Monday, June 4, 2007

Excess bacteria don't influence bowel disease

Source: http://www.sciam.com/article.cfm?alias=excess-bacteria-dont-infl&chanID=sa003&modsrc=reuters

NEW YORK (Reuters Health) - An abnormally high number of bacteria in the small intestine does not appear to be a major factor affecting the symptoms of irritable bowel syndrome, Swedish researchers report in the medical journal Gut.

Irritable bowel syndrome (IBS), or spastic colon, is a common disorder characterized by abdominal pain, diarrhea, cramping, and constipation. The syndrome is thought to arise from overactivity of the nerves in the intestine that control movement.

"The data do not support an important role for small intestinal bacterial overgrowth, according to commonly used clinical definitions, in IBS," senior investigator Dr. Magnus Simren told Reuters Health.

Simren and colleagues at Sahlgrenska University Hospital, Gothenburg, note that a high rate of bacterial overgrowth has been reported in patients with IBS, but these observations were based on tests that only indirectly measured bacteria levels.

They therefore assessed small intestinal bacterial overgrowth by a direct test -- bacterial culture of small-bowel test samples -- among 162 patients with IBS and 26 healthy subjects. Cultures revealed the exact same rate of intestinal bacterial overgrowth in both groups, 4 percent.

Signs of intestinal movement abnormalities were seen in 86 percent of patients with overgrowth and in 39 percent of patients without overgrowth. The investigators also observed that movement abnormalities did not reliably predict altered small-bowel bacterial levels.

PET/CT Should Be 'First-step' Test For Patients With Crohn's Disease

Source: http://www.sciencedaily.com/releases/2007/06/070604155841.htm

PET/CT Should Be 'First-step' Test For Patients With Crohn's Disease
Science Daily — The molecular imaging power of PET/CT is invaluable in noninvasively monitoring Crohn's disease--a chronic inflammatory disease of the gastrointestinal tract that mainly affects young people, according to a study released by Belgian scientists at the 54th Annual Meeting of SNM, the world's largest society for molecular imaging and nuclear medicine professionals.

"Our study is the first one demonstrating the value of PET/CT in Crohn's disease," said Roland Hustinx, head of the nuclear medicine division at the University Hospital of Liège and professor of nuclear medicine at the University of Liège. "PET/CT (positron emission tomography/computed tomography) imaging--with the radiotracer fluorodeoxyglucose or FDG--could be used as a first-step test in patients with clinical or biological signs suggesting active disease," he noted. "PET/CT can answer the major question: What is the activity of the disease"" explained Hustinx.

Crohn's disease, an inflammatory bowel disease (IBD) that can affect the digestive system, has no medical cure, and its causes are unknown, explained Hustinx. Once the disease begins, it can fluctuate between periods of inactivity (remission) and activity (relapse). During relapses, symptoms--varying in nature, frequency and intensity--include abdominal pain, diarrhea and worsening general physical condition. Estimates indicate that up to 2 million people in this country could be affected by Crohn's and related diseases. IBD most commonly begins during adolescence and early adulthood.

"The clinical course of the disease is characterized by a succession of periods of clinical relapses and remissions," said Hustinx. "Its diagnosis relies on clinical and biological signs (markers of inflammation in the blood) as well as direct examination of the bowel using ileocolonoscopy, an endoscopic examination of the large bowel, where the last part of the small bowel (ileum) is also examined," added Hustinx, who indicated that prevalence of the disease is increasing.

"Endoscopic evaluation--a diagnostic medical procedure in which a small, flexible tube with a light and lens is inserted into the body to assess the interior surfaces of an organ--is the gold standard to answer, 'What is the activity of this disease"'" said Hustinx. The answer to this question will decide whether the clinician prescribes a treatment that is likely to be effective but also very costly and associated with side effects. "Ileocolonoscopy is invasive, unpleasant for the patient, sometimes incomplete due to unreachable segments and can only assess mucosal lesions, while the disease may sometimes affect deeper parts of the bowel wall," he indicated.

"The big advantage of PET/CT is that it is noninvasive, simple, fast and without any side effects. There was no preparation for the patients, except that they fasted for six hours. Each study took less than 20 minutes," said Hustinx. "If the PET/CT is positive, the doctor should confirm the results using endoscopy. If the PET/CT is negative, there would be no need for the endoscopy--given the high negative predictive value of the technique," he added.

