Information of Irritable Bowel Syndrome (IBS)

Irritable Bowel Syndrome
The irritable bowel syndrome (IBS) is the most common of all digestive disorders, affecting nearly everyone at one time or another and accounting for up to 50% of patients referred to a gastroenterologic practice. Although characterized as a disorder of bowel motility, in many patients it is an exaggeration of normal physiologic responses.
Numerous terms have been used to describe the syndrome (Table -1). Irritable bowel syndrome seems to be the most appropriate. Terms that include the word colon or colitis are inaccurate because the condition is not limited to the colon, and inflammation is not a feature. Furthermore, use of the term colitis leads to confusion with ulcerative colitis and conveys an inaccurate impression to the patient. The terms spastic bowel syndrome and nervous bowel, although inaccurate in that they do not encompass all instances of IBS, may be useful in explaining the condition to some patients.
  • Pathogenesis. The causes and pathogenesis of IBS remain obscure. Nevertheless, clinical and laboratory evidence indicate that it most likely is a disorder of bowel motility. Constipation and abdominal cramps are prominent complaints of many patients with IBS. These symptoms could be explained on the basis of hypertonic segmental contractions, which would slow transit by increasing the resistance to passage of feces. On the other hand, it is possible that patients with diarrhea have a hypomotile bowel, which would decrease resistance to passage of feces, or that they simply have an increase in peristaltic contractions.
    • Myoelectric activity of the colon is composed of slow waves and spike potentials superimposed on the slow waves. In healthy people, slow-wave frequency ranges from 6 to 10 cycles per minute, although rates of 3 cycles per minute occur some of the time. The superimposed spike potentials take the form of short spike bursts and long spike bursts. The short spike bursts are less than 5 seconds and occur at the same time as the slow waves, resulting in muscular contractions of the same frequency as the slow waves. On the other hand, long spike bursts last from 15 seconds to several minutes and produce sustained contractions. Abnormalities in colonic myoelectric activity have been described in patients with IBS but have been inconsistent and, thus far, of no practical clinical use.
    • Intestinal motor activity. In patients with IBS the increase in colonic motor activity that normally occurs after eating is blunted but continues longer than in asymptomatic people and may even become stronger. Emotional stress also induces colonic motor activity, both in healthy people and in patients with IBS, but it is possible that symptoms are perceived to a greater degree in patients with IBS. Balloon distention of the rectosigmoid colon in patients with IBS causes spastic contractions of greater amplitude than in asymptomatic subjects. Furthermore, there is evidence that patients with IBS who complain of gaseous distention and abdominal cramps cannot tolerate quantities of small-bowel intraluminal gas that are easily tolerated by healthy people .
  • Diagnosis
    • Clinical presentation
      • Symptoms. Patients with IBS typically complain of crampy abdominal pain and constipation. In some patients, chronic constipation is punctuated by brief episodes of diarrhea. A minority of patients have only diarrhea. Symptoms usually have been present for months to years, and it is common for patients with IBS to have consulted several physicians about their complaints and to have undergone one or more gastrointestinal evaluation.
        TABLE -1. SYNONYMS FOR IRRITABLE BOWEL SYNDROME
        Irritable colon syndrome Splenic flexure syndrome
        Spastic bowel syndrome Functional bowel disease
        Spastic colitis Psychophysiologic bowel disease
        Mucous colitis Nervous bowel


