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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


The Science Of Motility: Advances And Opportunities In Chronic Constipation And Irritable Bowel Syndrome


GOAL
To provide gastroenterologists and general internists up-to-date information on the epidemiology, pathophysiology, and current and emerging treatments of chronic constipation and irritable bowel syndrome.

TARGET AUDIENCE
This activity is designed for gastroenterologists and general internists. No prerequisites required.

LEARNING OBJECTIVES
The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity. At the conclusion of this activity, participants should be able to:

  • Examine the epidemiology, etiology, and pathophysiology of irritable bowel syndrome (IBS) and its symptoms.
  • Discuss issues relevant to the appropriate diagnostic evaluation of the patient suspected of having chronic constipation (CC).
  • Integrate the most current available data regarding treatment of CC into daily practice.
  • List treatment options and emerging therapies for CC.
  • Describe current and potential future treatments for IBS vis-á-vis CC.

ACCREDITATION STATEMENT
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

The estimated time to complete this educational activity: 2 hours.

Release date: November 15, 2005. Expiration date: November 15, 2007.

DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of The Johns Hopkins University School of Medicine name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.
This program is supported by an educational grant from Sucampo Pharmaceuticals and Takeda Pharmaceuticals North America, Inc.

Full Disclosure Policy Affecting CME Activities:
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of the Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Program Director and Participating Faculty reported the following:

PROGRAM DIRECTOR

Anthony Kalloo, MD
Chief
Division of Gastroenterology and Hepatology
The Johns Hopkins Hospital
Associate Professor of Medicine
Department of Gastroenterology
Johns Hopkins University School of Medicine
Baltimore, Maryland
Dr Kalloo reports no financial or advisory relationships with corporate organizations related to this activity.

PARTICIPATING FACULTY

Michael Camilleri, MD, PhD
Atherton and Winifred W. Bean Professor
Professor of Medicine and Physiology
Mayo Medical School
Consultant in Gastroenterology
Mayo Clinic
Rochester, Minnesota
Dr Camilleri reports that he has received grants/research support from Sucampo, Adolor, and Aryx; has served as a consultant to GlaxoSmithKline and Novartis; and has received honoraria related to consultant work for GlaxoSmithKline and Novartis. Dr Camilleri is funded by grants R01 DK54681, R01 DK67071, and K24 DK02638 from the National Institutes of Health.

Lin Chang, MD
Associate Professor of Medicine
Center for Neurovisceral Sciences & Women's Health
University of California, Los Angeles
Los Angeles, California
Dr Chang reports no financial or advisory relationships with corporate organizations related to this activity.

Lucinda A. Harris, MS, MD
Senior Associate Attending
Division of Gastroenterology
Department of Medicine
Mayo Clinic, Scottsdale
Scottsdale, Arizona
Dr Harris reports that she has received support from Novartis for research on dyspepsia.

Notice: The audience is advised that articles in this CME activity contain reference(s) to unlabeled or unapproved uses of drugs or devices.

Dr Harris—Lisapride, renzapride, prucalopride, and lubiprostone.

Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

Advances And Opportunities In Chronic Constipation And Irritable Bowel Syndrome
Anthony Kalloo, MD*

Chronic constipation (CC) and irritable bowel syndrome (IBS) are highly prevalent conditions in Western countries. Challenges in quantifying prevalence exist because of variation in accepted criteria for diagnosis and also because of variation in the symptomatology of individual patients. CC and IBS are more prevalent in women than in men. Both conditions significantly affect quality of life, with a conservative estimate of IBS-associated cost in 2000 of more than $1.6 billion.

Overlapping symptoms and "shifting diagnoses" between these 2 conditions suggest a common pathophysiologic etiology, at least in a subset of patients. Furthermore, confusing data and lack of consensus on clear definitions of the conditions have presented significant challenges to clinicians' ability to correctly diagnose and optimally manage patients with suspected CC or IBS.

This Advanced Studies in Medicine monograph discusses the epidemiology, etiology, and pathophysiology of CC and IBS in an effort to help clarify some of these issues. By understanding current mechanisms of action in the treatment of these disorders, the practicing clinician will gain clear insight into their management.

Dr Lin Chang, of the University of California, Los Angeles, opens the monograph with an overview of the epidemiology of IBS and functional constipation, including discussion of the differences in prevalence seen among various patient groups, and the costs of care for these conditions to healthcare delivery systems and society in general. Dr Michael Camilleri, of the Mayo Clinic College of Medicine in Rochester, Minn, follows with his review of the etiology and pathophysiology of IBS and CC. We close this issue with a review by Dr Lucinda A. Harris of the Mayo Clinic in Scottsdale, Ariz, on current standards of care as well as emerging new therapies for the treatment of patients with CC and constipation-predominant IBS.

These national experts define the scope of the problem of CC and IBS clearly, explaining the etiology and pathophysiology of these common conditions, and reviewing and updating the mechanisms of action of effective therapies for their treatment.

*Chief, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital; Associate Professor of Medicine, Department of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, Maryland.





Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.