Case 2: AR, a 32 y/o school teacher, had IBS symptoms of diarrhea andabdominal pain for 16 years. He had 10–15 bowel movements/day withminimal response to loperamide and tricyclic antidepressants. Life stylechanges had minimal impact. The patient was placed on alosetron 1mg pobid and BMs decreased to 5x/day. He was thrilled by his ability to teachuninterrupted.Results: These male patients were treated for 8–11 months. Both had reliefof IBS symptoms where other treatments failed. There were no adverseevents in these patients over the entire course of treatment. This representsour complete experience of treating men with alosetron for D–IBS.Conclusions: Alosetron is safe and effective in men for the long termtreatment of D–IBS. Proper patient selection is essential. The dose ofalosetron must be monitored and decreased if needed. Patients can beinstructed to take alosetron after the first bowel movement each day. Theuse of alosetron in men with IBS and diarrhea is worthy of further study.

Alosetron Dose and Long Term Efficacy in Men with D–IBS

PatientEffective

Dose (mg)

TreatmentDuration(months)

Relief ofDiarrhea

Relief ofurgency anddiscomfort

PM 0.5 qd 8 complete completeLH 1 bd 11 satisfactory complete

1) Gralnek Gastro 2000 2) Camilleri APT 1999 3) Wolfe Am J Gastro 2001.

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BARRIERS TO ADDRESSING FECAL INCONTINENCE:PHYSICIANS LACK KNOWLEDGEJennifer A. Christie, M.D. and Suzanne Rose, M.D.*. Gastroenterology,Mount Sinai School of Medicine, New York, NY.

Purpose: To assess the current knowledge, attitudes, and practices ofhealth care providers regarding fecal incontinence (FI) at an academicmedical center.Methods: An IRB approved survey instrument was administered to at-tending physicians, fellows, residents, and medical students in the fields ofInternal Medicine, Gastroenterology, and Geriatrics. The survey instrumentis a six–page document which solicited demographic data and assessedknowledge of pathophysiology of FI, tests of incontinence, and epidemi-ology. Physician barriers to managing patients with FI were also assessed.Results: Eighty–one participants (53 men and 28 women) completed thesurvey. Mean age was 38.9 years. 44% of the subjects were internists (IM),33% gastroenterologists (GIs), the others were pediatric GIs, medicalstudents, and nurse practitioners. 60% of participants have female predom-inant practices. 71.5% of the participants scored 70% on the pathophysi-ology questions. Figure 1 shows % correct answers. 80% of those surveyedwere unable to correctly list the majority of parameters measured by testsof anorectal function. 70% of participants felt they were inadequatelytrained to assess/evaluate patients with FI while 90% agreed that this wasa quality of life–limiting problem and 84% of subjects would like to learnmore about this disorder.

Conclusions: 1) Physician and student knowledge is lacking regarding thepathophysiology and evaluation strategies for the management of patientssuffering from FI. 2) Although gastroenterologists scored better than in-ternists on pathophysiology knowledge questions, the scores were stillpoor. 3) Physicians reported deficient skills and training in FI. 4) Partici-pants recognize FI as potentially limiting to quality of life and they areinterested in acquiring additional training. This study suggests that educa-tional inventions should be implemented in medical training programs andcontinuing medical education.

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PATTERNS OF MEDICAL CARE AMONG PATIENTS WITHCOLONIC ISCHEMIA AND IRRITABLE BOWEL SYNDROMEBeth L. Nordstrom, Ph.D., Tanya D. Alfredson, A.L.M., Suzanne F.Cook, Ph.D. and Alexander M. Walker, M.D.*. Epidemiology Division,Ingenix, Newton, MA and GlaxoSmithKline, Research Triangle Park,NC.

Purpose: The present study used cluster analysis to identify patterns ofdisease and treatment in patients with irritable bowel syndrome (IBS),colonic ischemia (CI), and a randomly selected group of controls.Methods: Using the UnitedHealthcare medical claims research database,we identified 1,386 patients, evenly divided among IBS cases, CI cases, andcontrols. For each patient, we obtained complete claims histories for aone–year period prior to the onset of CI or a random date after diagnosisof IBS. Using a modified k–means clustering algorithm, we identifiedpatient clusters whose members shared diagnoses and drug use. Separatecluster analyses were performed for patients under 50 years and those 50years and older.Results: The patients aged 20 to 49 split into 5 clusters, and the older groupsplit into 6 clusters. The clusters showed patterns of medical historiesranging from generally healthy, through subgroups defined primarily byrespiratory or skeletal and joint disorders, clusters centered on gastrointes-tinal illnesses, and clusters with major cardiovascular disease. In both agecategories, the CI group predominated in subgroups with cardiovasculardisease, with or without prominent gastrointestinal illness. In the youngerage group, patients with CI comprised 46% of a cluster defined by diag-noses of hypertension, hypercholesterolemia, and cardiac disease. In theolder population, CI patients were the predominant group in two clusterslargely defined by cardiac disease but differentiated by the frequency ofsevere gastrointestinal conditions. The IBS patients showed greater repre-sentation in the CI–dominated subgroups than did the controls.Conclusions: Patients with CI tended to occur more frequently in sub-groups with cardiovascular disease suggesting a possible relationship be-tween cardiovascular disease and CI. In addition, a substantial subset ofIBS patients had patterns of medical history that were similar to those ofmany CI patients. Consequently, there may also be a relationship in IBSpatients with patterns of cardiovascular, gastrointestinal, and other diseasestates that resemble those found in CI patients.

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TEGASEROD ALONE OR IN COMBINATION WITHANTIDEPRESSANT DRUGS IS WELL TOLERATED INPATIENTS WITH IBS–CPeter Ruegg, M.D., Martin Lefkowitz, M.D.*, Douglas Drossman, M.D.and Victor Shi, M.D. Clinical Research, Novartis Pharmaceuticals,East Hanover, NJ and Department of Digestive Diseases, University ofNC. School of Medicine, Chapel Hill, NC.

Purpose: Tegaserod (T), a GI serotonin receptor agonist active at the5–HT4 receptor, is effective in the treatment of irritable bowel syndromewith constipation (IBS–C). Low dose antidepressants (ADs), actingthrough 5–HT receptors, have also been used to treat the symptoms of IBS.The safety, tolerability and efficacy of T in a combination with ADs wereanalyzed from pooled phase 3 clinical studies.

S279AJG – September, Suppl., 2002 Abstracts