Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome (IBS), a functional bowel disorder associated with alterations of stool habits that can seriously affect quality of life (QoL), including social life, regular daily activities and diet. It is one of the most common gastrointestinal(GI) diseases in the industrialized world but lacks specific histopathological, biochemical or imaging findings that establish diagnostice criteria.
A variety of symptoms commonly occur: abdominal pain, bloating, nausea, an irregular but more frequent urge to defecate, and an altered stool consistency (sometimes switching between softer and harder stool forms). Those with IBS often lack the feeling of complete emptying after a bowel movement. Among these symptoms, abdominal pain is the most disruptive and found in almost all IBS patients.
Irritable Bowel Syndrome (IBS)
Epidemiology and Risk Factors
The prevalence of IBS varies depending on the region, with a global prevalence of 11%. It occurs in 10 to 20% of the Western world and 11% in Australia. Compared with the Western countries, Southeast Asia and especially China have low prevalences of IBS, which lie between 5 and 7% and India has the lowest prevalence of IBS (4.2%).
There appears to be a number of risk factors for IBS, such as anxiety, depression, stress, and there is an association between IBS and sexual, emotional or verbal abuse as well as between IBS and abuse in childhood or adulthood. Malnutrition may play a role. A history of previous bacterial gastroenteritis has been shown to be a major independent risk factor for the development of IBS.It is believed that having multiple risk factors potentiate the likelihood of developing IBS. A family history of IBS, female gender and history of hysterectomy also appear to be important risk factors.
Types of IBS
IBS can be characterized by having mostly diarrhea (IBS-D), mostly constipation (IBS-C), or mixed (IBS-M). The diarrhea-predominant subtype of IBS, is characterized by loose (mushy) or watery stools occurring in >25% and by hard or lumpy stools in <25% of bowel movements. IBS-D patients do not report on upper GI symptoms as often as people with IBS-C.
The constipation-predominant subtype of IBS, is characterized by hard or lumpy stools occurring in >25% and loose (mushy) or watery stools occurring in <25% of bowel movements.
Possible Causes and Contributing Factors to IBS
As a functional disease, IBS is believed to be multi-factorial in terms of causes and contributing factors with no single causative entity identified. Inflammation is thought to play a role as well as central sensitivity, diet, emotion, stress and dysregulation of intestional motility.
Disturbances in the intestinal bacterial colonization
At birth, the GI tract is not yet colonized by bacteria. After birth, the first bacteria, fungi and protozoa can orally reach and colonize the intestine. An individual microbial intestinal balance that stabilizes over time is thus created in every single human being. During this time, variations in the composition of the bacterial strains have already been formed and may establish the basis for the development of IBS. Through daily food intake, different bacterial populations are introduced into our intestinal tract. This complex bacterial system makes up the “microbiome” which consists of about 100 trillion bacteria, which in turn can affect physiological GI functions, and the fecal microbiome is altered in IBS patients.
GI infections may induce changes in the bacterial colonization of a normal intestinal flora and as this change continues, it may contribute to the development of IBS. Different bacterial products can affect the motility and secretion of the gut, or even the brain. It is known that a change in the bacterial balances of E. coli, Lactobacilli and Bifidobacteria is present in the IBS diarrhea-type.
SIBO (Small Intestinal Bacterial Overgrowth)
Overgrowth of bacterial can occur in the upper part of the small bowel and can be caused by altered intestinal contractions, altered gastric acid secretion, blind loops, and partial obstruction. Whether SIBO plays a role in IBS is not quite clear but the frequency of SIBO in IBS varies from 4 to 78%, and is higher in IBS patients than in controls. An association between SIBO and IBS seems likely and is currently being investigated.
Interactions with the Nervous System
The central nervous system (CNS) affects all the features of the GI tract, such as bowel movements, the perception of intestinal pain, and illness-related behavior. The GI tract is also enveloped and affected by the enteric nervous system and can be affected by malfunctions at this local level. Because of the direct connection between the GI tract and the nervous system, GI function can be markedly affected by the emotional state of an individual, especially in depression, and seriously impacted by stress.
Altered processing in the CNS is believed to occur in IBS and is likely related to the impact of emotion and stress. In IBS, this altered processing results in hypersensitivity to bowel symptoms, especially pain, a condition called Central Sensitivity. The GI pain of IBS is referred to as visceral pain, pain that arises from body organs including the pancreas, bladder and uterus. Like other types of pain, visceral pain is magnified in the presence of central sensitiviy but visceral pain is also particularlly influenced by emotion and stress. Therefore, daily thinking, feeling and acting may be constantly influenced by visceral pain, such that many activities are consistently avoided in an attempt to gain solitude and tranquility.
See: Central Sensitivity
Diet and IBS
Intake of specific foods is not considered to cause IBS but certain foods can definitely trigger exacerbations of IBS in some individuals. Foods commonly associated with triggering IBS exacerbations include high-fat fast foods, processed meat, whole grains, sweets, citrus fruit, garlic and onions.
See: IBS and Diet
When this integrity of the intestinal lining is compromised, the permeability of the gut is altered which allows substances to penetrate the lining of the gut and enter the blood stream, a condition referred to as “leaky gut.” The “inappropriate” entry of these substances is thought to possibly trigger inflammation and the immune system in ways that contribute to the symptoms of IBS.
See “Leaky Gut“
Treatment of IBS
Symptomatic treatment of IBS is directed at bowel function and pain. But the nature of IBS is such that an integrative approach that incorporates multiple modalities is most likely to be successful. Pharmacologic options for managing gut motility are commonly employed, dietary modification can be particularly important for some, reduction and management of anxiety and stress is pivotal as well as the treatment of comorbid depression. Addressing the leaky gut is gaining more attention as an effective treatment option fof IBS.
More information and specifics of treatment can be found:
See: Central Sensitivity
See: IBS and Diet
See: Leaky Gut
See: Using the Mind
IBS – Overviews
IBS – Treatment: Conventional
IBS – Treatment: CAM
IBS – Visceral Hypersensitivity
Emphasis on Education
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