IBS And Restless Legs Syndrome Linked

Found this article on Medpage Today: http://www.medpagetoday.com/tbprint2.cf ... opicid=174

IBS And Restless Legs Syndrome Linked

By Jeff Minerd, Contributing Writer, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
May 24, 2007

Review
WASHINGTON, May 24 -- Bacterial overgrowth in the gut, a factor in irritable bowel syndrome, may also be at work in restless legs syndrome and antibiotics can help both conditions, one small study suggests.

In 13 patients suffering from both conditions, all saw improvement in IBS symptoms and 10 found marked relief from restless legs symptoms after a 10-day course of antibiotics, said Leonard Weinstock, M.D., of Washington University in St. Louis.

Dr. Weinstock hypothesized a connection between IBS and restless legs syndrome when his cousin came down with both conditions after contracting a case of travelers' diarrhea, Dr. Weinstock told attendees at Digestive Disease Week here.

He said he'd also heard reports of IBS being linked with fibromyalgia, which in turn has been linked with restless legs syndrome. He hypothesized that bacterial overgrowth in the gut could be causing the problems and that antibiotic therapy targeting the small intestine might be the solution.

He tested his idea in a pilot study during which participants received a 10-day course of rifaximin (1,200 mg/day), which specifically destroys bacterial overgrowth in the small intestine. This short-term antibiotic therapy was followed by long-term tegaserod, and a one-month course of zinc and probiotic therapy, Dr. Weinstock said. The patients were followed for an average of 107 days.

Results became apparent, however, by day 11, he said. Abdominal pain improved by 74%, diarrhea by 73%, bloating by 70%, constipation by 64%, and flatulence by 47% from baseline. These improvements were maintained long-term, the study found.

Overall, IBS symptoms were rated as greatly improved by six patients, moderately improved by five, and mildly improved by two.

Restless legs syndrome symptoms improved as well: 10 of the 13 patients experienced an 80% improvement or greater from baseline after the antibiotic treatment. Five of them achieved and maintained 100% improvement in symptoms, Dr. Weinstock said.

Previous studies have shown that bacterial overgrowth in the small intestine causes inflammatory cells to increase production of IL-6, he noted. This cytokine, in turn, is known to boost levels of hepcidin, a protein that decreases iron absorption and transport. Because iron deficiency has been linked with restless legs syndrome, this process could account for the apparent link between IBS and restless legs, Dr. Weinstock speculated.

"Comprehensive bacterial overgrowth therapy may provide long-term improvement in symptoms of both IBS and restless legs syndrome, and further research on extra-gastrointestinal manifestations of bacterial overgrowth are warranted," Dr. Weinstock said.

"Our study provides the basis for a potential curative treatment for some patients, whereas current therapies only partially alleviate symptoms," he noted.

Dr. Weinstock and colleagues are undertaking a multi-center study with more than 600 patients to see if the pilot study results hold up.

The current study was supported by Salix pharmaceuticals, marketer of rifaximin. Dr. Weinstock is a consultant and speaker for Salix and has received grant/research support from the company. He is also a speaker for Novartis Pharmaceuticals.

Primary source: Digestive Disease Week
Source reference:
Leonard Weinstock et al. "Restless leg syndrome in patients with irritable bowel syndrome: response to bacterial overgrowth therapy." Abstract M2140. Presented at Digestive Disease Week 2007, Washington, D.C., May 19-21.

Disclaimer
The information presented in this activity is that of the authors and does not necessarily represent the views of the University of Pennsylvania School of Medicine, MedPage Today, and the commercial supporter. Specific medicines discussed in this activity may not yet be approved by the FDA for the use as indicated by the writer or reviewer. Before prescribing any medication, we advise you to review the complete prescribing information, including indications, contraindications, warnings, precautions, and adverse effects. Specific patient care decisions are the responsibility of the healthcare professional caring for the patient. Please review our Terms of Use.
© 2004-2006 MedPage Today, LLC. All Rights Reserved.

this message brought to you by the antibiotic pharmaceuticals manufacturers association, a division of Phillip Morris (cough, cough, cough)

The current study was supported by Salix pharmaceuticals, marketer of rifaximin. Dr. Weinstock is a consultant and speaker for Salix and has received grant/research support from the company. He is also a speaker for Novartis Pharmaceuticals.

hey I hope there is an association, but when the study of little red riding hood was conducted by the big bad wolf you have to wonder about the outcome.

