Irritable bowel syndrome

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder characterized by a group of symptoms that typically occur together, including abdominal pain and changes in bowel habits. It is a chronic condition that needs long-term management. 

Causes

The exact cause of IBS isn’t well understood, but several factors appear to play a role:

  • Severe Infection: A history of gastrointestinal infections (bacterial or viral) can trigger IBS.
  • Muscle Contractions in the Intestine: Altered movements in the gut can lead to IBS symptoms.
  • Nervous System: Abnormalities in the nerves in the digestive system can cause discomfort when the abdomen stretches from gas or stool.
  • Inflammation in the Intestines: Increased numbers of immune-system cells in the intestines can be associated with pain and diarrhea.
  • Changes in Microbiome: The gut flora might differ in people with IBS.
  • Food Sensitivities: Certain foods trigger symptoms in some people.
  • Genetics: Familial aggregation is observed in some cases, suggesting a possible genetic predisposition.

Diagnosis

There’s no specific test for IBS. Diagnosis typically involves:

  • Symptom Assessment: According to the Rome IV criteria, IBS is characterized by recurrent abdominal pain at least one day per week in the last three months, associated with two or more of the following:
    • Related to defecation.
    • Associated with a change in frequency of stool.
    • Associated with a change in form (appearance) of stool.
  • Medical History and Physical Examination: To rule out other causes.
  • Laboratory Tests: Like complete blood count (CBC), c-reactive protein (CRP), and stool tests to exclude other diseases.
  • Colonoscopy: In patients over 50 or with alarm features like weight loss, blood in stool, or family history of colon cancer.

Differential Diagnosis

  • Inflammatory Bowel Disease (IBD): Including Crohn’s disease and ulcerative colitis.
  • Colon Cancer: Especially in older patients or those with alarming symptoms.
  • Gastroenteritis: Infections of the gut.
  • Endocrine Disorders: Like hyperthyroidism.
  • Food Intolerances: Such as lactose intolerance.
  • Celiac Disease: An immune reaction to eating gluten.

Management

  • Dietary Modifications:
    • Low FODMAP Diet: A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.
    • Avoidance of trigger foods (like caffeine, dairy, or gluten, if they worsen symptoms).
  • Medications:
    • Fiber Supplements: For constipation-predominant IBS.
    • Laxatives: For constipation.
    • Antidiarrheal Medications: Like loperamide.
    • Anticholinergic Medications: To relieve painful bowel spasms.
      • Peppermint oil
      • Hyoscine
    • Microbiota modification: Rifaximin
    • Tricyclic Antidepressants or SSRIs: For pain and depression.
    • Probiotics: To help restore healthy gut bacteria.
  • Psychological Therapies:
    • Cognitive Behavioral Therapy (CBT).
    • Stress Management: Including relaxation techniques like meditation or yoga.
    • Hypnotherapy.
  • Regular Exercise: To improve bowel function and reduce stress.

Conclusion

IBS is a complex condition that requires an individualized treatment approach, often involving both lifestyle modifications and medication. Since the symptoms of IBS can resemble other diseases, a thorough evaluation is crucial to rule out other potential causes. Ongoing research is enhancing the understanding of IBS and leading to more effective treatments.