Irritable Bowel Syndrome (IBS) is a common intestinal disorder affecting 10-20% of people worldwide. Although this chronic and relapsing condition is not life-threatening, the misconceptions and lack of the cure is a great source of frustration to both sufferers and their treating doctors.
IBS is a complex ‘brain-gut’ disease process comprising both physical and mental processes. The intestinal wall becomes sensitised by a bacterial infection or psychological trigger (e.g. anxiety/depression) and subsequently changes in terms of its immunity, nerve activity, hormone secretion and contractions, giving rise to symptoms.
Typically symptoms are abdominal pain (on eating certain foods or when defecating) and bloating. Faeces formation is affected in either direction, with recognised variants of IBS-D (diarrhoea predominant) and IBS-C (constipation predominant.) There can sometimes be associated lethargy, nausea and bladder symptoms because of the pressure within the intestines.
IBS symptoms also occur in acute and life-threatening intestinal conditions such as inflammatory bowel diseases (ulcerative colitis/Crohn’s disease) or even bowel cancers. However, specific conditions differentiate them from IBS. These are rectal bleeding, weight loss, family history of these conditions, age over 45 and sudden change in symptoms over 6 weeks.
If any of these are present, then further investigations by a gastroenterologist are necessary before IBS can be considered the most appropriate diagnosis.
Unfortunately, there is no simple test that positively identifies IBS. Rather, investigations in IBS are aligned to exclude other diseases. These consist of stool tests to exclude subtle ongoing parasitic of bacterial infection or inflammation and blood tests to exclude:
1. High inflammation – from inflammatory bowel diseases or cancer
2. Tissue Transglutaminase Antibodies -from gluten intolerance (Coeliac’s disease)
3. Low Iron (anaemia) – from any of these other diseases
Sometimes, a scan of the abdomen like an Ultrasound or a colonoscopy may also be done to exclude rarer causes if necessary.
IBS is currently diagnosed by excluding other potential disease options than from positively recognising the symptoms themselves. However, this is evolving.
In May 2016, the definition for IBS was revised as part of the international standard Rome-IV classification, which now positively defines IBS as ‘recurrent abdominal pain on average for one day a week for the last three months’ alongside at least two of four conditions: pain with defecation, change in stool frequency, change in stool form, the first episode being 6 months previous.
If these symptoms are present without any markers for other diseases, a diagnosis of IBS is made.
Approximately, 75% of patients find relief in managing IBS through any combination of the following methods:
1. Symptom Relief (as required)
The abdominal pain from contractions can be controlled with intestinal wall muscle relaxants like Buscopan or Mebeverine. Bloating can be treated with Peppermint Oil capsules before meals. Constipation can be treated with laxatives and diarrhoea with Loperamide.
2. Diet adjustments
The low FODMAP (Fermented Oligo/Di/Mono And Polyols) diet has become the diet of choice in recent years and ongoing research is supportive of its effectiveness. It involves eliminating short chain carbohydrates, which are poorly absorbed by the small intestine and then ferment in the gut triggering pain and bloating. It includes removing items such as vegetables (garlic, onion, beans), fruits (apples, pears, plums), diary (come cheeses, cows/goats milk), cereals (wheat, bread) and drinks (beer, fruit juices). More comprehensive lists can be easily found on the internet and from health professionals.
3. Psychological support
Aside from identifying and managing psychological symptom triggers, CBT and hypnotherapy have some evidence in helping IBS sufferers. SSRI and TCA type antidepressant medications have also been shown to be effective for some patients.
To date, probiotics have not been adequately proven to effectively treat IBS. However, the FDA has recently approved two novel agents for IBS-D (the antibiotic Rifaxmin and nerve modulator Eluxadoline) – although more research needs to be done to better establish their effectiveness.
So, although IBS presents a challenge in its complexity, the medical community is rising to meet it with intensive ongoing research activity and treatment methods.
© Syed Z Arfeen
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Last updated on August 9, 2018.