The diagnosis and management of individuals suffering from Irritable Bowel Syndrome (IBS) remains a very challenging problem for the Gastroenterologist. IBS is considered a functional gastrointestinal (GI) disorder. Functional GI and other motility disorders are the most common GI disorders in the general population and account for about 40% of GI problems that Gastroenterologists may see in everyday practice. I estimate that at least 20% of individuals seen in our practice suffer from IBS, the majority women.
Symptoms of IBS can include diarrhea, constipation, or a mixture of both and are associated with abdominal discomfort, such as the feeling of fullness, bloating, gaseousness or abdominal pain. Some just experience abdominal symptoms alone. Symptoms may initially present after an illness such as gastroenteritis. Genetics and the environment are thought to be strong predictors in the development of IBS. Individuals suffering from IBS have been shown to have lowered thresholds for pain and discomfort in their Stomachs and Colons. These organs do not stretch and then relax appropriately after meals.
Much research over the past few decades has centered on the brain-gut response to explain IBS symptoms. It was discovered that the chemical neurotransmitters in the brain and the gut are the same, and that most importantly the neurotransmitter serotonin is present predominately in the gut-95% percent with the remaining 5 percent in the brain. It is our brain that perceives pain, discomfort, feelings of gaseousness and individuals suffering from IBS have been shown to have an abnormality in how the brain filters and then modulates signals coming from the gastrointestinal organs.
The diagnosis is made on clinical grounds. The Gastroenterologist must rule out serious organic illness which can present with similar symptoms. Managing the symptoms of IBS is frequently accomplished by stress management and modification of diet along with adjuncts that help management pain and modulate bowel movements/frequency. Consultation and follow-up with our dietician is a key element in management. Many novel medications for IBS have recently been FDA approved to help manage symptoms, and many more are in the late development stage. These new medications will significantly aid in the management of some of the more debilitating symptoms affecting people with IBS.