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Paxil May Help Irritable Bowel Syndrome

<P>Antidepressant Has Strong Effect in Those Not Feeling Fit After Fiber</P>
By
WebMD Health News

May 10, 2004 -- The antidepressant drug Paxil may help some people with irritable bowel syndrome feel better.

A new clinical study shows that Paxil, a type of drug called an SSRI, improves some irritable bowel symptoms. Although Paxil is mainly used to treat depression and anxiety, none of the patients in this study suffered from depression. In fact, says study leader George Arnold, MD, of the University of Pittsburgh Medical Center, patients with no hint of depression responded well to the drug.

"Paxil worked extremely well," Arnold tells WebMD. "These drugs are designed to treat anxiety and depression, but they work on irritable bowel in people without depression."

The cleverly designed study showed that more than one in four irritable-bowel patients get enormous relief simply by going on a high-fiber diet.

"On just the high-fiber diet, 26% of the people who were having a lot of symptoms felt well enough that they didn't want anything more done," Arnold says. "Their pain and their bloating improved, and their overall well-being improved enough to say they didn't want any more treatment."

Because people who enroll in clinical trials tend to be those with harder-to-treat irritable bowel syndrome, Arnold says that a high-fiber diet would help far more than 26% of patients.

When Fiber Fails

Not everybody with irritable bowel syndrome gets better after going on a high-fiber diet. In the Arnold team's study, those who didn't get better with a high-fiber diet went on to the second part of the study. The 81 patients in this part of the trial were randomly assigned to get Paxil or an identical-looking placebo for 12 weeks. Neither the patients nor their doctors knew which drug they were taking.

Nearly two thirds of the Paxil group -- 63.3% -- reported improvement in their overall well-being. Only 26.3% of the placebo group reported this kind of improvement. Paxil didn't help with abdominal pain or bloating. But patients who took Paxil had significantly better improvement in other symptoms -- straining, urgency, and a feeling of incomplete evacuation -- than those who took a placebo.

At the end of the 12 weeks, patients could choose to continue on their medication -- without learning whether they were taking Paxil or placebo. In the Paxil group, 84% wanted to continue. Only 37% of the placebo group chose to continue treatment. After six months, 76% of the Paxil group and 36% of the placebo group were still taking their pills.

These findings impress Reza Shaker (sha-CARE), MD, chief of the division of gastroenterology and hepatology at the Medical College of Wisconsin.

"It is an interesting study, and I think it is a real effect of Paxil they are seeing," Shaker tells WebMD. "I like this study because it is independent -- the drug companies did not pay for it -- because it was randomized, and because it has a six-month follow-up. It's a relatively small number of patients, but still it is very promising that in a subgroup of IBS patients, SSRI antidepressants may be helpful."

Irritable bowel syndrome, Shaker says, is not a single disease but may arise from several as-yet-unknown causes. By treating only patients who did not respond to fiber, he suggests, Arnold's team may have found a way to identify a group of patients with the kind of irritable bowl syndrome most likely to respond to antidepressant treatment.

"Obviously we should not take this study as encouragement to give this drug to everybody," Shaker warns. "It must be used in a select group of patients."

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