Hypertension

Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the blood pressure is chronically elevated. In current usage, the word "hypertension"^[ without a qualifier normally refers to arterial hypertension.

Hypertension can be classified either essential (primary) or secondary. Essential hypertension indicates that no specific medical cause can be found to explain a patient's condition. Secondary hypertension indicates that the high blood pressure is a result of (i.e., secondary to) another condition, such as kidney disease or tumours (pheochromocytoma and paraganglioma).

In individuals older than 50 years, hypertension is considered to be present when a person's systolic blood pressure is consistently 140 mm Hg or greater. Beginning at a systolic pressure of 115 and diastolic pressure of 75 (commonly written as 115/75 mm Hg), cardiovascular diseasePrehypertension is defined as blood pressure from 120/80 mm Hg to 139/89 mm Hg. Prehypertension is not a disease category; rather, it is a designation chosen to identify individuals at high risk of developing hypertension.Mayo Clinic specifies blood pressure is "normal if it's below 120/80". Patients with blood pressures over 130/80 mm Hg along with Type 1 or Type 2 diabetes, or kidney disease require further treatment.

(CVD) risk doubles for each increment of 20/10 mmHg. The

Distinguishing primary vs. secondary hypertension

Once the diagnosis of hypertension has been made it is important to attempt to exclude or identify reversible (secondary) causes.

• Over 91% of adult hypertension has no clear cause and is therefore called essential/primary hypertension. Often, it is part of the metabolic "syndrome X" in patients with insulin resistance: it occurs in combination with diabetes mellitus (type 2), combined hyperlipidemia and central obesity.
• Secondary hypertension is more common in preadolescent children, with most cases caused by renal disease. Primary or essential hypertension is more common in adolescents and has multiple risk factors, including obesity and a family history of hypertension.

Investigations commonly performed in newly diagnosed hypertension

Tests are undertaken to identify possible causes of secondary hypertension, and seek evidence for end-organ damage to the heart itself or the eyes (retina) and kidneys. Diabetes and raised cholesterol levels being additional risk factors for the development of cardiovascular disease are also tested for as they will also require management.

Blood tests commonly performed :

• Creatinine (renal function) - to identify both underlying renal disease as a cause of hypertension and conversely hypertension causing onset of kidney damage. Also a baseline for later monitoring the possible side-effects of certain antihypertensive drugs.
• Electrolytes (sodium, potassium)
• Glucose - to identify diabetes mellitus
• Cholesterol

Additional tests often include:

• Testing of urine samples for proteinuria - again to pick up underlying kidney disease or evidence of hypertensive renal damage.
• Electrocardiogram (EKG/ECG) - for evidence of the heart being under strain from working against a high blood pressure. Also may show resulting thickening of the heart muscle (left ventricular hypertrophy) or of the occurrence of previous silent cardiac disease (either subtle electrical conduction disruption or even a myocardial infarction).
• Chest X-ray - again for signs of cardiac enlargement or evidence of cardiac failure.

Prevention

Drug-free Treatment of Hypertension

Lifestyle modification (nonpharmacologic treatment)

• Weight reduction and regular aerobic exercise (e.g., jogging) are recommended as the first steps in treating mild to moderate hypertension. Regular mild exercise improves blood flow and helps to reduce resting heart rate and blood pressure. These steps are highly effective in reducing blood pressure, although drug therapy is still necessary for many patients with moderate or severe hypertension to bring their blood pressure down to a safe level.
• Reducing dietary sugar intake
• Reducing sodium (salt) in the diet may be effective: it decreases blood pressure in about 33 percent of people (see above). Many people choose to use a salt substitute to reduce their salt intake.
• Additional dietary changes beneficial to reducing blood pressure includes the DASH dietdietary approaches to stop hypertension), which is rich in fruits and vegetables and low fat or fat-free dairy foods. This diet is shown effective based on research sponsored by the US National Institutes of Health. In addition, an increase in daily calcium intake has the benefit of increasing dietary potassium, which theoretically can offset the effect of sodium and act on the kidney to decrease blood pressure. This has also been shown to be highly effective in reducing blood pressure. (
• Discontinuing tobacco use and alcohol consumption has been shown to lower blood pressure. The exact mechanisms are not fully understood, but blood pressure (especially systolic) always transiently increases following alcohol and/or nicotine consumption. Besides, abstention from cigarette smoking is important for people with hypertension because it reduces the risk of many dangerous outcomes of hypertension, such as stroke and heart attack. Note that coffee drinking (caffeine ingestion) also increases blood pressure transiently, but does not produce chronic hypertension.
• Reducing stress, for example with relaxation therapy, such as meditation and other mindbody relaxation techniques, by reducing environmental stress such as high sound levels and over-illumination can be an additional method of ameliorating hypertension. Jacobson's Progressive Muscle Relaxation and biofeedback are also used, particularly, device-guided paced breathing, although meta-analysis suggests it is not effective unless combined with other relaxation techniques.

