Irritated bowel syndrome ( IBS ) is a group of symptoms - including abdominal pain and changes in bowel movement patterns without any evidence of underlying damage. These symptoms occur for a long time, often years. It has been classified into four major types depending on whether general diarrhea, constipation is common, both common, or not common (IBS-D, IBS-C, IBS-M, or IBS-U). IBS negatively affects the quality of life and may result in missed schools or jobs. Disorders such as anxiety, major depression, and chronic fatigue syndrome are common among people with IBS.
The cause of IBS is unclear. Theories include a combination of intestinal brain-bowel problems, impaired bowel motility, pain sensitivity, infection including excessive bacterial colon growth, neurotransmitters, genetic factors, and food sensitivity. Onset can be triggered by intestinal infections, or stressful life events. IBS is a functional gastrointestinal disorder. Diagnosis is based on signs and symptoms without any alarming features. Unpleasant features include an onset of over 50 years of age, weight loss, blood in the stool, or a family history of inflammatory bowel disease. Other conditions may be the same as celiac disease, microscopic colitis, inflammatory bowel disease, malabsorption of bile acids, and colon cancer.
There is no cure for IBS. Treatment is done to improve symptoms. This may include dietary changes, medication, probiotics, and counseling. Dietary actions include increasing the intake of soluble fiber, gluten-free diets, or low-term diets low in fermented oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs). The drug loperamide can be used to help diarrhea while laxatives can be used to help constipation. Antidepressants can improve symptoms and overall pain. Patient education and good doctor-patient relationships are an important part of care.
About 10 to 15% of people in developed countries are believed to be affected by IBS. This is more common in South America and less common in Southeast Asia. It is twice as common in women as men and usually occurs before age 45. This condition seems to be less common with age. IBS does not affect life expectancy or cause other serious illnesses. The first picture of this condition in 1820 while the term "irritable bowel syndrome" is currently being used in 1944.
Video Irritable bowel syndrome
Classification
IBS may be classified as dominant diarrhea (IBS-D), dominant constipation (IBS-C), or with alternating stool patterns (IBS-A) or pain-dominant. In some individuals, IBS may have acute onset and develop after an infectious disease characterized by two or more: fever, vomiting, diarrhea, or positive fecal cultures. This postinfective syndrome has consequently been termed "postinfective IBS" (IBS-PI).
Maps Irritable bowel syndrome
Signs and symptoms
The main symptoms of IBS are abdominal pain or discomfort associated with frequent diarrhea or constipation and changes in bowel habits. Symptoms are usually experienced as an acute attack that subsides within a day, but recurrent attacks may occur. There may also be urgency for bowel movements, incomplete evacuation feelings (tenesmus), bloating, or abdominal distension. In some cases, the symptoms are reduced by bowel movements. People with IBS, more often than others, have gastroesophageal reflux, symptoms associated with the genitourinary system, chronic fatigue syndrome, fibromyalgia, headache, back pain, and psychiatric symptoms such as depression and anxiety. About one-third of men and women who have IBS also report sexual dysfunction usually in the form of decreased libido.
Cause
While the cause of IBS is still unknown, it is believed that the entire gut-axis of the brain is affected.
The risk of developing IBS increased six-fold after acute gastrointestinal infections. Post infection, further risk factors are young age, prolonged fever, anxiety, and depression. Psychological factors, such as depression or anxiety, have not been shown to cause or affect IBS onset, but may play a role in the persistence and severity of perceived symptoms. Nevertheless, they can aggravate the symptoms of IBS and the quality of life of patients. The use of antibiotics also appears to increase the risk of developing IBS. Research has found that genetic defects in innate immunity and epithelial homeostasis increase the risk of developing both post-infection as well as other forms of IBS.
Post-infection
About 10 percent of IBS cases are triggered by acute gastroenteritis infection. Genetic defects related to the innate immune system and epithelial barrier and high levels of stress and anxiety seem to increase the risk of developing postoperative IBS. Postoperative IBS usually manifests as a dominant diarrhea subtype. Evidence has shown that high levels of proinflammatory cytokine release during acute enteric infection leads to increased permeability of the bowel leading to the translocation of commensal bacteria across the epithelial barrier causing significant damage to local tissue, which can lead to chronic intestinal abnormalities in sensitive individuals. However, increased bowel permeability is strongly associated with IBS regardless of whether IBS is initiated by infection or not. The association between excessive intestinal bacterial growth and tropical canker sores has been suggested to be involved in the cause of IBS post-infection.