"In our study, all bowel areas that showed severe endoscopic lesions were correctly identified by PET/CT. There was not a single case in which the ileocolonoscopy showed severe lesions and PET/CT showed a normal metabolic activity," said Hustinx. "Conversely, this means that when the PET/CT is negative--no matter how important the clinical symptoms are--the disease is not active," he added. "PET/CT has, therefore, the potential to deeply modify the exploration algorithm of patients with Crohn's, reducing the number of endoscopic examinations and allowing a better, noninvasive monitoring of the disease's activity," he indicated.

PET/CT molecular imaging--with radioactive drugs such as FDG--enables the collection of both biological and anatomical information during a single exam, with PET picking up metabolic signals of body cells and tissues and CT offering a detailed map of internal anatomy.

"Our results must be confirmed by other investigators on a larger scale," said Hustinx, indicating that his team is currently conducting a study evaluating the capacity of PET/CT to assess early on the response of the disease to "biological treatments." Treatment has been significantly improved over the past few years with the development of biological treatments, which have shown potential for obtaining mucosal healing in Crohn's disease, noted Hustinx. "This mucosal healing has been associated with higher sustained quality of life, lower rate of hospitalization and lower need for surgery. A sustained clinical remission--and a control of intestinal lesion--has become the target of new treatment strategies," he said.

Clinically Proven Probiotic for IBS Symptoms

Source: http://www.healthnewsdigest.com/news/Family_Health_210/Clinically_Proven_Probiotic_for_IBS_Symptoms.shtml

(HealthNewsDigest.com)- CLEVELAND, OH --- For the nearly 60 million Americans* who suffer from Irritable Bowel Syndrome (IBS), everyday life can present many challenges. IBS is a common digestive disorder in which the gastro-intestinal system does not function properly, with symptoms ranging from mild to severe abdominal pain, cramping, bloating, gas, constipation and diarrhea. It’s estimated that 70-80% of all IBS sufferers are women. A probiotic treatment such as Digestive Advantage Irritable Bowel Syndrome, the only once-daily, over-the-counter product for IBS, has been proven effective in providing relief for IBS sufferers.

The recurring symptoms of IBS can affect all aspects of a person’s quality of life; personally, professionally, socially and financially. “As my symptoms continued to get worse, it was difficult to work, be social, travel and go about my daily activities because I had to be chained to a bathroom,” said 55 year-old Linda Hicks of Huntington Beach, California. “Often times it didn’t even matter what I ate, it seemed like it triggered my symptoms.”

Hicks has lived with IBS for the past two years and in that course of time sought out many treatment options to help relieve her abdominal pain and bloating. She tried numerous products and while they provided some relief, Hicks says she’s been able to live a more normal and active life since she began taking Digestive Advantage Irritable Bowel Syndrome, a once-daily, over-the-counter treatment for IBS that has proven to be extremely effective for numerous people in managing their IBS symptoms. “Digestive Advantage Irritable Bowel Syndrome gave me my life back,” said Hicks. “I now have the freedom to go out in public and live normally without worrying about my IBS.”

In an IBS double blind, placebo controlled study using Rome II criteria, the Ganeden Cultures™, or probiotic strain of bacteria, in Digestive Advantage Irritable Bowel Syndrome were proven to help reduce abdominal pain and bloating. Probiotics are beneficial or friendly bacteria that live in the digestive tract and help promote digestive health and strengthen the immune system.

Jeffrey D. Roberts, MSEd, BSc, President & Founder of the IBS Association/IBS Self Help and Support Group, has lived with IBS for more than 25 years and knows all too well what IBS sufferers live through.

“It’s extremely important that people seek out knowledge and gain a better understanding of their condition,” Roberts said. “Always seek advice from a doctor and manage your stress, along with changes in diet and lifestyle is wise advice for anyone, especially for the millions who experience IBS symptoms or have been diagnosed with Irritable Bowel Syndrome.” And while there is no cure for IBS, Roberts also touts the beneficial effects of probiotic supplements such as Digestive Advantage Irritable Bowel Syndrome in helping people feel significant relief.

