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7975 Lake Underhill Rd., Suite 360 Orlando, FL 32822 3000 N. Orange Ave., Suite C | |
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What kind of diets will help if I have Irritable Bowel Syndrome?
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A dietary history may reveal patterns of symptoms related to dairy or gas-producing foods.
Exclusion of foods that increase flatulence (e.g., beans, onions, celery, carrots, raisins, apricots, prunes, Brussels sprouts, wheat germ, pretzels, and bagels) should be considered in patients with symptoms of bloating or gas.
Underlying visceral hyperalgesia in IBS may explain the exaggerated discomfort experienced with the consumption of gas-producing foods.
Some patients diagnosed with irritable bowel syndrome may have undiagnosed lactose intolerance and can have lasting clinical improvement when placed on a lactose restricted diet.
An increase in the intake of fiber is generally recommended, through diet or the use of commercial bulking supplements. Although the efficacy of fiber supplements has not been proven, some improvement has been demonstrated in patients with IBS whose primary complaints are abdominal pain and constipation.
Many types of fiber supplements are available-some are synthetic, such as polycarbophil or methylcellulose, and others are of natural sources, such as bran or psyllium compounds. All types of fiber may cause increased bloating and gaseousness because of the colonic metabolism of nondigestible fiber.
Because of its safety, a trial of fiber supplementation is advised for patients with IBS, especially those with constipation-predominant symptoms. The amount should be titrated to symptoms.
Gluten Sensitivity
Gluten sensitivity (without overt celiac disease) has been proposed as a cause of functional bowel disorders but there are few convincing studies that have evaluated such a relationship in terms of pathogenesis or treatment of IBS.
Nevertheless, avoidance of gluten to relieve digestive complaints has become popular as evidence by growth in prepared foods that are gluten free.
Carbohydrate Malabsorption One theory related to IBS (and inflammatory bowel disease (IBD)) suggests that symptoms may be at least in part related to impaired absorption of carbohydrates. In patients with IBS or IBD, carbohydrates enter the distal small bowel and colon where they are fermented, leading to symptoms and increased intestinal permeability (and possibly inflammation). Avoidance of carbohydrates has been a long-popularized non-pharmacologic approach to reducing symptoms in IBS (and possibly modifying disease in IBD).
Fructose intolerance has been suggested as a possible form of carbohydrate malabsorption contributing to IBS.
It is reasonable for motivated patients to experiment with such approaches provided that the uncertain benefit is understood and their nutritional status is being monitored.
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Welcome to our newsletter! In this issue we will discuss Irritable Bowel Syndrome and review its signs and symptoms and pathophysiology. In the Patient Corner, we will go over diet recommendations for Patients with IBS. In addition, we will go over a Capsule Endoscopy's Case Study.
Please be sure to check the announcement for our next Patient Appreciation Day and our next meeting date for the Hepatitis' Support Group.
Our Hepatitis Support Group meets every other month, on the last Monday of the month at 5:30pm in our office.
Any comments and suggestions can be e-mailed to sseela@dlcfl.com. | |
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Irritable Bowel Syndrome (IBS) |
An estimated 15-20% of all Americans have Irritable Bowel Syndrome, and it's a devastating (not to mention incurable) condition.
Irritable Bowel Syndrome (IBS) is a gastrointestinal syndrome characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause. It is the most commonly diagnosed gastrointestinal condition.
IBS affects men and women, young patients, and the elderly. However, younger patients and women are more likely to be diagnosed with IBS. A systematic review estimated that there is an overall 2:1 female predominance in North America. |
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IBS: Signs and Symptoms
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Although as many as 1 in 5 American adults have signs and symptoms of Irritable Bowel Syndrome, fewer than half seek medical help. Yet it's important to see your doctor if you have a persistent change in bowel habits, or if you have any other signs or symptoms of IBS because these may indicate a more serious condition, such as colon cancer. Nevertheless, the absolute number of patients is still so large that IBS in its various forms comprises 25 to 50 percent of all referrals to gastroenterologists. IBS also accounts for a significant number of visits to Primary Care Physicians, and is the second highest cause of work absenteeism after the common cold. IBS has been associated with increased health care costs, with some studies suggesting annual direct and indirect costs of up to $30 billion.