Stress
Publications showing the role of the "axis" of the brain-intestine emerged in the 1990s and physical and psychological violence in childhood is often associated with the development of IBS.
Given the high levels of anxiety seen in IBS patients and overlap with conditions such as fibromyalgia and chronic fatigue syndrome, the potential IBS model involves disturbance of the stress system. The stress response in the body involves the HPA axis and the sympathetic nervous system, both of which have been shown to work abnormally in IBS patients. Psychiatric or anxiety disorders precede IBS symptoms in two-thirds of patients, and psychological traits affect previously healthy people to develop IBS after gastroenteritis.
Bacteria
Excessive bacterial gut growth occurs with greater frequency in patients who have been diagnosed with IBS compared with healthy controls. The most common SIBO in IBS is diarrhea-dominating but it also occurs in IBS constipation-dominant more often than healthy controls. Symptoms of SIBO include bloating, abdominal pain, diarrhea or constipation among others. IBS may be the result of abnormally interacting immune systems with intestinal microbiota resulting in abnormal cytokine signal profiles.
Mushroom
There is increasing evidence that changes in intestinal microbiota (dysbiosis) are associated with IBS bowel manifestations, but also with psychiatric morbidity coexisting in up to 80% of patients with IBS. The role of intestinal mycobiota, and especially of the abnormal proliferation of Candida albicans yeast in some patients with IBS, is under investigation.
Protozoa
Protozoal infections may cause symptoms that reflect certain IBS subtypes, such as infection by certain subtypes of blastocystis hominis (blastocystosis).
By 2017, evidence suggests that blastocystis colonization occurs more frequently in IBS-infected individuals and is a possible risk factor for developing IBS. Dientamoeba fragilis has also been considered a possible organism to study, although it is also found in people without IBS.
Vitamin D
Vitamin D deficiency is more common in individuals exposed to irritable bowel syndrome.
Mechanism
There is evidence that abnormalities occur in the intestinal flora of individuals who have IBS, such as reduced diversity, decreased bacteria belonging to the Bacteroidetes phylum, and an increase in those included in the phyla. Firmicutes . The most profound changes in intestinal flora in individuals with dominant IBS diarrhea. Antibodies to the common component (ie flagellin) of commensal intestinal flora are a common occurrence in individuals affected by IBS. Low-grade chronic inflammation usually occurs in individual-exposed IBS with abnormalities found including elevated enterochromaffin cells, intraepithelial lymphocytes, and mast cells resulting in chronic mediated immune inflammation of the intestinal mucosa.
Genetic, environmental, and psychological factors seem to be important in the development of IBS. Studies have shown that IBS has a genetic component despite the presence of dominant environmental factors. IBS has been reported in larger numbers in multigenerational families with IBS than in the plain population.
Diagnosis
There are no special laboratories or imaging tests that can be performed to diagnose irritable bowel syndrome. Diagnosis involves an exclusionary condition that produces IBS-like symptoms, and then follows a procedure for categorizing the patient's symptoms. The exclusion of parasitic infections, lactose intolerance, excessive intestinal bacterial growth, and celiac disease are recommended for all patients before the diagnosis of irritable bowel syndrome is performed. In patients over 50 years, they are recommended to undergo colonoscopy examination. IBS sufferers have a high risk of having unsuitable surgery such as appendicitis, cholecystectomy, and hysterectomy because their IBS symptoms are misdiagnosed as other medical conditions.
Differential diagnosis
Colon cancer, inflammatory bowel disease, thyroid disorders, and giardiasis can all show abnormal bowel movements and abdominal pain. Less common causes of this symptom are carcinoid syndrome, microscopic colitis, bacterial overgrowth, and eosinophilic gastroenteritis; However, IBS is a general presentation, and testing for this condition will result in a low number of positive results, so it is considered difficult to justify the cost.
