Bob Babinski

MONTREAL – The association of methamphetamine use with an unusual manifestation of a rare immunologic disease challenges the accepted management of acute respiratory distress and signals a new and immediate public health concern, Dr. Carl Kaplan said in a poster presentation at the annual meeting of the American College of Chest Physicians.

He reported two cases of an anti-glomerular basement membrane (anti-GBM) antibody-negative, Goodpasture's-like alveolar hemorrhage syndrome in 22-year-old women who were involved in the use and manufacture of methamphetamine.

Both 22-year-olds were admitted with frank hemoptysis and acute respiratory failure with no other comorbidities, said Dr. Kaplan, professor of internal medicine at St. Louis University, in an interview.

“These individuals came in with immediately, overtly life-threatening presentations. They were so profoundly ill that death was expected,” he said.

Such cases normally would have been treated as severe viral pneumonia, given the absence of bacterial infection, Dr. Kaplan noted.

However–thanks to some evidence in the literature suggesting the value of open-lung biopsy in acute respiratory distress syndrome, as well as the patients' severe condition–he performed bronchoalveolar lavage. The procedure demonstrated alveolar hemorrhage in both patients, with increasingly bloody lavage fluid.

Open-lung biopsy and renal biopsies were then performed. The lung biopsy confirmed the hemorrhage, with one case associated with capillaritis with areas of organization. Immunofluorescence revealed prominent linear staining of both the alveolar and glomerular basement membranes for IgG and complement C3, reported Dr. Kaplan, who is also the director of critical care services and director of respiratory care and bronchoscopy services at Saint Louis Hospital.

After the administration of parenteral corticosteroids and plasmapheresis, both patients fully recovered within 2 weeks.

“This disease [anti-GBM negative Goodpasture's-like alveolar hemorrhage syndrome] is usually classified as a pulmonary renal syndrome, with overt manifestations of both kidney disease and acute lung disease,” Dr. Kaplan said. “But these patients had absolutely no signs of any kidney disease, and so normally one would eliminate even considering this diagnosis,” he said. “And normally one would never do a bronchoscopy or bronchoalveolar lavage in such patients, let alone an open-lung biopsy and a kidney biopsy. It would be considered excessive and putting the patients at risk with unclear benefits.”

Dr. Kaplan's decision to investigate more thoroughly was lifesaving. “The risk-benefit consideration was in favor of doing everything for them,” he said. “It was lucky that we did, because it changed our management profoundly to invasive intervention.”

“We have to totally rethink our paradigm,” Dr. Kaplan said. “People don't usually volunteer the information that they manufacture illicit substances, and so if a young patient comes in with acute respiratory distress syndrome, this diagnosis has to be a strong consideration unless we are 100% confident that this is a bacterial pneumonia,” he said.

Given the increasing availability of methamphetamine and how commonly it is manufactured in people's homes, emergency physicians should keep this diagnosis fairly high in their list of differentials, he said.

“We have a large population at risk, and these patients didn't have any warning symptoms. The presentation was immediately life-threatening. So the public health risk is death–not long term, but immediate death,” Dr. Kaplan said.

He has contacted the Centers for Disease Control and Prevention and Missouri's State Board of Health to alert other emergency physicians to this new association.

MONTREAL – The association of methamphetamine use with an unusual manifestation of a rare immunologic disease challenges the accepted management of acute respiratory distress and signals a new and immediate public health concern, Dr. Carl Kaplan said in a poster presentation at the annual meeting of the American College of Chest Physicians.

He reported two cases of an anti-glomerular basement membrane (anti-GBM) antibody-negative, Goodpasture's-like alveolar hemorrhage syndrome in 22-year-old women who were involved in the use and manufacture of methamphetamine.

Both 22-year-olds were admitted with frank hemoptysis and acute respiratory failure with no other comorbidities, said Dr. Kaplan, professor of internal medicine at St. Louis University, in an interview.

“These individuals came in with immediately, overtly life-threatening presentations. They were so profoundly ill that death was expected,” he said.

Such cases normally would have been treated as severe viral pneumonia, given the absence of bacterial infection, Dr. Kaplan noted.

However–thanks to some evidence in the literature suggesting the value of open-lung biopsy in acute respiratory distress syndrome, as well as the patients' severe condition–he performed bronchoalveolar lavage. The procedure demonstrated alveolar hemorrhage in both patients, with increasingly bloody lavage fluid.

Open-lung biopsy and renal biopsies were then performed. The lung biopsy confirmed the hemorrhage, with one case associated with capillaritis with areas of organization. Immunofluorescence revealed prominent linear staining of both the alveolar and glomerular basement membranes for IgG and complement C3, reported Dr. Kaplan, who is also the director of critical care services and director of respiratory care and bronchoscopy services at Saint Louis Hospital.

After the administration of parenteral corticosteroids and plasmapheresis, both patients fully recovered within 2 weeks.

“This disease [anti-GBM negative Goodpasture's-like alveolar hemorrhage syndrome] is usually classified as a pulmonary renal syndrome, with overt manifestations of both kidney disease and acute lung disease,” Dr. Kaplan said. “But these patients had absolutely no signs of any kidney disease, and so normally one would eliminate even considering this diagnosis,” he said. “And normally one would never do a bronchoscopy or bronchoalveolar lavage in such patients, let alone an open-lung biopsy and a kidney biopsy. It would be considered excessive and putting the patients at risk with unclear benefits.”

Dr. Kaplan's decision to investigate more thoroughly was lifesaving. “The risk-benefit consideration was in favor of doing everything for them,” he said. “It was lucky that we did, because it changed our management profoundly to invasive intervention.”

“We have to totally rethink our paradigm,” Dr. Kaplan said. “People don't usually volunteer the information that they manufacture illicit substances, and so if a young patient comes in with acute respiratory distress syndrome, this diagnosis has to be a strong consideration unless we are 100% confident that this is a bacterial pneumonia,” he said.

Given the increasing availability of methamphetamine and how commonly it is manufactured in people's homes, emergency physicians should keep this diagnosis fairly high in their list of differentials, he said.

“We have a large population at risk, and these patients didn't have any warning symptoms. The presentation was immediately life-threatening. So the public health risk is death–not long term, but immediate death,” Dr. Kaplan said.

He has contacted the Centers for Disease Control and Prevention and Missouri's State Board of Health to alert other emergency physicians to this new association.

MONTREAL – The association of methamphetamine use with an unusual manifestation of a rare immunologic disease challenges the accepted management of acute respiratory distress and signals a new and immediate public health concern, Dr. Carl Kaplan said in a poster presentation at the annual meeting of the American College of Chest Physicians.

He reported two cases of an anti-glomerular basement membrane (anti-GBM) antibody-negative, Goodpasture's-like alveolar hemorrhage syndrome in 22-year-old women who were involved in the use and manufacture of methamphetamine.

Both 22-year-olds were admitted with frank hemoptysis and acute respiratory failure with no other comorbidities, said Dr. Kaplan, professor of internal medicine at St. Louis University, in an interview.

“These individuals came in with immediately, overtly life-threatening presentations. They were so profoundly ill that death was expected,” he said.

Such cases normally would have been treated as severe viral pneumonia, given the absence of bacterial infection, Dr. Kaplan noted.

However–thanks to some evidence in the literature suggesting the value of open-lung biopsy in acute respiratory distress syndrome, as well as the patients' severe condition–he performed bronchoalveolar lavage. The procedure demonstrated alveolar hemorrhage in both patients, with increasingly bloody lavage fluid.

Open-lung biopsy and renal biopsies were then performed. The lung biopsy confirmed the hemorrhage, with one case associated with capillaritis with areas of organization. Immunofluorescence revealed prominent linear staining of both the alveolar and glomerular basement membranes for IgG and complement C3, reported Dr. Kaplan, who is also the director of critical care services and director of respiratory care and bronchoscopy services at Saint Louis Hospital.

