Irritable Bowel Syndrome

ABOUT 20 percent of people in the United States (323.58 million population) have Irritable Bowel  Syndrome ((IBS) of some type, a condition that is not well-understood and under-diagnosed. I could not determine its prevalence/incidence in the Philippines (UN population estimate as of April 7, 2016: 101,884,176), but I would surmise it could be close to that figure.

What Is IBS?
Irritable Bowel Syndrome is a gastrointestinal disorder that involves the large intestine (colon) without causing any inflammation or permanent damage. It is a poorly understood condition and hence no specific treatment regimen could be adopted. The symptoms are non-specific, and they could include abdominal pain, bloating or cramping, gas, constipation or diarrheas, or even mucus in the stool, and the symptom may be one or in any combination of those, and could also change, even in the same patient. Most of us have experienced a sense of abdominal discomfort or bloating after a meal at one time or the other, but if the symptoms happen regularly after a meal, it could be IBS.

Does IBS affect children?
Yes, children could also be affected by IBS, but since the symptoms are so non-specific, IBS is hard to diagnose especially among children. A study of the National Digestive Diseases Information Clearing House (NDDIC) stated that “one study of children in North America found that girls and boys are equally prone to having IBS…..The study also found that as many as 14% of high school students and 6% of
middle school students have IBS….FDA has not
approved any drugs for treating IBS in children.”
Individuals with IBS are usually sensitive to a variety of food items. Each case is unique.

What causes IBS?
Medical science does not know what causes IBS.
Diet is a suspect and what persons with IBS eat or drink are important to note in a diary they are recommended to write after each meal, to find out if any food item precipitates the abdominal pains and/or other symptoms. Could carbohydrates in general, or fried foods, or food with gluten (like wheat, etc.) be causing intolerance in some or all of persons with IBS? Could it be
digestive enzyme deficiency, like lactose (milk and other dairy food) intolerance? Or lack of good bacteria which helps in food digestion in the gut? Irritable Bowel Syndrome is still a puzzle even to physicians today.

So, why even seek medical consultation?
It is very important for those with any of the symptoms above to see a physician in order to find out if it is only lactose intolerance (enzyme deficiency which could effectively be treated with lactase enzyme tablet) and to rule out the possibility of a more serious condition. Indeed, medical consultation is strongly recommended for persons with any symptom or sign that bothers them. As I have repeatedly advocated in this column, we must love our body and listen to what it tells us.

Could stress cause it?
“Most people would agree that stress plays an important role in triggering symptom flares in irritable bowel syndrome,” states Dr. Emeran Mayer at the University of California, Los Angeles, is an NIH-funded scientist who’s working to find treatments to correct altered brain-gut interactions. He says “one possibility is that it comes from changes in the way that the brain and the gut communicate…. People with irritable bowel syndrome often report higher levels of stress or anxiety… Stress reduction strategies and cognitive behavioral therapy, a type of talk therapy, can help relieve the symptoms of irritable bowel syndrome.”

Would probiotics help?
Changes (reduction) in the gut bacteria is also a suspect. To help restore the helpful bacteria, which aid in our digestion, probiotic supplement (capsules, tablet, or powder, or live active cultures as in yogurts) is an added recommendation. Many people with irritable bowel syndrome find that certain foods can make them feel worse. “There is no specific irritable bowel syndrome diet,” says Mayer. “Irritable bowel syndrome patients are generally more sensitive to a variety of foods.” Every case of irritable bowel syndrome is unique.

How common is it among adults?
IBS appears to be most common among those younger than 45 years old, with most of them experiencing the first symptoms when they were in their 20’s. Women are somehow more often affected than men. Those with family history of IBS are more prone to have it too. Anxiety, depression and other psychological issues have been found to be common among individuals with IBS. The question among those with depression and IBS is which is causing which, which came first?

Is there a medical test for it?
To date, there is no specific medical test that can definitively confirm the diagnosis of Irritable Bowel Syndrome. The physician
arrives at a “diagnosis” based on the clinical history, symptoms, physical examination and laboratory findings, ruling out all other
medical conditions.

Why keep a diary of foods eaten?
As I have alluded to above, the type or kind of food might be a triggering factor in IBS. Keeping a list of food consumed at mealtimes and noting any symptoms developing after the meal, and the time interval, could provide valuable information for
prophylactic avoidance of any food items that may be causing the irritation.

Does IBS lead to cancer?
No, Irritable Bowel Syndrome does not lead to cancer or cause permanent damage to the colon. IBS does not progress or lead to other GI diseases. The abdominal discomfort or pain, and other symptoms, if present, are quite
annoying and bothersome, but they usually subside spontaneously.

What is the treatment for IBS?
Since the cause is unknown, there is no specific treatment for Irritable Bowel Syndrome. After the physician has ruled out all other more serious medical conditions, the treatment regimen includes changes in diet (if the trigger food item(s) is/are identified), probiotic supplement, daily exercise and stress management. Diarrhea and constipation, if present, are treated accordingly. For those with IBS with persistent and intractable (not responsive to standard drugs) constipation, Linzess (linaclotide) and Amitiza (lubiprostone), have been approved by the US-FDA recently. For IBS with persistent diarrhea, Lotronex (alosetron) is the new drug. Medication should be the last resort. Diet and lifestyle changes, especially exercise and stress management, are the first best option. Since certain foods can trigger IBS symptoms, like food rich in carbohydrates (a nutrient called polyols in carbs), fatty foods, spicy foods, milk products, coffee, alcohol and caffeine in general, these foods are to be minimized, if not avoided.
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TAGS: Colon, diarrheas, health, Irritable Bowel Syndrome
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