The general perception is that IBS symptoms are somewhat vague. They include cramping, abdominal pain, bloating, constipation and diarrhea.
Physicians use the Rome III criteria, an international effort to create scientific data to help diagnose and treat functional gastrointestinal disorders, plus a careful history and physical exam for diagnosis.
What epitomizes IBS is the colonoscopy study, where IBS patients who underwent colonoscopy had diagnostic findings of nil. This tended to frustrate patients more, not reduce their worrying, as the study authors had hoped.
Rather, it plays into that idea that patients don’t have diagnostic signs, yet their sickness has a profound effect on their quality of life. Socially, it is difficult to admit having IBS. Plus, with a potential psychosomatic component, it leaves patients wondering if it’s “all in their heads.”
So, what can be done to improve IBS? There are a number of possibilities to consider.
Mental state’s effect
The “brain-gut” connection is real. It refers to the direct connection between mental state, such as nervousness or anxiety, to gastrointestinal issues.
Mindfulness-based stress reduction was used in a small, but randomized, eight-week clinical trial with IBS. Those in the treatment group showed statistically significant results in decreased severity of symptoms compared to the control group, both immediately and three months post-therapy.
Those in the treatment group were instructed to do meditation, gentle yoga and “body scanning” — focusing on the body for muscle tension detection. The control group attended a weekly IBS support group.
A preliminary study suggests there might be a link between IBS and migraine and tension-type headaches. The study of 320 participants, 107 with migraine, 107 with IBS, 53 with episodic tension-type headaches (ETTH), and 53 healthy individuals, identified significant occurrence crossover among those with migraine, IBS and ETTH.
Does gluten play a role?
In a small randomized clinical trial, patients who were given gluten were more likely to complain of uncontrolled symptoms than those who were given a placebo (68 percent vs. 40 percent, respectively).
The authors concluded that nonceliac gluten intolerance may exist and that gluten sensitivity may be an important factor. I suggest to my patients that they might want to start avoiding gluten and then add it back into their diets to see the results.
In a forward-looking study, IBS patients were tested for fructose intolerance with a breath test. The results were dose-dependent: when patients were given a 10 percent fructose solution, 39 percent tested positive for fructose intolerance, but when they were given a 33 percent solution, 88 percent tested positive.
The symptoms of fructose intolerance included flatus, abdominal pain, bloating, belching and alternating bowel habits. Foods with high levels of fructose include certain fruits, like apples and pears, but not bananas.
What is the role of lactose?
Another small study found that about one-quarter of patients with IBS also have lactose intolerance. Note that is very difficult to differentiate the symptoms of lactose intolerance from IBS.
Of the IBS patients who tested as lactose intolerant, there was a marked improvement in symptomatology at both six weeks and five years when placed on a lactose-restrictive diet.
Do probiotics help?
Treatment with probiotics from a study that reviewed 42 trials shows that there may be a benefit to probiotics, although the trials focused on different endpoints.
Probiotics do show promise, including the two most common strains, Lactobacilli and Bifidobacteri, which were covered in the review.
All of the above gives IBS patients hope that there are options for treatments that involve modest lifestyle changes. Patients should work with their physicians to choose a path that results in the greatest symptom reduction.