., Amy Weaver, Sara Farmer, L. Joseph Melton III, M.D., and Nicholas Talley, M.D., Ph.D.

A peer-review journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by the Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 75 years and has a circulation of 130,000 nationally and internationally.