The original version of this article was to inform our readers and further discuss the good news about the approval of Lotronex, for use in females with diarrhea-predominant IBS, by the FDA in February. Many of our study patients and other's we have had contact with were long-awaiting the release of a medication specifically designed to treat IBS symptoms. Our group, along with many of our patients, were very disappointed when Lotronex was voluntarily removed from the market by GlaxoWellcome in early December ( please see "A Message From the Director"). Lotronex had been prescribed for many of our patients by their physicians, and was being utilized with success by many of them.

Lower abdominal pain and/or discomfort and irregular bowel movements in the form of diarrhea, constipation, or a pattern alternating between the two types, characterizes IBS. Other frequently associated symptoms are fecal urgency, bloating, a feeling of incomplete evacuation, and passage of mucus. IBS affects up to 20% of the population, and accounts for one of the top 10 reasons for visits to physicians. Women experience IBS two to three times more frequently than men. IBS is also cited as the second most common cause of absenteeism from work or school.

Patients who suffer from diarrhea-predominant IBS have hypersensitivity and hypermotility of the gut, i.e., they are more sensitive to pain, gas and other sensations arising from the intestine, and food moves through the gut at a much faster rate than normal. We know that the neurotransmitter serotonin (or 5HT) plays an important role in the brain-gut interaction, modulating the nervous system activities of the gut and that the body's of people with IBS overreact to the serotonin. Some medications that are being researched are serotonin (5HT) receptor antagonists. Although the exact site of action is not yet known, this drug blocks and binds to a particular serotonin receptor (5HT3 receptor), creating the positive effects of decreasing pain, urgency, and improving bowel consistency.

5HT3 receptor antagonists, are considered a novel approach to treating IBS, in that they provide relief from multiple symptoms. In clinical trials, they have been shown to be effective in relieving pain and discomfort, reducing urgency and improving stool consistency. Per the data from the clinical drug trials, symptom relief began to occur within 1 - 2 weeks, although anecdotally, the patients in studies using this class of medication often reported feeling an improvement in symptoms within 1 - 2 days.

The most common side effect of this class of medications is constipation. Mild or moderate constipation is usually managed by increasing fiber, laxatives or temporarily stopping the drug. When constipation occurs, we encourage patients to begin dealing it by increasing their exercise and also their intake of fiber and fluids. Like any drug, 5HT3 receptor antagonists need be used with common sense, caution, and remaining in close communication with your health care provider.

We always encourage patients to keep track of the effect of any new medication on their IBS, noting any changes or abnormalities. Patients should discontinue the drug and contact their health care providers if they note worsening of any symptoms, especially worsening of constipation, diarrhea, or increased abdominal pain or discomfort. Two potentially serious side effects could be severe constipation and ischemic colitis. Potential warning signs of ischemic colitis are a sudden worsening of pain with bloody diarrhea or blood in your bowel movements.

Our group has been involved in the testing of several new medicines for IBS, as well as looking at other treatments and new studies are always starting. One of our new studies will involve comparing women who have IBS with those who don't, and how IBS may impact sleep, looking at the activity of the heart and intestines during sleep. Another potential study would evaluate if receiving a specific education about IBS, stress, and stress reduction ("IBS Class"), in addition to taking a medication for IBS would further increase the drug's effectiveness. The IBS class will continue to be offered, but at this point it is unclear what, if any medication would be utilized in conjunction with the class.

For some patients, the use of this class of drug, to quote one study subject, was "life changing". Patients have frequently reported an improvement in their quality of life, as they no longer feel fearful of social events, travel, or going to work. For many patients, it allowed them to eat foods that had been on their forbidden list, oftentimes for years, and enjoy going out to restaurants and other social occasions.

This continues to be a very hopeful time as we understand more about what causes IBS and are continuously developing new medications and other more effective treatments for IBS, but none of this happens, or could've happened, without your help! Thanks once again to all of you who make this very valuable knowledge possible; you are truly appreciated.

For further information on IBS or other GI disorders, please refer to the following:

For more on IBS or other functional GI disorders, go to: www.iffgd.org
FDA News and Publications: www.fda.gov/opacom/hpnews.html
For information on clinical drug trials being conducted with our group, go to http://www.cns.med.ucla.edu/PatientClinTrials.htm