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Irritable bowel syndrome (IBS) is a lower intestine painful disorder that affects 10% to 15% of Americans, yet physicians will often rank IBS lower in priority to other conditions and diseases because it doesn’t shorten a patient’s lifespan or increase the likelihood of developing other diseases perceived to be more serious such as colon cancer. Nevertheless, IBS is a serious disorder that often decreases a person’s quality of life and their ability to function—both personally and professionally—on a daily basis. The challenge for physicians is to identify the triggers and symptoms (cramping, abdominal pain, bloating, constipation, or diarrhea) of IBS; the challenge lies in that all IBS symptoms are individualized to the patient and are essential determinants of therapies.

Historically, physicians believed that IBS was a gastrointestinal (GI) manifestation of psychological disease. Although a significant number of IBS sufferers experience mental distress, it’s difficult to determine which condition precedes the other. For example, patients with underlying anxiety or depression may experience more severe GI symptoms as their psychological problems increase; however, patients may also experience anxiety as a result of their severe GI symptoms. In some cases, IBS can be so severe that the symptoms are debilitating, causing significant fear of leaving their homes because they may have an episode of abdominal pain, urgency, or diarrhea. Such sufferers experience psychological distress as a result of their IBS.

Get the Facts on IBS

A common misconception is that lactose intolerance is usually a contributor to IBS, but that’s not always true. Approximately 20% of Americans are lactose intolerant, and not all of them suffer from IBS, leading to a hypothesis that a lactase deficiency in and of itself doesn’t always cause IBS. Individuals who are lactose intolerant may have symptoms indistinguishable from IBS that may improve with a lactose-reduced diet. Therefore, it’s generally beneficial to evaluate the effects of such a diet. However, it’s important to note that a lactose-reduced diet may not improve symptoms even in the presence of lactose intolerance because IBS symptoms may be unrelated to that condition.

Restrictive Diets Aren’t Always Necessary

Two-thirds of patients with GI problems associate symptom onset with the ingestion of a meal, suggesting an association between food and symptoms. However, a restrictive diet consisting of bland food may not always improve symptoms and isn’t required for all patients who suffer from IBS. To determine if symptoms are food-related, patients can keep a food diary for 2 or 3 weeks to identify specific foods that may be associated with their symptoms and avoid them if necessary (eg, fatty or greasy foods are common triggers for symptoms). If no foods are identified, a strict exclusion of a wide variety of foods from a patient’s diet may not be beneficial.

IBS: Diagnosable & Treatable

Validated symptom-based criterion such as the Rome III criteria and the exclusion of IBS “red flags,” which may include worsening symptoms, evidence of unexplained weight loss, GI bleeding, refractory vomiting, or a family history of colon cancer, inflammatory bowel disease, or celiac sprue, can allow physicians to confidently arrive at a diagnosis of IBS. In turn, empiric therapy based on the patient’s predominant symptoms can be safety initiated. Although there is no universally effective therapy for IBS, pursuing dietary lifestyle recommendations and therapy plans can make a significant impact on our patients’ lives. The goal of treating IBS isn’t to cure the condition because there are currently no cures. Instead, we can aim to improve symptoms so patients can function on a day-to-day basis and enjoy life.

Dr. Chey has indicated to Physician’s Weekly that he has or has had the following financial interest: AGI, Axcan, Microbia, Novartis, Procter & Gamble, Santarus, Salix, Smart Pill, Takeda, and TAP.