Some people, who have worked for years for IBS, may have non-celiac gluten sensitivity (NCGS). Gastrointestinal symptoms of IBS are clinically indistinguishable from NCGS, but the presence of one of the following non-intestinal manifestations suggests a possible NCGS: headache or migraine, "foggy thoughts", chronic fatigue, fibromyalgia, joint and muscle pain, limbs or numb arm , tingling extremities, dermatitis (eczema or skin rash), atopic disorders, allergic to one or more inhalants, food or metals (such as mites, graminaceae, parietaria, cats or dog furs, shells, or nickel), depression, anxiety, anemia, iron deficiency anemia, folate deficiency, asthma, rhinitis, eating disorders, neuropsychiatric disorders (such as schizophrenia, autism, peripheral neuropathy, ataxia, hyperactive disorder deficit attention) or autoimmune disease. Improvements with a gluten-free diet of immune-mediated symptoms, including autoimmune diseases, after simply ruling out celiac disease and wheat allergy, are another way to realize the differential diagnosis.
Due to the many causes of diarrhea that provide IBS-like symptoms, the American Gastroenterological Association publishes a set of guidelines for tests to be done to rule out other causes of these symptoms. These include gastrointestinal infections, lactose intolerance, and celiac disease.
Research has suggested that these guidelines are not always followed. After other causes have been excluded, the IBS diagnosis is performed using a diagnostic algorithm. Algorithms include Manning criteria, obsolete Roman I and II criteria, and Kruis criteria, and studies have compared their reliability. The more recent Rome III process was published in 2006 and the IV Rome criterion was published in 2016.
Criteria IV Rome includes recurrent abdominal pain, on average, at least 1 day/week in the last 3 months, related to two or more of the following criteria:
- Related to defecation
- Associated with stool frequency changes
- Associated with the shape change (appearance) of the stool.
Doctors may choose to use either of these guidelines or may simply choose to rely on their own anecdotal experiences with past patients. The algorithm may include additional tests to guard against misdiagnosis of other diseases such as IBS. Symptoms of such a "red flag" may include weight loss, gastrointestinal bleeding, anemia, or nocturnal symptoms. However, red flag conditions do not necessarily contribute to accuracy in diagnosis; for example, as many as 31% of IBS patients have blood in their stools, many possibilities of haemorrhagic hemorrhage.
The diagnostic algorithm identifies a name that can be applied to a patient's condition based on a combination of symptoms of diarrhea, abdominal pain, and patient constipation. For example, the statement "50% of returning travelers have developed functional diarrhea while 25% have developed IBS" meaning half of travelers experience diarrhea while a quarter have diarrhea with abdominal pain. While some researchers believe this categorization system will help doctors understand IBS, others question the value of the system and suggest that all IBS patients have the same underlying disease but with different symptoms.
Investigation
Investigations are carried out to exclude other provisions:
- Microscope and fecal culture (to exclude infectious conditions)
- Blood tests: Complete blood tests, liver function tests, blood sedation rate, and serologic tests for celiac disease
- Ultrasound Ulcers (to remove gallstones and other biliary tract diseases)
- Endoscopy and biopsy (to rule out peptic ulcer disease, celiac disease, inflammatory bowel disease, and malignancy)
- Hydrogen breath test (to get rid of fructose and lactose malabsorption)
Misdiagnosis
Some common examples of misdiagnosis include infectious diseases, celiac disease, Helicobacter pylori , parasites (non-protozoal).
Celiac disease in particular is often misdiagnosed as IBS. The American College of Gastroenterology recommends that all patients with IBS symptoms be tested for celiac disease.
Malabsorption bile acid also sometimes misses in patients with IBS-dominant diarrhea. SeHCAT tests suggest about 30% of D-IBS patients have this condition, and most respond to bile sequestrants acid.
The chronic use of certain hypnotic tranquilizers, especially benzodiazepines, can cause symptoms such as irritable bowel that can lead to a misdiagnosis of irritable bowel syndrome.
Comorbidities
Some medical conditions, or comorbidities, arise with greater frequency in patients diagnosed with IBS.
- Neurological/psychiatric: A study of 97,593 individuals with IBS identified comorbids such as headache, fibromyalgia, and depression. IBS occurs in 51% of patients with chronic fatigue syndrome and 49% of fibromyalgia patients, and psychiatric disorders occur in 94% of IBS patients.
- Inflammatory bowel disease: IBS may be a type of low-grade bowel disease. Researchers have suggested IBS and IBD are interconnected diseases, noting that patients with IBD experience IBS-like symptoms when their IBD is in remission. A three-year study found that patients diagnosed with IBS were 16.3 times more likely to be diagnosed with IBD during the study period. Serum markers associated with inflammation have also been found in patients with IBS. Abdominal surgery: IBS patients experience an unnecessarily increased risk of unnecessary gallbladder surgery not because of an increased risk of gallstones, but rather to abdominal pain, awareness of having gallstones, and inappropriate surgical indications. These patients were also 87% more likely to have abdominal and pelvic surgery and were three times more likely to have gallbladder surgery. Also, IBS patients are twice as likely to have a hysterectomy.
