NICE in the United Kingdom Gives Positive Recommendation for Eluxadoline (Truberzi) for IBS-D

July 31, 2017

Today, via the social media of the IBS Network, the U.K. charity for irritable bowel syndrome, IBS Impact received the following linked press release from Allergan, the pharmaceutical company for eluxadoline, which is known in the U.K. and throughout the European Union by the brand name Truberzi. This is the same medication which is known in the U.S. and Canada by the brand name Viberzi. It is a twice-daily oral medication for irritable bowel syndrome with diarrhea (IBS-D)

According to the press release, dated July 27, 2017, the National Institute of Health and Care Excellence, still known by its former acronym, NICE, issued a Final Appraisal Determination that the National Health Service (NHS) make eluxadoline available to adults with IBS-D who have not responded to, or for medical reasons, cannot use other IBS treatment interventions usually offered. If there is no appeal to this determination, this guidance will be published in August, and availability under the NHS is expected sometime this fall.

Eluxadoline was originally approved for use in the EU by the European Commission in September 2016, by the Food and Drug Administration (FDA) in the United States in May 2015 and by Health Canada in March 2017. It has been used successfully by many people with IBS-D throughout North America and the European Union in that time frame, but as reported by this blog on March 15, 2017, the FDA issued a warning to U.S. physicians that eluxadoline should not be prescribed to patients who do not have a gallbladder because of reports of many cases of serious pancreatitis and two deaths in that subgroup. We advise anyone considering any specific IBS medication or treatment to read available evidence-based information, to familiarize themselves with the benefits and risks, and to consult their own doctors as to if the given intervention is worth trying in their specific situations. IBS Impact focuses on awareness and advocacy and does not endorse particular interventions, but does encourage accurate and up to date information from reputable sources so that individuals with IBS and their families can make the most informed choices for their own needs and desires.


U.S. Food and Drug Administration Issues Drug Safety Communication for IBS-D Medication Eluxadoline (Viberzi), March 2017

March 15, 2017

Today, March 15, 2017, IBS Impact learned via IFFGD social media that the U.S. Food and Drug Administration (FDA) issued a drug safety communication for eluxadoline (also known by the brand name Viberzi), currently used in treating irritable bowel syndrome with diarrhea in adults, 18 and older, both men and women. This warning applies specifically to people without a gallbladder, whom the FDA advises should not take eluxadoline (Viberzi). There is an apparent high risk of serious pancreatitis, which has resulted in many reported cases of hospitalization and two deaths.

According to the FDA warning notice issued today, as of February 2017, in the 21 months since eluxadoline’s FDA approval in May 2015, the FDA received 120 reports of serious pancreatitis or death. 76 of the 120 patients reported required hospitalization and 2 of them died. In 68 of the patients, it is known whether or not they had a gallbladder. 56 did not have a gallbladder, including the 2 individuals who died. 22 of the 120 cases of serious pancreatitis or death reported additional complications. As a result, the FDA is advising that those with IBS-D who do not have a gallbladder not be prescribed eluxadoline (Viberzi) at this time. For physicians, the drug safety communication includes several suggestions of alternative over-the-counter and prescription medications for IBS-D.

The FDA is working with the pharmaceutical company Allergan to address the safety concerns and urges patients and physicians to report any adverse events to the FDA.  There are no announced changes in safety concerns or recommendations regarding eluxadoline (Viberzi)  for those individuals who do have a gallbladder.

IBS Impact urges readers who have IBS-D and no gallbladder and are currently taking eluxadoline (Viberzi) to consult their physicians promptly. We advise anyone considering any specific IBS medication or treatment to read available evidence-based information, to familiarize themselves with the benefits and risks, and to consult their own doctors as to if the given intervention is worth trying in their specific situations. IBS Impact focuses on awareness and advocacy and does not endorse particular interventions, but does encourage accurate and up to date information from reputable sources so that individuals with IBS and their families can make the most informed choices for their own needs and desires.


