Irritable Bowel Syndrome
Irritable Bowel Syndrome (IBS) is a gastrointestinal disease affecting millions of people worldwide. There are many clinical forms of IBS depending on which symptom predominates: Diarrhea predominant (IBS-D), constipation-predominant (IBS-C) or IBS with alternating stool pattern (IBS-A). Irritable bowel syndrome is characterized by a group of symptoms in which abdominal pain or discomfort is associated with a change in bowel pattern, such as loose or more frequent bowel movements, diarrhea, and/or constipation.
Irritable bowel syndrome (IBS) affects approximately 10-20% of the general population. It is the most common disease diagnosed by gastroenterologists and one of the most common disorders seen by primary care physicians.
IBS is generally classified as a "functional" disorder. A functional disorder refers to a disorder or disease where the primary abnormality is an altered physiological function rather than an identifiable structural or biochemical cause.
Irritable bowel syndrome is understood as a multi-faceted disorder. In people with IBS, symptoms result from what appears to be a disturbance in the interaction between the gut or intestines, the brain, and the autonomic nervous system that alters regulation of bowel motility and sensory function.
Current Treatment Options for Irritable Bowel Syndrome
Diet
Certain types of food can provoke exacerbation of symptoms in patients with IBS due to their heightened visceral sensitivity. This can lead to abdominal pain, diarrhea, and/or constipation. Although the exact cause of IBS is not known, there are dietary factors that appear to alter the manifestations of the syndrome.
Definitive determination of dietary issues can be accomplished by testing for the physiologic effects of specific foods. Food allergy testing can identify specific foods to which a patient has a reaction. Testing can also determine if there are nutritional deficiencies that may also play a role.
Drugs
Medications may consist of stool softeners and laxatives in constipation-predominant, and antidiarrheals in diarrhea-predominant IBS for mild symptoms. Low dosage of tricyclic and SSRI antidepressants were shown to relieve symptoms of visceral sensitivity (pain) and diarrhea or constipation respectively. Other drugs include Alosterone, a selective 5-HT3 antagonist for IBS-D and Tegeserod, a selective 5-HT4 antagonist for IBS-C.
Biofeedback Therapy
The role of biofeedback therapy for the treatment of chronic constipation is emerging. Biofeedback therapy involves training the patient, using special equipment to relax pelvic floor and anal sphincter muscles. In constipated patients, biofeedback techniques have generally been used to assist patients having spasms of the pelvic musculature during the act of defecation.
The Placebo Effect
The use of most treatment options for IBS has not been shown to be conclusively beneficial due to the large number of individuals who respond to the placebo effect; although the cause is unknown, the placebo effect remains higher than normal in sufferers of IBS for most treatment modalities.
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