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    Antibiotic May Aid Irritable Bowel

    Xifaxan Reduces Bloating, May Attack Main IBS Cause

    Change of IBS Treatment?

    Is Xifaxan a new treatment for IBS? Not yet. A larger study, looking at IBS patients treated by their own doctors with Xifaxan, is already underway. Until those results are known, Xifaxan is not an officially approved treatment for IBS.

    But Pimentel says he's treated "thousands" of IBS patients with Xifaxan -- and he says now the word is getting out.

    "The gem here is you have a sustained effect in IBS. The larger, longer studies will show how well this works," he says. "We've reported these results at professional meetings, and it has changed the way IBS is treated. Sixty percent of gastroenterologists in the country are starting to do it this way."

    Pimentel says the average patient needs re-treatment every two or three months, but that response varies greatly from patient to patient.

    Controversy Over IBS Treatment

    Not all experts are convinced that bacterial overgrowth is a root cause of IBS, or that antibiotics are the best treatment. One of these experts is Douglas A. Drossman, MD, co-director of the University of North Carolina Center for Functional GI and Motility Disorders, Chapel Hill.

    In an editorial accompanying the Pimentel study, Drossman notes that IBS is a complex disorder that springs from the complex interplay of an oversensitive gut and the brain.

    Breath tests, he says, aren't reliable for diagnosing bacterial overgrowth. And Pimentel's study, he says, does not prove that treating bacterial overgrowth helps.

    Drossman is not impressed by Pimentel's finding that IBS patients reported an average 36.4% improvement in the 10 weeks after treatment with Xifaxan, while those given placebo treatment reported an average 21% improvement.

    "Only bloating improved, and abdominal pain, diarrhea, and constipation did not improve," Drossman notes. "The benefit of using antibiotics is not fully proven and must be balanced with potential risks in terms of side effects, high costs … and the need for recurrent treatment."

    Pimentel says new studies now coming out will support the bacterial-overgrowth theory of IBS. He does, however, say people with IBS have "movement disorders of the small bowel." He is hoping that a drug to promote movement in the small bowel will improve outcomes for IBS patients treated with antibiotics.

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