Interactive Infographic on Evidence-Based Treatments for Irritable Bowel Syndrome (IBS)

June 22, 2015

IBS Impact is primarily an awareness, advocacy and news blog by people with IBS and does not recommend specific treatments, as experiences of individuals. with IBS vary widely, and those decisions are appropriately made in consultation with one’s health care providers. However, the following interactive infographic from the BMJ (formerly the British Medical Journal) is so well done and potentially useful, that it is worth sharing here. Incorporating the Rome III international diagnostic criteria. (Rome IV was completed by a worldwide group of functional GI experts in December 2014 and is expected to be published in gastroenterology journals for use by early to mid-2016), and the symptom subtypes IBS-D (diarrhea predominant), IBS-C (constipation predominant) IBS-M (mixed, formerly IBS-A for alternating), and IBS-U (unsubtyped), the infographic grades the scientific evidence on many different existing treatment types to give users an idea of what the likely options are for a male or female with a given subtype. The link can be accessed below.

http://www.bmj.com/content/350/bmj.h1622/infographic

This is only intended as a starting point to make readers aware of some treatments with which they may not be familiar. Again, please consult your personal medical professionals.


U.S. Food and Drug Administration Approves Eluxadoline and Rifaximin for IBS with Diarrhea

May 30, 2015

Earlier this week, on May 27, 2015, the U.S. Food and Drug Administration approved two new medications, eluxadoline (to be known by the brand name Viberzi) and rifaximin (known by the brand name Xifaxan)  for use in treating irritable bowel syndrome with diarrhea in adults, 18 and older, both men and women. Both medications have met the FDA’s safety and effectiveness standards and reduced symptoms of IBS-D for subsets of study volunteers in multiple large, double-blind, placebo controlled clinical trials. Neither Viberzi nor Xifaxan is approved for use in children, and there is no known information at this time regarding potential future availability in countries other than the United States.

Viberzi is an oral medication to be taken with food twice daily. It is a mixed opiod receptor agonist designed to lessen bowel contractions. There are several reported possible side effects and it is not appropriate for those with a history of bile duct obstruction, pancreatitis, severe liver impairment, severe constipation or those who consume more than three alcoholic drinks daily. As Virberzi is a narcotic, the FDA expects it to be classified as a controlled substance. It is manufactured by Panteon Pharmaceuticals and is to be distributed by Forest Laboratories. It is projected to be available for doctors to prescribe to patients by early 2016.

Xifaxan is an antibiotic that is not absorbed in the gut and is believed to change the bacterial composition of the gastrointestinal tract. It is meant to be taken by mouth three times daily for 14 days at a time. There are some risks of side effects, but it is generally considered safe, although it also should not be used by those with severe liver impairments or along with certain other medications. In addition, research shows an eventual relapse rate of almost two-thirds among volunteers in the most recent Xifaxan clinical trials. In those individuals for whom IBS-D symptoms return after use of Xifaxan, the FDA has deemed up to two 14 day periods of re-treatment appropriate.

This was second application for approval of Xifaxan for IBS-D. In 2011, the FDA denied the first request, citing concerns about the high relapse rate and requesting more studies. Xifaxan is currently available in the United States for other conditions, and has been prescribed “off label” for use in IBS-D by some physicians. While this practice is legal, this week’s official approval for use in IBS-D will allow Salix Pharmaceuticals to market the medication specifically for irritable bowel syndrome with diarrhea, thereby presumably increasing availability and awareness among physicians and people with IBS-D. Further details on this approval can be found at the reputable links below.

The original FDA press release about Virberzi and Xifaxan.

International Foundation for Functional Gastrointestinal Disorders (IFFGD) summary on Viberzi

IFFGD summary on Xifaxan

Lengthy, detailed article with sources, “New Meds OK’d for Hard-to-Treat IBS With Diarrhea” by Kathleen Doheny, WebMD Health News, May 28, 2015

As many in the IBS community are aware, FDA-approved prescription medications specifically for irritable bowel syndrome of any subtype are extremely limited, and no single treatment, whether it is medication, diet, psychological interventions, or others, proves appropriate or effective for every individual with IBS, even those with similar symptom patterns. The only prescription drug specifically for IBS with diarrhea, alosetron (Lotronex), was approved for use only in women with IBS-D in 2000 but was quickly withdrawn from the market within months due to reports of serious side effects including several deaths. According to The New York Times at the time, in 2002, after advocacy from the IBS community, Lotronex was reintroduced only under significant restrictions for use in those women with very severe IBS-D for whom no other treatments are effective. IBS Impact is pleased that those with diarrhea-predominant IBS will soon have two safer and more widely available options in Viberzi and Xifaxan, and hopes that research on these two medications and others in development will continue.

