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Pharmacists have a major role to play in treating patients with irritable bowel syndrome(IBS).
Pharmacists have a major role to play in treating patients with irritable bowel syndrome (IBS). "Pharmacists can be a major support mechanism for patients," said Patrick Meek, Ph.D., professor of pharmacy at the University of Wisconsin School of Pharmacy, both in providing psychological support and in managing drug therapies. "It's important for patients to know someone is available who can help," he said.
IBS is generally classified as a "functional disorder;" that is, it is a disease in which the primary abnormality is an altered physiological function rather than an identifiable structural or biochemical cause, according to the International Foundation for Functional Gastrointestinal Disorders. IBS is diagnosed after a review of the symptoms and a process of elimination of other intestinal disorders, such as colitis, diverticulitis, and colon cancer. The symptoms of IBS are loose or more frequent bowel movements, diarrhea, and/or constipation. In some patients, the predominant symptoms are cramping, pain, or bloating.
While the structural cause of IBS is unknown, researchers are looking at a possible link between the gut or intestine, the brain, and the autonomous nervous system that alters regulation of bowel motility (motor function) or sensory function, explained Meek. "We're looking at a 'brain-gut' reaction," he said.
Both hospital and community pharmacists have a role to play in helping to manage this disease, according to experts in the field. Patients seeking relief from IBS are most likely to be women, said Meek. "A diagnosis of IBS has been reported by 10% to 20% of adults in the United States," and symptoms of IBS are responsible for more than three million annual visits to physicians, according to information supplied by the Irritable Bowel Syndrome Self Help and Support Group.
IBS exhibits predominance in women, with females representing more than 70% of IBS sufferers. But Meek said that doesn't necessarily mean more women have the disease but that more women seek treatment for it. However, the symptoms do appear to be more severe in women at certain times, such as in the post-ovulation period. "And in both men and women, the severity of the symptoms seems to be more acute when a sufferer is under stress," he noted.
In the retail pharmacy setting, R.Ph.s can play a critical role in identifying symptoms in patients who have been diagnosing themselves with IBS. Pharmacists need to be on the lookout for patients who have been buying fiber laxatives or antidiarrheal medications over a prolonged period of time. They should question patients about their symptoms and inquire whether there are any additional symptoms, such as blood in the stool, weight loss, or severe abdominal pain.
And since IBS generally affects persons under the age of 45, pharmacists need to be alert to patients who show symptoms of what appears to be IBS after 45, Meek said. Patients exhibiting any of these symtoms must to be promptly referred to a physician, said Diana Brixner, R.Ph., Ph.D., associate professor and chair of the department of pharmacy practice at the University of Utah College of Pharmacy in Salt Lake City.
Where pain and cramping are the predominant symptoms, the prescription drug Bentyl (dicyclomine, Aventis) is often prescribed, said Meek. One new agent that can also help with pain is Zelnorm (tegaserod, Novartis). It's prescribed for abdominal pain and discomfort, bloating, and constipation. Tegaserod activates or stimulates the serotonin 4 receptor. Tricyclic antidepressants, such as amitriptyline, have also been effective for the pain associated with IBS.
Another new agent designed to treat IBS is Lotronex (alosetron HCl, GlaxoSmithKline), which blocks the serotonin 3 receptor. It is indicated for women with severe diarrhea-predominant IBS who have failed to respond to conventional therapy, whose IBS symptoms are chronic, and who have had other gastrointestinal conditions ruled out. Alosetron is available under restricted conditions of use. Symptoms that make diarrhea-predominant IBS severe are frequent and serious abdominal pain, fecal incontinence or the uncontrolled urge to have a bowel movement, or curtailment of daily activities because of IBS.
Both Brixner and Meek agreed that the new agents should be used cautiously, since IBS can usually be managed with OTCs. The new prescription drugs should be used "only in patients with the most debilitating conditions," warned Meek. In treating patients, pharmacists need to monitor for the depression that can often accompany IBS, he said.
"In some cases, an intervention is necessary, and an antidepressant should be prescribed," concluded Meek.
Kathleen Gannon. More women than men seek treatment for IBS. Drug Topics Women's Health Supplement;147:17s.