- Endometriosis: One study reported statistically significant associations between migraine headaches, IBS, and endometriosis.
- Other chronic disorders: Interstitial cystitis may be associated with other chronic pain syndromes, such as irritable bowel syndrome and fibromyalgia. The relationship between these syndromes is unknown.
Management
A number of treatments have proven effective, including fiber, speech therapy, antispasmodic and antidepressant medications, and peppermint oil.
Diet
Studies have shown that up to 70% of IBS patients benefit from eating a low FODMAP diet. The most likely symptoms to improve from such a diet include urgency, abdominal bloating, bloating, abdominal pain, and changing stool output. A national guideline suggests a low FODMAP diet for managing IBS when diet and other lifestyle measures do not work. This diet limits a variety of less-absorbed carbohydrates in the small intestine, as well as fructose and lactose, which are equally poorly absorbed in those who are intolerant of it. Fructose and fructan reduction has been shown to reduce the symptoms of IBS by dose-dependent treatment in patients with fructose malabsorption and IBS.
Some IBS patients believe they have some form of dietary intolerance; However, tests that try to predict the sensitivity of food at IBS have proven disappointing. A small study reported that the IgG antibody test was somewhat effective in determining food sensitivity in IBS patients, with patients on the elimination diet experiencing a 10% reduction in symptoms than those on fake diets. However, more research is needed before testing of IgG can be recommended.
Low-FODMAP diet
FODMAPs are oligo, di-, monosaccharides and fermentable polyols, which are poorly absorbed in the small intestine and then fermented by bacteria in the small intestine and proximal distal portions. This is a normal phenomenon, common to everyone. The resulting gas production has the potential to cause bloating and flatulence. Although FODMAPs can produce certain digestive discomforts in some people, not only do they not cause intestinal inflammation, but they avoid them, as they produce profitable changes in the intestinal flora that contribute to maintaining healthy bowel health. FODMAPs are not the cause of irritable bowel syndrome or other functional gastrointestinal disorders; rather, a person develops symptoms when the underlying gut response is overdone or abnormal.
The low-FODMAP diet consists of limiting them from diet. They are globally trimmed, rather than individually, that are more successful than for example restricting only fructose and fructan, which are also FODMAPs, as recommended for those with fructose malabsorption.
The low-FODMAP diet may help to correct short-term gastrointestinal symptoms in adults with irritable bowel syndrome, but long-term follow-up can have a negative effect as it causes adverse effects on intestinal microbiota and metabolom. It should only be used for a short period of time and under the advice of a specialist. The low-FODMAP diet is very strict in different groups of nutrients and can be impractical to follow in the long run. More research is needed to assess the true impact of this diet on health.
In addition, the use of a low-FODMAP diet without medical advice can lead to serious health risks, including nutritional deficiencies, cancer risk or even death. The low-FODMAP diet can improve and mask the symptoms of a serious illness that usually presents digestive symptoms similar to irritable bowel syndrome, such as celiac disease, inflammatory bowel disease and colon cancer. It is important to have a complete medical evaluation before starting a low-FODMAP diet to ensure a correct diagnosis and that appropriate therapy can be performed. This is particularly relevant in cases of celiac disease. Because gluten consumption is suppressed or reduced by a low-FODMAP diet, the improvement of digestive symptoms with this diet may not be related to FODMAPs withdrawal, but gluten, indicating the presence of unrecognized celiac disease, avoiding the correct diagnosis and treatment, with the consequent risk of several health complications serious, including various types of cancer.
Fiber
Some evidence suggests supplementation of soluble fiber (eg, psyllium/ispagula husk) is effective. Acting as a bulking agent, and for many IBS-D patients, allows for more consistent stools. For IBS-C patients, it seems possible for a softer, moist, and more impassable stool.
However, insoluble fiber (eg, bran) has not been found to be effective for IBS. In some people, insoluble fiber supplementation may exacerbate the symptoms.
Fiber may be beneficial for those with constipation dominance. In people who have IBS-C, soluble fiber can reduce overall symptoms, but will not reduce pain. Research that supports dietary fiber contains conflicting small studies that are complicated by fiber type heterogeneity and doses used.
