New insights into irritable bowel syndrome

The symptoms of IBS are not unique , making diagnosis difficult since it can be confused with other conditions. Women are diagnosed with IBS more often than men, and onset of symptoms after age 50 years is unusual (although it may have been present and unrecognized. )

 

Even though IBS, irritable bowel syndrome, is a common gastrointestinal disorder, medical science still cannot fully explain its origin or understand the best way to treat it. But physicians can do much more to help patients with this condition than previously thought.

This information is current as of the publication date; it is general medical information that helps doctors and patients make decisions about what is right for them. Medical recommendations and practice changes as we learn new things. If you deal with any of these issues , please discuss with your doctor before taking any action.

What is IBS?

Recurrent abdominal pain or discomfort averaging 1 day per week for 3 months associated with

  • altered bowel movements
  • change in frequency of stool
  • change in form or appearance of stool
  • not explained by other conditions that are known to cause similar symptoms

IBS patients may have any combination of pain, diarrhea, and constipation, which can alternate or go in remission at times. Other common symptoms include

  • passage of mucus
  • increased gas
  • bloating and/or fullness
a diagram of the gastrointestinal system

Physicians do not expect IBS to cause bleeding, fever, weight loss, nausea, or vomiting; such symptoms prompt investigation of other conditions, including

  • inflammatory bowel diseases-Crohn’s disease and ulcerative colitis
  • celiac disease
  • gluten sensitivity
  • lactose intolerance
  • infection
  • malabsorption syndromes

The symptoms of IBS are not unique , making diagnosis difficult since it can be confused with other conditions. Women are diagnosed with IBS more often than men, and onset of symptoms after age 50 years is unusual (although it may have been present and unrecognized. ) Children and adolescents can have IBS.

Currently there is no one generally recognized blood test, scan, image, or other diagnostic test that confirms IBS.

Why does IBS happen?

The cause of IBS is still uncertain but gastrointestinal specialists cite several issues that likely contribute.

At one time doctors believed it was due to overactive muscles in the bowel wall, altered motility, leading to the once used name “spastic colon.” Now there are several additional factors that seem to contribute.

One pathway involves the neurotransmitters in the nerves of the bowel that transmit signals from there to the brain and back. A deficiency of these neurotransmitters may be interpreted as pain or may alter gut motility causing diarrhea or constipation.

Changes in the number and type of “gut microflora”, the bacteria that live in the bowel ,has been identified as a possible cause.

electron microscopic (TEM) image of rotavirus
This transmission electron microscopic (TEM) image reveals some of the ultrastructural details exhibited by a number of single shelled rotavirus viral particles. These virions cause gastroenteritis in both mammals, and avian species. CDC/ Dr. Erskine Palmer, public domain

Some people develop IBS after having viral gastroenteritis (infection). The infection may trigger an intense immune response leading to chronic inflammation as the cause of the persistent symptoms.

Managing IBS

The symptoms of IBS may fluctuate and even go into remission spontaneously, so it can be difficult to definitely know what works and what doesn’t.

a simple bed, window shade down, small lamp on a side table

upclose view of a woman with eyes closed, arms outstretched, looks peaceful
sports shoes, jump rope

Regular exercise, such as a daily walk, and conditioning with moderate to vigorous exercise 3-5 times a week improves digestion and encourages the bowel to move more efficiently.

Adequate and restful sleep helps manage stress that frequently precipitates symptoms.

Mind based therapies

Because of the nervous system involvement, inadequate and unproductive response to life’s stressors will exacerbate symptoms of IBS.  Adequately addressing stress plays a key role in managing IBS symptoms.  Psychological therapies may be needed- CBT (cognitive behavioral therapy), hypnotherapy, and psychotherapy.

Eating to manage IBS

Experts recommend appropriate food choices and eating habits as basic steps to symptom control.

They emphasize eating meals at regular intervals, limited snacking, and not overeating at any time.

No one food or food group is universally off limits, but some IBS patients do well by avoiding

  • alcohol, caffeinated and/or carbonated beverages, and milk
  • spicy and fatty foods
  • gas-producing foods
  • gluten
  • artificial sweeteners
  • insoluble fiber

Some studies show a low FODMAP diet is especially helpful for bloating whether diarrhea or constipation is the major problem. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols short-chain carbohydrates (sugars) that aren’t absorbed properly in the gut.

