On the Money

When traditional drugs didn't work for her patients, Dr. Mary Money tried another approach

When traditional drugs didn't work for her patients, Dr. Mary Money tried another approach


Hagerstown doctor Mary Money hopes a "landmark" study will prove that a drug that's been on the market for years will relieve symptoms of a common intestinal disorder.

Money is conducting a scientific experiment to determine if a pancreatic enzyme called Viokase - which for decades has been used as a digestive aid - might effectively reduce symptoms of irritable bowel syndrome in patients whose symptoms are triggered by specific foods, she said.

Money is now seeking patients to participate in her PAZAS Study - Effectiveness of PAncreatic EnZyme in Reduction of IrritAble Bowel Syndrome Symptoms.


"This has never been done before," said Money, who scoured dozens of medical journals and the Internet for published information linking pancreatic enzyme deficiency to irritable bowel syndrome.

IBS, which affects between 25 and 55 million people worldwide, is an intestinal disorder that leads to crampy pain, gassiness, bloating and changes in bowel habits, according to the National Institutes for Health Web site.

The cause of IBS is unknown and there is no cure, said Money, an internist who has been in practice in Washington County since 1979. Diagnostic tests such as colonoscopies and blood tests show no sign of disease in IBS patients.

"Little progress has been made in effectively managing the disorder despite its prevalence as well as significant impact on health care costs and personal productivity," according to a Feb. 2002 article in "Disease-A-Month" medical journal.

For some irritable bowel sufferers, the disorder can be disabling.

"It's embarrassing when you have to leave the table and run to the bathroom and hope you make it," said Pat K., who asked to be identified by her first name only.

Pat, 65, has struggled with IBS for most of her life. She was in her early 20s when she started experiencing cramping, gas and diarrhea every time she ate certain foods - especially tomato-based sauces and spicy dishes, she said.

The condition worsened as Pat got older, she said, and she tried a variety of over-the-counter remedies and prescription drugs to no avail.

Some doctors prescribe drugs that control colon muscle spasms or slow the movement of food through the digestive system, Money said, but these drugs haven't proven very effective.

She decided to try a different approach last September when she prescribed a pancreatic enzyme to a distressed IBS patient, she said.

"I was ready to experiment," Money said. "It was a safe product and I had nothing to lose."

Viokase has long been used to treat patients with pancreatic insufficiency, a shortfall of the digestive enzymes that the pancreas normally secretes into the small intestine, Money said.

It worked.

The patient's symptoms were "significantly reduced," said Money, who in October 2001 started prescribing the drug to other patients with symptoms of irritable bowel syndrome to validate that the first patient's successful treatment wasn't a fluke.

Two of the more than one dozen patients who have taken Viokase have documented a 64 to 75 percent improvement. Others claim improvements of up to 95 percent, Money said.

"It doesn't work for everybody," she said. But Viokase "is changing the quality of their lives" for the majority of her IBS patients taking the drug, she said.

Pat K., of Martinsburg, W.Va., has been taking Viokase since November 2001.

"It seems to be doing the job," she said. "For the first time, I can go out to eat and feel comfortable."

Marguerite T., of Hagerstown, can eat slaw without debilitating side effects for the first time in nearly 80 years since starting to take Viokase several months ago, she said.

"Slaw will get me every time," said Marguerite, 85. "I can take the pill and eat my slaw now."

Encouraged by such success stories, Money decided to formally test her hypothesis that symptoms of IBS may be attributed to problems with digestion and/or absorption of certain foods. IBS patients might thus be effectively treated with digestive aids - pancreatic enzymes - such as Viokase, she said.

"I'm cautiously optimistic," Money said. "Nothing is absolute."

The Investigative Review Board at Washington County Hospital in January approved her request to conduct a double-blind crossover study to test the effectiveness of Viokase compared to a placebo in reducing IBS symptoms, Money said.

She hopes to enroll 52 people in the free experiment to ensure statistical significance.

As of mid-April, 15 people had signed up for the study, Money said. To increase enrollment, some other local physicians will recruit their IBS patients for the study and oversee their progress. Dr. Pear Enam of Gastroenterology Associates in Hagerstown said he and his colleagues, who specialize in stomach and intestinal problems, will likely serve as sub-investigators.

"I think it is a study that is worth pursuing," Enam said. "It could be helpful to a lot of people."

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