The signs and symptoms of Irritable Bowel Syndrome can vary widely from person to person and often resemble those of other diseases. Among the most common are: - Abdominal pain or cramping described as crampy sensation with variable intensity and periodic exacerbations.
- A bloated feeling.
- Gas (flatulence).
- Diarrhea or constipation - sometimes alternating bouts of constipation and diarrhea.
- Mucus in the stool.
Other Gastrointestinal Symptoms: - GERD, dysphagia, early satiety, intermittent dyspepsia and nausea and non-cardiac chest pain.
Extraintestinal Symptoms: - Impaired sexual dysfunction, increased urinary frequency and urgency, dysmenorrhea and fibromyalgia symptoms.
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IBS: Pathophysiology | |
The pathophysiology of IBS remains uncertain. Its pathophysiology is still not clear, and the diagnosis and management are often challenging.
Hereditary and environmental factors are likely to have a role. Many studies have reported abnormal gastrointestinal motility, visceral hypersensitivity, psychologic dysfunction, and emotional stress in patients with IBS.
Despite intensive investigations, the results have often been conflicting and no physiologic or psychologic abnormality has been found to be specific for this disorder.
To date, no physiologic mechanism unique to IBS has been identified. Rather, it is currently viewed as a biopsychosocial disorder resulting from an interaction among a number of factors-visceral hyperalgesia, genetic and environmental factors, gut motility, and psychological factors. Postinfectious mechanisms and the role of gut flora are evolving mechanisms.
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| Capsule Endoscopy Corner | |
Case Study 1:
34 year old man with chronic diarrhea, abdominal bloating and colicky postprandial abdominal pain. During the last several months, he has observed maroon stools, low grade fevers, weakness, nausea and vomiting. An EGD revealed mild gastritis and colonoscopy was significant for mild colitis in the rectosigmoid. An ASCA was positive and the CRP was elevated.
Figure B1 Figure B2 Figure B3
Diagnosis: Small Bowel Crohn's Case Study 2:
A 36-year-old man presented with abdominal cramps, diarrhea and passing large amounts of maroon-colored blood in his stool-signs and symptoms of gastrointestinal bleeding. Laboratory analysis revealed mild anemia. Anemia worsened slightly after he received IV fluids, and he additionally became iron deficient. He was hemodynamically stable. Despite extensive testing that included upper endoscopy, colonoscopy, abdominal pelvic CT scan and a tagged red-blood-cell scan, a bleeding source was never identified. His symptoms stopped as abruptly as they had started. He never required blood transfusions but stabilized and was discharged on oral iron replacement. Over the next several months, his iron deficiency anemia corrected.
The patient presented again two years later with similar symptoms. He underwent upper endoscopy and small-bowel follow-through, but a bleeding site was not identified. As before, his bleeding stopped. He was treated conservatively and his iron deficiency corrected.
Subsequently, the patient was referred after a third episode of GI bleeding. He denied weight loss but reported occasional crampy, non-radiating, left-lower quadrant abdominal pain. A careful history revealed he intermittently used ibuprofen to treat migraine headaches. The care team suspected mid-gut bleeding, most likely from a NSAID-induced ulcer. Because of his age, a small-bowel tumor was considered in the differential diagnosis.
He underwent small-bowel capsule endoscopy. Capsule endoscopy identified small bowel tumor. The patient has had routine follow-ups and has experienced no further bleeding or symptoms.
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Our next Patient Appreciation Day is:
Tuesday, 06/15/10
Time: 8:30am-10:30am
Breakfast will be served!
Please R.S.V.P. with our office at 407-384-7388.
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Our next Hepatitis Support Meeting is:
Monday, 05/24/10
Time: 5:30pm
Come and learn valuable information to take better care of yourself or your family members!
Refreshments and Appetizers will be served!
Please R.S.V.P. with our office at 407-384-7388.
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Irritable Bowel Syndrome (IBS): Diagnosis
Irritable Bowel Syndrome (IBS): Treatment
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