tests? The answer is `Yes`, according to consultant gastroenterologist
professor Eamonn Quigley of Cork University Hospital in Ireland. Speaking at a
Novartis satellite symposium during GUT 2003, he said the problem with IBS as
a medical disorder was in its very definition.
Aapproach making a cllinical diagnosis of IBS is based on symptoms alone. If
the patient is below age 50, has typical symptoms and without alarm features
such as hematochezia·anemia·persistent fever·weight loss of more than 10
lbs·chronic severe diarrhea and family history of colon cancer, then a diagnosis
of IBS can almost certainly be made, said Quigley.
Furthermore, a review of tests done in patients with clinical features of IBS
and a study comparing the prevalence of organic diseases in IBS patients with
the general population do not support the performing of diagnostic tests in
IBS patients.
What happens with IBS over time? Over a 12-month period, about 50% of
IBS patients will remain symptom-positive. About 21% will develop new
symptoms and another 11% will lose their symptoms.
Management of IBS
A systematic review of randomized, controlled trials of the traditional
pharmacologic agents for IBS found smooth-muscle relaxants beneficial for
abdominal pain and loperamide effective for reducing diarrhea(Ann Intern Med
2000;133:136~147).
"Surprisingly, there isn`t a lot of good data to support the use of bulking
agents," commented Quigley. He added that the studies on psychotropic
agents were small and inconclusive. "But overall, I do feel that the tricyclic
antidepressants are effective."
Psychological therapy, which includes hypnosis and psychotherapy, has
been shown to be effective in reducing pain and diarrhea. While the mode of
action is unclear, the best response is found in patients whose symptom onset
is linked to stressors and who have a "waxing-and-waning" symptom pattern.
The newer agents for IBS target serotonin. Alosetron, a 5-
hydroxytryptamine type 3 (5-HT3) antagonist, has been shown to be effective
in females with diarrhea-predominant IBS. Tegaserod(Zelmac?, Novartis), a 5-
HT4 partial agonist, is effective for constipation-predominant IBS.
A recent study on tegaserod in the Asia-Pacific population showed that the
drug provided greater overall satisfactory relief compared with placebo. The
effect of tegaserod was observed as early as week 1 and maintained
throughout the 12-week treatment period(Gut 2003;52:671~676).
■ 기사 요지
본지 자매지 메디칼트리뷴에 게재된 내용으로 임상증상을 통한 과민성대장증후군(IBS) 진
단 및 치료법에 대해 다루고 있다.
아일랜드 코크의대 에몬 퀴글리 박사에 의하면, 50세 이하의 연령에 혈변배설·빈혈·지속발
열·만성설사·체중감소·결장암 가족력 등이 아닌 전형적 증상만이 나타날 경우는 대부분 IBS로
진단할 수 있다.
최근의 새로운 IBS치료제들은 세로토닌을 타깃으로 한다. 최근 발매된 젤멕(Zelmac,
tegaserod)은 변비를 주증상으로 하는 과민성대장증후군 치료에 효과적이다. 최근 아태지
역 환자들을 대상으로 한 임상시험에서는 젤멕의 증상완화 정도가 위약군에 비해 높은 것으
로 확인됐다.
정리·이상돈 기자
sdlee@kimsonline.co.kr