Lege Artis Medicinae

[New approaches in the pharmacotherapy of irritable bowel syndrome]


APRIL 01, 2000

Lege Artis Medicinae - 2000;10(04)

[New findings and data obtained in the pathophysiology of IBS had promoting role in the revision of pharmacotherapy of IBS and they were crucial to stimulate the development of new classes of drugs. Symptom-specific treatment is based on three groups of drugs: products modifying the gastrointestinal smooth muscle activity, the visceral hypersensitivity and the central modulatory processes. Only small group of products fulfill the new evaluation criteria.]


  1. Szegedi Tudományegyetem, Általános Orvosi Kar, I. Sz. Belgyógyászati Klinika, Szeged



Further articles in this publication

Lege Artis Medicinae


VÁLYI-NAGY István, PETŐ Mónika, CSÁSZÁR Albert, VIRÓK Dezső, BURIÁN Katalin, HELTAI Krisztina, GÖNCZÖL Éva

[The well-known risk factors of atherosclerosis (high level of serum cholesterol, high blood pressure, diabetes, smoking) can only be re cognized in about half of the patients. Athero sclerosis begins in childhood. In vivo and in vitro data suggest that certain pathogens, like the intracellular bacterium Chlamydia pneu moniae (member of the Chlamydia genus) and cytomegalovirus (member of the herpesvirus family) may play a role in the development of atherosclerosis. Both pathogens infect the pop- ulation in childhood. Infected patients are often symptom-free, sometimes Chlamydia pneumoniae may cause respiratory disease. Both Chlamydia pneumoniae and cytomega- lovirus can be detected in atherosclerotic plaques and patients with atherosclerosis carry pathogen-specific antibodies more frequently and in higher titers. Aortic lesions similar to human atherosclerotic plaques can be indu ced by infection with Chlamydia pneumoniae or cytomegalovirus in experimental animals. Antichlamydial treatment results in the regres sion of these lesions in the infected animals. In vitro infection of tissue culture cells of human arterial origin with Chlamydia pneumoniae or cytomegalovirus results in the induction of cel- lular changes characteristic to atherosclerosis. Strategies to prevent or treat atherosclerosis might be complemented by antimicrobial treatment if the infectious origin of the disease is further confirmed. ]

Lege Artis Medicinae

[Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography]


Lege Artis Medicinae

[Disparity in the perception of the disease in asthmatics and their pulmonologists plus resource in Hungary (HUNAIR study)]


[INTRODUCTION - Bronchial asthma is a chro­nic disease having an increasing prevalence in childhood and adulthood, affecting about 3-5% of the population in the developed countries. The AIR study in the United Kingdom compared the perception of the disease in asthmatic patients' to the view of their physicians (pulmonologists). Based on the results of AIR Study the Hungarian Board of Pulmonologists conducted a partially different survey in Hungary (H UNAIR Study). The fundamental objective of the HUNAIR Study was to address the following questions: 1. The persisting symptoms and limitations in daily activity of treated pediatric and adult asth­matic patients. 2. Comparison of the GINA classification of asthmatic patients (based on self-assessed symptom severity) and their pulmonologists. 3. Determination of the total asthma-related drug costs in different severity categories. 4. Determination of the total asthma-related cost for the society and its components (total drug costs, cost of lost workdays, cost of emergency visits, cost of specialist visits, cost of GP visits, cost of hospitalisation) in the different severity categories. 5. Potential differences in total cost between adult and pediatric asthmatic patients. PATIENTS AND METHODS - Data collection based on questionnaires was carried out from October 1998 to May 1999 and was directed by the Board of Pulmonologist. 699 adults and 375 children participated in the survey. The study was conducted in 19 adult and 8 pediatric cent­res in Hungary with the participation of 103 pulmonologists. RESULTS - Significant difference was found in the severity classification (based on GINA ) done by the physicians or the patients themselves. Substantial proportion of patients complained of more symptoms and limitations considering their own condition more severe than indicated by their physicians. Minor difference was found in the use of inhaled steroids among patients with mild, moderate and severe persistent asth­ma. An approximate "one-third " rule could be set up by the health economic evaluation: about 1/3 of the total cost was made up by lost work­ days, 1/3 by drug costs and 1/ 3 by other costs. One-third of the total drug cost was made up by controller and reliever antiasthmatics , 1/3 by emergency medicines and 1/3 by other medi­cines. Cost distribution of controller and reliever medicines: in case of adult patients 1/3 of the costs was constituted by controller medication and 2/3 (73%) by reliever medicines. That ratio was reversed in children: about 2/3 (73%) of the costs was spent on controller and '1 3 on reliever medicines. Further findings: 1. The increased health care resource utilisation correlated with the physician's perception more than the patient's self-assessment; 2. the resource utilisa­tion was twice as high in asthmatic children as in adults ; 3. the resource utilisati on was not affected by the usage of inhaled steroids during the 14 days of the study. CONCLUSIONS - lt can be concluded that in real life situations the current medical treatment of asthmatic patients is unsatisfactory (vs. in clinical trials). The cost-effectiveness of any medication can only be studied in a complex way, considering all the costs incurred in real life situations. New end-points are needed to assess the condition of asthmatics, which con­sider the limitations of patients in their daily routine activities and are not based exclusively on lung function tests.]

