Digestive Problems, More on Gastritis and IBS (Part II)

by dr.Ay

Now, let’s continue our previous discussion about one other disorder that can commonly make stomachache, irritable bowel syndrome.

Irritable Bowel Syndrome (IBS)

Definition. In gastroenterology, IBS is a functional bowel disorder characterized by mild to severe abdominal pain, discomfort, bloating and alteration of bowel habits. In some cases, the symptoms are relieved by bowel movements

Symptomps. The primary symptoms of IBS are abdominal pain or discomfort in association with frequent diarrhea and/or constipation, a change in bowel habits. There may also be urgency for bowel movements, a feeling of incomplete evacuation (tenesmus), bloating or abdominal distention. People with IBS more commonly than others have gastroesophageal reflux, symptoms relating to the genitourinary system, psychological symptoms, fibromyalgia, headache and backache. IBS affects the colon, or large bowel, which is the part of the digestive tract that stores stool.

IBS can be classified as either diarrhea-predominant (IBS-D), constipation-predominant (IBS-C) or IBS with alternating stool pattern (IBS-A or pain-predominant). In some individuals, IBS may have an acute onset and develop after an infectious illness characterised by two or more of the following: fever, vomiting, diarrhea, or positive stool culture. This post-infective syndrome has consequently been termed "post-infectious IBS" (IBS-PI)

Diagnosis. Because there are many causes of diarrhea and IBS-like symptoms, the American Gastroenterological Association has published a set of guidelines for tests to be performed to diagnose other conditions which may have symptoms similar to IBS. These include gastrointestinal infections, lactose intolerance and Coeliac disease. Research has suggested that these guidelines are not always followed. Once other causes have been excluded, the diagnosis of IBS is performed using a diagnostic algorithm. Well-known algorithms include the Manning Criteria, the Rome I Criteria, the Rome II Process, the Kruis Criteria, and studies have compared their reliability. The more recent Rome III Process was published in 2006. Physicians may choose to use one of these criteria, or may use other guidelines based on their own experience and the patient's history. The algorithm may include additional tests to guard against mis-diagnosis of other diseases as IBS. Such "red flag" symptoms may include weight loss, GI bleeding, anemia, or nocturnal symptoms. However, researchers have noted that red flag conditions may not always contribute to accuracy in diagnosis — for instance, as many as 31% of IBS patients have blood in their stool.

Diet Changes

Some foods and drinks make IBS worse. Foods and drinks that may cause or worsen symptoms include:

• fatty foods, like french fries
• milk products, like cheese or ice cream
• chocolate
• alcohol
• caffeinated drinks, like coffee and some sodas
• carbonated drinks, like soda

Take your notes to the doctor to see if certain foods trigger your symptoms or make them worse. If so, you should avoid eating these foods or eat less of them.

Some foods make IBS better. Fiber may reduce the constipation associated with IBS because it makes stool soft and easier to pass. However, some people with IBS who have more sensitive nerves may feel a bit more abdominal discomfort after adding more fiber to their diet. Fiber is found in foods such as breads, cereals, beans, fruits, and vegetables. Examples of foods with fiber include

Fruits	Vegetables	Breads, cereals, and beans
apples peaches	broccoli (raw) cabbage carrots (raw) peas	kidney beans lima beans whole-grain bread whole-grain cereal

Add foods with fiber to your diet a little at a time to let your body get used to them. Too much fiber at once can cause gas, which can trigger symptoms in a person with IBS.

Your doctor may ask you to add more fiber to your diet by taking a fiber pill or drinking water mixed with a special high-fiber powder.

Eat small meals. Large meals can cause cramping and diarrhea in people with IBS. If this happens to you, try eating four or five small meals a day instead of less-frequent big meals.

Medication

Initial treatments

Medications may consist of stool softeners and laxatives in constipation-predominant IBS, and antidiarrheals (e.g., opioid or opioid analogs such as loperamide, diphenoxylate or codeine in diarrhea-predominant IBS for mild symptoms.

Laxatives. For patients who do not adequately respond to dietary fiber, osmotic agents such as polyethylene glycol, sorbitol, and lactulose can help avoid 'cathartic colon' which has been associated with stimulant laxatives. Among the osmotic laxatives, 17 to 26 grams/day of polyethylene glycol (PEG) has been well studied.

Antispasmodics. The use of antispasmodic drugs (e.g. anticholinergics such as hyoscyamine or dicyclomine) may help patients, especially those with cramps or diarrhea. Antispasmodics can be divided in two groups: neurotropics and musculotropics. Neurotropics, such as atropine, act at the nerve fibre of the parasympathicus but also affect other nerves and have side effects. Musculotropics such as mebeverine act directly at the smooth muscle of the gastrointestinal tract, relieving spasm without affecting normal gut motility. Since this action is not mediated by the autonomic nervous system, the usual anticholinergic side effects are absent. Antispasmodic drugs are also available in combination with tranquilizers or barbiturates, such as chlordiazepoxide and Donnatal. The value of the combination therapies has not been established.

Drugs affecting serotonin. Drugs affecting serotonin (5-HT) in the intestines can help reduce symptoms. Serotonin stimulates the gut motility and so agonists can help constipation predominate irritable bowel while antagonists can help diarrhea predominant irritable bowel:

Other alternatives treatments are probiotics and accupuncture.

Points to Remember

• IBS means your bowel doesn’t work the right way.
• IBS can cause cramping, bloating, gas, diarrhea, and constipation.
• IBS doesn’t damage the bowel or lead to other health problems.
• The doctor will diagnose IBS based on your symptoms. You may need to have medical tests to rule out other health problems.
• Stress doesn’t cause IBS, but it can make your symptoms worse.
• Fatty foods, milk products, chocolate, alcohol, and caffeinated and carbonated drinks can trigger symptoms.
• Eating foods with fiber and eating small meals throughout the day may reduce symptoms.
• Treatment for IBS may include medicine, stress relief, and changes in eating habits.

Related sources:

Irritable bowel syndrome - Wikipedia, the free encyclopedia.mht

What I need to know about Irritable Bowel Syndrome. National Digestive Diseases Information Clearinghouse

Irritable Bowel Syndrome (IBS) - Causes, Symptoms and Treatment Options on eMedicineHealth_com.mht