We urge those who are considering either Viberzi or Xifaxan to read the available information, to familiarize themselves with the benefits and risks and to consult their own doctors as to if either medication is worth trying in their specific situations. IBS Impact focuses on awareness and advocacy and does not endorse particular treatments, but does encourage accurate and up to date information from reputable sources so that individuals with IBS and their families can make the most informed choices for their own needs and desires.


Clinical Trial: Assessing Cognitive Behavioral Therapy in Irritable Bowel Syndrome University of Southampton, UK, 2015

March 15, 2015

The University of Southampton, in collaboration with Kings College, London, has an ongoing multi-center clinical trial begun in 2013 and expected to be published in 2018 comparing the clinical and cost effectiveness of therapist cognitive behavioral therapy and lower intensity web-based cognitive behavioral therapy for people with refractory irritable bowel syndrome (IBS).

A total of 495 volunteers with IBS have been or will be recruited from primary and secondary care in Southampton and London and randomized into one of the two groups. The therapist CBT group receives 6 one-hour telephone sessions with a therapist over a period of 9 weeks, plus two one-hour followup calls at 4 months and 8 months following treatment for a total of 8 hours contact time with the therapist.  The lower intensity web-based CBT group receives a web-based self-management program plus 3 half-hour telephone sessions with a therapist over 9 weeks, plus two half-hour followup up calls at 4 months and 8 months following treatment for a total of 2 1/2 hours contact time with a therapist. The original listing can be found here on the University of Southampton website.  ACTIB Cognitive Behavioral Therapy Study, Southampton For further details or to volunteer, please contact Gilly O’Reilly, Trial Manager, at gor@soton.ac.uk

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While IBS Impact attempts to highlight a diversity of available opportunities, this is not intended as an exhaustive resource. Previous posts on open clinical trials for IBS can be found by clicking the clinical trials category in the blog archives on the upper right sidebar of this blog. We also have a page for IBS studies on the main IBS Impact site. Because studies stop accepting new volunteers or are completed over time, please check the post date on this blog, or the last update date on studies page, to verify that the study you are interested in is relatively recent rather than from a few years ago. Depending on how you accessed this blog, the post date will appear either at the top or at the bottom of the post, and is occasionally included in the post title. On the studies page on the main site, the date of the last update is at both the top and the bottom of the page. The research and links pages and the July 26, 2011 post provide additional general resources.

We welcome researchers affiliated with academic, medical or pharmaceutical entities, or reputable organizations representing IBS or related or commonly overlapping conditions, to contact us directly with additional studies they wish to be considered for posting or if an existing listing needs to be updated. Contact links for the founder/listowner and the webmaster can be found on the home page of the main IBS Impact website.

IBS Impact makes these study announcements available for general information, and encourages its members and site visitors to make their own individual, informed choices about their potential participation in any study. IBS Impact, as an entity, is not directly affiliated with any research sponsor and receives no funding from any source for studies or links we feature on this blog, the main site or social media.


NICE Guidelines in the United Kingdom for Adult Irritable Bowel Syndrome (IBS) Updated for 2015

March 6, 2015

Last month, February 2015, the National Institute for Health and Care Excellence, formerly the National Institute for Clinical Excellence and still widely known by its original acronym NICE, released revised guidelines for the diagnosis and treatment of adults with irritable bowel syndrome (IBS) in the United Kingdom. NICE’s stated goal is to provide evidence-based information to improve the overall quality of care and reduce variation in care through the National Health Service. The committees responsible for the IBS guidelines included many professionals from a variety of academic research centers and hospitals throughout the U.K.

The last update to the NICE guidelines for IBS was in 2008. In a portion of the guidelines on its website directed to the general public,  NICE cautions that these guidelines are not intended for those with IBS who are under the age of 18 or those who have other gastrointestinal disorders such as non-ulcer dyspepsia or coeliac (celiac) disease. The guidelines are primarily for use by general practitioners/primary care physicians who are the first health professionals to assess people with possible symptoms of IBS. The relevant section of the NICE website includes several additional tools, including cost information.

With a few specific country variations, the NICE guidelines are consistent with the international Rome criteria developed by leading functional gastrointestinal disorder clinicians and researchers from several countries (currently Rome III. See page 889. Rome IV was completed in December 2014 and is expected to be published in 2016.) and best practices advocated by those same IBS experts, such as patient-centered care. For example, the NICE guidelines advise primary care providers to ask open-ended questions, to be aware that many patients will not disclose incontinence without being specifically asked, and to be sensitive to individuals for whom English is not the first language or who have disabilities that may hinder effective communication.