One meta-analysis found only soluble fiber improves global symptoms of the irritable bowel, but no type of fiber reduces pain. A meta-analysis updated by the same authors also found soluble fiber that reduces symptoms, while insoluble fiber worsens symptoms in some cases. Positive studies have used 10-30 grams per day of ispaghula (psyllium). One study specifically examined the effect of dosage, and found 20 g ispaghula (psyllium) better than 10 g and equivalent to 30 g per day.
Drugs
Drugs may consist of stool softeners and laxatives in IBS-C and antidiarrheal (eg opioids, opioids, or opioid analogues such as loperamide, codeine, diphenoxylate) if diarrhea is dominant.
Drugs that affect serotonin (5-HT) in the gut may help reduce symptoms. On the other hand, many IBS-D patients reported that SSRI-type drugs worsened seizures and diarrhea. This is thought to be due to the large number of serotonin receptors in the gut. 5HT3 antagonists such as ondansetron are effective in postoperative IBS and IBS are dominant diarrhea because of their serotonin blockade at 5HT3 receptors in the intestine; the reason for their benefit is believed that excessive serotonin in the gut is thought to play a role in the pathogenesis of several IBS subtypes. Certain atypical antipsychotic drugs, such as clozapine and olanzapine, may also provide relief because of the serotonergic properties possessed by these agents, acting on the same receptors as other drugs in this particular category. Its benefits may include reducing diarrhea, reducing abdominal cramps, and improving general welfare. Any nausea present may also respond to the 5HT3 antagonist because of its antiemetic properties. Serotonin stimulates intestinal motility so that agonists can help frequent bowel movements in irritation, while antagonists can help colon-susceptible colon. Selective serotonin reuptake inhibitors, SSRIs, are often prescribed for panic and/or anxiety and depression disorders, affecting the serotonin in the intestine, as well as the brain. The intestine relies heavily on serotonin for nerve communication. "Selective serotonin reuptake inhibitor antidepressants seem to promote global well-being in some patients with irritable bowel syndrome and, possibly, some improvement in abdominal pain and intestinal symptoms, but this effect does not seem to be dependent on increased depression.
Mast cells and secreted compounds are central to pathophysiology and are involved in IBS care; some mediators of secreted mast cells (and related receptors) who have been implicated in IBS symptoms or specific subtypes include: histamine (HRH1, HRH2, HRH3), tryptase and chymase (PAR2), serotonin (5-HT3), PGD2 (DP1). Histamine also causes the secretion of chloride and water ions (associated with secretory diarrhea) through signals through unrecognized ionic receptors or ducts in 2015. A 2015 review notes that both H1 antihistamines and mast cell stabilizers have shown efficacy in reducing pain associated with visceral hypersensitivity in IBS; Other low quality studies also suggest the benefits of these agents for IBS. In a review related to idiopathic mast cell activation syndrome (including IBS), a combined treatment approach using antileukotrien, H1/H2-antihistamine, and mast cell stabilizers is recommended.
Laxatives
For patients who do not adequately respond to dietary fiber, osmotic laxatives such as polyethylene glycol, sorbitol, and lactulose may help avoid the "cathartic colon" that has been associated with stimulant laxatives. Among osmotic laxatives, the dose of 17-26 g/d polyethylene glycol has been studied well. Lubiprostone (Amitiza) is a gastrointestinal agent used for the treatment of chronic idiopathic constipation and IBS, which is dominated by constipation. It is well tolerated in adults, including elderly patients. On July 20, 2006, lubiprostone has not been studied in pediatric patients. Lubiprostone is a bicyclic fatty acid (prostaglandin E1 derivative) acting to actively activate the ClC-2 chloride channel on the apical aspects of gastrointestinal epithelial cells, resulting in the secretion of chloride-rich liquids. This secretion softens the stool, improves motility, and promotes spontaneous bowel movements. Unlike many laxatives, lubiprostone shows no signs of tolerance, dependence, or changes in serum electrolyte concentrations.
Antispasmodik
The use of antispasmodic drugs (eg, anticholinergics such as hyoscyamine or disyclomine) may help patients, especially those with cramps or diarrhea. A meta-analysis by Cochrane Collaboration concluded that if seven patients were treated with antispasmodics, one patient would benefit. Antispasmodics can be divided into two groups: neurotropic and musculotropic.
