The etiology of irritable bowel syndrome (IBS) is still not well-understood even with recent advances in treatments for IBS with constipation (IBS-C) and IBS with diarrhea (IBS-D). Irritable bowel syndrome is a multifaceted condition characterized by abdominal pain and altered bowel habits. Consequently, no single treatment sufficiently manages IBS in a majority of patients. One option for treatment of IBS is to use a combination of different drugs or an all-in-one combination drug to help treat multiple aspects of the syndrome. Combination drugs which affect the brain-gut connection as well as an anticholinergic mechanism are standard-of-care for the treatment of IBS. They represent viable alternatives to newly approved agents. Even though drugs such as a combination of belladonna alkaloids/phenobarbital or Donnatal ® , are used safely and effectively to manage IBS, their history of clinical investigation and results are not well-recognized by the field of gastroenterology given the lack of recent studies. This review is meant to update the field on the breadth of studies conducted on this combination drug for IBS.
For many patients with inflammatory bowel disease, the need for a proctocolectomy with the establishment of a J-pouch is a necessary procedure. In some patients, an inflammatory condition of the J-pouch known as pouchitis contributes to symptoms that include bloody diarrhea, urgency, dehydration and endoscopic evidence of inflammation. The specific cause of pouchitis is unknown, and there is also no universally accepted or FDA-approved treatment for pouchitis. As such, many patients are managed empirically with multiple medication regimens. Ten patients with pouchitis, who experienced flares and poor management of their condition with conventional drug treatments, had severe, unremitting chronic diarrhea. It was not until the addition of serum-derived bovine immunoglobulin/protein isolate (SBI) that 8 of 10 patients experienced satisfactory management of their pouchitis-associated diarrhea. An ongoing analysis of 7 of these 10 patients for up to 5 years found that 5 of these patients experienced ongoing management of their diarrhea associated with pouchitis with no reports of any flares with the remaining 2 patients reporting a few minor flares. One patient out of the 5 analyzed was able to discontinue all adjunctive therapies. Three of the 10 original patients were lost-to-follow up or moved out of state and no further details were available for ongoing analysis. As a medical food, SBI is not intended for the specific treatment of pouchitis, but these patients demonstrate beneficial effects in the long-term management of diarrhea-associated with pouchitis.
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