In general, NICE advises that IBS should be considered a possible diagnosis for people who have chronic symptoms of abdominal pain and change in bowel habits  (altered frequency or stool form) and at least two of the following additional symptoms: changes in stool passage (such as straining, urgency, incomplete evacuation), bloating, symptoms worsened by eating, or passage of mucus. Additionally, NICE states that the following common non-GI or extraintestinal symptoms can further support diagnosis of IBS: lethargy, nausea, backache and bladder symptoms.

Symptoms or circumstances that are not present in irritable bowel syndrome or otherwise warrant further investigation and referral to a specialist in gastroenterology include: unintentional and unexplained weight loss (not from changes in eating habits or physical activity), rectal bleeding, family history of bowel cancer or, for women, of ovarian cancer,  chronic frequent and/or looser stools in individuals over age 60,  anaemia (anemia), rectal or abdominal masses, and or inflammatory markers for inflammatory bowel disease (IBD).

The Rome III criteria discourage extensive testing of all people with symptoms of possible IBS. As reported on this blog on October 9, 2011, IBS experts have not considered it a diagnosis of exclusion for over two decades, and state that a properly done Rome III diagnosis is 98% accurate. As there is no clinically available test specifically for IBS at this time, many IBS experts feel that absent symptoms or risk factors for disorders other than IBS, as discussed above, routine, extensive testing is time-consuming for patients and physicians, expensive and not cost-effective, stress-producing for patients and their families, and may delay appropriate IBS education and treatment for many people with IBS, who frequently spend months or years continuing to look for other statistically unlikely causes of their symptoms. In contrast, NICE guidelines do recommend certain simple blood tests to exclude other possible diagnoses: full blood count, erythrocyte sedimentation rate (ESR) or plasma viscosity, c‑reactive protein (CRP) antibody testing for coeliac (celiac) disease (endomysial antibodies [EMA] or tissue transglutaminase [TTG]), as well as serum CA 125 in women who meet NICE guidelines for possible ovarian cancer.  However, NICE guidelines also discourage procedures that are more invasive, involved, or generally not cost-effective. They specifically state that the following are generally not necessary to confirm a diagnosis of IBS for those who meet diagnostic criteria: ultrasound, rigid or flexible sigmoidoscopy, colonoscopy, barium enema, thyroid function test, faecal (fecal) ova or parasite tests, faecal (fecal) occult blood, and hydrogen breath tests for lactose intolerance or bacterial overgrowth. These details are mostly identical to the the 2008 version of the NICE guidelines.

The updates in the 2015 guidelines are concentrated in the treatment/management section, based on a review of research evidence and cost-effectiveness. Primary care physicians are encouraged by NICE to begin their advice to newly diagnosed people with IBS with general lifestyle and simple dietary measures. These include exercise and other relaxing leisure activities, regular meals that are not rushed, adequate fluid intake, reduction of caffeinated, carbonated, and alcoholic beverages, as well as adjustments in types or amounts of fiber, starches, fruit or sorbitol depending on specific symptoms. If these are not effective for particular individuals, NICE newly emphasizes this year that more extensive dietary exclusions, including the low-FODMAP diet, be tried only with the guidance of healthcare professionals with diet and nutrition expertise. For people with IBS who desire to try probiotics, NICE recommends that physicians advise them to continue for 4 weeks. This is a 2008 recommendation that has not changed.

If medications are needed, NICE recommends laxatives, except lactulose, for constipation-predominant IBS, and loperamide (Immodium) for diarrhea-predominant IBS. Among prescription medications, antispasmodics are considered by NICE to be the first line treatment. If those are not sufficiently effective, tricylic antidepressants are preferred by NICE over selective serotonin reuptake inhibitors (SSRIs) as the next line of treatment, with SSRIs only being used if tricyclics are ineffective. These 2008 recommendations were reviewed by the relevant NICE committee and unchanged for 2015. New for 2015,  NICE advises to physicians to be aware of potential side effects from both tricyclics and SSRIs, and to follow up regularly with their patients taking them, initially after 4 weeks, then every 6-12 months thereafter. NICE states that linaclotide (brand name Constella in Europe, Linzess in the United States) should be considered only for those with IBS with constipation (IBS-C) who have not had success with maximum doses of different classes of laxatives for at least 12 months. For 2015, NICE added a recommendation that physicians follow up after 3 months of use. The committee also considered  lubiprostone in this 2015 review, but did not find the evidence strong enough to make a specific recommendation regarding its use for IBS-C. Lubiprostone (Amitiza) is approved for IBS-C in the United States and is available in the United Kingdom for certain other types of constipation under specific strict conditions, but is not specifically approved in the U.K. for IBS-C at this time. Any prescription of lubiprostone for IBS in the U.K. would be off-label.

