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November 3, 2003

A University of Michigan Health Minute update on important health issues.

Exposing the hidden syndrome: Irritable Bowel

U-M physician shares treatment options for the many symptoms of Irritable Bowel Syndrome

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ANN ARBOR, MI -Irritable bowel syndrome (IBS) is among the most common gastrointestinal problems in the United States. Between 7 percent and 20 percent of Americans experience symptoms suggestive of IBS, such as abdominal pain, constipation and diarrhea, but many shy away from discussing the problem and end up missing out on effective treatment for the syndrome. Physicians at the University of Michigan are building IBS awareness in hopes that those suffering will seek medical help.

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“Probably only a quarter of those patients that are symptomatic will actually seek medical care related to their gastrointestinal complaints,” says William Chey, M.D., director of the Gastrointestinal Physiology Laboratory, director for the Office of Clinical Research-Division of Gastroenterology and associate professor of Internal Medicine.

Irritable bowel syndrome is a disorder that interferes with normal functions of the bowel and refers to chronic or recurrent symptoms that are case-specific to each IBS patient. Common symptoms include any combination of cramping, bloating, constipation or diarrhea.

What causes irritable bowel syndrome?

The precise cause of IBS remains unclear, but several different factors appear to play a role. Abnormalities in contractions, secretion and sensation of the intestine and colon are common in IBS. Further, function and sensation of the bowel can be influenced by factors including diet, stress, depression, anxiety and infections of the bowel.

Susan Weber developed IBS after severe salmonella food poisoning. Two years later, Weber is still working to manage her IBS.

“I would say that in the beginning, it was the flu-like symptoms—a lot of throwing up and a lot of diarrhea. Then after a week, the throwing up subsided, but the diarrhea stayed. Two more weeks went by and my life still wasn’t back on track. I was very lethargic. I could not stay awake. I was putting very little in my system and eventually couldn’t keep my weight up; I lost 22 pounds,” says Weber.

Weber was diagnosed with irritable bowel syndrome after the gastrointestinal symptoms turned into an everyday occurrence. Though doctors often think that IBS is a difficult diagnosis to make, studies show that it can be confidently diagnosed if a patient has the appropriate symptoms and there are no “warning signs” such as bleeding, weight loss or a family history of serious gastrointestinal diseases.

Treating symptoms

Irritable bowel syndrome is not curable, but there are many different options that can effectively relieve symptoms.

“There’s no question that IBS can be very successfully treated. In fact, the majority of patients that we take care of with IBS have a very good outcome. You can broadly think about therapy for IBS in two categories: non-pharmacological therapy such as diet and stress management strategies versus medication use,” says Chey.

Controlling symptoms with diet and stress management:

  • Be aware of potential problem foods, such as fatty foods, milk products, chocolate, alcohol, caffeine and carbonated drinks.
  • Eat foods with more fiber to reduce constipation, such as whole-grain bread, beans, broccoli, carrots, peas, apples and peaches.
  • Try eating four or five small meals during the day instead of two or three large ones.
  • Reduce stress to lessen symptoms. Try exercise, meditation or talking to a counselor.
  • Start a food diary to find out what foods make symptoms worse.
  • Drink plenty of water.
  • Avoid chewing gum and eating too quickly. Gas will decrease if the amount of air swallowed is minimized.

Medication use:

  • Increasing dietary fiber intake to 15-25 grams per day or using laxatives, such as milk of magnesia, can help to reduce constipation. Note: fiber and laxatives may worsen abdominal pain or bloating.
  • A new drug, Tegaserod, appears to improve abdominal pain and constipation in some patients with IBS.
  • Loperamide is helpful in many patients with IBS and complaints of diarrhea.
  • Antispasmodics will slow the contractions in the bowel. This may help with pain and diarrhea.
  • Antidepressants can help IBS patients in severe pain.

IBS affects people differently; some patients may have severe constipation, others severe diarrhea, or some may have spells of both. It is necessary to work with a physician to find the best combination of medicine, diet and stress reduction to control the symptoms particular to the patient.

“The reality of gastrointestinal problems is that they aren’t very glamorous so people tend to shy away from discussing these problems. But the bottom line is that these are important problems that clearly affect quality of life and now, more than ever, physicians have effective therapies to help patients with IBS,” says Chey.

Facts about irritable bowel:

  • IBS is a disorder found more often in women than in men and usually begins around age 20-35.
  • The syndrome is diagnosed by its symptoms and by the absence of “warning signs” that suggest a more serious disease such as colon cancer.
  • IBS affects approximately 30 million people—7 percent to 20 percent of the population.

Learn more on the World Wide Web:

U-M Health Topics A-Z: Irritable Bowel Syndrome (Spastic Colon)
http://www.med.umich.edu/1libr/aha/aha_ibs_crs.htm

National Institutes of Health: Irritable Bowel Syndrome
http://digestive.niddk.nih.gov/ddiseases/pubs/ibs/index.htm

International Foundation for Functional Gastrointestinal Disorders: About IBS
http://www.aboutibs.org/

 

Written By Erin Block

 

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