- Musculotropics, like mebeverine, act directly on the smooth muscle of the gastrointestinal tract, eliminating spasm without affecting the normal bowel motility. Because this action is not mediated by the autonomic nervous system, the usual anticholinergic side effects do not exist. Antispasmodic otilonium may also be useful.
Termination of proton pump inhibitor
Proton pump inhibitors (PPIs) used to suppress stomach acid production can lead to overgrowth of bacteria that cause IBS symptoms. Discontinuance of PPI in certain individuals has been recommended as it may lead to an increase or resolution of IBS symptoms.
tricyclic antidepressants
Strong evidence suggests low doses of tricyclic antidepressants can be effective for IBS. However, the evidence is less strong for the effectiveness of other antidepressant classes such as SSRIs.
Serotonin agonists
- Tegaserod (Zelnorm), a selective 5-HT4 agonist for IBS-C, is available to eliminate IBS constipation in women and chronic idiopathic constipation in both men and women. On March 30, 2007, the FDA called on Novartis Pharmaceuticals to voluntarily discontinue marketing of tegaserod based on a recently identified finding of an increased risk of serious cardiovascular side effects (heart problems) associated with the use of the drug. Novartis agrees to voluntarily suspend drug marketing in the United States and in many other countries. On July 27, 2007, the FDA approved a limited treatment IND program for tegaserod in the US to allow limited access to medicines for patients in need if no alternative drugs or alternative treatments were available to treat the disease. The FDA has issued two prior warnings about the serious consequences of tegaserod. In 2005, it was rejected as an IBS drug by the European Union. Tegaserod, marketed as Zelnorm in the United States, is the only approved agent for treating various IBS symptoms (only in women), including constipation, abdominal pain, and bloating.
- Selective serotonin reuptake inhibitor antidepressants (SSRIs), due to their serotonergic effects, seem to help IBS, especially those with constipation. Early crossover studies and randomized controlled trials supported this role. Biased publications can play a role in the real benefits of SSRIs. One study concluded that tricyclic antidepressants can improve overall symptoms of irritable bowel syndrome; However, there is no solid evidence to confirm the effectiveness of SSRIs.
Serotonin antagonists
Alosetron, a selective 5-HT3 antagonist for IBS-D and cilansetron (also a selective 5-HT3 antagonist) were tested for IBS. Because of severe side effects, ie ischemic colitis and heavy constipation, they are not available or recommended.
Other agents
Magnesium silicate aluminum and alverin citrate drugs can be effective for IBS.
Conflicting evidence about antidepressant benefits in IBS. Some meta-analyzes have found benefits, while others do not. A meta-analysis of randomized controlled trials, especially TCA found that three patients should be treated with TCA for one patient for repair. A separate randomized controlled trial found the best TCA for patients with IBS-D.
Rifaximin can be used as an effective treatment for flatulence and flatulence, giving more credibility to the potential role of excessive bacterial growth in some patients with IBS.
In individuals with IBS and low levels of vitamin D supplementation is recommended. Some evidence suggests that vitamin D supplementation may improve the symptoms of IBS, but more research is needed before it can be recommended as a special treatment for IBS.
Domperidone, a dopamine and parasympathomimetic receptor blocker, has been shown to reduce flatulence and stomach as a result of accelerated transit time and reduce faecal load, ie, relief from 'hidden constipation'; defecation is also improved.
The use of opioids is controversial because of the potential risk of tolerance, physical dependence, and addiction, but may be the only help for some dominant cases of diarrhea when other treatments are ineffective.
SIBO therapy
A statistically significant decrease in IBS symptoms occurs after antibiotic therapy for excessive bacterial colonic growth. However, recent research has shown that lactulose hydrogen breath tests do not actually measure SIBO, and that SIBO is unlikely to be the cause of IBS.
Psychological therapy
Mind-body or brain-intestine interactions have been proposed for IBS, and are receiving increased research attention. Hypnosis can improve mental health, and cognitive behavioral therapy can provide psychological mitigation strategies to deal with troublesome symptoms, and help suppress thoughts and behaviors that improve IBS symptoms, although the evidence base for the effectiveness of psychotherapy and hypnosis is weak. and such therapy is generally not recommended. However, in drug-resistant cases where pharmacological therapy for at least 12 months has failed to provide assistance, NICE clinical guidelines recommend that consideration be given to psychological treatment strategies such as cognitive behavioral therapy [CBT], hypnotherapy and/or psychological therapy.
