Health, fitness and Food

Has the dreaded IBS finally met its match?

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A taskforce of experts and scientists from 19 European countries have formed a International network called GENIEUR (Genes in Irritable Bowel Syndrome Europe), Led by Dr. Beate Niesler at Heidelberg University Hospital’s Institute of Human Genetics and Scientific teams from the Sahlgrenska Academy, Unversity of Gothenburg and Karolinska Instituet, (Sweden) they have formed an multidisciplinary network who are researching into the causes of IBS with the aim of better understanding the condition and improving diagnosis and treatment.
Up to 1 in 5 people in the UK develop IBS during their life, it is one of the most common causes for being off work after the common cold and has a considerable impact on quality of life and the economy with 66% of IBS sufferers reporting in sick during the last six months.

Irritable bowel syndrome (IBS) is well known as a chronic and relapsing condition which is typically characterised by abdominal pain or discomfort associated with bloating and a change in bowel habit ie diarrhoea and or constipation. It is a functional disorder meaning that there is a problem with the gut function but there is no structural abnormality.
As well as the above, sufferers may also have nausea, headaches, belching, loss of appetite, fatigue, muscular pains and heartburn.

  1. IBS is thought to originate from an over activity in part or parts of the gut but the essential trigger factor is not always known.
  2.  However, there are several theories suggested:
  3. Over activity of the nerves or muscles of the gut which may be due to stress or emotional upset. (A new study from the University of Michigan Health System showed that stress does not cause IBS but it does alter Brain Gut interactions and stimulates Intestinal inflammation leading to the familiar IBS symptoms.)

Intolerance to certain foods, but not very common.

After a Gastrointestinal infection about 1 in 6 cases develop into IBS.

There is no single defining test for IBS and diagnosis in Primary care is usually done via the History ,symptoms described earlier and by exclusion. Blood tests can help to rule out anaemia, and distinguish between an Inflammatory Bowel Disease (IBD) such as Ulcerative colitis or Crohn’s disease, antibody testing for Coeliac disease is also recommended. This is all supported by the NICE guidelines and the British Society of Gastroenterology(BSG) .

Once a positive diagnosis of IBS has been made there is currently no known cure, symptomatic relief should be provided depending upon the presenting symptoms. Self management is regularly encouraged and advice on diet and lifestyle and stress management offered if appropriate.
The initial approach in managing IBS is one of dietary modifications and the addition of fibre, probiotics plus pain relief using antispasmodics. Those suffering with constipation will benefit from  a medication called Linaclotide. This relatively new medication to the market is useful for this symptom plus abdominal pain. If diarrhoea is the problem then Loperamide may be helpful. If all other treatments have not helped then antidepressants may be considered. A good patient Doctor relationship has been shown to help their IBS, this type of continuity will lead to improved outcomes especially in chronic conditions. Remember, IBS comes in a variety of guises and various subtypes have been identified over the years.

IBS sufferers should be referred to secondary care only if the following Alarm features are present:
Rectal Bleeding, unexplained unintentional weight loss, a family history of bowel/ ovarian cancer, late onset >50 years old.

Ultimately the prognosis for IBS is good. Most sufferers will tend to have long term symptoms, but their severity will change from intense to mild and sometimes and there may be long periods without any symptoms at all. Treatment is usually very effective in “flare ups” and in a few cases the problem may resolve completely. IBS is not known to alter you expected lifespan does not lead to bowel cancer or cause intestinal blockage. Combining this with the new exciting research may finally lead to unravelling the puzzle that is IBS

References: NICE Guidelines, The British Society of Gastroenterologists,The IBS Network, The British Journal of General Practice,Gastroenterology, Family Practice.
 

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