|
New Contract
CPD
Registartion exam
IBS
Storage temperature
The Society
Letters to the Editor
|
IBS
More caution required in use of antispasmodics?
From Dr M. Griffiths, MRPharmS
The proposed reclassification of hyoscine butylbromide as a general sale
list medicine for irritable bowel syndrome (PJ, 23 August, p228) adds
to the confusion which already exists over the use of smooth muscle relaxants
for diverticular disease of the colon.
When infection (diverticulitis) is absent, patients are often told that
their symptoms of colon malfunction are due to irritable bowel syndrome,
which is inaccurate because IBS by definition excludes any physical colon
changes. Some consultants think that diverticula are irrelevant when
IBS is diagnosed.1 This opinion, that diverticular disease does not cause
functional problems, is at odds with the many researchers who have used
these same “IBS” symptoms to evaluate and promote treatments
for diverticular disease, including a high fibre diet.
As well as the structural changes, raised intracolonic pressure and altered
gut flora, differences in neurotransmitters, receptors and enzyme levels
have been reported with diverticular disease. Differences in response
to acetylcholine have also been reported. There are no randomised controlled
trials supporting a role for antispasmodics in diverticular disease2
and they have not shown any consistent beneficial effects.3 Nevertheless,
they are prescribed and purchased as “intestinal analgesics” and
painful diverticular disease is an indication for one product.
Pain in diverticular disease can arise from diarrhoea, constipation,
distension by gas, strictures, partial obstruction, adhesions, inflammation,
infection and the complications which lead to surgery. Because many sufferers
are elderly, faecal impaction, colon atony, and side effects from treatments
for other conditions could also be involved. When medical opinion is
so confused about the relationship between lBS and diverticular disease,
should there be more caution in the use of antispasmodics?
Mary Griffiths
Macclesfield, Cheshire
References
1. Heaton KW, Thompson WG. Fast facts — irritable bowel syndrome.
Oxford: Health Press Ltd; 1999.
2. Afzal NA, Thomson M. Diverticular disease in adolescence. Best Pract
Res Clin Gastroenterol 2002; 16:621–34.
3. Murray CDR, Emmanuel AV. Medical management of diverticular disease.
Best Pract Res Clin Gastroenterol 2002;16:611–20. |
* PDF files on PJ Online require Acrobat
Reader 4 or later.