[Rose]

This might be a "dumb" question, but here goes: I just finished reading the Johns Hopkins Magazine article on IBS and found it very interesting, but my question has to do with one of the studies. It said that Marvin Schuster, Chief of Gastroenteroloy at Johns Hopkins conducted a study on the "peristalic contractions" in the colon. So called "normal" people had between 6-8 contractions in a 24 hour period. IBS-C types had almost no contractions and IBS-D types had 25 or more contractions per day. I know there are anti-spasmotic medications for the "D" types to slow down the contractions, but does anybody know of any medications for the "C" types to increase the contractions? I am assuming that laxatives increase contractions, but they are not safe to use all the time. It only makes sense the lack of contractions causes the constipation, so my question is: is there any medication to increase contractions that is not a laxative? If not, it seems unreasonable to me that with the advancements in medical science they can't come up with something to increase these contractions. It appears that these peristalic contractions are the cause of all our problems...both "D"s and "C"s alike.------------------"Today is the first day of the rest of your life"Rose

 

[Guest]

Rose-I agree with you completely. In my opinion, IBS in a nutshell is a motility problem in the bowel-either to fast or to slow. I think that the only "druglike" item that there is that would help increase motility for C's would be a fiber supplement like Fibercon. It is marketed as having laxative action naturally, thereby being safe. Fiber also helps D by bulking up the stools and making them slower, but it doesnt act on the bowel itself like an antispasmodic. I have used fibercon faithfully 2 a day for my IBS, I am both C and D and find that other than giving me more gas it really helps me stay on an even keel. I originally took it for mainly D symptoms. I'm not aware of any medications that jump start peristalsis that would be considered safe to use chronically, but I read either on this board or perhaps on another that there is currently a clinical trial going on involving a bowel motility drug. I don't think this is lotronex which has already gone through all the trials. I'm not sure how you could find out info on this medication, maybe the FDA would know something about it if they regulate clinical trials.------------------Nancy

 

[LDanna]

Well, it's not a drug -- although it should be classified as one -- but, caffeine is known to increase colon spasms. That's why us D-types usually have to give up coffee.

 

[flux]

Basically, there are two types of contractions in the gut, peristalsis, which everyone probably has heard of and segmentation. Peristalsis are propulsive movements. They move digesta forward (or backward when vomiting). Segmentation refers to mixing movements. I believe the study being referred here is the one in which high-amplitude peristaltic contractions (HPACs) were being studied. I think these are sort of mass movements that occur only in the colon that move large quantities of digesta through. I believe the contractions themselves were normal, only that they occurred more frequently, so it would not explain why people have pain. It could be that the gut is more sensitive to normal sensory stimuli and that this triggers the increased contractions. That implies that IBS-D is not a motility disorder per se.There are a variety of drugs that can stimulate these motions. The first line of therapy are prokinetic agents such as cisapride (newer ones are being studied: Renazpride). Cholinergics might do it as well as sympathetic blockers. Opiate antagonists might also. The antibiotic erythromycin is a motilin agonist and is often prescribed to treat severe constipation. Octeotride, a somatostatin agonist, might also do it for severe constipation.