The aim of treatment should be blood pressure control to <140/90 style="text-decoration: underline;"> Each added drug may reduce the systolic blood pressure by 5-10 mmHg, so often multiple drugs are necessary to achieve blood pressure control.

Commonly used drugs :

• ACE inhibitors such as creatine captopril, enalapril, fosinopril (Monopril), lisinoprilquinapril, ramipril (Altace) (Zestril),
• Angiotensin II receptor antagonists: eg, telmisartan (Micardis, Pritor), irbesartanlosartan (Cozaar), valsartan (Diovan), candesartan (Amias) (Avapro),
• Alpha blockers such as prazosin, or terazosin. Doxazosin has been shown to increase risk of heart failure, and to be less effective than a simple diuretic^[29], so is not recommended.
• Beta blockers such as atenolol, labetalol, metoprolol (Lopressor, Toprol-XL), propranolol.
• Calcium channel blockers such as nifedipine (Adalat)^[30] amlodipine (Norvasc), diltiazem, verapamil
• Direct renin inhibitors such as aliskiren (Tekturna)
• Diuretics: eg, bendroflumethiazide, chlortalidone, hydrochlorothiazide (also called HCTZ)
• Combination products (which usually contain HCTZ and one other drug)

Complications

While elevated blood pressure alone is not an illness, it often requires treatment due to its short- and long-term effects on many organs. The risk is increased for:

• Cerebrovascular accident (CVAs or strokes)
• Myocardial infarction (heart attack)
• Hypertensive cardiomyopathy (heart failure due to chronically high blood pressure)
• Hypertensive retinopathy - damage to the retina
• Hypertensive nephropathy - chronic renal failure due to chronically high blood pressure
• Hypertensive encephalopathy - confusion, headache , convulsion due to vasogenic edema in brain due to high blood pressure.

Acinetobacter does not usually pose a threat to healthy people

Hospitals need to be vigilant against an emerging drug-resistant bacterium Acinetobacter baumannii, infection control experts have warned.

Like MRSA and Clostridium difficile, the bacterium poses the greatest risk to seriously ill patients.

Rates of resistance to antibiotics that halt the bug currently stand at 30%, Lancet Infectious Diseases reports.

The journal report authors said the infection was a growing public health worry across the world.

Measures in the UK to control MRSA and other "hospital-acquired infections" should also bring down Acinetobacter rates, experts said.

It is important that Trusts remain vigilant in their treatment of this and all healthcare associated infections A spokeswoman for the Health Protection Agency

Acinetobacter shares many of the "superbug" properties of MRSA and Clostridium difficile, such as survival on surfaces and resistance to disinfectants. This makes it difficult to eradicate from wards once it is there, experts say.

Typically, the bacterium causes bloodstream infections, pneumonia or infection of a wound.

It can be carried on the skin of healthy people and can be passed to patients by poor hand hygiene.

It also survives in dust and on objects such as bedding for months, making rigorous cleaning of wards essential to control its spread.

The strains of Acinetobacter that are resistant to standard treatments can be treated with other antibiotics, however, and the bug does not usually pose a threat to healthy people.