FODMAPs are found in various  fruits, vegetables, cereals, breads, dairy, and sweeteners so it can be challenging to know what’s acceptable and what’s not. Using a list such as this one or working with a knowledgeable dietician can make it easier to find what works for you.

The Cleveland Clinic offers this FODMAP guide.

 

Drug therapy for IBS

Non -prescription drugs used for IBS include

Both groups may also get help from probiotics.

(These are affiliate links used to support this blog at no additional cost to you.)

Prescription meds available in the United States specifically for IBS include linaclotide, lubiprostone, eluxadoline , rifaximin, plenecatide,and tegaserod.

Fecal Microbiota Transplantation

An interesting investigational treatment involves fecal transplantation (or bacteriotherapy) , the transfer of stool from a healthy donor into the gastrointestinal tract . Small studies have shown it effective for IBS but the effect may not be long lasting. Fecal transplantation is currently not routinely performed for reasons other than recurrent C. difficile colitis. More research studies are still needed to determine if fecal transplantation should be performed for other clinical indications. Fecal transplantation for other clinical indications should be considered experimental, and performed only as part of a research study where your safety is closely monitored.

a female physician talking to a male patient

 

What to do if you think you may have IBS

Monitor your symptoms carefully, keeping a written record, for 1-2 months. Take this to your doctor for an evaluation. However if you have these symptoms, see your doctor immediately.

  • bleeding in bowel movements
  • unexpected weight loss
  • fever
  • profuse diarrhea
  • persistent failure to pass stool
  • severe, disabling pain

A primary care doctor-a family medicine or internal medicine doctor- can evaluate these symptoms initially, and decide if referral to a GI specialist, a gastroenterologist , is needed for more specialized testing.

The American College of Gastroenterology offers these resources for patients with irritable bowel syndrome. 

 

If you have been diagnosed with IBS

Your doctor likely has already recommended some of the measure I have listed above. If not, and your symptoms are not controlled, then you might want to discuss to see if they are appropriate for you.

Remember, this is provided for your information and is not intended as advice or treatment. I  encourage you to seek care from your personal physician. 

exploring the HEART of health

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me. I also want you to find and follow me on Facebook, Pinterest , Instagram, and LinkedIn .

I appreciate your sharing  this post on your social media pages.

Thank you for  viewing  the advertisements and using the affiliate links  that fund this blog; with your  help, we can grow, reach more people, and support worthy causes that bring health and wholeness to people around the world.

26952564_10213093560871954_4239554644472378905_o

                              Dr. Aletha 

Are advanced weight management options right for you

So who should consider advanced weight loss options? Anyone whose weight is excessive enough to be a health problem.

What should you do if you have tried everything to lose weight and still have excess pounds (or kilograms) that you need or want to lose?

Consult your physician

If you haven’t already, talk to your doctor. Your doctor can evaluate your weight in the context of your total health. Perhaps you have medical conditions or medications that promote weight gain or make weight loss more difficult. You may need to address those before any weight loss plan will be successful.

Beyond that, you and your doctor might then consider weight loss medications. In general, they can be helpful in the short run which may get you started with sustained weight loss, but in general none of them have proven as successful and doctors and patients would like. This post describes what’s available now.

Collage of Various Types and Colors of Medication

How to lose weight when nothing else has worked.

In helping people lose weight, there is a significant gap that needs to be closed. When diet/exercise fails, we need something less invasive  before resorting to surgery with its significant risks and complications. One option is prescription medication.

This information is current as of the publication date; it is general medical information that helps doctors and patients make decisions about what is right for them. Medical recommendations and practice changes as we learn new things. If you deal with any of these issues , please discuss with your doctor before taking any action.

Options beyond lifestyle alone

someone standing on a scale
New weight loss options are good news.

So who should consider advanced weight loss options? Anyone whose weight is excessive enough to be a health problem. In general this is considered to be those with

  • a BMI, body mass index, of 40 or greater.
  • a BMI of 30- 35 and certain medical conditions especially type 2 diabetes, heart disease, and sleep apnea

Calculate your BMI here.

