Irritable bowel syndrome (IBS), the most prevalent of functional gastrointestinal disorders, is commonly diagnosed by gastroenterologists and primary care physicians. Recurrent abdominal pain and altered bowel habits, along with bloating and distention, are typical features of IBS. It impacts up to 15 percent of adults and interferes with patients’ daily lives. Economically, IBS is associated with reduced productivity and poses a burden to the healthcare system. Amid quantifiable costs measured by outpatient visits, diagnostic tests, and medications, the individual patient’s quality of life suffers with no single go-to therapy.
A diagnosis of exclusion, this chronic disorder is a gut dysfunction better defined by what it is not: an anatomic or structural lesion, a cancer or predisposition to malignancy, a precursor to other gastrointestinal diseases. The absence of these characteristics is equal parts reassuring and frustrating. Clinical heterogeneity, a lack of a validated treatment algorithm, and a long-held misconception that stress and anxiety cause IBS can prove challenging for both providers and patients in the search to relieve symptoms.
It’s not in their head, it’s in their gut: so, where to go from here?
Irritable bowel syndrome is not a psychosomatic disorder. Ongoing research suggests that gut dysfunction is caused by disruption in nerves and muscles overseeing gastrointestinal motility. It’s not in their head, it’s in their gut: so, where to go from here?
A clinical history includes identifying which symptoms are predominant (pain, bloating, diarrhea, constipation, or a mix), reviewing dietary habits, and evaluating for alarm features. An opportunity to ensure age-appropriate screening arises with new colon cancer guidelines recommending that average risk screening begin at age 45 instead of age 50. In previous years, the American College of Gastroenterology had recommended average risk screening for African Americans begin at age 45.
Diagnostic approaches vary with no firm recommendation for routine abdominal imaging and serologic testing. Screening for celiac disease in any IBS subtype should be considered.
Validating patients’ symptoms and acknowledging IBS as a real medical condition provide a robust therapeutic foundation from which to help patients optimize their quality of life and begin to heal.
Treatment is aimed toward reducing the predominant IBS symptoms. Evidence behind IBS therapies is moderate at best, but the options are typically low-risk and can potentially provide significant relief. Anti-diarrheal agents for IBS-D and osmotic laxatives and pro-secretory medications are available for IBS-C. Probiotics and peppermint oil reduce bloating. Anti-spasmodics and tricyclic antidepressants alleviate abdominal pain. Exercise and psyllium fiber are beneficial interventions. The majority of IBS patients associate symptom onset or worsening with eating. A trial of the low FODMAP diet, avoiding or limiting gas-producing foods that contain fructose and lactose, can improve symptoms. Some patients, even after testing negative for celiac disease, find relief with gluten avoidance. A referral to a dietitian can help patients meal plan more meticulously.
The disparate subtypes of IBS, multiple therapies, and variable responses to treatment may feel formidable to navigate as a patient or a provider. Still, the patient-centered approach it demands can be rewarding. Validating patients’ symptoms and acknowledging IBS as a real medical condition provide a robust therapeutic foundation from which to help patients optimize their quality of life and begin to heal.