Vigilance

Strict hygiene compliance and more thorough research into drug choice, especially those for multidrug-resistant Acinetobacter baumannii, are vital to prevent major outbreaks, say the report authors Professor Matthew Falagas and Dr Drosos Karageorgopoulos, of the Alfa Institute of Biomedical Sciences in Athens, Greece.

In the UK, the numbers of Acinetobacter bloodstream infections reported to the Health Protection Agency via its voluntary surveillance scheme increased by 5.4% between 2003 and 2007 to 1,187 reports.

We mustn't be complacent but currently its impact can be geographically constrained Dr Andrew Berrington, a consultant microbiologist at Sunderland Royal Hospital

But the HPA says this increase could be due to increased awareness and reporting rather than a true rise in infection rates.

A spokeswoman for the Health Protection Agency said: "Acinetobacter can cause problems in those who are already seriously ill with weakened immune systems.

"Although we do see some outbreaks of this infection in the UK, numbers of cases are fortunately small.

"Transmission of this infection can be reduced by careful attention to infection control procedures such as cohort nursing groups, hand hygiene and environmental cleaning. It is important that trusts remain vigilant in their treatment of this and all healthcare associated infections."

She said the HPA had no plans to make the reporting of cases mandatory, largely because it is not deemed to be as great a threat as the notifiable hospital-acquired infections such as MRSA and C.difficile.

Professor Richard James, director of the Centre for Healthcare Associated Infections at Nottingham University, said: "If we could overnight solve the problems of hospital infections caused by C.difficile and MRSA then there are other potential superbugs like Acinetobacter baumannii lying in wait.

"Hospitals are full of sick patients and very fit bacteria that will spread from patient to patient unless infection control measures are up to the challenge.

"Acinetobacter baumannii, multidrug resistant tuberculosis (MDR-TB) and extremely drug resistant tuberculosis (XDR-TB) are examples of new threats to public health that are already causing serious problems in other countries."

Dr Andrew Berrington, a consultant microbiologist at Sunderland Royal Hospital, said there was little evidence to suggest outbreaks of Acinetobacter were becoming more common in the UK.

"We mustn't be complacent but currently its impact can be geographically constrained - some hospitals struggle to control outbreaks, others see very little of it."

Young people are particularly vulnerable

Tooth decay, known technically as dental caries, is one of the most common health complaints in the world.

It is particularly common in children and young adults, and rates have been fuelled by an increase in sugars in the diet, and poor dental hygiene.

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What causes tooth decay?

The problem is caused by sticky deposits called plaque that collect, in particular, around the gum line, the edges of fillings and the grooved surfaces of the teeth.

Plaque is made up of food debris, saliva and the bacteria that are normally present in the mouth, and convert food into acids.

If plaque is allowed to collect over time it will harden into a substance called tartar.

Both tartar and plaque contain acids which, over time, can dissolve away the protective, hard enamel coating of the tooth, and create holes, or cavities.

Most cavities form over a period of months, or even years.

They are usually painless, but they can grow very large, and damage the much softer internal structures of the tooth such as the dentin and the pulp, which is found at the core.

If they remain untreated, they can kill the nerve and blood vessels of the tooth, and ultimately the tooth itself.

What are the symptoms?

The most obvious sign of tooth decay is toothache, particularly after hot or cold foods or drinks. However, pain may not be present until decay has reached an advanced stage.

Pits or holes may also be visible in the teeth.

Most tooth decay is discovered at an early stage during a routine check up.

A serious complication can be the development of a tooth abscess - the build up of pus resulting from a bacterial infection of the centre of the tooth.

Infection may spread out from the root of the tooth and to the bones supporting the tooth.

Plaque and tartar also irritate the gums, and lead to a gum disease called gingivitis.

Is diet a factor?

Yes. Eating a diet rich in sugar and starch increases the risk of tooth decay, and sticky foods can be a particular problem because they are more likely to remain on the surface of the teeth.

Frequent snacking also increases the amount of time that acids are in contact with the teeth.

In the absence of good oral hygiene, it doesn't take long for damage to begin. The acids generated by the breakdown of food stuff in the mouth can begin to attack the tooth enamel within 20 minutes of a meal.