For those who do not respond adequately to medications within 12 months, NICE states referral to psychological interventions such as hypnotherapy or cognitive behavioral therapy can be considered. In 2015, NICE reviewed relaxation therapy, computerized cognitive behavioral therapy and mindfulness, but did not make specific recommendations about their use for IBS at this time. NICE recommends further research into computerized CBT and mindfulness, specifically their cost-effectiveness.

The 2008 guidelines include statements discouraging specific alternative medicine interventions. These were neither reviewed nor changed for 2015. Aloe vera, acupuncture and reflexology show insufficient evidence of effectiveness for IBS and are explicitly not recommended by NICE.

The full guidelines, 2015 supplement, addenda, tools and resources can be found on the NICE website at the following link:

NICE Guidelines (U.K.) for Adult Irritable Bowel Syndrome in Primary Care, February 2015

IBS Impact appreciates the work of all of the health care professionals involved in developing this revision to the NICE guidelines. Peer review is important to the scientific process and future advances. The availability of this document provides additional guidance to health care professionals and interested people with IBS in the most current standards of care for adults with IBS in the United Kingdom. When so many people with IBS, families and professionals continue to receive outdated or inaccurate information about basic aspects of IBS, an evidence-based document is an important tool in education and management of IBS.

 


Book Review: The Gut Solution for Parents with Children Who Have Recurrent Abdominal Pain and Irritable Bowel Syndrome

June 27, 2014

Because most educational materials, research studies and other resources related to irritable bowel syndrome are focused on adults, readers may not be aware that children and adolescents can also develop IBS. A subset of these young people may have a parent or other genetic relatives who also have IBS or a commonly overlapping chronic condition, while others will have no known family history. According to IFFGD Fact Sheet #846,Irritable Bowel Syndrome (IBS) in Children, one source estimates that 14% of all high school students and 6% of middle school students show symptoms of IBS. (The overall prevalence of IBS in all ages is widely quoted as 10-20% depending on the source, and anywhere from 9-23% in different countries worldwide.) The international diagnostic criteria, Rome III, for pediatric IBS specifies ages 4-18. While in adults, IBS is statistically more common in women than men, IBS affects boys and girls equally.

Because of this relative dearth of youth-centered material, IBS Impact was pleased to learn recently of a relatively new book written especially for parents of children and teens with IBS or recurrent abdominal pain (RAP), also known as functional abdominal pain (FAP). RAP/FAP is a specific medical diagnosis that involves chronic abdominal pain similar to that in IBS but does not include disturbances in bowel movements. The book, The Gut Solution for Parents with Children Who Have Recurrent Abdominal Pain and Irritable Bowel Syndrome by Michael Lawson, M.D. and Jessica Del Pozo, PhD, (Lemke Health Partners:2013) appears to be a helpful resource for families.

Dr. Lawson is a board-certified gastroenterologist educated in both Australia and the United States who is currently practicing at Kaiser Permanente of Northern California, is a Clinical Professor at the University of California at Davis and has volunteered in Nicaragua, the Dominican Republic and Cambodia as part of his interest in multicultural medicine. Dr. Del Pozo is a licensed clinical psychologist, also at Kaiser Permanente of Northern California, who focuses on assisting those with chronic illnesses, including IBS and other chronic pain conditions. For several years, she and Dr. Lawson have collaborated as part of a multidisciplinary team treating school-aged children and teens with IBS or RAP/FAP. They use the SEEDS Program, which was developed by Dr. Lawson. SEEDS stands for Stress management, Education and communication, Exercise, Diet and Sleep, which the authors claim has been successful in reducing IBS or RAP/FAP symptoms long-term for the vast majority of several hundred youth who have participated since the program’s inception several years ago. This protocol has been presented at Digestive Disease Week, a large, well known annual international conference for professionals in the field of gastroenterology.