Benefits of weight loss

Although these can be true even for people with lower BMI , when those with BMI 30+ lose weight, they can experience

  • improved blood glucose control in diabetics
  • lower cholesterol
  • lower blood pressure
  • less sleep apnea
  • less urinary incontinence
  • less back and joint pain
  • lower risk of many types of cancer
  • less gastroesophageal reflux-heartburn

Weight-loss Devices

The FDA regulates four devices intended for weight loss in certain adult patients age 18 and older.

Gastric Band –

bands are placed around the top portion of the stomach leaving only a small portion available for food.

Lap-Band Adjustable Gastric Banding System

Electrical Stimulation Systems –

electrical stimulator is placed in the abdomen to block nerve activity between the brain and stomach.

The Maestro Rechargeable System is implanted under the skin; an intermittent pulse generator delivers an electrical signal to the vagus nerve in the abdomen. The vagus nerve controls stomach action; when slowed down, one feels full sooner and theoretically will eat less. However, the company has not marketed it since 2018.

Gastric Balloon Systems

inflatable balloons are placed in the stomach to take up space and delay gastric emptying

The ReShape Integrated Dual Balloon System was approved by the U.S. Food and Drug Administration in July 2015. Apollo Endosurgery purchased it in 2018 and replaced it with their existing product the Orbera Gastric Balloon.

The company claims patients with Orbera experience three times more weight loss than diet & exercise alone and are provided with the right tools and resources to successfully learn to keep it off.

The device is placed into the stomach by going through the mouth and down through the esophagus with a tube called an endoscope. It takes about 30 minutes and requires on a mild sedative, not general anesthesia. Once in the stomach the “balloons” are inflated; by taking up space in the stomach it can trigger a feeling of fullness.

Gastric Emptying Systems

a tube is inserted between the stomach and outside of abdomen to drain food after eating

This device is called AspireAssist. This is a tube inserted into the stomach, from which a portion of the stomach contents can be “aspirated” (sucked out) after eating. The company claims patients lost 3 times more weight than those who received only diet and exercise counseling. The most successful patients lost over 100 pounds in the first year.

People lose weight with these devices largely due to the intensive counseling and support they received along with use of the device.

I encourage you to follow the links to learn more about each device.

 

tape-403591_1280
Obesity is defined using BMI, body mass index, but waist circumference is also important and may be more accurate.

Bariatric surgery

Two procedures comprise the majority of operations done to help people lose significant amounts of weight.

Sleeve Gastrectomy

In this procedure, a surgeon trained in bariatric procedures removes a large portion of the stomach.

The new, smaller stomach is about the size of a banana. It limits the amount of food you can eat by making you feel full after eating small amounts of food.

Gastric bypass

There are 2 steps during gastric bypass surgery:

In the first step the surgeon uses staples to divide the stomach into a small upper section and a larger bottom section. The top section, about the size of a walnut (called the pouch)will receive the food one eats. It holds only about 1 ounce (oz) or 28 grams (g) of food, causing one to eat much less.

The second step is the bypass. The surgeon connects a small part of the small intestine (the jejunum) to a small hole in your pouch. The food will now travel from the pouch into this new opening and into the small intestine. As a result, the body will absorb fewer calories.

Thus weight loss occurs from eating less and absorbing less food.

A success story

After gaining weight with her pregnancies, one woman , J.T. ,successfully lost weight with gastric bypass surgery.

I gained over 100 lb after my pregnancies. When my family doctor diagnosed me as borderline diabetic with high cholesterol, I panicked. Discouraged after failing numerous diets, I felt hopeful when I read about gastric bypass.

Learn about the lifestyle changes she made at this article from American Family Physician journal

 

Review these other posts about weight management
Obesity and BMI defined
How we should view excess weight 
How effective are weight management programs? 
A success story; how a doctor helped her patient lose weight
When diet alone doesn’t work
and, one of my all time most read posts

How my friend lost weight and inspired others with her example

exploring the HEART of achieving a healthy weight

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me. I also want you to find and follow me on Facebook, Pinterest , Instagram, and LinkedIn .

                              Dr. Aletha 

Here are some affiliate links you may find helpful. Thanks for considering and using, which helps me fund this blog’s mission-to share the HEART of health.

Spring/Summer Banners