It is thought that tooth decay only became a widespread problem with the establishment of sugar plantations in the 18th century, and worsened with the subsequent widespread cultivation of sugar beet in Europe .

How do you prevent decay?

The best way to keep your teeth in health condition is to ensure that you clean them regularly to get rid of any plaque build up.

Most dentists recommend that you clean your teeth at least twice a day. Using a toothpaste containing fluoride is probably a good idea as this provides the teeth with added protection from the effects of acid.

Flossing between the teeth is also a good idea, as is rinsing out your mouth after eating sticky foods.

It is also important to have a regular check up at the dentist - most suggest once every six months to a year.

Unfortunately, even good oral hygiene does not prevent decay as the bacteria congregate in areas inaccessible to brushes and floss.

How is decay treated?

Once the structure of a tooth has been damaged by decay, there is no way to repair it.

However, if decay is picked up at an early stage its progression can be blocked.

Decayed material can be removed, and replaced with a restorative material such as silver alloy, or plastic. This is known as a filling.

If the decay is more extensive, then another option is a crown. The decayed or weakened area is removed and repaired and a covering jacket - the crown - is fitted over the remainder of the tooth.

If the nerve in a tooth has died, either from decay or a blow, then a dentist will consider root canal work.

This involves removing the centre of the tooth, including the nerve and blood vessel tissue.

The root is then filled with a sealing material, and the process is completed with either filling, and possibly a crown।

Prevention

Oral hygiene

Personal hygiene care consists of proper brushing and flossing daily. The purpose of oral hygiene is to minimize any etiologic agents of disease in the mouth. The primary focus of brushing and flossing is to remove and prevent the formation of plaque. Plaque consists mostly of bacteria. As the amount of bacterial plaque increases, the tooth is more vulnerable to dental caries. A toothbrush can be used to remove plaque on most surfaces of the teeth except for areas between teeth. When used correctly, dental floss removes plaque from areas which could otherwise develop proximal caries. Other adjunct hygiene aids include interdental brushes, water picks, and mouthwashes.

Professional hygiene care consists of regular dental examinations and cleanings. Sometimes, complete plaque removal is difficult, and a dentist or dental hygienist may be needed. Along with oral hygiene, radiographs may be taken at dental visits to detect possible dental caries development in high risk areas of the mouth.

Dietary modification

For dental health, the frequency of sugar intake is more important than the amount of sugar consumed. In the presence of sugar and other carbohydrates, bacteria in the mouth produce acids which can demineralize enamel, dentin, and cementum. The more frequently teeth are exposed to this environment, the more likely dental caries are to occur. Therefore, minimizing snacking is recommended, since snacking creates a continual supply of nutrition for acid-creating bacteria in the mouth. Also, chewy and sticky foods (such as dried fruit or candy) tend to adhere to teeth longer, and consequently are best eaten as part of a meal. Brushing the teeth after meals is recommended. For children, the American Dental Association and the European Academy of Paediatric Dentistry recommend limiting the frequency of consumption of drinks with sugar, and not giving baby bottles to infants during sleep. Mothers are also recommended to avoid sharing utensils and cups with their infants to prevent transferring bacteria from the mother's mouth.

It has been found that milk and certain kinds of cheese like cheddar can help counter tooth decay if eaten soon after the consumption of foods potentially harmful to teeth., chewing gum containing xylitol (wood sugar) is widely used to protect teeth in some countries, being especially popular in the Finnish candy industry. Xylitol's effect on reducing plaque is probably due to bacteria's inability to utilize it like other sugars. Chewing and stimulation of flavour receptors on the tongue are also known to increase the production and release of saliva, which contains natural buffers to prevent the lowering of pH in the mouth to the point where enamel may become demineralised।

Other preventive measures

The use of dental sealants is a means of prevention. A sealant is a thin plastic-like coating applied to the chewing surfaces of the molars. This coating prevents the accumulation of plaque in the deep grooves and thus prevents the formation of pit and fissure caries, the most common form of dental caries. Sealants are usually applied on the teeth of children, shortly after the molars erupt. Older people may also benefit from the use of tooth sealants, but their dental history and likelihood of caries formation are usually taken into consideration.