Lege Artis Medicinae

[Modern approach to functional gastrintestinal disorders]


[Functional gastrointestinal disorders defined as a variable combination of chronic or recurrent gastrointestinal symptoms not explained by structural or biochemichal abnormalities, are everpresent in the society and in physicians' offices. These conditions account for half of the referrals to gastroenterologists, at least in the ,,developed countries". The pathophysiological mechanisms involved in the pathogenesis of these disorders are complex. The symptoms are believed to be biologically multidetermined, abnormalities in motor activity, visceral sensation (hypersensitivity and hyperalgesia) and/or central perception are the best known pathogenetic factors. Cultural/familiar influence, psychosocial status, life stress and early life events may also play important role in the development or amplification of the symptoms. Since functional gastrointestinal disorders are interrelated in their pathophysiology and clinical expression, many patients will have overlapping clinical features. Predominant symptoms, however, may be used for classifying these disorders (functional dyspepsia, irritable bowel syndrome etc) and for the positive (symptom-based) diagnostic approach of the functional gastrointestinal disorders. A biopsychosocial model created to explain complex pathophysiology described above provides the rationale also for the use of a multidisciplinary approach in the therapy. ]

Lege Artis Medicinae

[Funcitonal Dyspepsia]


[Functional dyspepsia is defined as a group of different epigastric symptoms without definite morphological, biochemical or infectious origin, having overlapping clinical features. The pathogenesis of the syndrome is surely multi factorial, involving the alterations of visceral perception, as well. Gastric acid hypersecretion does not play an essential role in the development of symptoms, however its pharmacological inhibition may result in symptomatic improvement. Several clinical studies have proved recently that Helicobacter pylori infection has secondary importance in the clinical history of functional dyspepsia patients, nevertheless (in the ulcer-like functional dyspepsia subgroup) eradication therapy is generally accepted as a preventive tool. The dysmotility-type subgroup of the functional dyspepsia syndrome is caused primarily by a multifactorial mixture of gastrointestinal motility disorders and altered visceral perception. The need for positiv diagnosis is emphasized by the authors. The correct doctor-patient relationship plays the most important role in the management of functional dyspepsia patients, complete with a well proven series of acid-inhibitory, prokinetics and anti-anxiety drugs.]

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Clinical Neuroscience

Adult attachment and parental bonding in irritable bowel syndrome and in panic disorder - Implications for psychotherapy

PÉNZES István, CZEGLÉDI Edit, SZALAI Dömötör Tamás, CSALA Irén, TÚRY Ferenc

Background and purpose - Attachment theory provides an integrative perspective about the interplay between cognitive, affective, behavioral and interpersonal processes and is relevant for understanding irritable bowel syndrome (IBS) and panic disorder (PD). The aim of the present study was to examine the adult attachment style and parental bonding of IBS and PD patients. Methods - In a cross-sectional questionnaire-based study, 65 PD and 65 IBS patients with clinical diagnosis participated. Measures were Attachment Style Questionnaire, Experiences in Close Relationships Scale - Revised, and Parental Bonding Instrument. Results - The frequencies of insecure attachment (80.0% vs. 63.1%) and paternal neglect (35.4% vs. 16.9%) were higher in IBS than in PD (χ2 (1)=4.571, p=0.033, and χ2 (3)=7.831, p=0.050, respectively). The frequency of secure attachment was significantly higher for optimal paternal bonding than with suboptimal paternal bonding (75.0% vs. 21.9%, χ2 (1)=19.408, p<0.001). According to the results of multiple binary logistic analysis, optimal paternal bonding predicted secure attachment after adjusting for the background variables (OR=9.26, p=0.001). Conclusion - A high frequency of insecure attachment was present in both groups, especially in IBS. With regard to maternal bonding, IBS and PD groups showed similar patterns, while an apparent difference was observed for paternal bonding. These highlighted the developmental similarities of these two, symptomatically different disorders. While optimal maternal bonding did not predict adult attachment security, paternal bonding did thus replete with therapeutic implications. Attachment functions, like responsiveness, attunement and affection modulation were apparent in the psychotherapist-patient relationship as well.

