Irritable bowel syndrome (IBS) is a chronic disorder of the digestive system. Its primary symptoms are abdominal pain and altered bowel habits (constipation and/or diarrhea).
IBS is the most commonly diagnosed gastrointestinal disorder. It is estimated that 10-20% of people suffer from IBS, although only 15% of those affected seek medical attention. It is twice as common in women in the U.S. and western countries, and often starts in young adulthood. IBS does NOT increase risk of colorectal cancer.
Causes: Though definitive causes are unknown, these factors play a role in the development of IBS:
- Spastic colon theory (overactive contractions cause cramps, bloating and diarrhea; weak contractions cause constipation)
- Nervous system theory (poorly coordinated signals between the brain and intestines cause the body to overreact)
- Inflammation of the intestines (increased number of immunesystem cells)
- Severe infection or gastroenteritis
- Changes in bacteria in the intestines (microflora)
- Food (dairy products, wheat, citrus fruit, beans and carbonated drinks)
- Stress – (stress is not a cause of IBS, but an aggravator)
- Hormones (may worsen around menstrual period)
Diagnosis: There is no single diagnostic test for IBS. Symptoms can be similar to malabsorption, inflammatory bowel disease, celiac disease, and microscopic colitis.
Treatment: Primarily aimed at relieving symptoms, treatments are often used in combinations.
- Identify factors that worsen symptoms
- Modify diet accordingly to relieve symptoms
- Reduce stress and anxiety
- Exercise daily
- Medications (traditionally used for treatment of symptoms). These include:
• Anticholinergic medications (e.g., Bentyl, Levsin)
• Antidepressants (tricyclic antidepressants, serotonin reuptake inhibitors)
• Antidiarrheal drugs (e.g., IMODIUM®, Lomotil)
• Antianxiety drugs (e.g., Valium, Ativan)
• Herbal remedies are UNPROVEN
We asked Dr. Ali Rezaie, medical director, GI Motility Program at Cedars-Sinai Medical Center in Los Angeles about the IBS medications that have been heavily marketed on TV.
Are these medications helpful and should they be used as a first-line medications?
Currently, the FDA has approved five drugs for management of IBS:
- Diarrhea-predominant IBS (IBS-D) XIFAXAN®, VIBERZI® and LOTRONEX®
- Constipation-predominant IBS (IBS-C LINZESS® and AMITIZA
The efficacy of these medications has been shown in large multicenter clinical trials, with thousands of patients. They should be reserved for use when dietary and lifestyle modifications are not fully helpful in controlling IBS symptoms.
What is the difference between IBS, IBD & lactose intolerance?
Patients with lactose intolerance specifically develop symptoms of bloating, abdominal pain and diarrhea when they consume dairy products. IBS patients experience symptoms unpredictably which significantly affects their quality of life. Inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis, are associated with ulceration of the bowel which can further lead to bleeding, weight loss and bowel obstruction.
It is very important to note that these diseases are not mutually exclusive and can overlap. For example, up to 30% of IBD patients have overlapping IBS.
As the role of gut microbiome (microorganisms living in our bowels) is becoming clearer in IBS, multiple medications are being developed to modify the gut microbiome for treatment of IBS. There are also several drugs in the pipeline that aim to target the motility of the bowel to improve IBS symptoms.
SUSAN LOCKE is Healthnetwork Foundation’s medical director.
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