Fluoride therapy is often recommended to protect against dental caries. It has been demonstrated that water fluoridation and fluoride supplements decrease the incidence of dental caries. Fluoride helps prevent decay of a tooth by binding to the hydroxyapatite crystals in enamel. The incorporated fluoride makes enamel more resistant to demineralization and, thus, resistant to decay. Topical fluoride is also recommended to protect the surface of the teeth. This may include a fluoride toothpaste or mouthwash. Many dentists include application of topical fluoride solutions as part of routine visits.

Furthermore, recent research shows that low intensity laser radiation of argon ion lasers may prevent the susceptibility for enamel caries and white spot lesions. Also, as bacteria are a major factor contributing to poor oral health, there is currently research to find a vaccine for dental caries. As of 2004, such a vaccine has been successfully tested on animals, and is in clinical trials for humans as of May 2006.

Common Cold

What is the common cold, and what causes it?

The common cold, also known as a viral upper respiratory tract infection, is a self-limited contagious illness that can be caused by a number of different types of viruses. More than 200 different types of viruses are known to cause the common cold. Because so many different viruses can cause a cold and because new cold viruses constantly develop, the body never builds up resistance against all of them. For this reason, colds are a frequent and recurring problem. In fact, children in preschool and elementary school can have three to 12 colds per year while adolescents and adults typically have two to four colds per year. The common cold is the most frequently occurring illness in the world, and it is a leading cause of doctor visits and missed days from school and work.

What are the symptoms of the common cold?

Symptoms of the common cold include nasal stuffiness or drainage, sore or scratchy throat, sneezing, hoarseness, cough, and perhaps a fever and headache. Many people with a cold feel tired and achy. These symptoms will typically last anywhere from three to 10 days.

How is the common cold spread?

The common cold is usually spread by direct hand-to-hand contact with infected secretions or from contaminated surfaces. For example, if a person with a cold blows or touches their nose and then touches someone else, that person can subsequently become infected with the virus. Additionally, a cold virus can live on objects such as pens, books, telephones, computer keyboards, and coffee cups for several hours and can thus be acquired from contact with these objects.

Does it have anything to do with exposure to cold weather?

Though the common cold usually occurs in the fall and winter months, the cold weather itself does not cause the common cold। Rather, it is thought that during cold-weather months people spend more time indoors in close proximity to each other, thus facilitating the spread of the virus. For this same reason, children in day care and school are particularly prone to acquiring the common cold.

What is the difference between the common cold and influenza (the flu)?

Many people confuse the common cold with influenza (the flu). Influenza is caused by the influenza virus, while the common cold generally is not. While some of the symptoms of the common cold and influenza may be similar, patients with the common cold typically have a milder illness. Patients with influenza are usually sicker and have a more abrupt onset of illness with fever, chills, headache, body aches, dry cough, and extreme weakness.

Though differentiating between the common cold and influenza can be difficult, there is laboratory testing available to confirm the diagnoses of influenza.

What is the treatment for the common cold?

There is no cure for the common cold. Home treatment is directed at alleviating the symptoms associated with the common cold and allowing this self-limiting illness to run its course.

Supportive measures for the common cold include rest and drinking plenty of fluids. Over-the-counter medications such as throat lozenges, throat sprays, cough drops, and cough syrups may also help bring relief. Decongestants such as pseudoephedrine (Sudafed) or antihistamines may be used for nasal symptoms. Saline sprays and a humidifier may also be beneficial.

Acetaminophen (Tylenol and others) and ibuprofen (Advil and others) can help with fever, sore throat, and body aches.

WARNING: The United States Food and Drug Administration (FDA) recommends that over-the-counter cough and cold medications not be used in children younger than 2 years of age because serious and potentially life-threatening side effects can occur.

Do not use aspirin or aspirin containing medications in children or teenagers because it has been associated with a rare potentially fatal condition called Reye's syndrome।

Are antibiotics a suitable treatment for the common cold?

