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Zinc and gastrointestinal disease Sonja Skrovanek, Katherine DiGuilio, Robert Bailey, William Huntington, Ryan Urbas, Barani Mayilvaganan, Giancarlo Mercogliano, and James M Mullin Abstract: This review is a current summary of the role that both zinc deficiency and zinc supplementation can play in the etiology and therapy of a wide range of gastrointestinal diseases. The recent literature describing zinc action on gastrointestinal epithelial tight junctions and epithelial barrier function is described. Zinc enhancement of gastrointestinal epithelial barrier function may figure prominently in its potential therapeutic action in several gastrointestinal diseases. Core tip: This is an overview of the role that both zinc deficiency and zinc supplementation can play in the etiology and therapy of a wide range of gastrointestinal diseases. >> Read full article Articles from World Journal of Gastrointestinal Pathophysiology are provided here courtesy of Baishideng Publishing Group Inc

Hello, I wanted to know if is it normal to have watery diarrhea the days after of having a colonoscopy? And a little discomfort in the anus? I guess the latter is for the tube...

I suffer with extreme bloating, gas feels like bubbling, too much urge and many trips to the bathroom. Can't eat properly due to this problem. Suffering from 24;years, medicines don't help much. I remain stressed

Hi, I am new to this group, but I am wondering if any one has insight. I have had an ongoing issue with what my PCP believes is IBS-D, but I never received a firm diagnosis so now I am seeing a GI. About 10 years ago I had a pretty intense bought with a virus which caused both vomitting and diarrhea for a week straight. Once I recovered, I noticed I had irregular stools. This problem has only gotten more irregular and now is to the point where I only have loose stools and diarrhea with urgency, but no incontinence. I have recently had blood work and stool samples ordered by my GI which to my surprise came back normal - negative for inflammation, cdif, parasite, blood, etc with enzymatic tests coming back normal. My GI advised me to abstain from eating foods with lactose and I have, but I'm still having problems. Due to covid I am highly anxious to go in for an appointment with my GI, but I know an endoscopy is the next step for me. I am wondering if any one might have similar experiences? Thank you

Mice study offers new insight on irritable bowel syndrome Sometimes the end of an intestinal infection is just the beginning of more misery. Of those who contract traveler's diarrhea, for example, an unlucky few go on to develop irritable bowel syndrome (IBS), a chronic inflammation of the intestinal tract. Scientists aren't sure exactly how this happens, but some think an infection may contribute to IBS by damaging the gut nervous system. A new Rockefeller study takes a close look at why neurons in the gut die and how the immune system normally protects them. Conducted with mice, the experiments described recently in Cell offer insight on IBS and could point toward potential new treatment approaches. Keeping inflammation in check In a healthy gut, the immune system must strike a careful balance between responding to threats and keeping that response in check to avoid damage. Full article >> https://www.news-medical.net/news/20200112/Mice-study-offers-new-insight-on-irritable-bowel-syndrome.aspx Source: Rockefeller University Matheis, F., et al. (2020) Adrenergic Signaling in Muscularis Macrophages Limits Infection-Induced Neuronal Loss. Cell. doi.org/10.1016/j.cell.2019.12.002. AZoNetwork, © 2000-2020

I'm a long time sufferer of IBS-D. I have been keeping close tabs on the newest medication to be approved by the FDA for IBS-D, called Viberzi (eluxadoline), and my doctor just prescribed the 100mg tablets for me, twice daily. I was disappointed that the pharmacist was so unfamiliar with the new medication that they failed to mention that you should take Viberzi with meals and that you need to be careful about the amount of alcohol you consume with it. I asked them to look for drug interactions and they correctly found that I may have a problem with Crestor (a statin) while on Viberzi. They asked me to speak with my family doctor about that. I will post my experience as I start to take it. I decided to start with dinner tonight and with only 50mg - half the usual dosage. Why half the dosage? I’m super sensitive to new medications and I was kind of expecting the worst, so I decided to only go with half the dosage so that the side effects would be minimized. Not scientific in the least and this wasn’t recommended by my doctor. Within 45 mins I started to feel a little light headed and dopey. That lasted about 30 mins and then I felt as usual. From then on I haven’t noticed any side effects other than being a touch nauseated.

Medical Management of IBS is Improving With Time Healio Gastroenterology, October 2019 Mark Pimentel, MD In my clinic, it still feels like we get countless referrals for irritable bowel syndrome. We have gained so much knowledge and obtained so many new treatments in our arsenal over the years, but we are still going to need more solutions going forward if we are going to successfully serve all our patients. We need to build on this knowledge and keep making strides to ensure our patients are getting adequate care. Full story >> https://bit.ly/34d7Ziz

Has anyone tried CBD oil for IBS? I've heard it has a calming effect on the whole body so am wondering if it might help IBS symptoms.