Stress Relief
Reducing stress can reduce the frequency and severity of IBS symptoms. Techniques that can help include:
- Relaxation techniques like meditation
- Physical activities such as yoga or tai chi
- Regular exercise like swimming, walking, or running
Probiotics
Probiotics may be useful in the treatment of IBS; taking 10 billion to 100 billion beneficial bacteria per day is recommended for beneficial results. However, further research is needed on the individual strains of beneficial bacteria for more refined recommendations. Probiotics have positive effects such as increasing intestinal mucosal barrier, providing physical barrier, bacteriocin production (reducing the number of pathogenic bacteria and gas producers), reducing bowel permeability and bacterial translocation, and regulating the immune system both locally and systemically. other beneficial effects. Probiotics can also have a positive effect on the intestinal axis of the brain by its positive effects against the effects of stress on intestinal immune and bowel function.
A number of probiotics have been found to be effective, including Lactobacillus plantarum , and Bifidobacteria infantis ; but one review found only Bifidobacteria infantis shows efficacy. B. infantis may have effects outside the intestine through it causing a reduction in the activity of proinflammatory cytokines and an increase in blood tryptophan levels, which may lead to an increase in depressive symptoms. Some yogurt is made using probiotics that can help alleviate the symptoms of IBS. Yeast probiotics called Saccharomyces boulardii have some evidence of effectiveness in the treatment of irritable bowel syndrome.
Certain probiotics have different effects on certain IBS symptoms. For example, Bifidobacterium breve , B. longum, and Lactobacillus acidophilus have been found to relieve stomach upset. B. breve, B. infantis, L. casei , or L. plantarum species relieve distention symptoms. B. breve, B. infantis, L. casei, L. plantarum, B. longum, L. acidophilus, L. bulgaricus , and Streptococcus salivarius ssp. thermophilus all found to affect the levels of gas in the stomach. Most clinical studies show probiotics do not increase tension, incomplete evacuation, fecal consistency, fecal urgency, or stool frequency, although some clinical studies have found some benefits of probiotic therapy. Conflicting evidence for whether probiotics improve overall quality of life scores.
Probiotics can have beneficial effects on IBS symptoms by maintaining intestinal microbiota, normalizing blood levels of cytokines, increasing intestinal transit times, decreasing small bowel permeability, and by treating the growth of small intestinal bacteria that is too rapid in bacterial fermentation.
Medicinal herbs
Peppermint oil looks useful. In a meta-analysis found superior for placebo for the improvement of IBS symptoms, at least in the short term. A previous meta-analysis suggests that peppermint oil yields are temporary because the number of people examined is small and blinding those who receive treatment is unclear. Safety during pregnancy has not been established, however, and caution is necessary not to chew or damage the enteric coating; otherwise, gastroesophageal reflux may occur as a result of lower esophageal sphincter relaxation. Occasionally, nausea and burning perianal occur as side effects. Iberogast, a multi-herbal extract, was found to be superior in efficacy to placebo.
There is only limited evidence for the effectiveness of other herbal remedies for IBS. As with all herbs, it is wise to be aware of possible drug interactions and side effects.
Yoga
Yoga may be effective for some IBS patients, especially the pose that exercises the lower abdomen.
Acupuncture
A meta-analysis found no benefit of acupuncture relative to placebo for IBS symptom severity or IBS-related quality of life.
Epidemiology
The prevalence of IBS varies by country and by age range examined. The bar graph on the right shows the percentage of symptoms of IBS population reporting in studies from different geographic regions (see table below for reference). The following table lists research conducted in different countries that measure the prevalence of IBS and IBS-like symptoms:
Gender
Women about two or three times more likely to be diagnosed with IBS and four to five times more likely to seek special care for it than men. These differences may reflect a combination of both biological (gender) and social (gender) factors. People diagnosed with IBS are usually younger than 45 years. Studies of female patients with IBS indicate the severity of symptoms often fluctuates with the menstrual cycle, suggesting hormonal differences may play a role. Support for gender-related features has been linked to quality of life and psychological adjustment in IBS. Gender differences in health care search can also play a role. Gender differences in anxiety traits can contribute to lowering the pain threshold in women, placing them at greater risk for a number of chronic pain disorders. Finally, sexual trauma is a major risk factor for IBS, with as many as 33% of those affected report abuse. Because women are at higher risk of sexual harassment than men, the risk of sex-related harassment may contribute to higher IBS rates in women.