After the administration of parenteral corticosteroids and plasmapheresis, both patients fully recovered within 2 weeks.

“This disease [anti-GBM negative Goodpasture's-like alveolar hemorrhage syndrome] is usually classified as a pulmonary renal syndrome, with overt manifestations of both kidney disease and acute lung disease,” Dr. Kaplan said. “But these patients had absolutely no signs of any kidney disease, and so normally one would eliminate even considering this diagnosis,” he said. “And normally one would never do a bronchoscopy or bronchoalveolar lavage in such patients, let alone an open-lung biopsy and a kidney biopsy. It would be considered excessive and putting the patients at risk with unclear benefits.”

Dr. Kaplan's decision to investigate more thoroughly was lifesaving. “The risk-benefit consideration was in favor of doing everything for them,” he said. “It was lucky that we did, because it changed our management profoundly to invasive intervention.”

“We have to totally rethink our paradigm,” Dr. Kaplan said. “People don't usually volunteer the information that they manufacture illicit substances, and so if a young patient comes in with acute respiratory distress syndrome, this diagnosis has to be a strong consideration unless we are 100% confident that this is a bacterial pneumonia,” he said.

Given the increasing availability of methamphetamine and how commonly it is manufactured in people's homes, emergency physicians should keep this diagnosis fairly high in their list of differentials, he said.

“We have a large population at risk, and these patients didn't have any warning symptoms. The presentation was immediately life-threatening. So the public health risk is death–not long term, but immediate death,” Dr. Kaplan said.

He has contacted the Centers for Disease Control and Prevention and Missouri's State Board of Health to alert other emergency physicians to this new association.

MONTREAL – Non-GI symptoms can help distinguish irritable bowel syndrome from inflammatory bowel disease, Dr. Noel B. Hershfield said at the 13th World Congress of Gastroenterology.

Patients with irritable bowel syndrome (IBS) are more likely than patients with inflammatory bowel disease (IBD) to present with fatigue, depression/anxiety, and headache, as well as sleep loss for reasons not related to intestinal discomfort, Dr. Hershfield reported.

He reached these conclusions based on his survey of 400 patients who came to his outpatient clinic. All of the patients were younger than 50 years old.

Of the 200 patients with IBS, almost three-quarters had chronic fatigue syndrome, compared with one-quarter of the 200 patients with IBD, he said.

Nearly half of the IBS patients reported headaches, compared with less than a quarter of the patients with IBD. More than 40% of IBS patients had depression or anxiety; that figure was less than 10% for the IBD group, said Dr. Hershfield, a gastroenterologist at the University of Calgary (Alta.).

Of the IBS patents, 156 reported sleep disturbance not due to GI symptoms, compared with only 12 IBD patients. Conversely, only 2 IBS patients reported sleep disturbance due to gastrointestinal pain, compared with 179 IBD patients (Can. J. Gastroenterol. 2005;19:231–4).

“The object of this paper was to get physicians to take a better history, so they wouldn't have to do so many tests to prove IBS,” Dr. Hershfield said. “If you spend some time with them, you don't have to do very many tests to know that they have irritable bowel.”

Night sweats, sleep disturbance due to diarrhea and abdominal pain, and weight loss are symptoms that are associated with organic bowel disease. “People with IBD often have tremendous weight loss. … They can't eat, they don't absorb food properly, so they lose weight and all the things that go with that,” he said.

IBS patients, on the other hand, don't present with weight loss, anemia, and bleeding, Dr. Hershfield added.

MONTREAL – Non-GI symptoms can help distinguish irritable bowel syndrome from inflammatory bowel disease, Dr. Noel B. Hershfield said at the 13th World Congress of Gastroenterology.

Patients with irritable bowel syndrome (IBS) are more likely than patients with inflammatory bowel disease (IBD) to present with fatigue, depression/anxiety, and headache, as well as sleep loss for reasons not related to intestinal discomfort, Dr. Hershfield reported.

He reached these conclusions based on his survey of 400 patients who came to his outpatient clinic. All of the patients were younger than 50 years old.

Of the 200 patients with IBS, almost three-quarters had chronic fatigue syndrome, compared with one-quarter of the 200 patients with IBD, he said.

Nearly half of the IBS patients reported headaches, compared with less than a quarter of the patients with IBD. More than 40% of IBS patients had depression or anxiety; that figure was less than 10% for the IBD group, said Dr. Hershfield, a gastroenterologist at the University of Calgary (Alta.).

Of the IBS patents, 156 reported sleep disturbance not due to GI symptoms, compared with only 12 IBD patients. Conversely, only 2 IBS patients reported sleep disturbance due to gastrointestinal pain, compared with 179 IBD patients (Can. J. Gastroenterol. 2005;19:231–4).

“The object of this paper was to get physicians to take a better history, so they wouldn't have to do so many tests to prove IBS,” Dr. Hershfield said. “If you spend some time with them, you don't have to do very many tests to know that they have irritable bowel.”

Night sweats, sleep disturbance due to diarrhea and abdominal pain, and weight loss are symptoms that are associated with organic bowel disease. “People with IBD often have tremendous weight loss. … They can't eat, they don't absorb food properly, so they lose weight and all the things that go with that,” he said.

IBS patients, on the other hand, don't present with weight loss, anemia, and bleeding, Dr. Hershfield added.

MONTREAL – Non-GI symptoms can help distinguish irritable bowel syndrome from inflammatory bowel disease, Dr. Noel B. Hershfield said at the 13th World Congress of Gastroenterology.

Patients with irritable bowel syndrome (IBS) are more likely than patients with inflammatory bowel disease (IBD) to present with fatigue, depression/anxiety, and headache, as well as sleep loss for reasons not related to intestinal discomfort, Dr. Hershfield reported.

He reached these conclusions based on his survey of 400 patients who came to his outpatient clinic. All of the patients were younger than 50 years old.

Of the 200 patients with IBS, almost three-quarters had chronic fatigue syndrome, compared with one-quarter of the 200 patients with IBD, he said.

Nearly half of the IBS patients reported headaches, compared with less than a quarter of the patients with IBD. More than 40% of IBS patients had depression or anxiety; that figure was less than 10% for the IBD group, said Dr. Hershfield, a gastroenterologist at the University of Calgary (Alta.).

Of the IBS patents, 156 reported sleep disturbance not due to GI symptoms, compared with only 12 IBD patients. Conversely, only 2 IBS patients reported sleep disturbance due to gastrointestinal pain, compared with 179 IBD patients (Can. J. Gastroenterol. 2005;19:231–4).

“The object of this paper was to get physicians to take a better history, so they wouldn't have to do so many tests to prove IBS,” Dr. Hershfield said. “If you spend some time with them, you don't have to do very many tests to know that they have irritable bowel.”

Night sweats, sleep disturbance due to diarrhea and abdominal pain, and weight loss are symptoms that are associated with organic bowel disease. “People with IBD often have tremendous weight loss. … They can't eat, they don't absorb food properly, so they lose weight and all the things that go with that,” he said.

IBS patients, on the other hand, don't present with weight loss, anemia, and bleeding, Dr. Hershfield added.

MONTREAL – Comorbid psychosocial disorders are an important consideration in patients presenting with severe symptoms of irritable bowel syndrome, Dr. Douglas A. Drossman said at the 13th World Congress of Gastroenterology.

Such factors “should be looked at in the first visit because in some cases it might prevent you from doing unnecessary tests” in patients with IBS, he said. “Even more important than that, it gives you the whole package of what's going on, both physically and psychologically. That can affect your diagnostic and treatment approach.”

