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Think Twice Before IBS Antibiotic

By Sara Calabro

What does irritable bowel syndrome have in common with ear infections and sore throats? All three now represent tempting opportunities for doctors to unnecessarily—and often dangerously—put people on antibiotics.

New research, published last week in The New England Journal of Medicine, shows that a two-week course of antibiotics helped IBS symptoms in 41 percent of patients. Although the findings are neither impressive (30 percent got better with placebo), comprehensive (patients with constipation were not included), nor unbiased (the studies were sponsored by Salix Pharmaceuticals, the drug’s maker), they provide doctors, finally, with something to offer patients.

IBS has proven especially tough for mainstream medicine to gets its arms around. Stress is known to play a significant role, leading many doctors to prescribe anxiety or depression drugs, but a clear physiological explanation remains elusive within biomedical parameters.

Acupuncture, because it considers the interdependent relationships of anatomical structures and how they’re affected by emotional and environmental factors, is a more sensible approach than medication for IBS.

The Problem With IBS Medications

Given the complicated nature of IBS, it’s not surprising that medications, which work by targeting isolated structures within the body, have so far been a bust.

Zelnorm, a popular IBS drug for people who tended toward constipation, was pulled from the market in 2007 because it was shown to increase risk of stroke and heart attack. Lotronex, given to people whose IBS mostly involves diarrhea, is known to cause serious side effects such as colitis and severe constipation.

The fact that these medications—as well as rifaximin, the antibiotic used in the NEJM studies—treat constipation or diarrhea is problematic.

Many people with IBS suffer from both constipation and diarrhea, an alternating of the two. It’s an issue of regulation, or lack thereof. Even in people who tend toward one or the other, completely shutting down or revving up the bowel won’t solve the larger imbalance that’s causing symptoms in the first place.

Acupuncture for IBS

Acupuncture works differently than medications in that its effects are dictated by the person receiving the treatment.

For example, ST25, a common acupuncture point for digestive disorders, is used for both constipation and diarrhea. In a person with constipation, ST25 activates the bowel, while in someone with diarrhea, it slows things down.

Medications force the body toward a particular outcome, usually by either adding or taking something away—the NEJM study, for example, was based on the idea is that IBS symptoms are caused by an overgrowth of bacteria in the small intestine; by killing that bacteria, you kill the symptoms. In contrast, acupuncture gets the body’s existing components working more smoothly.

One way it does this is by calming the sympathetic nervous system. Stress, in biomedical and acupuncture circles alike, is an established component of IBS. According to Hans Selye’s General Adaptation theory, our bodies react to long-term stress by developing patterns, or diseases, of adaptation. These can be anything from IBS to insomnia to back pain. Acupuncture helps modulate our natural stress response, thereby decreasing the “need” to develop adaptation patterns/diseases.

But even once a pattern has developed, acupuncture is still a better bet than meds.

Chronic stress—emotional as well as physical stress, such as too many sit-up exercises—can lead to trigger points in the abdominal muscles. While trigger points are traditionally thought of in relation to pain, they also can cause visceral symptoms such as constipation, diarrhea and others that are characteristic of IBS. When indicated, trigger-point acupuncture can resolve many of these problems.

According to NPR, rifaximin has limited side effects because it stays in the gut and doesn’t enter the bloodstream the way other antibiotics do. But PubMed lists the following as potential side effects: hives; skin rashes; itching; difficulty breathing or swallowing; swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs; hoarseness; fever, chills, sore throat, and other signs of infection. Not to mention the potential long-term repercussions of killing off all bacteria, good and bad, in a part of the body whose function is dependent on a healthy bacterial balance.

Even more troubling than the risk of side effects may be mainstream medicine’s tendency to overuse antibiotics.

Since rifaximin is already approved for travelers’ diarrhea, it’s available now for doctors to prescribe off-label for IBS. But the two-week course of treatment is pricey, about $900. These recent studies allow Salix to apply for FDA approval for the IBS indication. If that comes through, insurance companies are more likely to cover it and doctors are more likely to prescribe it.

The two-week regimen produced sustained improvement in some patients throughout all 12 weeks of the NEJM studies. The paper’s authors say this suggests that “rifaximin is affecting an underlying cause of IBS” rather than just treating symptoms. That may prove to be true for some patients, however, significantly more research, plus long-term followup studies, are needed to confirm it.

Antibiotic resistance is already a problem of significant magnitude. Until we know more about rifaximin for IBS, acupuncture as a first-line therapy is a safe and comprehensive way to effectively address this multifaceted condition.

Photo by Sara Calabro

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