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 drugs for the treatment of abdominal pain are a group
of drugs called smooth-muscle relaxants.
The gastrointestinal tract muscle is composed of a type of muscle called smooth muscle. (By contrast, skeletal muscles, such as the biceps, are composed of a type of muscle called striated muscle.) Smooth muscle
relaxing drugs reduce the strength of contraction of the smooth muscles but do not affect the contraction of other types of muscles. They are used in IBS with the assumption (not proved) that strong or prolonged contractions of smooth muscles in the intestine-spasms-are the cause of pain in IBS. There are smooth muscle relaxants that are placed under the tongue, like
nitroglycerin for treatment of angina, so that they may be absorbed rapidly. Smooth muscle relaxants are approximately 20% more effective than a placebo in reducing abdominal pain. It is not clear if smooth muscle relaxants have a beneficial effect on constipation or diarrhea.
Some commonly used smooth muscle relaxants are
hyoscyamine (for example, Levsin) and
methscopolamine (for example, Pamine). Other drugs combine smooth muscle relaxants with
a sedative (for example, Donnatal),
but there is no evidence that the addition of sedatives adds to the efficacy
(effectiveness) of the treatment.
Psychotropic drugs
Patients with IBS are frequently found to be suffering from
depression, but it is unclear
if depression is the cause of IBS, the result of the IBS, or unrelated to
the IBS. Several trials have shown that antidepressants are effective in IBS in
relieving abdominal pain and, perhaps, diarrhea. The antidepressants work in
IBS, however, at relatively low doses that have little or no effect on
depression. It is believed therefore, that they are working not by combating
depression, but in different ways (through different mechanisms). For example,
these drugs have been shown to adjust (modulate) the activity of nerves and to
have analgesic (pain-relieving) effects as well. Commonly used psychotropic
drugs include the tricyclic antidepressants,
amitriptyline (Elavil, Endep),
desipramine (Norpramine), and
trimipramine (Surmontil).
Although studies are encouraging, it is not yet clear whether the newer class of
antidepressants, the serotonin-reuptake inhibitors, such as
fluoxetine (Prozac),
sertraline (Zoloft), and
paroxetine (Paxil) are
effective.
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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