New evidence-based guidelines target IBS. (Diagnostic Work-Up Simplified).

SEATTLE -- The time is ripe for a major medical campaign targeting irritable bowel syndrome, American College of Gastroenterology officials declared in announcing the first evidence-based management recommendations for this common and disabling disorder.

Released during the ACG's annual meeting and published as a supplement to the November issue of the AmericanJournal of Gastroenterology, the guidelines advocate a simplified, low-tech approach to diagnosis of irritable bowel syndrome (IBS).

The guidelines also bestow a highest-level, "grade A" treatment recommendation--the only therapies so designated--on two new drugs developed specifically for GI disorders. The new drugs are the selective serotonin 5[HT.sub.4] receptor agonist tegaserod (Zelnorm) and the 5-[HT.sub.3] receptor antagonist alosetron (Lotronex). Their grade A status reflects clinical trials data showing that these novel agents are markedly more effective and better tolerated in IBS than anything previously available.

"These are drugs that significantly change people's lives for the better," commented Dr. Lawrence J. Brandt, chairman of the ACG Functional Gastrointestinal Disorders Task Force that developed the evidence-based management approach.

Tegaserod received FDA marketing approval last summer. Alosetron was approved in 2000 but taken off the market due to a problem with ischemic colitis. The Food and Drug Administration recently cleared it for reintroduction with new labeling restrictions.

Dr. Kevin W Olden, an ACG task force member who is both a gastroenterologist and a psychiatrist, noted that LBS has a 10%-15% prevalence in the U.S. population, with a male-to-female ratio of 1:2. It accounts for 12% of all visits to primary care physicians and 28% of visits to gastroenterologists. The toll of IBS has been put at 830 billion annually in direct and indirect costs. The disorder is the number two cause of workplace absenteeism.

The working definition of LBS used in the ACG report is abdominal discomfort associated with altered bowel habits. One-third of patients have constipation-predominant IBS, one-third have LBS with diarrhea, and the remainder have IBS alternating between constipation and diarrhea.