In a study of 211 patients with moderate and severe functional bowel disorder, Dr. Drossman found that major depression was more pronounced in patients with severe symptoms than in those with moderate symptoms (12.5 versus 9.3 on the Beck Depression Inventory). Poor coping responses, such as catastrophizing, were more common in patients with severe symptoms, compared with patients with moderate symptoms (12.9 versus 8.2 on the Coping Strategies Questionnaire) (Am. J. Gastroenterol. 2000;95:974–80).

The study also showed that, compared with patients with milder symptoms, those with more severe symptoms felt that they had less control of their symptoms and reported having a significantly poorer quality of life.

“There is also a higher frequency of sexual, physical, or emotional abuse in those with more severe symptoms,” said Dr. Drossman, codirector of the University of North Carolina Center for Functional GI and Motility Disorders, Chapel Hill.

Studies suggest that 5%–40% of IBS patients have severe symptoms, and 25%–50% have moderate symptoms.

The precise relationship between functional bowel disorders and psychosocial disorders is unclear, he said. It is possible that comorbid psychosocial factors may affect perception of physical experiences, or that stress can lower the pain threshold and produce other GI symptoms.

Poor coping responses were more common in patients with severe functional bowel disorder. DR. DROSSMAN

MONTREAL – Comorbid psychosocial disorders are an important consideration in patients presenting with severe symptoms of irritable bowel syndrome, Dr. Douglas A. Drossman said at the 13th World Congress of Gastroenterology.

Such factors “should be looked at in the first visit because in some cases it might prevent you from doing unnecessary tests” in patients with IBS, he said. “Even more important than that, it gives you the whole package of what's going on, both physically and psychologically. That can affect your diagnostic and treatment approach.”

In a study of 211 patients with moderate and severe functional bowel disorder, Dr. Drossman found that major depression was more pronounced in patients with severe symptoms than in those with moderate symptoms (12.5 versus 9.3 on the Beck Depression Inventory). Poor coping responses, such as catastrophizing, were more common in patients with severe symptoms, compared with patients with moderate symptoms (12.9 versus 8.2 on the Coping Strategies Questionnaire) (Am. J. Gastroenterol. 2000;95:974–80).

The study also showed that, compared with patients with milder symptoms, those with more severe symptoms felt that they had less control of their symptoms and reported having a significantly poorer quality of life.

“There is also a higher frequency of sexual, physical, or emotional abuse in those with more severe symptoms,” said Dr. Drossman, codirector of the University of North Carolina Center for Functional GI and Motility Disorders, Chapel Hill.

Studies suggest that 5%–40% of IBS patients have severe symptoms, and 25%–50% have moderate symptoms.

The precise relationship between functional bowel disorders and psychosocial disorders is unclear, he said. It is possible that comorbid psychosocial factors may affect perception of physical experiences, or that stress can lower the pain threshold and produce other GI symptoms.

Poor coping responses were more common in patients with severe functional bowel disorder. DR. DROSSMAN

MONTREAL – Comorbid psychosocial disorders are an important consideration in patients presenting with severe symptoms of irritable bowel syndrome, Dr. Douglas A. Drossman said at the 13th World Congress of Gastroenterology.

Such factors “should be looked at in the first visit because in some cases it might prevent you from doing unnecessary tests” in patients with IBS, he said. “Even more important than that, it gives you the whole package of what's going on, both physically and psychologically. That can affect your diagnostic and treatment approach.”

In a study of 211 patients with moderate and severe functional bowel disorder, Dr. Drossman found that major depression was more pronounced in patients with severe symptoms than in those with moderate symptoms (12.5 versus 9.3 on the Beck Depression Inventory). Poor coping responses, such as catastrophizing, were more common in patients with severe symptoms, compared with patients with moderate symptoms (12.9 versus 8.2 on the Coping Strategies Questionnaire) (Am. J. Gastroenterol. 2000;95:974–80).

The study also showed that, compared with patients with milder symptoms, those with more severe symptoms felt that they had less control of their symptoms and reported having a significantly poorer quality of life.

“There is also a higher frequency of sexual, physical, or emotional abuse in those with more severe symptoms,” said Dr. Drossman, codirector of the University of North Carolina Center for Functional GI and Motility Disorders, Chapel Hill.

Studies suggest that 5%–40% of IBS patients have severe symptoms, and 25%–50% have moderate symptoms.

The precise relationship between functional bowel disorders and psychosocial disorders is unclear, he said. It is possible that comorbid psychosocial factors may affect perception of physical experiences, or that stress can lower the pain threshold and produce other GI symptoms.

Poor coping responses were more common in patients with severe functional bowel disorder. DR. DROSSMAN

Kate Johnson of the Montreal Bureau contributed to this report.

MONTREAL — Continuous oral contraceptive regimens suppress ovulation better than do conventional 21-day regimens, according to research presented at the conjoint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

This effect of continuous oral contraceptives (COCs) has not been previously reported, said Roger Pierson, Ph.D., explaining that COCs have been promoted primarily for their ability to eliminate cyclic bleeding and premenstrual symptoms.

“The side effect of not bleeding is much more effective contraceptive control,” said Dr. Pierson, professor of obstetrics, gynecology, and reproductive sciences at the University of Saskatchewan, Saskatoon.

In his single-center, randomized, open-label trial sponsored by the Canadian Institutes of Health Research, Dr. Pierson compared two different formulations of traditional 21-day oral contraceptive (OC) regimens with the same formulations given continuously for 28 days per cycle. Women took the pills for three cycles. Transvaginal ultrasonography was used to monitor follicular development once weekly for the first 3 weeks of the study and then every third day until the end of the third cycle.

The nine women on the 28-day regimen of 30-mcg ethinyl estradiol/150-mcg levonorgestrel and the 11 women on the 28-day regimen of 35-mcg ethinyl estradiol/250-mcg norgestimate showed less follicular development than did the women given the traditional 21-day regimens of both formulations (8 women in each group).

The women on the continuous regimen had no dominant follicles and no ovulations. Together, women on the standard regimens produced a total of eight dominant follicles, two of which ovulated.

The time to return of normal ovulation during the first cycle after contraceptive discontinuation was measured in both the conventional OC and COC groups, and this was compared with historical data for ovulation after discontinuation of other forms of contraception.

Follicles developing after discontinuation of COCs took about 5 days longer to ovulate than did follicles developing after discontinuation of conventional OCs. Time to ovulation for both OC groups was longer than in natural cycles. In addition, serum estradiol 17-? at a follicular diameter of 18 mm was significantly higher after discontinuation of OCs, compared with natural cycles. Dr. Pierson said the delayed return to normal ovulation was not significant, but noted the study's short length.

Kate Johnson of the Montreal Bureau contributed to this report.

MONTREAL — Continuous oral contraceptive regimens suppress ovulation better than do conventional 21-day regimens, according to research presented at the conjoint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

This effect of continuous oral contraceptives (COCs) has not been previously reported, said Roger Pierson, Ph.D., explaining that COCs have been promoted primarily for their ability to eliminate cyclic bleeding and premenstrual symptoms.

“The side effect of not bleeding is much more effective contraceptive control,” said Dr. Pierson, professor of obstetrics, gynecology, and reproductive sciences at the University of Saskatchewan, Saskatoon.

In his single-center, randomized, open-label trial sponsored by the Canadian Institutes of Health Research, Dr. Pierson compared two different formulations of traditional 21-day oral contraceptive (OC) regimens with the same formulations given continuously for 28 days per cycle. Women took the pills for three cycles. Transvaginal ultrasonography was used to monitor follicular development once weekly for the first 3 weeks of the study and then every third day until the end of the third cycle.

The nine women on the 28-day regimen of 30-mcg ethinyl estradiol/150-mcg levonorgestrel and the 11 women on the 28-day regimen of 35-mcg ethinyl estradiol/250-mcg norgestimate showed less follicular development than did the women given the traditional 21-day regimens of both formulations (8 women in each group).