Hello all, Haven't visited here in months - mainly because I thought I was over IBS. SO, I ate whatever I wanted, drank lots of coffee, and simply did not take good care of myself. Fast forward: A stressful weekend, and my enemy is back in full force! I am feeling alone and just wanted to connect. As many of you know, most who do not suffer IBS just don't get it, even if they try. I am trying to be positive, but feel pretty awful. I have diarrhea, lower stomach pain, and zero appetite. I am going back on the FODMAP as well as I can, have started my pro-biotics, and am taking my hyoskyamine for intestinal spasms. I am also doing a guided meditation for IBS I found on YouTube. I have always been somewhat overweight, but over the past year after bouts of IBS-d, I have lost weight and have not gained it back. While that's a good thing, I don't want to lose any more. Has anyone experienced this? I have read that weight loss is not a part of IBS, it sure has been for me! Here's to healing and peace for my fellow IBS sufferers! Peggy

Camilleri: Tropifexor (LJN452), a non-bile acid FXR agonist, in patients with primary bile acid diarrhea and secondary its effect on transit time with small study (n=17) - safe, well tolerated,; however an increase in cholesterol was seen Camilleri: Summary of study: further exploration of Tropifexor may be worthwhile for this non-bile acid FXR agonist for functional diarrhea or IBS-D

A Bug's World: The Microbiome in Gastrointestinal Conditions Chair: William Chey, MD, Nostrant professor of gastroenterology & nutrition, University of Michigan Health System Speakers: Mark Pimental, MD, asst professor of medicine & exec director, David Geffen School of Medicine & Cedars-Sinai; Mille Long, MD, associate professor of medicine , University of North Carolina; Brennan Spiegel, MD, professor of medicine & public health director, Cedars-Sinai Health System Supported by Salix Pharmaceutical Altered microbiome leads to 2 gases, CH4 (methane) which leads to constipation and H2S (hydrogen sulphide) which lets to diarrhea Proposed IBS Pathophysiologic Sequence related to altered microbiome

