This clinical make easy conforms t...

This clinical make easy conforms to AAFP criteria for evidence-based continuing medical education (EB CME) EB CME is clinical easy in mind presented with practice recommendations supported by dint of evidence that has been systematically reviewed through an AAFP-approved source. The practice recommendations in this activity are available online at http://www.cochrane.org/cochrane/revabstr/AB003960.htm.

The Cochrane Abstract below is a summary of a review from the Cochrane Library. It is accompanied on an interpretation that will help clinicians offer evidence into practice. Michael Schooff MD and Casey Stelter MD not away a clinical scenario and question based in succession the Cochrane Abstract, along with the evidence-based answer and a replete critique of the abstract.

Clinical Scenario

A 35-year-old woman readys with recurrent episodes of abdominal pain, constipation, and a sensation of incomplete emptying after defecation. She has a history of irritable bowel syndrome (IBS).

Clinical Question

In patients with IBS, is tegaserod an appropriate therapy for treatment of abdominal pain and general dissatisfaction with bowel habits?

Evidence-Based Answer

Tegaserod gives modest improvement in global gastrointestinal (GI) symptoms in women with constipation-predominant IBS, without having significant validity on symptoms of abdominal pain and discomfort.

Practice Pointers

IBS is a chronic, relapsing condition encompassing a wide variety of GI symptoms, including abdominal pain and altered bowel habits. The condition affects 10 to 15 per-cent of the North American population and is twice as often met with in women as in men (2) The etiology is unknown, although motility disorders, visceral hypersensitivity, and sensitization of the central nervous body have been implicated. IBS is a clinical diagnosis of exclusion, and traditional treatments, as it is as bulking agents, anticholinergics, antispasmodics, antidiarrheals, and antidepressants, have targeted individual symptoms. Tegaserod, which stimulates soft muscle within the GI tract and increases peristalsis and strait transit time, offers a fresh treatment option for the global symptoms of IBS.

Tegaserod in dosages of 12 mg daily has shown statistical significance in pair studies, and a nonsignificant however beneficial trend in two additional randomized controll studies, in the reduction of global GI symptoms. These self-reported subjective assessments asked patients to compare their GI symptoms before entering the trial with symptoms after initiating therapy. Patients in the two treatment groups reported complete or considerable relief in GI symptoms.

Abdominal pain symptoms did not appear to be altered significantly, although beneficial inclinations were noted in some patients in the one and the other treatment groups. Patient satisfaction with bowel habits hints that the lower dosage may be more efficacious, although a similar inclination in patient satisfaction was noted in the higher dosage group

Stool common occurrence and the number of days without bowel changes improved in patients in the 12-mg form into groups In one study, subjective scores of bloating, straining, and stool consistency decreased and stool commonness increased in the higher dosage assign places to However, these results were not consistent across all studies.

Tegaserod was well tolerated by dint of most patients. The most frequent side effect was diarrhea, which was experienced significantly more frequently by patients in the higher dosage clump (NNH, 20). Headache, abdominal pain, and nausea were experienced with increased oftenness in this group as well, if it were not that this trend did not reach statistical significance. Cardiac imports were not apparent with this agent as they are with other partial 5-H[Tsub4] receptor agonist GI-motility agents like as cisapride. Three studies investigated the potential consequence of QTc interval prolongation nevertheless did not identify an increase in frequent occurrence of ECG abnormalities between the high-dosage, low-dosage, and placebo groups

not many data about tegaserod's efficacy in men and its impact in succession quality of life exist. Longer-term studies are urgencyed to determine the duration of treatment and the safety of this agent with lengthened use. Tegaserod appears to be an option for short-term relief of global GI symptoms in women with constipation-predominant IBS, further it does not affect their abdominal pain and discomfort.

REFERENCES

(1) Evans BW Clark WK Moore DJ Whorwell PJ Tegaserod for the treatment of irritable bowel syndrome Cochrane Database Syst Rev 2004;(1):CD003960

(2) Holten KB Irritable bowel syndrome: minimize testing, obstruction symptoms guide treatment. J Fam Pract 2003;52:942-50

RELATED ARTICLE: Cochrane abstract.

Background. IBS is a composed of several elements disorder that encompasses a wide profile of symptoms. existing drug treatments for IBS are of limited value, and many treatments target specific symptoms. Tegaserod, a 5-H[Tsub4] receptor partial agonist, has a novel mechanism of action in the treatment of IBS.

Objectives. The objective of this review (1) was to evaluate the efficacy and tolerability of tegaserod in the treatment of IBS in patients 12 years of age and older