The women on the continuous regimen had no dominant follicles and no ovulations. Together, women on the standard regimens produced a total of eight dominant follicles, two of which ovulated.

The time to return of normal ovulation during the first cycle after contraceptive discontinuation was measured in both the conventional OC and COC groups, and this was compared with historical data for ovulation after discontinuation of other forms of contraception.

Follicles developing after discontinuation of COCs took about 5 days longer to ovulate than did follicles developing after discontinuation of conventional OCs. Time to ovulation for both OC groups was longer than in natural cycles. In addition, serum estradiol 17-? at a follicular diameter of 18 mm was significantly higher after discontinuation of OCs, compared with natural cycles. Dr. Pierson said the delayed return to normal ovulation was not significant, but noted the study's short length.

Kate Johnson of the Montreal Bureau contributed to this report.

MONTREAL — Continuous oral contraceptive regimens suppress ovulation better than do conventional 21-day regimens, according to research presented at the conjoint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

This effect of continuous oral contraceptives (COCs) has not been previously reported, said Roger Pierson, Ph.D., explaining that COCs have been promoted primarily for their ability to eliminate cyclic bleeding and premenstrual symptoms.

“The side effect of not bleeding is much more effective contraceptive control,” said Dr. Pierson, professor of obstetrics, gynecology, and reproductive sciences at the University of Saskatchewan, Saskatoon.

In his single-center, randomized, open-label trial sponsored by the Canadian Institutes of Health Research, Dr. Pierson compared two different formulations of traditional 21-day oral contraceptive (OC) regimens with the same formulations given continuously for 28 days per cycle. Women took the pills for three cycles. Transvaginal ultrasonography was used to monitor follicular development once weekly for the first 3 weeks of the study and then every third day until the end of the third cycle.

The nine women on the 28-day regimen of 30-mcg ethinyl estradiol/150-mcg levonorgestrel and the 11 women on the 28-day regimen of 35-mcg ethinyl estradiol/250-mcg norgestimate showed less follicular development than did the women given the traditional 21-day regimens of both formulations (8 women in each group).

The women on the continuous regimen had no dominant follicles and no ovulations. Together, women on the standard regimens produced a total of eight dominant follicles, two of which ovulated.

The time to return of normal ovulation during the first cycle after contraceptive discontinuation was measured in both the conventional OC and COC groups, and this was compared with historical data for ovulation after discontinuation of other forms of contraception.

Follicles developing after discontinuation of COCs took about 5 days longer to ovulate than did follicles developing after discontinuation of conventional OCs. Time to ovulation for both OC groups was longer than in natural cycles. In addition, serum estradiol 17-? at a follicular diameter of 18 mm was significantly higher after discontinuation of OCs, compared with natural cycles. Dr. Pierson said the delayed return to normal ovulation was not significant, but noted the study's short length.

MONTREAL — Comorbid psychosocial disorders are an important consideration in patients presenting with severe symptoms of irritable bowel syndrome, Douglas A. Drossman, M.D., said at the 13th World Congress of Gastroenterology.

Such factors “should be looked at in the first visit because in some cases it might prevent you from doing unnecessary tests” in patients with IBS, he said in an interview. “Even more important than that, it gives you the whole package of what's going on, both physically and psychologically.”

In a study of 211 patients with moderate and severe functional bowel syndrome, Dr. Drossman found that major depression was more pronounced in patients with severe symptoms than in those with moderate symptoms (12.5 vs. 9.3 on the Beck Depression Inventory). Poor coping responses like “catastrophizing” were more common in patients with severe symptoms, compared with patients with moderate symptoms (12.9 vs. 8.2 on the Coping Strategies Questionnaire) (Am. J. Gastroenterol. 2000;95:974–80).

The study also showed that compared with patients with milder symptoms, those with more severe symptoms felt that they had less control of their symptoms (2.2 vs. 2.6 on the Coping Strategies Questionnaire) and reported having a significantly poorer quality of life (58.5 versus 69.3 overall score on the IBS Quality of Life questionnaire). “There is also a higher frequency of sexual, physical, or emotional abuse in those with more severe symptoms,” said Dr. Drossman, codirector of the University of North Carolina Center for Functional GI and Motility Disorders, Chapel Hill.

Studies suggest that 5%–40% of IBS patients have severe symptoms, and 25%–50% have moderate symptoms. “If you are in a primary care setting, your severe group will be much smaller—maybe 5%—but if you're in a major referral center, you are going to see 50%–60% severe patients,” he said.

The precise relationship between functional bowel disorders and psychosocial disorders is unclear, Dr. Drossman said. Some theories are that comorbid psychosocial factors may affect perception of physical experiences; stress can lower the pain threshold and produce other GI symptoms; and psychosocial disturbances may increase pain perception via functional changes in the brain's pain modulation center.

MONTREAL — Comorbid psychosocial disorders are an important consideration in patients presenting with severe symptoms of irritable bowel syndrome, Douglas A. Drossman, M.D., said at the 13th World Congress of Gastroenterology.

Such factors “should be looked at in the first visit because in some cases it might prevent you from doing unnecessary tests” in patients with IBS, he said in an interview. “Even more important than that, it gives you the whole package of what's going on, both physically and psychologically.”

In a study of 211 patients with moderate and severe functional bowel syndrome, Dr. Drossman found that major depression was more pronounced in patients with severe symptoms than in those with moderate symptoms (12.5 vs. 9.3 on the Beck Depression Inventory). Poor coping responses like “catastrophizing” were more common in patients with severe symptoms, compared with patients with moderate symptoms (12.9 vs. 8.2 on the Coping Strategies Questionnaire) (Am. J. Gastroenterol. 2000;95:974–80).

The study also showed that compared with patients with milder symptoms, those with more severe symptoms felt that they had less control of their symptoms (2.2 vs. 2.6 on the Coping Strategies Questionnaire) and reported having a significantly poorer quality of life (58.5 versus 69.3 overall score on the IBS Quality of Life questionnaire). “There is also a higher frequency of sexual, physical, or emotional abuse in those with more severe symptoms,” said Dr. Drossman, codirector of the University of North Carolina Center for Functional GI and Motility Disorders, Chapel Hill.

Studies suggest that 5%–40% of IBS patients have severe symptoms, and 25%–50% have moderate symptoms. “If you are in a primary care setting, your severe group will be much smaller—maybe 5%—but if you're in a major referral center, you are going to see 50%–60% severe patients,” he said.

The precise relationship between functional bowel disorders and psychosocial disorders is unclear, Dr. Drossman said. Some theories are that comorbid psychosocial factors may affect perception of physical experiences; stress can lower the pain threshold and produce other GI symptoms; and psychosocial disturbances may increase pain perception via functional changes in the brain's pain modulation center.

MONTREAL — Comorbid psychosocial disorders are an important consideration in patients presenting with severe symptoms of irritable bowel syndrome, Douglas A. Drossman, M.D., said at the 13th World Congress of Gastroenterology.

Such factors “should be looked at in the first visit because in some cases it might prevent you from doing unnecessary tests” in patients with IBS, he said in an interview. “Even more important than that, it gives you the whole package of what's going on, both physically and psychologically.”

In a study of 211 patients with moderate and severe functional bowel syndrome, Dr. Drossman found that major depression was more pronounced in patients with severe symptoms than in those with moderate symptoms (12.5 vs. 9.3 on the Beck Depression Inventory). Poor coping responses like “catastrophizing” were more common in patients with severe symptoms, compared with patients with moderate symptoms (12.9 vs. 8.2 on the Coping Strategies Questionnaire) (Am. J. Gastroenterol. 2000;95:974–80).

