By Richard A. Krause, M.D.

 

 Asian

"I'm bloating... I'm cramping... I'm embarrassed!
I can't go out with my friends to eat dinner. 
I know where every bathroom is in the mall 
and on the way home from the mall.  
I suffer from constipation and /or diarrhea.  
I have IBS!!"

 

What is irritable bowel syndrome (IBS)?

It is the chronic disorder associated with abdominal pain or discomfort, bowel irregularity, bloating, and cramping. Irritable bowel is not colitis, infectious, or cancer.  Its symptoms are magnified by eating and stress.


Why is Irritable bowel important?

  1. 10 to 20% of the adult U.S. population have IBS.
  2. 30 billion dollars are spent every year in the U>S. on treatment and diagnosis of IBS.
  3. IBS patients lose or miss three times the normal number of days from work or school.
  4. IBS patients go to they physician five times a year compared to one or two times for non-IBS patients.
  5. Irritable bowel may not result in death, however, it certainly effects quality of life

Is IBS a problem only in the United States?

Irritable bowel patients can be found throughout the world.  In Japan, 25% of the population have irritable bowel.  in China, 23%, and in Europe, 15 to 22%.


When do patients develop irritable bowel syndrome?

Most patients develop irritable bowel between the age 15 and 44.  However, 10% develop it after the age of 45.  It is more unlikely to develop IBS after the age of 50, but not impossible.


Who goes to their doctor for irritable bowel symptoms?

It is interesting to note that in the United States, more women than men go to their doctor because of irritable bowel symptoms.  However, in Japan, the opposite is true.  It is also interesting to note that only 25% of people with IBS symptoms actually go to a doctor.  The rest stay at home probably complaining to their spouse.


What about quality of life for IBS patients?

IBS patients’ quality of life is similar to that of depression.  It is worse than migraine headaches, asthma, GERD or diabetes type II.


What causes irritable bowel?

There is no specific cause of irritable bowel syndrome.  However, there is definitely an abnormal transmission of information from the gut to the brain.  Irritable bowel patients have increased bowel contractions and a colon that is hypersensitive to food and stress.  There appears to be a hormone called serotonin that may be the cause of many of the symptoms.  (Serotonin in the brain is associated with migraine headaches and depression.  Serotonin in the gut is associated with abdominal discomfort, cramps, diarrhea, and/or constipation.)  Irritable bowel patients pain threshold in the gut is much lower than in a “normal” individual.


How do you diagnose irritable bowel syndrome?

There is no specific test.  One must rule out other possibilities before assuming that you have irritable bowel.  Other diseases could include colon cancer, colitis, Crohn’s disease, milk intolerance, a parasite called Giardia, food intolerance, sprue, and celiac disease.


What tests will be ordered to diagnose irritable bowel?

Evaluation of the colon with X-rays or endoscopy would normally be suggested at least once.  X-ray of the small bowel (above the colon) may be necessary.  Lab work and stool specimens as well as history and physical exam must be performed before assuming this diagnosis.  Careful review of diet for specific food intolerance must also be obtained.  Physicians will check for “red flags”.  These are specific symptoms that would indicate a more serious problem.  These include microscopic or gross blood in the stool, significant weight loss, abnormal lab work, and strong family history of colon cancer, colitis or Crohn’s disease, and age 50 or above.


What is the current general treatment of IBS?

  1. Establish a definite diagnosis and reassure the patient.
  2. Control of symptoms since there is no cure for irritable bowel.
  3. Set realistic goals for control and treatment of symptoms.
  4. Dietary modification.

 

What are some of the dietary changes suggested for irritable bowel?

Avoid caffeine, fatty foods, low fiber foods, foods high in sorbitol or fructose, and gas producing foods.  keep a food diary for at least two weeks trying to correlate symptoms with particular groups of food.

What are some of the specific treatments for diarrhea?

  • Imodium Advanced is probably one of the best ways to treat diarrhea.  However, it is suggested that the Imodium Advanced be taken daily to prevent diarrhea rather than wait until the patient has symptoms.
  • Binding agents such as Questran and WelChol may be added.
  • Anti-spasm medication may also be used (Librax, Levsin, Bentyl, Robinul, etc.)
  • Low dose codeine may be necessary but only in rare cases.
  • Lotrinex, which was taken off the market several years ago for irritable bowel can be obtained in special cases for intractable diarrhea.

 

What is the treatment for gas-bloat syndrome?

  • Over the counter medication such as Simethicone, Beano, and pancreatic enzymes may be helpful but only in a limited number of patients.
  • Strengthening abdominal muscles by exercise will help decrease bloating.
  • Flagyl or Xifaxan may be added to kill certain types of bacteria that produce gas.  The bacteria in yogurt may be added to help decrease gas production.
  • Unfortunately, nothing works well, and therefore, adjustment of medication and diet is frequently necessary.
  • Suggestions to decrease belching include reduce swallowing air (avoid drinking through a straw, sucking hard candy, chewing gum, drinking carbonated drinks, easting fast, and talking while you eat).  It is also suggested that one stop smoking and treat postnasal drip. Both of these will increase bloating.  Probably the best treatment for gas-bloat is to take a walk after eating.

 

What specific treatment is there for constipation?

  • Increase fiber in your diet will help in some patients providing the fiber is increased slowly to the diet.  high doses of fiber may increase gas and bloating.
  • Increasing water intake (six to eight glasses a day) will help some patients.  Unfortunately, most patients just increase urination rather that increase bowel movements.
  • Medication that retains water in the stool such as Chronulac or Lactulose will help.  However, the down side of this is increased rectal gas.
  • MiraLax is quite effective in chronic constipation patients since it holds water in the stool and is not absorbed.
  • The newest treatment for constipation and irritable bowel is a drug called Linzess.  This may also be effective in approximately 50% of the patients.

 

IBS is a very common problem in the United States and the world for that matter.  IBS patients miss work and/ or school.  They have a rather poor quality of life and are frequently misunderstood by their spouse, friends, and even their physicians.  Irritable bowel patients cost the United States 30 billion dollars a year.  However, pharmaceutical companies are now aware of the significance of irritable bowel and are rapidly developing new drugs to treat these symptoms.  If you are not responding to current therapy feel free to contact our Research Department at (423)-698-4584.