What You Should Know About IBS
听in the United States have irritable bowel syndrome听(滨叠厂), which is听characterized by abdominal pain or discomfort, and altered bowel habits. It鈥檚 a staggering number for a听syndrome with unknown origins.听
To mark听,听David Wan, M.D.,听assistant听professor of Medicine鈥 at 富二代成版人app Medical College, Cornell University,听and听assistant听attending听physician鈥 at听NewYork-Presbyterian Hospital/ 富二代成版人app (WCM),听discusses听the condition, its听sub-types and听symptoms, and the resources available for IBS patients.听听
How would you describe听irritable bowel syndrome?听
IBS is characterized by symptoms of recurrent abdominal pain associated with diarrhea听or听constipation. Patients will have changes in their bowel form or frequency that is tied to abdominal pain. They will also frequently have bloating.听
How is IBS diagnosed, and about how long does it typically take for a patient to be diagnosed with IBS?听
IBS can be diagnosed and treated fairly rapidly鈥攐ften within听one听visit.听To diagnose IBS, a gastroenterologist will take a听careful clinical history showing the symptoms in the absence of alarm features (alarm features include听weight loss, blood in the stool,听whether the听age of onset of symptoms听is greater than听50, family history of inflammatory bowel disease or colon cancer)听that lasts听more than听six听months.听听
The gastroenterologist also would perform听a physical examination and minimal diagnostic testing, which听can 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 unless听a patient听needs听it for screening purposes.听Sometimes conducting that听more comprehensive search for other causes of the symptoms听can听sometimes听delay the diagnosis, but it generally doesn鈥檛 take long.听听
听
IBS听is often听described as a听鈥disorder of gut-brain reaction.鈥听Is this a new way of thinking about the condition? What is the gut-brain听dynamic听that causes IBS?听
Yes, this is a new way of framing the disease,听and听it听highlights 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.鈥听
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Are there genetic components to the syndrome?听
There may be, but it has not been clearly worked out.听Some studies suggest听that,听if you have a relative with IBS, you're more at听risk for IBS.鈥 Nevertheless,听鈥the underlying gene pathways, genes and functional variants linked with IBS remain unknown.鈥听
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Is IBS a sign of other, more serious conditions听or听associated with other health problems?听听听
IBS听is听associated with conditions such as small intestinal bacterial overgrowth, fibromyalgia, and psychiatric disorders such as depression and anxiety.听But听generall,听the symptoms of IBS听(abdominal pain听and听altered bowel habits)听are non-specific听and听rarely due to other,听more serious conditions听like听celiac disease, inflammatory bowel disease,听or听colon cancer.听These conditions are unlikely in the听absence of alarm symptoms.鈥听
What are the different types of IBS, and how are they treated?听
There are four types听of IBS:听听
- IBS-C - mostly constipation听
- IBS-D - mostly diarrhea听
- IBS-M - relatively equal mix of constipation and diarrhea听
- IBS-U - unable to be determined听
Treatments for IBS should be tailored to each patient's听IBS听蝉耻产迟测辫别.鈥听听
In general, diet plays a major role听because听certain foods听can听trigger symptoms.听Specific diets,听such as the听听have been shown to improve symptoms. This diet involves eliminating and re-introducing certain foods to determine which foods are best to avoid.鈥疘ncorporating soluble fiber听and peppermint oil also听can help听patients.听听
For听patients with听IBS-C, medical options听can听include听lubiprostone, linaclotide, and听plecanatide. For younger women without heart issues,听tegaserod听can help.听
To address the diarrhea and pain听associated with IBS-D,听we sometimes听prescribe rifaximin,鈥eluxadoline, or tricyclic antidepressants.听
Antispasmodic听medications can be helpful听to ease听abdominal cramps听and, for constipation itself, polyethylene glycol (i.e.听Miralax) can help.鈥 Probiotics have limited data to support their use but are often given with some anecdotal success.听
Gut-directed psychotherapies and complementary therapies also听can听be helpful. These听can听include听cognitive-behavior therapy (CBT),听鈥hypnosis, mindfulness, and mindfulness-based stress reduction.听
What resources does WCM have available to IBS patients?听
Many听of our providers specialize in IBS, and听the听Center for Advanced Digestive Care听at 富二代成版人app also has dedicated GI nutritionists.听At the听Integrative Health and Wellbeing Program, patients can learn about听complementary鈥痶herapies that听may be helpful in managing听IBS.听