What is IBS and who gets it?

IBS is a chronic functional disorder of the lower gastrointestinal tract. Characteristic symptoms are abdominal pain or discomfort in association with either an alteration in stool form or frequency.

Other symptoms such as the relief of pain or discomfort by passing stools are also suggestive of IBS.

Patients with IBS may have different symptoms depending on the type of stool that is predominant. There are three main sub-groups as follows:

• IBS-D (Diarrhoea predominant)
• IBS-C (Constipation predominant)
• IBS-M (Mixed – fluctuating between diarrhoea and constipation)
• Some patients do not fall into any of these categories and the predominant stool type often changes with time.
• IBS is more common in patients aged less than 50 years and in women.
• IBS is likely to be a lifelong disorder with symptoms waxing and waning periodically.

What is the underlying cause of IBS?

There is no single cause to explain the symptoms that patients report.

However numerous mechanisms have been proposed.  Its presence is associated with increased levels of mental health problems and maladaptive coping strategies. Patients with IBS shower higher levels of anxiety and depression than controls without IBS.

The condition aggregates in families and patients often show abnormal small bowel and colonic transit compared with healthy controls.

How is IBS diagnosed?

The diagnosis is usually made on clinical grounds without the need for invasive investigations like colonoscopy. Most doctors will make a diagnosis based on symptoms which may be any of the following:

• Abdominal pain relieved by opening of the bowels and passage of stool
• More frequent stools with onset of pain
• Looser stools with onset of pain
• Feeling of incomplete emptying
• Abdominal distension reported by patients.

Evidence does not support undertaking a panel of routine blood tests nevertheless most GPs will often order tests such as a Full Blood Count, and inflammatory markers e.g. ESR or CRP and sometimes tests for coeliac disease (gluten intolerance).  About 5 % of patients with suspected IBS have coeliac disease.

Red Flag symptoms which should be investigated further in patients are:

1. Age over 50 years at first presentation
2. Family history of colon cancer
3. Weight loss ( patients with IBS do not usually lose weight)
4. Rectal Bleeding
5. Recent change in bowel habit in older patients over the age of 50 years
6. Abdominal mass
7. Anaemia

What are the treatment options?

Diet and Lifestyle:

Fibre increases the intestinal transit time and trials have shown improved symptoms with use of isapghula (Fybogel /Regulan).

Patients often report that certain foods may aggravate their symptoms.

Foods such as apples, cherries, peaches, nectarines, artificial sweeteners, lactose containing products and green vegetables such as broccoli, Brussels sprouts, cabbage and peas may generate symptoms via their fermentation effects in the gut, increasing bloating and wind. Many patients often report a benefit from a gluten free diet even when they test negative for coeliac disease.

In the BMJ Clinical Review of IBS (September 2012/Volume 345) there was mention of a recent trial of 102 patients with IBS who were randomised into 2 groups.

One group was instructed to increase their physical activity for 12 weeks whereas the other was instructed to maintain their current activity. Patients who participated in physical exercise showed significant improvement in their scores of symptom severity compared to their baseline scores and also compared to the other group who were more likely to undergo worsening of their symptoms.

Antispasmodic medication and Peppermint oil:

• These bring about smooth muscle relaxation and may have beneficial effects on abdominal pain and discomfort.
• Antidepressants:
• These are effective in treatment of chronic pain conditions and alter gastrointestinal transit time.  Evidence suggests benefit in IBS.

These may have a beneficial effect on abdominal pain and bloating.

Psychological and behaviour therapies:

Cognitive behavioural therapy (CBT) and hypnotherapy may be tried for patients who fail to benefit from conventional treatment.

Acupuncture:

Several studies conducted in China suggest that acupuncture seemed to be superior to medication in IBS.

Although there is a lack of evidence from randomised controlled trials many practitioners of acupuncture notice that the addition of acupuncture to the treatment results in significant benefits for patients in terms of decreased severity and frequency of IBS symptoms.  When performed responsibly by a qualified practitioner has the advantage of being safe,  with minimal or no side effects and avoids use of regular medications.