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Trying to Soothe a Balky Bowel

Doctors search for better treatment of irritable bowel syndrome

THURSDAY, Dec. 27, 2001 (HealthDayNews) -- Its cause and treatment are largely unknown, and the symptoms vary. But one thing is certain about irritable bowel syndrome (IBS), researchers say: The condition is taking a toll not just on sufferers but also on the nation's medical resources.

IBS affects an estimated 4.7 million people -- 70 percent of whom are women -- in the United States, according to the Irritable Bowel Syndrome Self Help Group.

The condition manifests itself through chronic symptoms ranging from constipation to diarrhea, as well as abdominal pain, gassiness and bloating.

According to a recent study of Medicaid recipients in California, people who suffer from IBS cost the health system about $1,000 more per year than those who don't have the condition.

The study, presented at a recent meeting of the American College of Gastroenterology, found that the average annual Medicaid expenditure for a person with IBS was $2,952.

IBS patients also were found to utilize health services more often than non-sufferers. For instance, IBS patients visited physicians almost twice as often as non-IBS patients (13.3 physician visits compared to 6.7 physician visits per person, annually). And doctors wrote 50 percent more prescriptions for IBS patients than for those without IBS (38.7 compared to 25.3 prescriptions per year, per patient).

The average age of the IBS patients was 55.

Although the study didn't directly compare IBS costs with other health conditions, author Bradley Martin, an associate professor in the College of Pharmacy at the University of Georgia, says previous research shows the costs are right up there with other common chronic ailments.

"The net cost of IBS per patient is roughly comparable to the net cost of treating a person suffering from asthma," says Martin.

But unlike the relatively easy diagnosis and proven treatment options that go along with asthma, IBS' causes -- and effective treatments -- continue to elude doctors.

"The diagnosis and treatment needs to be much more standardized," says Martin. "Right now, you get treatment for a specific symptom. For instance, you'll get medication for diarrhea, but there aren't treatments to try to reduce the underlying phenomenon."

Dr. Douglas Drossman, co-director of the University of North Carolina Center for Functional GI Disorders, says IBS seems to have both physical and psychological components, with the worst symptoms in those with higher levels of anxiety and depression.

"What we're looking at is a brain-gut disorder," he explains. "IBS isn't caused solely by psychological factors, but people who have more psychological disturbance and distress have been shown to be the people who are the high health-care utilizers and need the most treatment."

ALthough medications for the bowel symptoms are often prescribed, Drossman says milder cases often can be treated with lifestyle changes that focus on improving how patients manage stress and improving diet. More severe cases can include those therapies as well as the use of anti-depressants.

In addition, experts are looking into the value of other medications, based on preliminary research of brain scans showing that the brain's ability to turn down certain pain signals may be impaired in people with IBS.

In the meantime, Drossman says, one way to reduce doctor visits and the medical needs of IBS patients is to better educate physicians on how they can help patients help themselves.

"I think doctors need to learn more about it because the burden on the system is high from the many people who have IBS, and sometimes there's an overuse of health resources," he says.

"Yet in many cases, patients can look at their own lifestyle and help themselves without having to run to the doctor every time they have the symptoms," Drossman adds.

What to Do: Visit the National Institute of Diabetes and Digestive and Kidney Diseases for more information on irritable bowel syndrome. And try the Irritable Bowel Syndrome Self Help Group for the latest news and research on IBS.

SOURCES: Interviews with Bradley Martin, Ph.D., associate professor, the College of Pharmacy, University of Georgia, Athens; Douglas Drossman, M.D., co-director, University of North Carolina Center for Functional GI Disorders, Chapel Hill
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