Enzymes might help to alleviate the stomach woes of IBS suffers

Hagerstown doctor's study shows that taking a pill before eating might help

Hagerstown doctor's study shows that taking a pill before eating might help

November 16, 2009|By TIFFANY ARNOLD

It was garlic that left the Rev. Kelly Crenshaw no choice but to leave right after the prayer during a wedding reception, spending the rest of the time in the bathroom.

"Which is awkward if you're officiating the wedding," said Crenshaw, who's the reverend at Shepherd's Summit Church in Boonsboro.

The reason for her quick dash to the bathroom? She has irritable bowel syndrome, known as IBS.

Generally triggered by food, IBS is different from a food allergy. It is an intestinal disorder associated with recurrent abdominal pain, diarrhea or constipation - symptoms so pervasive that sufferers often find themselves afraid to go to social functions out of fear that something will trigger their IBS.

For years, many sufferers like Crenshaw have been told by physicians the cause is unknown. IBS patients were directed to treatments that only seem to treat the symptoms.

But now, Crenshaw said she has found relief from pancreatic enzymes.


"It restores the quality life that you lose," Crenshaw said. "I can pretty much eat whatever I want."

Crenshaw participated in a clinical trial in which IBS patients were given a pancreatic enzyme before they ate in order to relieve their IBS symptoms, specifically those whose primary symptom was diarrhea.

The pancreas is a large gland behind the stomach that produces digestive enzymes. The trial found that when given the enzyme pancrealipase, most participants experienced reduced IBS symptoms or no symptoms at all, said Dr. Mary Money, the Hagerstown doctor who led the trial.

Washington County Hospital's Investigational Review Board approved Money's trial in 2002; it concluded in 2003.

Thirty-nine participants completed the study. Participants were prescribed a pill to be taken before eating trigger foods. During the course of the study, each received both the enzyme and a placebo, but were not told which drug they received on a given day. Twenty-five participants (64 percent) reported the enzyme as the more effective agent.

Ever since, Money has been trying to get the results published in medical journals in hopes other doctors will consider the use of pancreatic enzymes as a legitimate form of treatment for IBS.

Money contends that too often doctors end up treating the symptoms of IBS or blaming a patient's IBS on anxiety or stress.

The problem is that there's no clear acceptance of prescribing pancreatic enzymes as treatment, though in March 2009, the medical journal Pancreas published Money's letter to the editor that outlined her finding.

But because there aren't published studies that suggest the pancreatic enzymes work, doctors are reluctant to prescribe it.

Also, "there's no guarantee it will work," Money said.

Symptoms of IBS are commonly treated by eating more fiber, taking over-the-counter Imodium, or taking drugs that help control colon muscle spasms, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a division of the National Institutes of Health.

But sometimes those treatments alone aren't enough.

"It got to the point that I had difficulty going to people's houses," Crenshaw said.

In the trial, Money hypothesizes that some of the symptoms of IBS are due to maldigestion or malabsorption of certain foods, which leads to a laxative effect.

More recently, Money discovered that fat might be another clue in finding out what causes IBS, as some of the patients after the trial showed signs of fat malabsorption, an element that she continues to research.

This was the case for Crenshaw, who said she has since found even more success with her IBS by taking the enzymes with cholesterol medication, Welchol.

Crenshaw said her symptoms aren't completely gone - garlic makes her feel "mildly sick."

"It's never with the severity as it was before," Crenshaw said.

Money estimates that 10 to 15 percent of the population has IBS.

Moving forward, Money said she'd like to conduct further studies in patients who have IBS, in a continued effort to figure out what causes it.

"Hopefully, it's going to change the paradigm," Money said.

Foods that can trigger symptoms

Participants of a recent clinical trial led by Hagerstown internist Dr. Mary Money were asked to identify foods that triggered their IBS symptoms.

While 39 patients completed the study, Money said 49 were originally enrolled. She said 10 dropped out because they would have been required to eat the trigger foods with neither a placebo nor the enzyme in order to establish a baseline assessment. Money said the patients did not want to endure the after effects.

All 49 of the patients who completed the trial most commonly identified the following foods as triggers:

  • Spicy seasoning

  • Lettuce

  • Italian-style food

  • Milk-based products

  • Cabbage

  • Chinese-style food

  • Fried food

  • Barbecue spices

  • Hot peppers

  • Green peppers

  • Tomatoes

  • Onions

  • Apples

  • Eggs

  • Orange juice

  • Soy sauce

  • Beef

  • Pork

  • Garlic

  • Coffee

  • Tea

  • Chocolate

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