No. Antibiotics play no role in treating the common cold. Antibiotics are effective only against illnesses caused by bacteria, and colds are caused by viruses. Not only do antibiotics not help, but they can also cause allergic reactions that can be fatal (1:40,000). Furthermore, using antibiotics when they are not necessary has led to the growth of several strains of common bacteria that have become resistant to certain antibiotics (including one that commonly causes ear infections in children). For these and other reasons, it is important to limit the use of antibiotics to situations in which they are medically indicated.

Though occasionally a bacterial infection, such as sinusitis or a middle ear infection, can develop following a cold, treatment with antibiotics should be left at the discretion of your physician or health-care practitioner.

When should a doctor or other health-care practitioner be consulted?

Generally speaking, the common cold can be treated at home and managed with over-the-counter medications. However, if you develop more severe symptoms such as shaking chills, high fever (greater than 102 F), severe headache or neck stiffness, nausea, vomiting, difficulty breathing or chest pain, you should consult your physician or health-care practitioner immediately.

If you have a sore throat and a fever with no other cold symptoms, you should also be seen by your physician. This illness may be strep throat, a bacterial infection requiring treatment with antibiotics.

Finally, if you notice facial pain or yellow/green drainage from your nose accompanied by a fever, it is possible that you have a sinus infection (sinusitis) that would benefit from a medical evaluation and a possible course of antibiotics।

How do you prevent the common cold?

The most important measure to prevent the common cold is frequent hand washing, as this can destroy viruses that you have acquired from touching contaminated surfaces. Also, try to avoid sharing utensils and try to use disposable items (such as disposable cups) if someone in your family has a cold. Finally, lifestyle modifications such as smoking cessation and stress management may decrease your susceptibility to acquiring the common cold.

Health Tip: Caught a Cold?

You shouldn't treat a cold -- always caused by a virus -- with antibiotics, since these medicines are meant to treat bacterial infections. But there are things you can do to feel better while the cold runs its course.

• Try over-the-counter medications, such as an antihistamine, decongestant or cough medicine.
• Get plenty of sleep.
• Increase the amount of fluids you drink.
• Take a pain reliever to control headache and fever.
• Soothe a sore throat by gargling with warm salt water.
• Apply petroleum jelly to sore, dry skin around the nose and lips.
• Use a warm steam to ease congestion।

Back pain is a common problem

Back pain is one of the most common ailments in the UK.

It is thought more than 17 million Britons suffer from the problem, and the Health and Safety Executive estimates that it is responsible for nearly 5 million lost working days a year.

How is the back made up?

The major feature is the spine. This is a highly complex and delicate structure which is made up of 33 small bones called vertebrae.

In between each vertebra is a disc which acts as a shock absorber, and stops the bones rubbing together.

The discs are made up of a jelly like substance, which is protected by a tough, fibrous outer casing.

The spine is supported by specialised back muscles, and an array of ligaments, nerves and tendons.

What causes back pain?

As the spine is such a complex structure, it can often be difficult to pin down the exact cause of back pain.

Probably the most common cause is when the back muscles begin to spasm.

This can often occur after strenuous activity, or can be a reaction to repetitive strain.

The muscle is damaged, or irritated, and goes into spasm to protect the area from further injury.

This can be extremely painful, and can lead to muscle tears if undue stress is exerted.

Other causes of back pain include arthritis, fractures and infections.

In many cases experts believe back pain is a manifestation of emotional upset, rather than a physical problem.

More serious causes can include a prolapsed disc, or degenerative diseases of the spine - but these are relatively rare.

Are certain parts of the back more vulnerable?

Yes. The lower - or lumbar - region of the back is particularly prone to injury.

This because it bears the entire weight of the upper body, and is twisted and bent more than other parts.

As a result it inevitably suffers more wear and tear.

Why is back pain on the increase?

Experts believe that a major factor is the modern tendency to lead a sedentary lifestyle, both at work and home.

Spending long stretches of time sitting in one position - often with the back not properly supported - is not good for the spine.

The reliance on comfy soft furnishing may seem appealing - but often it encourages us to adopt a poor posture.

Back pain is much less common in places such as India, where many more people are used to sitting on the floor, which is thought to allow the back muscles to find their own natural position.

What is the treatment?

