Irritable Bowel Syndrome (IBS)

What is it?

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder. It is defined as abdominal pain and discomfort with a change in bowel habits that are unexplained by any other medical condition.

Cause:

Current medical dogma is that IBS is a syndrome of unknown origin. IBS results in a hypersensitivity of the bowels to a variety of stimuli, including stress, caffeine, acidic foods and drinks, wheat and dairy products, and many medications. Women are more likely than men to suffer from IBS. Approximately 10 to 15 percent of the U.S. population is affected by IBS, making it quite common.

Teaching Point: The cause of IBS is currently unknown. Women are more susceptible.

Symptoms:

IBS may present with several different symptoms, including:
- Abdominal discomfort or pain for at least 12 weeks in the preceding year
- Relief of pain with bowel movement
- Change in stool frequency (>3/day; or <3/week)
- Change in stool consistency (loose and watery or lumpy and hard)
- Urgency or feeling of incomplete evacuation
- Mucus in stool
- Bloating or sensation of fullness in belly

IBS does not ever present with fever, abnormal weight loss, or blood in stool. These symptoms typically indicate a more serious medical condition.

Teaching Point: A combination of bloating, change in stool frequency or consistency, and abdominal pains may signal the presence of IBS.

Risk Factors:

As stated earlier, women are more susceptible to IBS. People with co-existing mood disorders also are more likely to develop IBS. There is no family predisposition to developing IBS. IBS afflicts adults and does not occur in childhood.

Teaching Point: Co-existing mood disorders often accompany IBS.

Diagnosis:

Specific criteria (known as Rome criteria) exist for making a diagnosis of IBS (see symptoms above). They are as follows:
- At least three months of continuous or recurrent abdominal pain that is relieved with defecation and/or is associated with a change in stool consistency

- Plus, at least two of the following on at least 25% of days:

• Altered stool frequency
• Altered stool form or passage
• Passage of mucus
• Bloating or feeling of abdominal distention

Other criteria are also used by medical professionals (Manning criteria) and must include the presence of three of the following:

• Abdominal pain
• Pain relief with defecation
• Increased stool frequency with pain
• Looser stools with pain
• Mucus in stools
• Feeling of incomplete evacuation

Teaching Point: Specific criteria are needed to confirm the diagnosis of IBS.

Treatments:

Several treatments are available for IBS. Many of them can provide useful relief of one or more symptoms. Below is a complete list of the currently available treatments recommended by medical authorities:

• Avoidance of dietary triggers, such as caffeine, citrus, corn, dairy products, and wheat products
• Increasing dietary fiber
• Supplemental guar gum, a polysaccharide that is sometimes found in dairy products like cheese.
• Antispasmodic medications (Dicyclomine, Hyoscyamine). These agents relax smooth muscle in the gut and reduce painful contractions
• Antidiarrheal agents (Loperamide or Imodium) for reducing frequency of stools
• Antidepressant and antianxiety medications (e.g. Amitriptyline, clomipramine, desipramine, doxepine) have been shown to relieve pain with low doses
• 5-HT3 and 5-HT4 receptor modulators (Alosetron and Tegaserod, respectively) are two medications indicated for specific types of IBS (diarrhea-predominant and constipation-predominant IBS, respectively) and are only useful for short-term therapy
• Probiotics, or agents used to help restore normal bacterial levels to the gut, are recommended as add-on treatment to one or more of the above
• Peppermint, ginger and aloe vera are herbal/plant products with favorable effects on IBS
• Psychotherapy, stress management and relaxation techniques are of value in helping IBS sufferers deal with this chronic condition

Teaching Point: Combining dietary approaches with FDA-approved medicine(s) is the current treatment plan that works best for relieving or alleviating the symptoms of IBS.

Complications:

Fortunately, there are no long-term complications associated with IBS.

The final word:

IBS is a chronic condition afflicting many young, otherwise healthy adults. Key to managing this troubling condition is to use a combination of medications, as needed, along with non-medicinal dietary and psychological therapies. Please consult your family doctor for further information.

References:

1. Hadley, SK; Gaardner, SM. American Family Physician. 2005. 72(12).
2. Tillisch, K; Chang, L. Diagnosis and treatment of IBS: state of the art. Curr Gastroenterol Rep. August 2005; 7(4): 249-56.
3. Mertz, HR. Irritable Bowel Syndrome. N Engl J Med 2003; 349: 2136-46.
4. Cayley, WE. Letter to the editor re: Diagnostic Criteria for Patients with IBS. 2006; 74(4).

Copyright 2007, MD Kiosk