Hungarian Radiology

[Diagnostic and therapeutical possibilities in constipation]


[Constipation is a common gastrointestinal problem. The prevalence of symptoms related with constipation fluctuates from 3 to 20 per cent. Constipation occurs more frequently in the elderly people and in females and more frequent in case of inactivity and less fiber intake. Assesment of patients with severe constipation includes specialized investigations. Exclusion of primary organic causes has to be the first step, then metabolic, neurological and iatrogenic causes (such as medicament side effects, etc) have to be excluded. After these considerations special functional gastroenterological investigations are needed which contribute to the diagnosis and differential diagnosis of the cause of the constipation. Anorectal manometry, ballon expulsion test, defecography and colon transit studies allow us to distinguish between slow colon transit, colon inertia, different subtypes of outlet obstruction, and the constipation predominant irritable bowel syndrome. The evaluation of these specific studies leads to the exact diagnosis and appropriate treatement for their problem can be given to the patients, which always has to be individually planed in all cases.]

Lege Artis Medicinae

[Bacterial contamination and irritable bowel syndrome]


[Irritable bowel syndrome (IBS) is one of the most common gastrointestinal condition, which affects 10-15% of adults in developed countries. Recent observations have raised the possibility that disturbances in the gut microbiota and/or the accompanying low-grade inflammatory state might contribute to the etiology and symptomatology of irritable bowel syndrome. Some studies indicate that small intestinal bacterial overgrowth (SIBO), as confirmed by hydrogen breath tests (HBT), is more prevalent in patients with irritable bowel syndrome than in matched controls without IBS. Although the data are conflicting, this observation has led to the hypothesis that bacterial contamination was the primary cause of IBS. As a consequence of this hypothesis, a lot of therapeutic options have found their way into the armamentarium of those who treat patients with IBS. These agents include probiotics, prebiotics, antibiotics and anti-inflammatory agents. This paper describes the various mechanisms by which changes in the gut flora might contribute to IBS and also discusses the efficacy and safety of antibiotic therapies, especially rifaximin, for treating IBS/SIBO symptoms.]

Lege Artis Medicinae

[Therapy and examination of generalized anxiety disorder in general practitioner practice]


[Anxiety disorders are the most common psychiatric conditions in primary care, but still the ratio of treated patients is low. Clinically significant anxiousness decreases work efficacy and quality of life, it can cause and often goes with somatic and other psychiatric comorbidities. Patients with anxiety disorders usually undergo many diagnostic tests and interventions turning out negative on all levels of the health system. The general practitioner has a significant role in diagnosing and assessing anxiety disorders, based on a focused history, tests for differential diagnosis and questionnaire screening tools. The generalised anxiety disorder (GAD) is highly prevalent in primary care, appr. 8- 10%, 2-4 times frequent in women. Treat - ment is complex, evidence-based methods are available as certain lifestyle modifications, psychotherapy and pharmacotherapy. A regular consultation with a psychiatrist colleague can improve the chronic care of patients with anxiety disorders.]

Hypertension and nephrology

[The new European ESH/ESC guidelines. Part III. Pharmacotherapeutic strategies on treatment of patients with high cardiovascular risk based]


[The new joint hypertension guidelines of the European Society of Hypertension and European Society of Cardiology will simultaneously be published in August, 2018 in the Journal Hypertension and European Heart Journal on the diagnostics, evaluation, treatment and follow up of hypertensive patients. This guidelines put emphasis on definition, and therapeutic strategies in patients with high cardiovascular risk. In this paper I summarise the cardiovascular risk factors and put emphasis on possibilities of reduction of cardiovascular risk.]