The study also showed that compared with patients with milder symptoms, those with more severe symptoms felt that they had less control of their symptoms (2.2 vs. 2.6 on the Coping Strategies Questionnaire) and reported having a significantly poorer quality of life (58.5 versus 69.3 overall score on the IBS Quality of Life questionnaire). “There is also a higher frequency of sexual, physical, or emotional abuse in those with more severe symptoms,” said Dr. Drossman, codirector of the University of North Carolina Center for Functional GI and Motility Disorders, Chapel Hill.

Studies suggest that 5%–40% of IBS patients have severe symptoms, and 25%–50% have moderate symptoms. “If you are in a primary care setting, your severe group will be much smaller—maybe 5%—but if you're in a major referral center, you are going to see 50%–60% severe patients,” he said.

The precise relationship between functional bowel disorders and psychosocial disorders is unclear, Dr. Drossman said. Some theories are that comorbid psychosocial factors may affect perception of physical experiences; stress can lower the pain threshold and produce other GI symptoms; and psychosocial disturbances may increase pain perception via functional changes in the brain's pain modulation center.

MONTREAL — The use of the immunosuppressive agent azathioprine and surgery reduced the risk of cancer in patients with Crohn's disease, according to an 11-year retrospective analysis.

“This study suggests that controlling the inflammation, or the disease activity, can reduce or eliminate any risk of GI-related cancer,” Elizabeth Strevel, M.D., of the University of Toronto, said in an interview.

The investigation, which Dr. Strevel presented as a poster at the World Congress on Gastroenterology, used databases to review the cases of 1,351 Crohn's disease patients hospitalized at the city's teaching centers.

Sixty-five patients had one or more malignancies, with 37 of those originating in the gastrointestinal tract.

Patients who had a surgical intervention were at a decreased risk of malignancy of all types (odds ratio [OR] 0.4), as were patients who were given azathioprine (OR 0.4). A similar association was found for the use of steroids (OR 0.5).

“Our results showed that when we looked at all malignancies, indicators of increased inflammation, such as fistula, increased the risk of cancer,” she said, noting an odds ratio of 1.7.

“That became more prevalent when we did a subgroup analysis, just in the GI cancer group. It indicated that what we found in the whole group was probably just an effect of the GI cancers,” Dr. Strevel said.

“We also found that the effect of the immunosuppressive agent azathioprine also became more strongly protective in the subgroup, indicating that the effect is mostly on GI cancers.”

Although cancer in Crohn's disease patients is quite rare, there is a need for more study, Dr. Strevel said. “While malignancy isn't overly present in Crohn's disease, it is obviously a complication with a lot of morbidity and mortality.”

“Given the numbers, it would be hard to do a randomized controlled trial. But a prospective cohort study following these people in a database, seeing what happens and assessing, will provide more accurate information,” she added.

MONTREAL — The use of the immunosuppressive agent azathioprine and surgery reduced the risk of cancer in patients with Crohn's disease, according to an 11-year retrospective analysis.

“This study suggests that controlling the inflammation, or the disease activity, can reduce or eliminate any risk of GI-related cancer,” Elizabeth Strevel, M.D., of the University of Toronto, said in an interview.

The investigation, which Dr. Strevel presented as a poster at the World Congress on Gastroenterology, used databases to review the cases of 1,351 Crohn's disease patients hospitalized at the city's teaching centers.

Sixty-five patients had one or more malignancies, with 37 of those originating in the gastrointestinal tract.

Patients who had a surgical intervention were at a decreased risk of malignancy of all types (odds ratio [OR] 0.4), as were patients who were given azathioprine (OR 0.4). A similar association was found for the use of steroids (OR 0.5).

“Our results showed that when we looked at all malignancies, indicators of increased inflammation, such as fistula, increased the risk of cancer,” she said, noting an odds ratio of 1.7.

“That became more prevalent when we did a subgroup analysis, just in the GI cancer group. It indicated that what we found in the whole group was probably just an effect of the GI cancers,” Dr. Strevel said.

“We also found that the effect of the immunosuppressive agent azathioprine also became more strongly protective in the subgroup, indicating that the effect is mostly on GI cancers.”

Although cancer in Crohn's disease patients is quite rare, there is a need for more study, Dr. Strevel said. “While malignancy isn't overly present in Crohn's disease, it is obviously a complication with a lot of morbidity and mortality.”

“Given the numbers, it would be hard to do a randomized controlled trial. But a prospective cohort study following these people in a database, seeing what happens and assessing, will provide more accurate information,” she added.

MONTREAL — The use of the immunosuppressive agent azathioprine and surgery reduced the risk of cancer in patients with Crohn's disease, according to an 11-year retrospective analysis.

“This study suggests that controlling the inflammation, or the disease activity, can reduce or eliminate any risk of GI-related cancer,” Elizabeth Strevel, M.D., of the University of Toronto, said in an interview.

The investigation, which Dr. Strevel presented as a poster at the World Congress on Gastroenterology, used databases to review the cases of 1,351 Crohn's disease patients hospitalized at the city's teaching centers.

Sixty-five patients had one or more malignancies, with 37 of those originating in the gastrointestinal tract.

Patients who had a surgical intervention were at a decreased risk of malignancy of all types (odds ratio [OR] 0.4), as were patients who were given azathioprine (OR 0.4). A similar association was found for the use of steroids (OR 0.5).

“Our results showed that when we looked at all malignancies, indicators of increased inflammation, such as fistula, increased the risk of cancer,” she said, noting an odds ratio of 1.7.

“That became more prevalent when we did a subgroup analysis, just in the GI cancer group. It indicated that what we found in the whole group was probably just an effect of the GI cancers,” Dr. Strevel said.

“We also found that the effect of the immunosuppressive agent azathioprine also became more strongly protective in the subgroup, indicating that the effect is mostly on GI cancers.”

Although cancer in Crohn's disease patients is quite rare, there is a need for more study, Dr. Strevel said. “While malignancy isn't overly present in Crohn's disease, it is obviously a complication with a lot of morbidity and mortality.”

“Given the numbers, it would be hard to do a randomized controlled trial. But a prospective cohort study following these people in a database, seeing what happens and assessing, will provide more accurate information,” she added.

MONTREAL — Comorbid psychosocial disorders are an important consideration in patients presenting with severe symptoms of irritable bowel syndrome, Douglas A. Drossman, M.D., said at the 13th World Congress of Gastroenterology.

Such factors “should be looked at in the first visit because in some cases it might prevent you from doing unnecessary tests” in patients with IBS, he told this newspaper. “Even more important than that, it gives you the whole package of what's going on, both physically and psychologically. That can affect your diagnostic and treatment approach,” he added.

In a study of 211 patients with moderate and severe functional bowel syndrome, Dr. Drossman found that major depression was more pronounced in patients with severe symptoms than in those with moderate symptoms (12.5 versus 9.3 on the Beck Depression Inventory).

Poor coping responses like “catastrophizing” were more common in patients with severe symptoms, compared with patients with moderate symptoms (12.9 versus 8.2 on the Coping Strategies Questionnaire) (Am. J. Gastroenterol. 2000; 95:974–80).

The study also showed that compared with patients with milder symptoms, those with more severe symptoms felt that they had less control of their symptoms (2.2 versus 2.6 on the Coping Strategies Questionnaire) and reported having a significantly poorer quality of life (58.5 versus 69.3 overall score on the IBS Quality of Life questionnaire).

“There is also a higher frequency of sexual, physical, or emotional abuse in those with more severe symptoms,” said Dr. Drossman, codirector of the University of North Carolina Center for Functional GI and Motility Disorders, Chapel Hill.

The precise relationship between functional bowel disorders and psychosocial disorders is unclear, he said.

Comorbid psychosocial factors may affect perception of physical experiences. Stress can lower the pain threshold and produce other GI symptoms, and psychosocial disturbances may increase pain perception via functional changes in the cingulated cortex, the brain's pain modulation center.

