In gastroenterology, irritable bowel syndrome (IBS) or spastic colon is a functional bowel disorder characterized by abdominal pain and changes in bowel habits that is not associated with any abnormalities seen on routine clinical testing. It is fairly common and makes up 20-50% of visits to gastroenterologists. There are two forms, dependent on which symptom predominates: Lower abdominal pain IBS and Non-ulcer dyspepsia. The abdominal pain type is usually described in a patient as either diarrhea-predominant (IBS-D), constipation-predominant (IBS-C) or IBS with alternating stool pattern (IBS-A). An important new IBS subtype, post-infectious IBS (IBS-PI), is drawing much clinical investigation.
I got the diarrhea dominant, yes it blows.
Features
Symptoms of IBS are abdominal pain or discomfort associated with changes in bowel habits in the absence of any apparent structural abnormality. The pain is commonly relieved by defecating or modulated by other triggers of gut motility. Generally there is no pain when patients are asleep. Symptoms usually start in young adulthood.
There appears to be an overlap of IBS with stress, chronic pelvic pain, fibromyalgia, chronic fatigue syndrome, and various mental disorders (in a small minority). While no single explanation for this phenomenon exists, it does strengthen the view that there is a neurological and psychological component to IBS. Recent studies indicate that presynaptic neural effects secondary to the release of histamine (part of immune response) is likely related to these problems.[1]
The role of hormones in IBS is not yet fully understood. Menstruation frequently triggers or exacerbates IBS symptoms,[2] while pregnancy and menopause can either worsen or improve symptoms. Hormone replacement therapy is associated with an increased risk of developing IBS.[3]
Diet
Repeated studies indicate that there are various causes of the set of IBS symptoms, including food allergies and sensitivities. Argument continues on the definition of cause as regards IBS and food allergies, but studies demonstrate that IBS symptoms are sometimes caused by immune response to foods and exclusion of those foods to which the immune system is responding results in reduction or elimination of IBS symptoms, a cause and effect link.[14]
Definitive determination of dietary issues can be accomplished by testing for the physiological effects of specific foods. The ELISA food allergy panel can identify specific foods to which a patient has a reaction. Other testing can determine if there are nutritional deficiencies secondary to diet that may also play a role. Removal of foods causing IgG immune response as measured using the ELISA food panel has been shown to substantially decrease symptoms of IBS in a several studies.[15]
There is no evidence that digestion of food or absorption of nutrients is problematic for those with IBS at rates different from those without IBS. However, the very act of eating can provoke an over-reaction of the gastrocolic response in some patients with IBS due to their heightened visceral sensitivity, and this can lead to abdominal pain, diarrhea, and/or constipation.
There are a number of diet changes a person with IBS can make to prevent the over-reaction of the gastrocolic reflex and lessen pain, discomfort and bowel dysfunction. Having soluble fiber foods and supplements, substituting soy or rice products for dairy, being careful with fresh fruits and vegetables that are high in insoluble fiber, and eating regular small amounts can all help to lessen the symptoms of IBS; Foods and beverages to be avoided or minimized include red meat, oily or fatty (and fried) products, dairy (even when there is no lactose intolerance), solid chocolate, coffee (regular and decaffeinated), alcohol, carbonated beverages (especialy those also containing sorbitol) and artificial sweeteners. However care should be taken to avoid adding foods to the diet to which the patient is allergic or intolerant.[16] Several of the most common dietary triggers are well-established by clinical studies at this point; research has shown that IBS patients are hypersensitive to fats, insoluble fibers, and fructose.[17][18][19] It also appears that some foods are more difficult for the gut as evidenced by elevated food-specific IgG4 antibodies being present,[20] [21] while others increase colonic contractions, which may be painful, due to increased visceral sensitivity in IBS sufferers.[22]
Alternative Treatment
Probiotics are generally accepted to be potentially beneficial strains of bacteria and yeast, often found in the human gut. One research study has shown a clear link between the ingestion of Lactobacillus plantarum LP299V and sufferers of Irritable Bowel Syndrome who reported resolution of their abdominal pain.[29] Another study showed the utility of B. infantis 35625, a strain of Bifidiobacteria in normalizing bowel movement frequency in sufferers of Irritable Bowel Syndrome.[30] Some practitioners of Integrative Medicine, now recommend a strain of Lactobacillus known commonly as "LGG" after its discoverers Gorbach and Goldin. This strain in particular has shown an ability to endure the acidic environment of the stomach and survive until presentation to the intestinal tract.[31]
Many sufferers of IBS seek relief from Acupuncture, a component of Traditional Chinese Medicine and a discipline representing some of the oldest and most used medical procedures in the world. This discipline continues to find increasingly widespread acceptance in the United States, and it is estimated that nearly 8.7 million Americans have sought its benefits.[32] One practitioner of TCM asserts that IBS has become a bit of a "garbage diagnosis" for some medical practitioners. Traditional Chinese Medicine does not recognize the Western diagnosis of IBS per se, as the named condition has no definitive single test for diagnosis, clear cause, or cure. Traditional Chinese Medicine approaches IBS on an individual symptom-by-symptom basis, rather than recognizing a standard "IBS" diagnosis, which then warrants a blanket "IBS" treatment.[33] The concept of Qi is important in Acupuncture, as obstructions to its proper flow throughout the body are considered a contributing factor to illness. Details of the specific mechanisms through which Qi function remain as yet unexplained by Western Scientific methods. According to the National Institutes of Health:[34]
Prognosis
IBS is not fatal nor is it linked to the development of other serious bowel diseases. However, due to the chronic pain, discomfort, and other symptoms, work absenteeism, social phobias, and other negative quality-of-life effects can be common in more serious cases. Individuals who find a caring primary caregiver and/or sufficient self-help options should be able to develop a successful treatment program for their symptoms and lead normal lives.
