What You Should Know About IBS
in the United States have irritable bowel syndrome(), which ischaracterized by abdominal pain or discomfort, and altered bowel habits. It’s a staggering number for asyndrome with unknown origins.
To mark,David Wan, M.D.,assistantprofessor of Medicine at ֭Ƶ Medical College, Cornell University,andassistantattendingphysician atNewYork-Presbyterian Hospital/ ֭Ƶ (WCM),discussesthe condition, itssub-types andsymptoms, and the resources available for IBS patients.
How would you describeirritable bowel syndrome?
IBS is characterized by symptoms of recurrent abdominal pain associated with diarrheaorconstipation. Patients will have changes in their bowel form or frequency that is tied to abdominal pain. They will also frequently have bloating.
How is IBS diagnosed, and about how long does it typically take for a patient to be diagnosed with IBS?
IBS can be diagnosed and treated fairly rapidly—often withinonevisit.To diagnose IBS, a gastroenterologist will take acareful clinical history showing the symptoms in the absence of alarm features (alarm features includeweight loss, blood in the stool,whether theage of onset of symptomsis greater than50, family history of inflammatory bowel disease or colon cancer)that lastsmore thansixmonths.
The gastroenterologist also would performa physical examination and minimal diagnostic testing, whichcan include blood tests to rule out celiac disease and a stool test to rule out inflammatory bowel disease. There is no need for a colonoscopy unlessa patientneedsit for screening purposes.Sometimes conducting thatmore comprehensive search for other causes of the symptomscansometimesdelay the diagnosis, but it generally doesn’t take long.
IBSis oftendescribed as a“disorder of gut-brain reaction.”Is this a new way of thinking about the condition? What is the gut-braindynamicthat causes IBS?
Yes, this is a new way of framing the disease,andithighlights the complex interplay between the gut and the brain. There are signals that go in both directions and will affect the nature and severity of symptoms. People with IBS seem to be more sensitive to activity in the gut related to food, bacteria, etc. In turn, when people are anxious or stressed, it can manifest itself with symptoms in the gut.
Are there genetic components to the syndrome?
There may be, but it has not been clearly worked out.Some studies suggestthat,if you have a relative with IBS, you're more atrisk for IBS. Nevertheless, the underlying gene pathways, genes and functional variants linked with IBS remain unknown.
Is IBS a sign of other, more serious conditionsorassociated with other health problems?
IBSisassociated with conditions such as small intestinal bacterial overgrowth, fibromyalgia, and psychiatric disorders such as depression and anxiety.Butgenerall,the symptoms of IBS(abdominal painandaltered bowel habits)are non-specificandrarely due to other,more serious conditionslikeceliac disease, inflammatory bowel disease,orcolon cancer.These conditions are unlikely in theabsence of alarm symptoms.
What are the different types of IBS, and how are they treated?
There are four typesof IBS:
- IBS-C - mostly constipation
- IBS-D - mostly diarrhea
- IBS-M - relatively equal mix of constipation and diarrhea
- IBS-U - unable to be determined
Treatments for IBS should be tailored to each patient'sIBSܲٲ.
In general, diet plays a major rolebecausecertain foodscantrigger symptoms.Specific diets,such as thehave been shown to improve symptoms. This diet involves eliminating and re-introducing certain foods to determine which foods are best to avoid. Incorporating soluble fiberand peppermint oil alsocan helppatients.
Forpatients withIBS-C, medical optionscanincludelubiprostone, linaclotide, andplecanatide. For younger women without heart issues,tegaserodcan help.
To address the diarrhea and painassociated with IBS-D,we sometimesprescribe rifaximin, eluxadoline, or tricyclic antidepressants.
Antispasmodicmedications can be helpfulto easeabdominal crampsand, for constipation itself, polyethylene glycol (i.e.Miralax) can help. Probiotics have limited data to support their use but are often given with some anecdotal success.
Gut-directed psychotherapies and complementary therapies alsocanbe helpful. Thesecanincludecognitive-behavior therapy (CBT), hypnosis, mindfulness, and mindfulness-based stress reduction.
What resources does WCM have available to IBS patients?
Manyof our providers specialize in IBS, andtheCenter for Advanced Digestive Careat ֭Ƶ also has dedicated GI nutritionists.At theIntegrative Health and Wellbeing Program, patients can learn aboutcomplementary therapies thatmay be helpful in managingIBS.