Yes, one does have to be cautious about who sponsors a study. However, I find this one interesting due to my own recent experiences. Over the past several months I have been very ill following heart valve surgery. These various illnesses required many weeks of IV antibiotic therapy and also some transfusions.

Although initially my RLS was worsened.....after the antibiotics and the transfusions it is better than it has been in years (although not gone entirely and thus I am up at 4:00 am). So I have to wonder if there could in fact be a connection.....the transfusions may have also helped in raising my blood counts.

So, interesting possibilities!

I have both of these and do find this interesting, although I've never noticed a difference in either when on antibiotics for other things. Maybe it has to be in a stronger dose than you would normally take.

I have gluten sensitivity and have been reading about it. For many people who have IBS, their condition disappears on a gluten free diet. If I had IBS, I'd for sure want to be tested for gluten intolerance. If the doctor refuses to test for gluten (likely), the person could try a gluten free diet to see if the IBS disappears.

Here's a page with some articles about the link between GS andIBS.

http://jccglutenfree.googlepages.com/crohn's,ibd,ibs

A couple of books my allergy doc recommended to start is "Dangerous Grains" and "Gluten Free Living for Dummies."

(If you think the medical-industrial complex missed the boat when it came to SDB, you'll recognize all the signs when you try to get dx'd with gluten sensitivity, which is not the same as celiac disease. All celiacs are gluten sensitive, but GS can take other forms as well).

ETA: I just remembered that there's another link between Fibromyalgia and GS. Here's another link.

http://jccglutenfree.googlepages.com/fi ... uesyndrome

Tegaserod is the generic for Zelnorm which was removed from the market in March 2007. It is interesting that this article was published in May, two months after this drug was removed from the market and one of the authors works for the pharmacuetical company that manufactured it. Here is some additional info from ePocrates:

Manufacturer: Novartis Pharmaceuticals
Metabolism: stomach, liver; CYP450: none
Excretion: feces 67% (unchanged), urine 33%; Half-life: 11h
Class: Constipation Other Gastrointestinals
Mechanism Of Action: binds to 5-HT4 receptors, stimulating GI peristalsis and decreasing visceral sensitivity

What is tegaserod?
Tegaserod increases the action of serotonin (a body chemical) in the intestines. This speeds the movement of stools (bowel movements) through the bowels.

Tegaserod is used to treat severe, chronic, irritable bowel syndrome (IBS) in women who have constipation as their main bowel problem (constipation-predominant). It is also used to treat chronic idiopathic constipation in patients less than 65 years of age. Tegaserod has not been shown to be helpful for men with irritable bowel syndrome.

Here is some info on the antibiotic mentioned in the article:

What is rifaximin?

Rifaximin is a non-systemic (does not get into bloodstream) antibiotic used to treat diarrhea caused by eating food or drinking fluids that have been contaminated with germs called bacteria.

When you swallow rifaximin, the drug passes into and remains almost entirely, in your gut and gastrointestinal tract. This differs from how other antibiotics work. Other antibiotics typically pass from the gastrointestinal tract into the bloodstream. Because rifaximin remains in the gastrointestinal tract, it is not suitable for treating other infections such as chest, sinus, or lung infections caused by bacteria.

Some forms or diarrhea may be caused by viruses and not bacteria. Rifaximin, like all antibiotics, does not kill viruses. You should contact your doctor or healthcare provider if you think your condition is getting worse or not improving after 24 to 48 hours (1 to 2 days) while taking rifaximin.

Rifaximin may also be used for purposes other than those listed in this medication guide

Manufacturer: Salix Pharmaceuticals
Approximate Retail Price from http://www.drugstore.com:
Tablet: 200 mg (30 ea): $125.01

I am not sure what function the Zinc serves but the probiotic will restore the normal bacteria in the GI tract. You can get a severe form of diarrhea caused by antibiotics called Clostridium Difficile which may explain the probiotics.