MONTREAL — Comorbid psychosocial disorders are an important consideration in patients presenting with severe symptoms of irritable bowel syndrome, Douglas A. Drossman, M.D., said at the 13th World Congress of Gastroenterology.

Such factors “should be looked at in the first visit because in some cases it might prevent you from doing unnecessary tests” in patients with IBS, he told this newspaper. “Even more important than that, it gives you the whole package of what's going on, both physically and psychologically. That can affect your diagnostic and treatment approach,” he added.

In a study of 211 patients with moderate and severe functional bowel syndrome, Dr. Drossman found that major depression was more pronounced in patients with severe symptoms than in those with moderate symptoms (12.5 versus 9.3 on the Beck Depression Inventory).

Poor coping responses like “catastrophizing” were more common in patients with severe symptoms, compared with patients with moderate symptoms (12.9 versus 8.2 on the Coping Strategies Questionnaire) (Am. J. Gastroenterol. 2000; 95:974–80).

The study also showed that compared with patients with milder symptoms, those with more severe symptoms felt that they had less control of their symptoms (2.2 versus 2.6 on the Coping Strategies Questionnaire) and reported having a significantly poorer quality of life (58.5 versus 69.3 overall score on the IBS Quality of Life questionnaire).

“There is also a higher frequency of sexual, physical, or emotional abuse in those with more severe symptoms,” said Dr. Drossman, codirector of the University of North Carolina Center for Functional GI and Motility Disorders, Chapel Hill.

The precise relationship between functional bowel disorders and psychosocial disorders is unclear, he said.

Comorbid psychosocial factors may affect perception of physical experiences. Stress can lower the pain threshold and produce other GI symptoms, and psychosocial disturbances may increase pain perception via functional changes in the cingulated cortex, the brain's pain modulation center.

MONTREAL — Comorbid psychosocial disorders are an important consideration in patients presenting with severe symptoms of irritable bowel syndrome, Douglas A. Drossman, M.D., said at the 13th World Congress of Gastroenterology.

Such factors “should be looked at in the first visit because in some cases it might prevent you from doing unnecessary tests” in patients with IBS, he told this newspaper. “Even more important than that, it gives you the whole package of what's going on, both physically and psychologically. That can affect your diagnostic and treatment approach,” he added.

In a study of 211 patients with moderate and severe functional bowel syndrome, Dr. Drossman found that major depression was more pronounced in patients with severe symptoms than in those with moderate symptoms (12.5 versus 9.3 on the Beck Depression Inventory).

Poor coping responses like “catastrophizing” were more common in patients with severe symptoms, compared with patients with moderate symptoms (12.9 versus 8.2 on the Coping Strategies Questionnaire) (Am. J. Gastroenterol. 2000; 95:974–80).

The study also showed that compared with patients with milder symptoms, those with more severe symptoms felt that they had less control of their symptoms (2.2 versus 2.6 on the Coping Strategies Questionnaire) and reported having a significantly poorer quality of life (58.5 versus 69.3 overall score on the IBS Quality of Life questionnaire).

“There is also a higher frequency of sexual, physical, or emotional abuse in those with more severe symptoms,” said Dr. Drossman, codirector of the University of North Carolina Center for Functional GI and Motility Disorders, Chapel Hill.

The precise relationship between functional bowel disorders and psychosocial disorders is unclear, he said.

Comorbid psychosocial factors may affect perception of physical experiences. Stress can lower the pain threshold and produce other GI symptoms, and psychosocial disturbances may increase pain perception via functional changes in the cingulated cortex, the brain's pain modulation center.

MONTREAL — The presence of symptoms outside the gastrointestinal tract can help distinguish irritable bowel syndrome from inflammatory bowel disease, Noel B. Hershfield, M.D., said at the 13th World Congress of Gastroenterology.

Patients with irritable bowel syndrome (IBS) are more likely than patients with inflammatory bowel disease (IBD) to present with fatigue, depression/anxiety, and headache, as well as sleep loss for reasons not related to intestinal discomfort, Dr. Hershfield reported.

He reached these conclusions based on his survey of about 400 patients who came to his outpatient clinic. All of the patients were younger than 50 years old.

Of the 200 patients with IBS, almost three-quarters had chronic fatigue syndrome, compared with one-quarter of the similar number of patients with IBD.

Nearly half of the IBS patients reported headaches, compared with less than a quarter of the patients with IBD.

More than 40% of IBS patients had depression or anxiety; that figure was less than 10% for the IBD group, said Dr. Hershfield, a gastroenterologist at the University of Calgary (Alta.).

Among the IBS patents, 156 reported sleep disturbance not due to GI symptoms, compared with only 12 of the IBD patients. Conversely, only 2 IBS patients reported sleep disturbance due to GI pain, compared with 179 of the IBD patients (Can. J. Gastroenterol. 2005;19:231–4).

“The object of this paper was to get physicians to take a better history, so they wouldn't have to do so many tests to prove IBS,” he said. “If you spend some time with them, you don't have to do very many tests to know that they have irritable bowel—you don't have to colonoscope them, or x-ray them, or all that stuff. It costs a fortune to do that.”

Night sweats, sleep disturbance due to diarrhea and abdominal pain, and weight loss are symptoms of organic bowel disease. “People with IBD often have tremendous weight loss. They show up with problems related to poor nutrition, they can't eat, they don't absorb food properly, so they lose weight and all the things that go with that,” Dr. Hershfield said.

MONTREAL — The presence of symptoms outside the gastrointestinal tract can help distinguish irritable bowel syndrome from inflammatory bowel disease, Noel B. Hershfield, M.D., said at the 13th World Congress of Gastroenterology.

Patients with irritable bowel syndrome (IBS) are more likely than patients with inflammatory bowel disease (IBD) to present with fatigue, depression/anxiety, and headache, as well as sleep loss for reasons not related to intestinal discomfort, Dr. Hershfield reported.

He reached these conclusions based on his survey of about 400 patients who came to his outpatient clinic. All of the patients were younger than 50 years old.

Of the 200 patients with IBS, almost three-quarters had chronic fatigue syndrome, compared with one-quarter of the similar number of patients with IBD.

Nearly half of the IBS patients reported headaches, compared with less than a quarter of the patients with IBD.

More than 40% of IBS patients had depression or anxiety; that figure was less than 10% for the IBD group, said Dr. Hershfield, a gastroenterologist at the University of Calgary (Alta.).

Among the IBS patents, 156 reported sleep disturbance not due to GI symptoms, compared with only 12 of the IBD patients. Conversely, only 2 IBS patients reported sleep disturbance due to GI pain, compared with 179 of the IBD patients (Can. J. Gastroenterol. 2005;19:231–4).

“The object of this paper was to get physicians to take a better history, so they wouldn't have to do so many tests to prove IBS,” he said. “If you spend some time with them, you don't have to do very many tests to know that they have irritable bowel—you don't have to colonoscope them, or x-ray them, or all that stuff. It costs a fortune to do that.”

Night sweats, sleep disturbance due to diarrhea and abdominal pain, and weight loss are symptoms of organic bowel disease. “People with IBD often have tremendous weight loss. They show up with problems related to poor nutrition, they can't eat, they don't absorb food properly, so they lose weight and all the things that go with that,” Dr. Hershfield said.

MONTREAL — The presence of symptoms outside the gastrointestinal tract can help distinguish irritable bowel syndrome from inflammatory bowel disease, Noel B. Hershfield, M.D., said at the 13th World Congress of Gastroenterology.

Patients with irritable bowel syndrome (IBS) are more likely than patients with inflammatory bowel disease (IBD) to present with fatigue, depression/anxiety, and headache, as well as sleep loss for reasons not related to intestinal discomfort, Dr. Hershfield reported.

He reached these conclusions based on his survey of about 400 patients who came to his outpatient clinic. All of the patients were younger than 50 years old.

