Wednesday, April 17, 2019

A Deeper Look at an Illness Often Bemoaned: Irritable Bowel Syndrome

By Virginia Barak, MD
Pediatric Resident at The University of Texas at Austin Dell Medical School
Member, Texas Medical Association

Do you have ongoing stomach issues troubling you? You might have irritable bowel syndrome (IBS).

IBS is the most commonly diagnosed gastrointestinal condition, affecting about 12% of the North American population. People with IBS experience the following symptoms:

  • Abdominal pain or discomfort partially relieved by having a bowel movement;
  • A change in bowel habits such as constipation or diarrhea (sometimes switching between the two); and/or
  • Gas, bloating, or abdominal distention (increased abdominal pressure that causes the person’s stomach area to stick out).
IBS is a chronic disease, and the severity of symptoms can come and go over time. It can significantly affect quality of life and, for some people, even the ability to work; therefore it is very important to discuss it with your doctor.

Part of the challenge of IBS is that many different things can cause it. People without any other illness can develop IBS, but it can be associated with chronic pain, reflux or indigestion, and psychiatric disorders. Doctors believe IBS can be caused by several conditions:

  • Neurologic factors, including: increased gut sensitivity, altered connection between your brain and the nerves in your intestinal tract, and altered pain perception. Learned illness behaviors, like recurrent abdominal pain starting in childhood as a response to other factors (below), can lead to changes in the brain-gut relationship and contribute to IBS;
  • Social factors such as early life stressors, current life stressors, or history of abuse; and/or
  • Environmental factors, including food intolerance, infection, other causes of inflammation, or antibiotic use.

Several different things can flare up IBS symptoms. Some foods containing lactose and sugars can trigger symptoms. (Lactose is in milk and other dairy products, and sugars are in many foods.) They can pull water into the intestines and cause diarrhea. Some over-the-counter treatments can make IBS worse. They include nonsteroidal anti-inflammatory drugs (NSAIDs, or pain relief medicines like aspirin and ibuprofen), antihistamines (a common medication for allergies), or supplements such as iron, magnesium, or wheat bran. Lots of prescription medications also can worsen IBS, including antibiotics, antidepressants, antipsychotics, diuretics, opioids, and metformin (a drug used to treat diabetes).

Extensive diagnostic testing for patients with IBS is not usually helpful. For most patients, tests do not point to a cause. However, if you have IBS with diarrhea, your doctor may want to screen you for celiac disease – in which eating gluten can damage the small intestine – because the symptoms are similar. Your doctor might be more insistent about this testing if you have any of these risk factors:

  • Onset of symptoms after 50 years old;
  • Rectal bleeding;
  • Anemia;
  • Severe or progressive symptoms;
  • Associated weight loss; or
  • Family history of cancer, inflammatory bowel disease, or celiac disease.

Treatment of IBS is based on treating the person’s symptoms. In general, the most important treatments are not medications, but rather exercise and diet, and addressing stress or emotional/mental health disorders. Exercise causes more movement of the bowels, which improves symptoms. Diet changes can have a large effect. If a patient is sensitive to gluten, a gluten-free diet or a FODMAP diet (a diet low in fermentable carbs like sweets and starched foods) might help. A FODMAP diet limits the amount of poorly absorbed carbohydrates found in certain fruits, vegetables, and dairy products. Some patients who have IBS associated with chronic pain or psychiatric disorders should consider participating in counseling, or visiting with a psychologist.

People with IBS experience symptoms like abdominal pain,
a change in bowel habits (constipation, diarrhea), and/or gas
and bloating.
Sometimes, medications can help alleviate symptoms. For diarrhea, physicians often prescribe loperamide (like Imodium) or probiotics (good bacteria that aid digestion and maintain gut health). Probiotics can sometimes help with pain, bloating, or gas as well. For constipation, laxatives or fiber supplements can help. Sometimes ondansetron (a drug used to prevent nausea and vomiting) or antispasmodics (which relax the smooth muscles of the digestive tract) can help improve general symptoms. A physician might prescribe stronger medications like antidepressants when a patient with IBS also has psychiatric or chronic pain disorders, because these medicines can help alter the perception of pain and improve overall mood. However, the risk of side effects has the potential to outweigh the benefits of using these drugs, so the doctor might recommend them only if other treatments have not been helpful.

For more information, I recommend reading this blog post about one woman’s personal IBS experience. If you are experiencing any stomach issues, and feel like they are affecting your quality of life, make an appointment with your primary care provider to discuss if any testing is needed, and what lifestyle modifications may be helpful for you.

Chey WD, Kurlander J, Eswaran S. Irritable Bowel Syndrome: A Clinical Review. JAMA. 2015;313(9):949–958. doi:10.1001/jama.2015.0954

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