For most cases of back pain the only treatment is pain relief, often through the use of non-steroidal anti-inflammatory drugs such as aspirin.

Physiotherapy, heat therapy, massage and hydrotherapy can help.

How can you minimise the risk?

The spine is naturally curved into an S shape. The best way to keep it healthy is to try to maintain this shape as much as possible.

This is particularly important when performing tasks, such as lifting, that carry an increased risk of injury.

Strengthening the back muscles, keeping fit by taking regular exercise, and maintaining a healthy weight can all help to minimise the risk of back pain.

It is also important to have a mattress that properly supports the body while you are asleep.

If you do have a bad back probably the worst thing you can do is take to your bed.

Experts believe that it is best to stay as active as you possibly can.

Could there be another explanation for back pain?

Some lumbar and lower spinal pain is caused by patients having one leg longer than the other.

This puts the pelvis out of alignment causing pain, which without correction leads to long term compensatory problems such as back pain.

In this case it might be wise to consult a podiatrist who will measure the patient's limbs and if required provide either an orthoses - an orthopedic appliance used to support, align, prevent, or correct deformities - or arrange to modify the patients shoe to correct the difference.

For some patients, the best therapy for irritable bowel syndrome (IBS) may be older, cheaper drugs such as fiber, antispasmodics and peppermint oil, a new study finds.

According to researchers, these simple treatments have fallen out of favor because of the availability of newer (and more expensive) drugs, some of which have been taken off the market due to safety concerns.

But more traditional therapies should become first-line treatments in guidelines for the treatment of IBS, the experts say.

"IBS can be difficult for physicians to treat," noted lead researcher Dr. Alex Ford, from McMaster University, Health Sciences Centre in Ontario, Canada.

"New drugs are always being developed, but recent ones such as alosetron and tegaserod have been withdrawn, and are now only available on a restricted basis, and renzapride has not been shown to be effective," he said. On the other hand "older drugs, which are cheap, safe, and in some cases available over the counter, appear to be effective in IBS."

The report is published in the Nov. 14 online edition of the BMJ.

As many as 45 million Americans may have IBS, the International Foundation for Functional Gastrointestinal Disorders reports. Between 60 percent and 65 percent of IBS sufferers are women.

In addition to pain and discomfort, people with IBS experience chronic or recurrent constipation or diarrhea -- or bouts of both. While the exact cause of the condition isn't known, symptoms seem to result from a disturbance in the interaction of the gut, brain and nervous system, according to the foundation.

For the study, Ford's team reviewed trials that compared IBS treatment with fiber antispasmodics and peppermint oil to a placebo or no treatment. The trials included more than 2,500 IBS patients.

The researchers found that fiber, antispasmodics and peppermint oil were effective treatments for IBS. Specifically, that meant that to prevent IBS symptoms in one patient, 11 needed to be treated with fiber, five with antispasmodics, and 2.5 with peppermint oil.

There were no serious side effects associated with any of these treatments, the researchers note.

Peppermint oil appeared to be the most effective therapy of those reviewed, the researchers found.

In trials comparing fiber with placebo, insoluble fiber such as bran was not effective. Instead, only soluble fiber, such as ispaghula husk, reduced symptoms. For antispasmodics, the most effective was hyoscine. This should be used first among antispasmodics, Ford's group advised.

"Physicians, particularly those in primary care, who are being asked to take increasing responsibility for the management of IBS, should consider the use of these agents as first-line therapies for IBS," Ford said.

Dr. Roger Jones, from Kings College London and author of an accompanying journal editorial, welcomed the study.

"These treatments might be slightly more effective than recently thought and they are worth trying," Jones said.

For some patients with pain and diarrhea the antispasmodics may be useful. Patients with constipation should try fiber and for other patients, peppermint oil may be helpful, Jones said.

"If you have IBS which is not under reasonably good control or you are not happy with your symptom profile, you should see your primary-care doc or gastroenterologist for review and perhaps remind them that there is new evidence about the effectiveness of these traditional medicines and you would like to give it a go," Jones said.

"Alternatively, if you feel sufficiently well-informed and confident, you can go do it yourself and get these treatments at the pharmacy," Jones added.