Of the 200 patients with IBS, almost three-quarters had chronic fatigue syndrome, compared with one-quarter of the similar number of patients with IBD.

Nearly half of the IBS patients reported headaches, compared with less than a quarter of the patients with IBD.

More than 40% of IBS patients had depression or anxiety; that figure was less than 10% for the IBD group, said Dr. Hershfield, a gastroenterologist at the University of Calgary (Alta.).

Among the IBS patents, 156 reported sleep disturbance not due to GI symptoms, compared with only 12 of the IBD patients. Conversely, only 2 IBS patients reported sleep disturbance due to GI pain, compared with 179 of the IBD patients (Can. J. Gastroenterol. 2005;19:231–4).

“The object of this paper was to get physicians to take a better history, so they wouldn't have to do so many tests to prove IBS,” he said. “If you spend some time with them, you don't have to do very many tests to know that they have irritable bowel—you don't have to colonoscope them, or x-ray them, or all that stuff. It costs a fortune to do that.”

Night sweats, sleep disturbance due to diarrhea and abdominal pain, and weight loss are symptoms of organic bowel disease. “People with IBD often have tremendous weight loss. They show up with problems related to poor nutrition, they can't eat, they don't absorb food properly, so they lose weight and all the things that go with that,” Dr. Hershfield said.

Kate Johnson of the Montreal Bureau contributed to this report.

MONTREAL — Continuous oral contraceptive regimens suppress ovulation better than do conventional 21-day regimens, according to research presented at the conjoint annual meeting of the American Society for Reproductive Medicine and Canadian Fertility and Andrology Society.

This effect of continuous oral contraceptives (COCs) has not been previously reported, said Roger Pierson, Ph.D., explaining that COCs have been promoted primarily for their ability to eliminate cyclic bleeding and premenstrual symptoms.

“The side effect of not bleeding is more effective contraceptive control,” said Dr. Pierson, professor of obstetrics, gynecology, and reproductive sciences at the University of Saskatchewan, Saskatoon.

In his single-center, randomized, open-label trial which was sponsored by the Canadian Institutes of Health Research, Dr. Pierson compared two different formulations of traditional 21-day oral contraceptive (OC) regimens with the same formulations given continuously for 28 days per cycle.

Women took the pills for three cycles. Transvaginal ultrasonography was used to monitor follicular development once weekly for the first 3 weeks of the study, then every third day until the end of the third cycle.

The nine women on the 28-day regimen of 30-mcg ethinyl estradiol/150-mcg levonorgestrel and the 11 women on the 28-day regimen of 35-mcg ethinyl estradiol/250-mcg norgestimate showed less follicular development than did those given the traditional 21-day regimens of both formulations (8 women in each group).

Those on the continuous regimen had no dominant follicles and no ovulations. Those on the standard regimens produced a total of eight dominant follicles, two of which ovulated. The time to return to normal ovulation during the first cycle after contraceptive discontinuation was measured in the conventional OC and COC groups and compared with historical data for ovulation after discontinuation of other forms of contraception.

Follicles developing after discontinuation of COCs took about 5 days longer to ovulate than did follicles developing after discontinuation of OCs. Time to ovulation for both OC groups was longer than in natural cycles. In addition, serum estradiol 17-β at a follicular diameter of 18 mm was significantly higher after discontinuation of OCs, compared with natural cycles. Dr. Pierson said the delayed return to normal ovulation was not significant, but noted the study's short length.

Kate Johnson of the Montreal Bureau contributed to this report.

MONTREAL — Continuous oral contraceptive regimens suppress ovulation better than do conventional 21-day regimens, according to research presented at the conjoint annual meeting of the American Society for Reproductive Medicine and Canadian Fertility and Andrology Society.

This effect of continuous oral contraceptives (COCs) has not been previously reported, said Roger Pierson, Ph.D., explaining that COCs have been promoted primarily for their ability to eliminate cyclic bleeding and premenstrual symptoms.

“The side effect of not bleeding is more effective contraceptive control,” said Dr. Pierson, professor of obstetrics, gynecology, and reproductive sciences at the University of Saskatchewan, Saskatoon.

In his single-center, randomized, open-label trial which was sponsored by the Canadian Institutes of Health Research, Dr. Pierson compared two different formulations of traditional 21-day oral contraceptive (OC) regimens with the same formulations given continuously for 28 days per cycle.

Women took the pills for three cycles. Transvaginal ultrasonography was used to monitor follicular development once weekly for the first 3 weeks of the study, then every third day until the end of the third cycle.

The nine women on the 28-day regimen of 30-mcg ethinyl estradiol/150-mcg levonorgestrel and the 11 women on the 28-day regimen of 35-mcg ethinyl estradiol/250-mcg norgestimate showed less follicular development than did those given the traditional 21-day regimens of both formulations (8 women in each group).

Those on the continuous regimen had no dominant follicles and no ovulations. Those on the standard regimens produced a total of eight dominant follicles, two of which ovulated. The time to return to normal ovulation during the first cycle after contraceptive discontinuation was measured in the conventional OC and COC groups and compared with historical data for ovulation after discontinuation of other forms of contraception.

Follicles developing after discontinuation of COCs took about 5 days longer to ovulate than did follicles developing after discontinuation of OCs. Time to ovulation for both OC groups was longer than in natural cycles. In addition, serum estradiol 17-β at a follicular diameter of 18 mm was significantly higher after discontinuation of OCs, compared with natural cycles. Dr. Pierson said the delayed return to normal ovulation was not significant, but noted the study's short length.

Kate Johnson of the Montreal Bureau contributed to this report.

MONTREAL — Continuous oral contraceptive regimens suppress ovulation better than do conventional 21-day regimens, according to research presented at the conjoint annual meeting of the American Society for Reproductive Medicine and Canadian Fertility and Andrology Society.

This effect of continuous oral contraceptives (COCs) has not been previously reported, said Roger Pierson, Ph.D., explaining that COCs have been promoted primarily for their ability to eliminate cyclic bleeding and premenstrual symptoms.

“The side effect of not bleeding is more effective contraceptive control,” said Dr. Pierson, professor of obstetrics, gynecology, and reproductive sciences at the University of Saskatchewan, Saskatoon.

In his single-center, randomized, open-label trial which was sponsored by the Canadian Institutes of Health Research, Dr. Pierson compared two different formulations of traditional 21-day oral contraceptive (OC) regimens with the same formulations given continuously for 28 days per cycle.

Women took the pills for three cycles. Transvaginal ultrasonography was used to monitor follicular development once weekly for the first 3 weeks of the study, then every third day until the end of the third cycle.

The nine women on the 28-day regimen of 30-mcg ethinyl estradiol/150-mcg levonorgestrel and the 11 women on the 28-day regimen of 35-mcg ethinyl estradiol/250-mcg norgestimate showed less follicular development than did those given the traditional 21-day regimens of both formulations (8 women in each group).

Those on the continuous regimen had no dominant follicles and no ovulations. Those on the standard regimens produced a total of eight dominant follicles, two of which ovulated. The time to return to normal ovulation during the first cycle after contraceptive discontinuation was measured in the conventional OC and COC groups and compared with historical data for ovulation after discontinuation of other forms of contraception.

Follicles developing after discontinuation of COCs took about 5 days longer to ovulate than did follicles developing after discontinuation of OCs. Time to ovulation for both OC groups was longer than in natural cycles. In addition, serum estradiol 17-β at a follicular diameter of 18 mm was significantly higher after discontinuation of OCs, compared with natural cycles. Dr. Pierson said the delayed return to normal ovulation was not significant, but noted the study's short length.

Two studies demonstrated a positive response to an investigational low-dose continuous oral contraceptive in terms of suppression of ovulation and premenstrual symptoms and return to normal ovulation, researchers reported at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

Both studies were sponsored by Wyeth, which has submitted the contraceptive for approval by the Food and Drug Administration. If approved, the contraceptive would be marketed under the trade name Lybrel.