History
One of the first references to the concept of "bowel irritation" appeared in the Rocky Mountain Medical Journal in 1950. The term is used to categorize patients who develop symptoms of diarrhea, abdominal pain, and constipation, but there is no cause for infection is known. Initial theory suggests that the irritable intestine is caused by psychosomatic or mental disorders.
Society and culture
Name
Other names for conditions used in the past include irritable colon, spastic colon, nerve colon, colitis, mucosal colitis, and spastic colon.
The terminology refers to the large intestine is inaccurate and desperate, since the disorder is not limited to the gastrointestinal tract. Similarly, the term "colitis" is inaccurate because inflammation does not exist. Another reason why these terms are abandoned is to reflect the notion that the disorder is not a figment of one's imagination.
Economy
United States
The overall cost of irritable bowel syndrome in the United States is estimated at $ 1.7-10 billion in direct medical costs, with an additional $ 20 billion in indirect costs, totaling $ 21.7-30 billion. A study by a managed care company comparing the medical costs of IBS patients with non-IBS controls identified a 49% annual increase in medical costs associated with IBS diagnosis. IBS patients spent an average annual cost of $ 5,049 and $ 406 excluding pocket expenditure in 2007. A study of workers with IBS found that they reported a 34.6% loss in productivity, corresponding to 13.8 lost hours per 40 hours a week. A study of the health costs associated with employers of Fortune 100 companies conducted with data from the 1990s found IBS patients spend US $ 4527 in claims vs. costs. $ 3276 for the control. A study of the cost of Medicaid done in 2003 by the University of Georgia College of Pharmacy and Novartis found IBS to be associated with an increase of $ 962 in Medicaid fees in California, and $ 2191 in North Carolina. IBS patients have higher costs for doctor visits, outpatient visits, and prescription drugs. This study suggests that costs associated with IBS are comparable to those found in asthmatic patients.
Research
Individuals with IBS have been found to experience a decrease in the diversity and number of bacterial microbiota. Preliminary studies of the effectiveness of stem microelectal transplantation in IBS treatment have been highly beneficial with a 'cure' rate between 36% and 60% with remission of IBS core symptoms persisting at 9 and 19 months of follow-up. Treatment with probiotic bacterial strains has proven to be effective, although not all strains of microorganisms provide similar benefits and adverse side effects have been documented in a small number of cases.
There is increasing evidence for the effectiveness of mesalazine (5-aminosalicylic acid) in the treatment of IBS. Mesalazine is a drug with anti-inflammatory properties that has been reported to significantly reduce the inflammation of immune mediation in the IBS colon affected individuals with mesalazine therapy resulting in increased IBS symptoms as well as general health feelings in people affected by IBS. It has also been observed that mesalazine therapy helps to normalize intestinal flora that is often abnormal in people who have IBS. The therapeutic benefits of mesalazine may be the result of improved epithelial barrier function.
Diet IgG-mediated food intolerance causes a 24% greater deterioration in symptoms compared with diet elimination and food elimination based on IgG antibodies may be effective in reducing IBS symptoms and eligible for further biomedical research. The main problem with this study is that the only symptom difference observed in the limited exclusion diet, treatment based on "abnormal" high IgG antibodies can not be recommended.
The differences in visceral sensitivity and intestinal physiology have been noted in IBS. Strengthening of the mucosal barrier in response to oral 5-HTP is absent in IBS compared with controls. Individual IBS/IBD rarely have positive HLA DQ2/8 than in upper functional gastrointestinal disease and healthy populations.
A 2006 questionnaire designed to identify patients' perceptions of IBS, their preferences on the kind of information they need, and the educational media and expectations of health care providers reveal misperceptions about IBS developing to other conditions, including colitis, malnutrition, and cancer. The survey found the most interested IBS patients to learn about food to avoid (60%), causes IBS (55%), drugs (58%), coping strategies (56%), and psychological factors associated with IBS (55% ). The respondents indicated that they would like their doctors to be available by phone or email after the visit (80%), have the ability to listen (80%), and provide hope (73%) and support (63%).
References
External links
- irritable bowel syndrome in Curlie (based on DMOZ)
- UNC Center for GI & amp; Functional Motility Disorder
Source of the article : Wikipedia
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