      • Timing of symptoms. The patient may be able to correlate symptoms with emotional stress, but often such a relation is not evident or becomes apparent only after careful questioning as the physician becomes acquainted with the patient. If abdominal cramps are a feature, they often are relieved temporarily by defecation. Bowel movements may be clustered in the morning or may occur throughout the day, but rarely is the patient awakened at night. Stools may be accompanied by an excessive amount of mucus, but blood is not present unless there are incidental hemorrhoids.
      • The differential diagnosis is broad, including most disorders that cause diarrhea and constipation . However, there are several features that suggest the diagnosis of IBS (Table -2). Several organic disorders may mimic IBS and, in fact, may be unrecognized for years in patients who mistakenly have been diagnosed as having IBS. Patients with lactose intolerance typically have postprandial diarrhea associated with crampy pain . They are healthy in all other respects. A careful history and a trial of a lactose-free diet usually are sufficient to make a diagnosis. Celiac sprue, Crohn's disease, and endometriosis also can masquerade as IBS because of the vagueness of the symptoms in many patients. A clinical history of postprandial abdominal pain suggests the possibility of gallbladder, pancreatic, or peptic disease. Because IBS may affect the entire digestive tract, belching and symptoms of gastroesophageal reflux and dyspepsia are common in patients with IBS.
        Anorexia, weight loss, fever, rectal bleeding, and nocturnal diarrhea all suggest a cause other than IBS for the patient's symptoms. The physician should remember, however, that other gastrointestinal disorders can develop in patients with IBS, and thus one should be alert to a change in the patient's complaints.
      • Physical examination. Patients generally appear healthy, although they may be somewhat tense or anxious. If abdominal pain is a prominent symptom, voluntary guarding may be evident, and sometimes a tender, firm sigmoid colon is palpable. A thorough physical examination, including a rectal examination, is important in the evaluation for a non-IBS disorder.
        TABLE -2. FEATURES SUGGESTIVE OF IRRITABLE BOWEL SYNDROME
        Characteristic Uncharacteristic
        Constipation or diarrhea or both Anorexia
        Crampy abdominal pain Weight loss
        Mucus in stools Rectal bleeding
        Symptoms related to stress Fever
        Weight stable or increasing Nocturnal diarrhea
        Appearance of health Recent onset of symptoms
        TABLE -3. CLINICAL AND LABORATORY EVALUATION OF PATIENTS WITH SUSPECTED IRRITABLE BOWEL SYNDROME
        All Patients Selected Patients
        Stool for occult blood
        If diarrhea, stool for leukocytes, ova, parasites bacterial pathogens
        Sigmoidoscopy
        Barium enema examination
        UGI and small-bowel series
        Ultrasound of gallbladder
        Abdominal and pelvic CT scan
        Serum amylase level
        Lactose tolerance test
        UGI endoscopy, colonoscopy and mucosal biopsy of small bowel and colon


    • Diagnostic studies. Because the diagnosis of IBS is largely one of exclusion, a number of clinical and laboratory studies should be performed to rule out other treatable disorders (Table -3). The extent of the evaluation depends on the nature of the patient's symptoms and the adequacy of previous evaluations.
      Again, it is important to note that patients with IBS are not immune to the development of other gastrointestinal disorders. Thus, the length of time that has elapsed since the last evaluation and the character of the current symptoms affect the decision of whether to proceed again with diagnostic studies.
      • Routine tests such as a complete blood count, an erythrocyte sedimentation rate, and a stool test for occult blood are appropriate for all patients. If the patient complains of diarrhea, the stool should be examined for leukocytes, ova, parasites, and bacterial pathogens. A flexible fiberoptic sigmoidoscopic examination should be performed in all patients with suspected IBS, whether or not they complain of diarrhea. This test should be followed by a double-contrast barium enema.
      • Whether additional diagnostic studies are indicated is a matter of judgment. Because Crohn's disease can be confused with IBS, an upper gastrointestinal series with a small-bowel follow-through should be performed in patients with persistent abdominal pain, particularly if they have had some weight loss. If the postprandial pain is predominantly in the upper abdomen, ultrasonography of the gallbladder may be indicated to rule out gallstones. Postprandial pain also raises the possibility of pancreatic disease.
        If the clinical context is suggestive of a pancreatic disorder, a serum amylase level and perhaps a computed tomography (CT) scan of the abdomen are indicated. A lactose tolerance test may be necessary to confirm lactase deficiency in some patients. Lymphocytic and collagenous colitis can be diagnosed only by colonic mucosal biopsies. Small-bowel biopsy may be indicated to rule out small-intestinal mucosal disease (e.g., celiac sprue, Whipple's disease, Crohn's disease, and others).
  • Irritable Bowel Syndrome (IBS) can have significant impact on individual's social, personal, and professional life. Homeopathy offers proven treatment for the IBS which treats the Mind and Body connections. 
    • Emotional support.
       Making the diagnosis of IBS is sufficient in some patients to alleviate anxiety about their symptoms. In particular, patients who suffer from cancer phobia are relieved to learn that they are cancer-free. However, most patients with IBS experience no relief merely from reassurance. Many have carried the diagnosis of IBS for years and continue to experience distressful symptoms despite supportive reassurance and diet and drug therapy. Although these patients often understand that they have a ‘nervous bowel,’ that understanding does little to alleviate symptoms, and they continue to seek treatment. Stress reduction programs may be effective.
    • Diet and fiber therapy. The commonsense approach to diet therapy is the most appropriate. There is no need for bland or highly restrictive diets in the treatment of IBS. Patients should avoid foods that they find cause symptoms. If lactose-containing foods produce cramps and diarrhea, these should be eliminated from the diet.
      The role of fiber in the treatment of IBS has been controversial. However, clinical experience suggests that a high-fiber diet and/or fiber supplements provide symptomatic relief in some patients. Patients with crampy abdominal pain and constipation seem most likely to benefit, although sometimes patients with watery diarrhea experience a firming of their stools after the fiber content of the diet has been increased.
we have treated more than 2000 cases of ibs.