New York Times, Dec 7, 2004
THE CONSUMER

By MARY DUENWALD

The women in the television commercial pull up their shirts to display the words "abdominal pain," "bloating" or "constipation" scrawled in black marker on their abdomens.

Some viewers probably respond by reaching for the remote control. But others may be prompted to ask their doctors whether Zelnorm, the Novartis drug in the advertisement, can actually ease the symptoms of irritable bowel syndrome.

The answer, experts say, is, "It depends."

Zelnorm is one of two drugs - the other is Lotronex from GlaxoSmithKline - approved by the Food and Drug Administration for the treatment of irritable bowel syndrome, or I.B.S., a disorder that is estimated to affect about 45 million Americans.

Twice as many women as men suffer from it. Their search for relief is often frustrating, because it has no single cause and no cure, and doctors are sometimes dismissive of patients' complaints.

The symptoms vary. About a third of sufferers have constipation, another third have diarrhea and the rest alternate between the two. Bloating after meals and lower abdominal pain are also common, as are severe fatigue, sleep difficulties, low interest in sex, hopelessness and tension, a recent study in The Archives of Internal Medicine says.

Zelnorm, the trade name for tegaserod, has been shown to be effective in treating the syndrome in large clinical trials. It works just for people who suffer constipation. A chief side effect is diarrhea.

"Because I.B.S. is so heterogeneous, an agent that may treat one symptom can potentially exacerbate another one," said Dr. Robert S. Fisher of the Temple School of Medicine in Philadelphia.

Zelnorm is specifically approved for women, but also prescribed for men. Most studies of its safety and effectiveness have been conducted mainly on women.

Doctors say that people with irritable bowel syndrome typically require both medications and changes in their routines, the exact regimen depending on a patient's symptoms and their severity.

The syndrome was once thought to be simply a visceral response to stress, because doctors could find no biological explanation. As a result, many patients felt that their doctors gave their problem short shrift or, worse, implied it was all in their heads.

"People with I.B.S. are sensitized to doctors' thinking they're crazy," Dr. Fisher said.

Recent studies indicate that the syndrome may arise from problems in the working of the colon and in the connection between the brain and the colon.

"The brain and bowels are wired with a series of nerves," Dr. Brennan M. R. Spiegel, a gastroenterologist at the University of California, Los Angeles, said. "If you have I.B.S., you're wired up in a slightly different way, and that can cause diarrhea, constipation or pain."

Studies have shown that people with the syndrome are more sensitive to colon pain and that their brains process the pain abnormally. Stress and anxiety can lead to symptoms or worsen them, but those factors do not cause the disorder, experts say.

Abnormal functioning of serotonin in the colon also appears to promote irritable bowel syndrome. In the brain, serotonin is thought to influence mood. But in the colon, where 95 percent of the body's serotonin is found, it helps produce the normal contractions of peristalsis.

Zelnorm stimulates serotonin receptors, enhancing peristalsis and relieving constipation. Alosetron, sold as Lotronex, works in an opposite manner, blocking serotonin receptors and slowing peristalsis.

Lotronex is for patients whose primary symptom is diarrhea. But the F.D.A. restricts its use because in some patients it has caused extreme diarrhea or restricted blood supply to the colon, problems that have in some cases been fatal. Patients given alosetron have to sign releases stating that they understand its risks.

Bacteria may also play a role. Dr. Henry C. Lin of the University of Southern California and others have found that in many patients bacteria that normally reside just in the large intestine move into the small intestine, where they interfere with digestion and generate excess gas, producing symptoms.

Because bloating and pain often occur after meals, patients are advised to cut back on foods that seem to set off the worst symptoms, including caffeine, alcohol, fats and milk. For mild cases of the syndrome with constipation, doctors recommend fiber laxatives like Metamucil or FiberCon.

Loperamide - Imodium or Kaopectate, for example - can relieve diarrhea.

Low doses of old-fashioned antidepressants like amitriptyline and desipramine have been shown to relieve abdominal pain. Newer antidepressants like Prozac do not seem to be as effective. More helpful, studies suggest, are techniques like cognitive therapy and hypnosis, which Dr. Spiegel says may help patients "get some control over their own symptoms."

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Hypnosis creates measurable,

marked changes

in brain activity

NewsTarget.com printable article. Monday, December 20, 2004

Overview:

* Hypnosis is more than just a party trick, it measurably changes how the
brain works, says a UK researcher.

* Hypnosis significantly affects the activity in a part of the brain
responsible for detecting and responding to errors, says John Gruzelier, a
psychologist at Imperial College in London.

* Using functional brain imaging, he also found that hypnosis affects an
area that controls higher level executive functions.

* "This explains why, under hypnosis, people can do outrageous things that
ordinarily they wouldn't dream of doing," says Gruzelier, who presented his
study at the British Association for the Advancement of Science Festival in
Exeter, UK.

* Gruzelier hopes it will also benefit emerging research showing, for
example, that hypnosis can help cancer patients deal with painful treatments.

* Gruzelier and his colleagues studied brain activity using an fMRI while
subjects completed a standard cognitive exercise, called the Stroop task.

* The team screened subjects before the study and chose 12 that were highly
susceptible to hypnosis and 12 with low susceptibility.

* During their first task session, before hypnosis, there were no
significant differences in brain activity between the groups.

* But under hypnosis, Gruzelier found that the highly susceptible subjects
showed significantly more brain activity in the anterior cingulate gyrus than
the weakly susceptible subjects.

* This area of the brain has been shown to respond to errors and evaluate
emotional outcomes.

* The highly susceptible group also showed much greater brain activity on
the left side of the prefrontal cortex than the weakly susceptible group.

* This is an area involved with higher level cognitive processing and
behaviour.

* "This is confirming our model of hypnosis with very direct evidence of
brain function," he says.

* Peter Naish, at the UK's Open University, says this moves the
understanding of hypnosis away from the popular misconceptions created by showy stage
hypnotists.