Friday, June 1, 2007

Crohn's disease patients fight to get drug on PBS

Source: http://www.abc.net.au/news/newsitems/200706/s1940562.htm

People living with Crohn's disease say the Federal Government is ignoring their plight as they fight to get a drug vital to their treatment on the Pharmaceutical Benefits Scheme (PBS).

Sarah Hird, 22, will eventually have her bowel removed if she cannot keep up with the $18,000 a year she needs for the drug Infliximab to keep her illness under control.

"There's got to be something the Government can do for us," she said.

"It has to be done."

The Pharmaceutical Benefits Advisory Committee (PBAC) has recommended the drug for the PBS, but sufferers are worried that it will not be listed.

Health Minister Tony Abbott says it is not the Government's fault.

"We are happy to go forward with this PBAC recommendations, for some reason the company won't," he said.

"The company is denying this drug to people with Crohn's disease."

But the company says the recommendation is too restrictive and would deny the drug to the majority of patients.

Drug firm's movie gets mixed reviews

Source: http://www.twincities.com/allheadlines/ci_6033025?nclick_check=1

Depending on whom you ask, the movie "Innerstate" is either a touching documentary about people overcoming autoimmune diseases, or a sly tactic in "Big Pharma" advertising.

Either way, it's coming soon to a theater in Brooklyn Center.

"Innerstate" chronicles a race car driver with Crohn's disease, a countrywestern singer with rheumatoid arthritis and a restaurant manager with psoriasis. All three have comeback stories despite their incurable diseases.

"The movie was meant to inspire people and give people hope," said Janie Feliz, 20, the singer, whose condition hasn't slowed her drive toward a career in Nashville.

The controversy comes from the fine print. The hourlong movie is funded and produced by Centocor Inc., the maker of Remicade, the top-selling drug for autoimmune conditions, which result when the immune system mistakenly attacks healthy cells. All three people in the movie take Remicade, and while the brand name isn't mentioned in the film, some critics believe it is an advertisement masquerading as a documentary.

"Innerstate" reflects a blending of advertising and art taking place in much of American culture. The movie's indirect approach also reflects a softer edge from a drug industry that usually hammers home brand names and catchphrases such as the Purple Pill. The idea of such "patient education" or "disease awareness" is to inform people about diseases so they are motivated to learn about treatments on their own.

"It's a means to create marketing buzz about these diseases," said Jon Schommer, a drug-marketing expert with the University of Minnesota College of Pharmacy.

"Innerstate" has appeared in 10 cities since February, and concern has been building. A labor union in Philadelphia complained last week that, although the drug name isn't mentioned in the movie, it is featured prominently in materials distributed after the show. The union represents custodians who clean Centocor's offices.

Centocor created the movie to inform the public about diseases that are poorly understood and can cause pain and humiliation for patients, said Michael Parks, Centocor's vice president of communications.

Remicade is a biologic drug, meaning it is made from human cell cultures, and it disrupts how the immune system attacks the body. There are several competing drugs for autoimmune diseases, but Remicade is the market leader, producing $3 billion in sales last year for Centocor and its parent company, Johnson Johnson.

Doctors have reported remarkable turnarounds for patients with autoimmune diseases since these drugs were developed. Previously, there was little to stop rheumatoid arthritis, for example, which deforms joints and causes severe pain and swelling.

Crohn's inflames the digestive tract, raising the risk of colon cancer and causing pain and chronic diarrhea. Psoriasis causes flaky, scaly skin that is not only uncomfortable but also can embarrass sufferers.

"Innerstate" opens with Jason Knott, 33, who grew up with psoriasis and skin lesions covering as much as 80 percent of his body. He recalls in the film how parents pulled their children out of the water as he dipped into a neighborhood pool.

Centocor's Parks selected the three patients for the film, focusing on young, active patients to break down myths about the diseases.

"It is, in our mind, unconscionable that psoriasis patients are still treated like lepers," Parks said. "It's not a communicable disease."

Public stigma over autoimmune diseases came up during this session of the Minnesota Legislature, when lawmakers took ridicule for voting to guarantee that people with Crohn's disease or ulcerative colitis could use restrooms in private buildings or retail stores.

Ray Ciccarelli, who is profiled in the movie, has Crohn's disease. The 36-year-old now races in a NASCAR junior league, but prior to treatment, he rarely left his house for fear of not getting to a bathroom in time.