The oral formulation of 20-mcg ethinyl estradiol and 90-mcg levonorgestrel is designed to be taken daily with no hormone-free intervals. One study, involving 37 women aged 18–35 years, showed complete inhibition of ovulation in all women while on the oral formulation.

“We showed that none of the subjects developed follicles equal to or greater than 10 mm during treatment,” said study investigator Susan A. Ballagh, M.D., of CONRAD Clinical Research Center at Eastern Virginia Medical School, Norfolk. “We used a very conservative measure to show there was no ovulation.”

Participants followed the continuous oral contraception (COC) regimen for 84 days, using three pill-pack segments.

After discontinuation of contraception, the time to return to normal ovulation—defined as serum progesterone levels greater than 5 ng/mL—was a mean of 20 days. A total of 95% of subjects ovulated within 25 days after discontinuation.

The study did not include women unable to meet the compliance demands of the program, and Dr. Ballagh said that's an element that will have to be explored in a future study.

“Our next question is, when women are taking the pills in less controlled circumstances, does this COC formulation in fact lead to less chance of them becoming pregnant,” she said. “Patient failure rates of pills in common use is estimated to be at least 3%, and some have recently suggested that it may be as high as 7%.”

The second study found that the same COC regimen significantly alleviated premenstrual symptoms.

A total of 278 women with a history of cycle-related symptoms or dysmenorrhea were monitored during three cycles of the COC regimen, with no pill-free interval. The subjects maintained a daily diary, rating mood, behavior, pain, and physical symptoms using the Penn Daily Symptom Rating scale. Two-thirds of the women improved their scores by 50% in the first 28-day cycle (one pill pack). In addition, work productivity was improved.

“What impressed me the most was the very immediate response of the first cycle and the strong response at end point,” said lead investigator Ellen Freeman, Ph.D., of the University of Pennsylvania in Philadelphia. “Almost all the response occurred right away. That's fast. Secondly, I was surprised that all four of the symptom subscales seemed to respond similarly.”

The study, which was not placebo-controlled, shows the impact of the COC on PMS symptoms to be more effective than what has been reported with selective serotonin reuptake inhibitors.

“SSRIs don't appear to reduce the symptoms to their postmenstrual level for women overall, which is what is considered the normal asymptomatic level. This data suggest this therapy does, but that has to be confirmed with a placebo-controlled study.” said Dr. Freeman.

Two studies demonstrated a positive response to an investigational low-dose continuous oral contraceptive in terms of suppression of ovulation and premenstrual symptoms and return to normal ovulation, researchers reported at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

Both studies were sponsored by Wyeth, which has submitted the contraceptive for approval by the Food and Drug Administration. If approved, the contraceptive would be marketed under the trade name Lybrel.

The oral formulation of 20-mcg ethinyl estradiol and 90-mcg levonorgestrel is designed to be taken daily with no hormone-free intervals. One study, involving 37 women aged 18–35 years, showed complete inhibition of ovulation in all women while on the oral formulation.

“We showed that none of the subjects developed follicles equal to or greater than 10 mm during treatment,” said study investigator Susan A. Ballagh, M.D., of CONRAD Clinical Research Center at Eastern Virginia Medical School, Norfolk. “We used a very conservative measure to show there was no ovulation.”

Participants followed the continuous oral contraception (COC) regimen for 84 days, using three pill-pack segments.

After discontinuation of contraception, the time to return to normal ovulation—defined as serum progesterone levels greater than 5 ng/mL—was a mean of 20 days. A total of 95% of subjects ovulated within 25 days after discontinuation.

The study did not include women unable to meet the compliance demands of the program, and Dr. Ballagh said that's an element that will have to be explored in a future study.

“Our next question is, when women are taking the pills in less controlled circumstances, does this COC formulation in fact lead to less chance of them becoming pregnant,” she said. “Patient failure rates of pills in common use is estimated to be at least 3%, and some have recently suggested that it may be as high as 7%.”

The second study found that the same COC regimen significantly alleviated premenstrual symptoms.

A total of 278 women with a history of cycle-related symptoms or dysmenorrhea were monitored during three cycles of the COC regimen, with no pill-free interval. The subjects maintained a daily diary, rating mood, behavior, pain, and physical symptoms using the Penn Daily Symptom Rating scale. Two-thirds of the women improved their scores by 50% in the first 28-day cycle (one pill pack). In addition, work productivity was improved.

“What impressed me the most was the very immediate response of the first cycle and the strong response at end point,” said lead investigator Ellen Freeman, Ph.D., of the University of Pennsylvania in Philadelphia. “Almost all the response occurred right away. That's fast. Secondly, I was surprised that all four of the symptom subscales seemed to respond similarly.”

The study, which was not placebo-controlled, shows the impact of the COC on PMS symptoms to be more effective than what has been reported with selective serotonin reuptake inhibitors.

“SSRIs don't appear to reduce the symptoms to their postmenstrual level for women overall, which is what is considered the normal asymptomatic level. This data suggest this therapy does, but that has to be confirmed with a placebo-controlled study.” said Dr. Freeman.

Two studies demonstrated a positive response to an investigational low-dose continuous oral contraceptive in terms of suppression of ovulation and premenstrual symptoms and return to normal ovulation, researchers reported at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

Both studies were sponsored by Wyeth, which has submitted the contraceptive for approval by the Food and Drug Administration. If approved, the contraceptive would be marketed under the trade name Lybrel.

The oral formulation of 20-mcg ethinyl estradiol and 90-mcg levonorgestrel is designed to be taken daily with no hormone-free intervals. One study, involving 37 women aged 18–35 years, showed complete inhibition of ovulation in all women while on the oral formulation.

“We showed that none of the subjects developed follicles equal to or greater than 10 mm during treatment,” said study investigator Susan A. Ballagh, M.D., of CONRAD Clinical Research Center at Eastern Virginia Medical School, Norfolk. “We used a very conservative measure to show there was no ovulation.”

Participants followed the continuous oral contraception (COC) regimen for 84 days, using three pill-pack segments.

After discontinuation of contraception, the time to return to normal ovulation—defined as serum progesterone levels greater than 5 ng/mL—was a mean of 20 days. A total of 95% of subjects ovulated within 25 days after discontinuation.

The study did not include women unable to meet the compliance demands of the program, and Dr. Ballagh said that's an element that will have to be explored in a future study.

“Our next question is, when women are taking the pills in less controlled circumstances, does this COC formulation in fact lead to less chance of them becoming pregnant,” she said. “Patient failure rates of pills in common use is estimated to be at least 3%, and some have recently suggested that it may be as high as 7%.”

The second study found that the same COC regimen significantly alleviated premenstrual symptoms.

A total of 278 women with a history of cycle-related symptoms or dysmenorrhea were monitored during three cycles of the COC regimen, with no pill-free interval. The subjects maintained a daily diary, rating mood, behavior, pain, and physical symptoms using the Penn Daily Symptom Rating scale. Two-thirds of the women improved their scores by 50% in the first 28-day cycle (one pill pack). In addition, work productivity was improved.

“What impressed me the most was the very immediate response of the first cycle and the strong response at end point,” said lead investigator Ellen Freeman, Ph.D., of the University of Pennsylvania in Philadelphia. “Almost all the response occurred right away. That's fast. Secondly, I was surprised that all four of the symptom subscales seemed to respond similarly.”

The study, which was not placebo-controlled, shows the impact of the COC on PMS symptoms to be more effective than what has been reported with selective serotonin reuptake inhibitors.

“SSRIs don't appear to reduce the symptoms to their postmenstrual level for women overall, which is what is considered the normal asymptomatic level. This data suggest this therapy does, but that has to be confirmed with a placebo-controlled study.” said Dr. Freeman.