The Newest Therapy for IBS
Saturday, November 14, 2020
10:40 am - 11:10 am
Nicholas J. Talley, AC, MD (NSW), PhD (Syd), MMedSci (Clin Epi)(Newc.), FAHMS, FRACP, FAFPHM, FRCP (Lond), FRCP (Edin), FACP, MACG, AGAF, FAMS, FRCPI (Hon)
Distinguished Laureate Professor, Faculty of Health and Medicine, University of Newcastle, Australia
NHMRC Leadership Fellow, and Chief Investigator NHMRC Centre for Research Excellence in Digestive Health
Senior Staff Specialist, John Hunter Hospital, Newcastle, Australia
Editor-in-Chief, Medical Journal of Australia
Adjunct Professor of Medicine and Professor of Epidemiology, Mayo Clinic, Rochester, MN, USA
Adjunct Professor, University of North Carolina, NC, USA
Foreign Guest Professor, Karolinska Institutet, Stockholm, Sweden
Professor Nicholas J. Talley, AC, MD (NSW), PhD (Syd.), FRACP, FAFPHM, FAHMS is a distinguished physician scientist and gastroenterologist, with a special interest in functional and inflammatory gastrointestinal diseases. He is currently Distinguished Laureate Professor of Medicine at the University of Newcastle; Nick has protected time for research and clinical practice as part of this appointment. He is a Past President of the Royal Australasian College of Physicians, a past Chair of the Council of Presidents of Medical Colleges, former Treasurer of the Australian Academy of Health and Medical Sciences, Editor-in-Chief of the Medical Journal of Australia, and a member of the NHMRC Research Committee and MBS taskforce. Nick has an outstanding highly cited academic track record with over 1000 publications. He is CIA on a NHMRC CRE in Digestive Health and PI on a University of Newcastle Priority Research Centre, has been a chief investigator on several successfully completed NHMRC and NIH grants, and has attracted funding worth more than AUD$15 million dollars in the 5 years.
Irritable bowel syndrome (IBS) is a common, heterogeneous disorder. Most treatments focus on symptom improvement, but complete relief is rare presumably because the treatments fail to target the underlying pathophysiology, even dividing IBS into diarrhea, constipation or mixed IBS subgroups based on stool form. Dietary factors are important and in some may induce small intestinal immune activation. Placebo is efficacious. There are very few head to head trials comparing different FDA approved treatments for the IBS subgroups, but recent network meta-analyses have provided new insights. For example, in IBS-diarrhea, linaclotide appears to provide a larger improvement (FDA endpoint) over tenapanor and plecanatide, but the confidence limits overlap. A multidisciplinary approach is superior to standard GI care based on a recent randomized trial. Promising new approaches include targeting mast cells, histamine blockade or bile salt malabsorption. New potential bacterial factors are under investigation (e.g. colonic spirochetes), and fecal microbial transfer may have a future role.