Regardless of whether "Innerstate" is intended as marketing, analysts believe it will help Centocor. As the market leader, it benefits from anything promoting the diseases its drugs can treat.

The key question is whether the film crosses the line from information to persuasion, said Schommer, the U expert, who has not seen the film.

Centocor appears to be using a marketing strategy common in Europe, where drug companies are banned from advertising directly to consumers, Schommer said. The strategy is to heighten public awareness about a disease and then arm physicians with drug information and samples they can offer when patients come to them with questions.

"The successful ones have it orchestrated beautifully," Schommer said.

Dr. Carolyn Bowles believes it is marketing, and that drug companies are poor sources for patient education. The Edina rheumatologist nonetheless accepted Centocor's invitation to speak after the June 9 screening in Brooklyn Center.

She said some patients don't need Remicade, which has such powerful effects on the immune system that it can increase the risks of infections such as tuberculosis.

Others need it earlier but are forced to wait because of insurance restrictions, she said. Remicade is given by infusion and costs each patient $12,000 to $20,000 per year.

Living with Crohn's

Source: http://www.newsobserver.com/105/story/587470.html

Missy Baxter, Correspondent
As a marathon runner and fitness specialist, Darren Pangle appears to be the picture of perfect health. His daily workouts include an hour of cardio training and at least 30 minutes of weight training. The results are evident. Standing 6 feet 2 inches and weighing 260 pounds, Pangle has 30-inch quads, 20-inch biceps and only about 10 percent body fat.

"A lot of people think I'm a bodybuilder when they first meet me," said the 42-year-old Chapel Hill resident.

So people are often shocked when they learn that Pangle has a chronic disease that almost cost him his life when he was a teen and continues to cause health problems.

"When I tell people about my life, they usually can't believe that I have any medical problems at all -- unless I show them the huge scar on my stomach," he explained.

Pangle is among hundreds of Triangle residents who have Crohn's disease, an illness that causes extreme intestinal problems and can lead to severe complications, such as an obstructed bowel, persistent diarrhea and rectal bleeding.

Pangle's medical problems began at age 19, when he flipped a riding lawn mower while cutting grass on a steep embankment. At first, the injury didn't seem too severe. There weren't any bruises, just a stiff back the next morning. Within a few days, though, the pain began to intensify.

"On the third day after the accident, I woke up sweating and I couldn't move at all," he recalled. "I called my brother, and ... he literally had to carry me to the hospital."

Physicians conducted a multitude of tests and determined that Pangle was suffering from peritonitis, an inflammation of the thin membrane that lines the abdominal wall. Doctors told him the problem could have been brewing before the accident or it could have been prompted by it. Either way, a life-threatening infection was rapidly spreading throughout his body.

"The doctors told me I had less than eight hours to live, so they needed to do emergency exploratory surgery and that's when they found out I had Crohn's disease," he recalled. "After surgery, I wound up in a coma for three days and I lost 72 pounds in six days."

How many have it

Named after Dr. Burrill B. Crohn, who documented the disease's symptoms in a 1932 research paper, Crohn's disease is similar to ulcerative colitis, which also causes extreme gastric problems. Crohn's and colitis are the two main categories of a larger group of illnesses known as inflammatory bowel diseases.

An estimated 1.3 million Americans have Crohn's or colitis, according to Kelli King, development director of the Carolinas Chapter of the Crohn's and Colitis Foundation of America.

"Each year, about 30,000 more people are diagnosed with Crohn's and colitis, of which about 10 percent are under age 18," King said.

For decades, many patients with Crohn's suffered quietly and the disease often went undiagnosed, King said. The nature of the disease sometimes prompts people to keep their condition secret from others.

"It's such a personal subject that many people don't discuss their symptoms and don't go to the doctor, but thankfully that seems to be changing," King said.

The number of patients diagnosed with Crohn's seems to be increasing, she said, because the public and doctors are becoming more aware of the symptoms.

To raise money for research on Crohn's, as well as educational and support programs, the Carolinas Chapter of CCFA has organized an annual event, known as the Guts & Glory Walk/Run, for almost three decades. More than 400 people are expected to participate in the 26th Annual Guts & Glory Run/Walk on Saturday at the GlaxoSmithKline campus in Research Triangle Park.

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