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Discussion Starter · #1 ·
Designing and applying clinical pharmacology models to conduct research in irritable bowel syndrome (IBS) represents a considerable challenge. A primal difficulty in entering this field is the lack of an appropriate definition of IBS. Efforts have been made (Manning, Kruis, Rome committee, and others) to establish valid criteria for the diagnosis of IBS based on symptoms. Of these published criteria, the compendium elaborated by the Rome committee 1 and presented as a consensus definition, has gradually become the most generally accepted, and most often used, in recent clinical drug trials. However, two major problems remain. First, the fact that practitioners' perception of what constitutes IBS is extremely variable. Therefore, in everyday clinical practice, the IBS label is often bestowed to patients that would not fit, or only partially fit, the Rome criteria and even less astringent definitions. Therefore, a dichotomy exists between investigations and trials conducted on the basis of consensus criteria and what many clinicians are actually doing in their practice settings. Unfortunately non-specialist clinicians often apply the diagnostic label IBS to any patient with abdominal symptoms in whom there is no obvious organic lesion. As examples we can cite patients with 'poor digestion', 'hepatic flexure syndrome', 'constipation' 'flatulence', etc. Of course, this situation arises because we do not have a biological marker for IBS, unlike other common gastroenterological ailments such as oesophagitis, peptic ulcer, inflammatory bowel disease, etc.The second problem, vis-�-vis the development of worthy clinical pharmacology models, is the current uncertainties about disease mechanisms involved in IBS. It is true that many pathophysiological abnormalities have been already identified with various degrees of reliability, however, we do not have a coherent hypothesis to assemble all these clues and end up with one pathogenesis that would apply either to all patients or to some subgroups of patients. Subgrouping is often contemplated by investigators because of the real possibility that different mechanisms might produce similar symptoms or combinations of symptoms, as described by patients in their medical history.The clinical pharmacological models developed so far suffer from two significant drawbacks. On one hand, patients selected for a particular study may have been gathered using different criteria than for other published studies and therefore may not represent comparable populations. Second, most clinical pharmacology models evaluate responses based on one or few putative mechanisms which, of course, we do not know whether they operate pathogenetically in every patient included in a given study (many clinical pharmacology studies involving relatively small numbers of study subjects).A final but important consideration involves the use of appropriate controls. The, sometimes subtle, physiological alterations that have been identified in IBS patients may not be in themselves indicative of a 'disease' state. Some apparently healthy individuals may present similar deviations from the general population norm, even if asymptomatic. Therefore, we may need to evolve conceptually from the traditional comparison 'patient group' vs. 'healthy control group', that assumes uniform physiological features in healthy volunteers. Instead, we may need to replace it with a frequency concept that accepts that patients and controls may differ in frequency and/or intensity of a given physiological feature, rather that it being present in one group and absent in the other.from Alimentary Pharmacology & Therapeutics Volume 13 Issue s2 Page 57 - May 1999 Review article: clinical pharmacology models of irritable bowel syndrome J.-R. Malagelada
 

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Discussion Starter · #3 ·
I never go to the research section,tom. Besides I thought people like kel might be interested in this article. Because they keep cribbing that they don't do the right kind of research. It is such an intractable disease as the article so well describes, that I thought it would be a nice counter balance to their constant complaints.
 

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I know what you mean but I think it would spare a lot of people if all these arguments about who is right took place in the research forum. Winning an argument in a forum for newbies (which is what jeff intends this forum for) is kind of pointless I think.tom
 

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I don't think Jeff intends this forum for newbies only - where did you get the impression. What about the other impressionable newbies? Don't you think they need to hear from someone other than kel. She is dominating this forum with all her alternative medicine theories.
 

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quote:I know what you mean but I think it would spare a lot of people if all these arguments about who is right took place in the research forum. Winning an argument in a forum for newbies (which is what jeff intends this forum for) is kind of pointless I think.
quote:Don't you think they need to hear from someone other than kel. She is dominating this forum with all her alternative medicine theories
Well said. Thank you both very much.
 

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It's been hard because the only people that has any money is these drug companies...and other approaches of testing cant come up with the money to do it...So as long as drug manufactures are involved we might never know...
 

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Discussion Starter · #10 ·
I would think drug companies would like to make money off of whatever cure they could find for IBS given that 10-20% of the population sufferes from IBS. If they had to supply Nystatin, the cure kel suggests, every day for a year, that is a lot of money.
 
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