ZAXINE® (rifaximin) - Now Indicated in Canada for Patients with Irritable Bowel Syndrome with Diarrhea (IBS-D) NEWS PROVIDED BY Lupin Pharma Canada Dec 06, 2018, 07:00 ET BSE: 500257 NSE: LUPIN REUTERS: LUPIN.BO BLOOMBERG: LPCIN MONTREAL, Dec. 6, 2018 /PRNewswire/ - Lupin Pharma Canada is pleased to announce the approval from Health Canada for ZAXINE® 550 mg (rifaximin) for the treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults. ZAXINE® for IBS-D is being launched in December of 2018 under a strategic licensing agreement with Salix Pharmaceuticals, Ltd., one of the largest specialty pharmaceutical companies in the world committed to the prevention and treatment of gastrointestinal diseases. The agreement grants Lupin exclusive rights to promote, distribute and market ZAXINE® in Canada. This is in addition to ZAXINE®'s previously approved indication for the reduction in risk of overt hepatic encephalopathy (HE) in adults.1 Canada has one of the highest rates of IBS worldwide, affecting 13-20% of the population.2, 3 Of those who do suffer from IBS, about one third have IBS with diarrhea as the primary symptom. Although the exact cause of IBS-D is not known, scientists believe that the microbiota in the gastrointestinal (GI) tract plays an important role in the development of the symptoms associated with IBS-D, such as abdominal pain, bloating, and diarrhea.1 Speaking on the occasion, Dr. Sofia Mumtaz, President - Pipeline Management & Legal, Lupin said, "We are delighted to receive the approval from Health Canada for ZAXINE® (rifaximin, 550 mg tablets) for the treatment of IBS-D. With this new indication approved, the medical fraternity and patients will now have access to an effective medication against one of the most rampantly prevailing issues of IBS-D." "There is an unmet treatment need for those who have irritable bowel syndrome with diarrhea, so this is great news for those still grappling to manage their digestive symptoms", said Gail Attara, Chief Executive Officer of the Gastrointestinal Society, a patient group known for its popular website, www.badgut.org. The safety and efficacy of ZAXINE® 550 mg three times daily for 2 weeks were demonstrated in 3 Phase-III placebo-controlled trials. After treatment, significantly more ZAXINE®-treated patients experienced self-reported relief of IBS symptoms.1 In addition, a significantly greater proportion of ZAXINE®-treated patients reported relief of abdominal pain and improvement in stool consistency.1, 4 "In irritable bowel syndrome, it is not always easy to manage the symptoms effectively," said Dr. Guy Aumais, MD, CSPQ, FRCP (C), Gastroenterologist at Maisonneuve-Rosemont and Associate Professor, University of Montreal. He further added, "ZAXINE® is a short-term, two-week therapy for IBS-D, which will act on symptoms such as diarrhea, bloating and abdominal pain, with lasting relief. With this indication, we now have an interesting new option in the management of IBS-D." "An alteration in host-microbiota interactions is a factor in the expression of subsets of IBS patients. ZAXINE® has been shown to improve symptoms in diarrhea predominant IBS-D and its action is likely mediated through attenuation of host microbiota interactions and subsequent symptom generation. This is an important new treatment option for IBS-D patients", said Dr. Stephen Collins MBBS, FRCP (UK), FRCPC, Professor, Department of Medicine at McMaster University. ABOUT ZAXINE® (RIFAXIMIN) ZAXINE® (rifaximin)'s primary mode of action reduces the bacterial load and bacterial products that can negatively affect the patient, alleviating the most common symptoms of IBS-D including bloating, abdominal pain and diarrhea.1 As an antibacterial agent that acts locally on the microflora of the gut thereby altering the gut microbiota, ZAXINE® represents an important new therapeutic option in the treatment of IBS-D. About Lupin Limited Lupin is an innovation led transnational pharmaceutical company developing and delivering a wide range of branded & generic formulations, biotechnology products and APIs globally. The Company is a significant player in the Cardiovascular, Diabetology, Asthma, Pediatric, CNS, GI, Anti-Infective and NSAID space and holds global leadership position in the Anti-TB segment. Lupin is the 13th largest generics pharmaceutical company in terms of market capitalization (30th September 2018, Bloomberg) and the 8th largest generics pharmaceutical company in terms of revenues (30th June 2018, Bloomberg LTM) globally. The Company is the 3rd largest pharmaceutical player in the US by prescriptions for the Total Market (IQVIA MAT September 2018); 3rd largest Indian pharmaceutical company by global revenues (30th June 2018, Bloomberg LTM); 6th largest generic pharmaceutical player in Japan (IQVIA MAT September 2018) and 5th largest company in the Indian Pharmaceutical Market (IQVIA MAT September 2018). For the financial year ended 31st March 2018, Lupin's Consolidated sales and Net profits before exceptional items were at Rs. 155,598 million (USD 2.41 billion) and Rs. 13,934 million (USD 216 million) respectively. Please visit http://www.lupin.com for more information. You could also follow us on Twitter – www.twitter.com/lupinglobal. CIN: L24100MH1983PLC029442 Registered Office: Lupin Ltd, 3rd Floor, Kalpataru Inspire, Off Western Express Highway, Santacruz (East), Mumbai 400 055. ZAXINE® (rifaximin) is manufactured by: Salix Pharmaceuticals, Inc. 400 Somerset Corporate Boulevard Bridgewater, NJ 08807 USA In Canada, ZAXINE® (rifaximin) is distributed exclusively by: Lupin Pharma Canada Ltd 1001 Bd. De Maisonneuve East Suite 304, Montréal, Québec H2L 4P9 Canada References: ZAXINE® Product Monograph. Salix Pharmaceuticals, Inc., November 30, 2018. http://cdhf.ca/en/disorders/irritable-bowel-syndrome-ibs/section/resources https://www.badgut.org/information-centre/a-z-digestive-topics/ibs/ Pimentel M, Lembo A, Chey WD et al. Rifaximin Therapy for Patients with Irritable Bowel Syndrome without Constipation. N Engl J Med 2011; 364:22-32. SOURCE Lupin Pharma Canada Related Links http://www.lupin.com

If you have diarrhea symptoms, when do you take an anti-diarrheal such as imodium? At first go? After 5 BM's? Never?

Sebela Pharmaceuticals Inc. is pleased to announce that Motofen® is now available in pharmacies nationwide. Please check with your local pharmacy for availability. For more information on Motofen, please visit motofen.com. Important Safety Information INDICATIONS AND USAGE Motofen® (difenoxin and atropine sulfate tablets) is indicated as adjunctive therapy in the management of acute nonspecific diarrhea and acute exacerbations of chronic functional diarrhea. CONTRAINDICATIONS Motofen® is contraindicated in patients with diarrhea associated with organisms that penetrate the intestinal mucosa (toxigenic E. coli, Salmonella species, Shigella) and pseudomembranous colitis associated with broad spectrum antibiotics. Motofen® is also contraindicated in children under 2 years of age, in patients with known hypersensitivity to difenoxin, atropine, or any of the inactive ingredients, and in patients who are jaundiced. WARNINGS Motofen® is not an innocuous drug and dosage recommendations should be strictly adhered to. Accidental overdose may result in severe respiratory depression and coma, possibly leading to permanent brain damage or death. The use of Motofen® does not preclude the administration of appropriate fluid and electrolyte therapy. Dehydration, particularly in children, may further influence the variability of response to Motofen® and may predispose to delayed difenoxin intoxication. Drug-induced inhibition of peristalsis may result in fluid retention in the colon, and this may further aggravate dehydration and electrolyte imbalance. Use with caution in patients with ulcerative colitis or liver or kidney disease. Motofen® may produce drowsiness or dizziness. Use caution when engaging in activities requiring mental alertness, such as driving or operating dangerous machinery. Keep out of reach of children. Please see full Prescribing Information at www.motofen.com.

