Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
The most widely studied drug for the treatment of
diarrhea in IBS is
loperamide (Imodium).
Loperamide appears to work by
inhibiting (slowing down) the contractions of the muscles of the small intestine
and colon. Loperamide is approximately 30% more effective than a placebo in
improving symptoms in patients who have diarrhea as the predominant
manifestation of their IBS. It is not clear if loperamide reduces
abdominal pain. Loperamide
can cause constipation. Therefore, the dose must be
carefully adjusted and individualized for each patient. Alosetron (Lotronex)
is used to treat diarrhea and abdominal discomfort that occurs in women with
severe IBS that does not respond to other simpler treatments.
Alosetron, like
tegaserod, affects the serotonin receptors. (See the discussion above of
tegaserod.) Alosetron blocks the 5-HT3 receptor, a receptor that causes
contractions when serotonin binds to it. Alosetron, by blocking 5-HT3 receptors,
prevents serotonin from binding and thereby prevents contractions.
Alosetron was approved by the FDA in February 2000, but was withdrawn from
the market in November, 2000, because of serious, life-threatening,
gastrointestinal side effects. In June 2002, it was approved again by the FDA
for marketing but in a restricted manner as part of a drug company-sponsored
program for managing the risks associated with treatment. The use of alosetron is
allowed only in women with severe, diarrhea-predominant, IBS who have failed
to respond to conventional treatment for IBS.
The most common side effect with alosetron is constipation. One-quarter to
one-third of patients may develop this side effect, but in only 10% (10 out of
every 100 patients) will the drug need to be stopped temporarily or permanently.
A rare side effect with alosetron is severe intestinal
inflammation caused by poor circulation of blood (ischemic colitis). This
complication is life-threatening, may require surgery, and has even caused death
in a small number of patients. Therefore, immediate medical attention should be
sought if signs of ischemic colitis (rectal bleeding or a sudden worsening
of abdominal pain) occur.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
Gas or "intestinal gas" means different things to different people. Everyone has gas and eliminates it by belching or farting (passing it through the rectum).
Constipation is defined medically as fewer than three stools per week and severe constipation as less than one stool per week. Constipation usually is caused by the slow movement of stool through the colon. There are many causes of constipation including medications, poor bowel habits, low fiber diets, abuse of laxatives, hormonal disorders, and diseases primarily of other parts of the body that also affect the colon.
Fibromyalgia, formerly
known as fibrositis, causes chronic pain, stiffness, and
tenderness of muscles, tendons, and joints without detectable inflammation. Fibromyalgia patients have an unusually low pain threshold. Symptoms of fibromyalgia include fatigue, abnormal sleep, mental/emotional disturbances, abdominal pain, migraine and tension headaches, and irritable bladder. Treatment of fibromyalgia involves patient education, medication, exercise, and stress reduction.
In lactose intolerance, the digestive system cannot digest lactose (the main sugar in milk). Symptoms of lactose intolerance include diarrhea, flatulence, abdominal pain, abdominal bloating, abdominal distention, and nausea. There are several tests to diagnose lactose intolerance. Treatment is generally made with dietary changes, supplements, and adaptation to small amounts of milk.
Small intestinal bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria (at least 100,000 bacteria per ml of fluid) are present in the small intestine and the types of bacteria in the small intestine resemble more the bacteria of the colon than the small intestine. There are many conditions associated with small intestinal bacterial overgrowth, to include: diabetes, scleroderma, Crohn's disease, and others. There is a striking similarity between the symptoms of irritable bowel syndrome and SIBO. It has been theorized that SIBO may be responsible for the symptoms of at least some patients with irritable bowel syndrome. Symptoms of SIBO include: excess gas, abdominal bloating, diarrhea, and abdominal pain.
Dyspepsia (indigestion) is a functional disease in which the gastrointestinal organs, primarily the stomach and first part of the small intestine, function abnormally. It is a chronic disease in which the symptoms fluctuate infrequency and intensity. Symptoms of dyspepsia include upper abdominal pain, belching, nausea, vomiting, abdominal bloating, early satiety, and abdominal distention (swelling). These symptoms are most often provoked by eating.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Irritable bowel syndrome (IBS) is a functional disease that can affect the quality of those who suffer from this condition. Individuals with IBS can make lifestyle changes that may modify or control the number and severity of episodes. Certain foods, medications, and hormone levels may trigger IBS episodes. Learn how to prevent the number and severity of IBS episodes of diarrhea and constipation.
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