The Gut Solution is only 144-157 pages long, depending on edition, and although IBS and RAP/FAP are complex topics, is written in relatively easy to understand language and includes a glossary, all aspects that busy parents who are not health professionals themselves would probably appreciate. The authors begin with explanations of what IBS is and is not on the neurological, biological and physiological levels, with particular emphasis on the brain-gut interaction and visceral hypersensitivity that characterize functional gastrointestinal disorders like IBS and FAP, diagnosis, and how they differ from other common gastrointestinal diagnoses. The authors continue with a brief overview of most common conventional and complementary treatments, then systematically explain each aspect of the SEEDS protocol, including sample questions for family discussion, tips for both the youth and parents or guardians related to each element of the program. One child’s experiences are interspersed through much of the book as a case example. The stress management chapter includes some suggested techniques, the exercise chapter includes some sample exercises and the diet chapter includes an explanation of the low FODMAPs diet and other diet advice, some sample menu items, as well as a fluid replacement recipe suggested for chronic diarrhea. The authors emphasize the importance of creating and/or maintaining stable routines, open communication and clear, healthy boundaries and expectations as a means of reducing stress for the child or adolescent with IBS or RAP/FAP and other members of the household. They offer suggestions to parents for talking to and listening to their children about IBS or RAP/FAP at different developmental stages and note some possible pitfalls in communication in different parenting styles.

Overall, the information in The Gut Solution appears to be scientifically accurate, evidence-based and up-to-date as of its publication date of 2013. The advice is generally consistent with the multidisciplinary, biopsychosocial approach advocated by functional GI experts. It is a good balance between abstract scientific explanations and practical strategies for helping a child or adolescent with IBS or RAP/FAP reduce symptoms and manage the condition over the long term. The section on other syndromes connected to IBS and the chapter on sleep are particularly worthy of mention, as fatigue and/or sleep disturbances are common extraintestinal (non-GI) symptoms for many children and adults with IBS. Extraintestinal symptoms and commonly overlapping conditions are rarely discussed in detail in most written material for affected individuals, families or the general public.

For a relatively short book, The Gut Solution covers a great deal of varied information, but does have some curious omissions. For example, in the section on diagnosis, the Rome criteria are explained, but the actual term “Rome criteria” and the fact that they are international guidelines are never mentioned, meaning parents might not recognize the term if they encountered it elsewhere, or not realize that these are standard diagnostic criteria rather than the authors’ or individual physicians’ opinions. Although “mind-body medicines” are briefly alluded to in the subsection on treatments under complementary and alternative medicine, and a publication by Olafur Palsson, PsyD. and William Whitehead, MD of the University of North Carolina Center for Functional GI Disorders on psychological treatments for IBS is listed in a “further reading” section, the generally effective and well-established evidence-based psychological treatments of gut-directed hypnotherapy and cognitive behavioral therapy are absent from Dr. Lawson’s and Dr. DelPozo’s overview of current treatment options in the actual text. Regular readers of this blog may also notice that some of the authors’ statistics throughout their book differ a bit from those of the primary sources IBS Impact often quotes or links on this blog, but this is a minor concern.

It is likely that most parents who read The Gut Solution, whether their children have been recently diagnosed with irritable bowel syndrome or recurrent abdominal pain/functional abdominal pain or have dealt with symptoms for some time, will find the book useful to them to some extent, though not all aspects of the SEEDS protocol or the parenting advice will necessarily apply equally to all children or all family situations. IBS Impact encourages parents to use the portions that appear to be helpful to them and their child in conjunction with their child’s own health care providers. We also encourage families to continue learning from Dr. Lawson and Dr. Del Pozo’s “further reading” section and other reputable sources. IBS Impact’s main website has a specific page dedicated to children with IBS and another page for family and friends. In addition, most resources on the other pages of the main site, this blog and social media are applicable to both children and adults with IBS.

The Gut Solution: For Parents with Children Who Have Recurrent Abdominal Pain and Irritable Bowel Syndrome by Michael Lawson, MD and Jessica Del Pozo, PhD is available from major online booksellers in a paperback edition and in a Kindle e-book edition. Please note that the Kindle edition does not appear to include the book’s index. Also, search results bring up completely different books by different authors with similar main titles, such as Gut Solutions, so readers should be careful that they have located the correct book.

Dr. Lawson and Dr. Del Pozo’s website for the book is linked here.

Although IBS Impact received an early PDF version of the book for our reference, we receive no funding for this review or for any sales of the book. As with all of the information on this blog, our main website and social media, it is provided in the interest of scientifically accurate public awareness and assisting blog readers dealing with IBS to make informed choices for themselves or their families.