Motofen is coming soon in the US! Great news for people who were waiting for Motofen to return to the market for IBS-D and non-specific D. I just received a note from the Pharma who makes it: Sebela Pharmaceuticals Inc. is pleased to announce that the FDA has approved the reintroduction of Motofen® to the market. We are working closely with pharmacies nationwide to make sure Motofen is easily available. We anticipate full availability in late June or early July and will update you at that time. More info on Motofen here, http://www.motofen.com

A new update about the medication Motofen (http://www.motofen.com) for diarrhea was recently sent to me:

Statins have been shown to affect the gut microbiome. I take a low dose statin for my kidney disease. A possible side affect is diarrhea. However, I am lucky and do not get that. I reversed my IBS-D in April, 2015 and am still doing fine. We perturb our gut microbiome in many ways. Here is some research on statins. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5550934/ btw Jeffery, what do you think of the human microbiome ?

Research study: A Pilot Study to Evaluate Fecal Microbiota Transplantation in Irritable Bowel Syndrome Location: Boston, Massachusetts Inclusion Criteria: IBS with diarrhea The study is to evaluate whether we can change the microbiome of individuals with IBS using a healthy donor. We then would like to see whether if we are able to change the microbiome, if there's a resulting improvement in symptoms. We randomize people to receive either a fecal transplant or a placebo fecal transplant. People are also receiving an antibiotic either rifaximin, a combination of Cipro/flagyl or no antibiotic as a pre-treatment. The capsule form of fecal matter transplant (FMT) is being used. Contact: Vivian Cheng 617.667.0682 vcheng2@bidmc.harvard.edu Principal Investigator: Anthony Lembo, MD, Beth Israel Deaconess Medical Center More clinical trials listed here: https://www.ibspatient.org/clinical-trials

Hi Jeffrey, I've read that statins can affect the gut microbiome, so this is worth considering. I have to take lovastatin for my kidney disease. But, I try to take the least amount possible, while achieving acceptable test results. We're only just beginning to understand that many products, medications, etc. affect the microbiome. How can we expect the best results to improve our microbiomes, if we still continue to perturb them with additives in our food, or other products ? Have you ever considered treatment at the Centre for Digestive Diseases in Australia ? I've read in "10% Human" by Alanna Collen that Dr. Borody is reversing IBS-D with an 80% success rate. So, have you considered this option ? It seems that he is more successful than others and may have a better technique. Lately, I've been experimenting with periods of fasting and then consumption of a variety of fresh fruits and fresh vegetables, in the hopes of reducing my need for sleep. I still haven't decided if it is helping. The reasons for this are; 1. We know that the microbiome responds rapidly to changes in our diet. 2. We know that we can get new bacteria from our food. 3. Bacteria have short life spans. So, the reasoning is; to starve out the existing population and hopefully introduce new species and promote the growth of our beneficial species. If one can tolerate them, prebiotic foods should definitely be considered and included in this approach, which I am also incorporating. I don't expect immediate results and am hoping that over time with this approach that I can improve my microbiome population and improve my need for sleep. Time will tell.

Recorded Webcast of a symposium for gastroenterologists about improving outcomes for IBS-D patients. Originally presented at DDW 2017. The information may be technical; however, I believe it will be well understood by many. Click to view the webcast at the bottom of the posting. Click to view the webcast

At Digestive Disease Week (DDW) in Chicago, I met with the new pharmaceutical (Sebela Pharmaceuticals) that will be marketing Motofen. Motofen is primarily used as an anti-diarrheal medication and has been on/off the market since 1978. Motofen contains difenoxin and is considered a Schedule IV medication which means it is unlikely to be habit forming; however, it needs to be managed very closely. Atropine is added to help the drug not become habit forming. The drug was recently acquired by Sebela and they are in the imminent process of marketing it. For some, this medication will work similar to Lomotil. You can read more about Motofen on its website, http://www.motofen.com