Irritable bowel syndrome (IBS ) is a functional gastrointestinal disorder characterized by abdominal pain associated with altered bowel habits in the absence of an organic pathology, although microscopic inflammation has been documented in some patients.
Symptoms of IBS
The symptoms of IBS, although chronic, present a variable intensity over time; In addition, significantly alter the quality of life of the patients.
As its definition indicates, the main symptoms are: alternating bowel rhythm associated with abdominal pain and abdominal distension.
Alternating bowel rhythm is characterized by:
- Constipation in the presence of hard feces of goats that does not improve with laxatives
- Diarrhea with emergency evacuation, usually of small volume
- The postpandrial defective urgency is frequent, but so is the alternating bowel rhythm between constipation and diarrhea.
As for abdominal pain, it is usually diffuse non-irradiated, is usually precipitated by ingestion and relieved by deposition, and can sometimes have a sharp and intense character. He usually goes to seasons and on many occasions is usually related to stress.
As important or more than an optimal description of the symptoms associated with IBS is the finding of the absence of symptoms that may suggest an organic pathology : the presence of acute symptoms, the presence of progressive intensity, the presence of nocturnal symptoms, Anorexia, fever, weight loss, rectal bleeding or steatorrhea or gluten intolerance.
Causes of IBS
The cause (or rather causes) of IBS are not well defined, although they are the subject of multiple investigations. Infectious, neurohormonal, intestinal mechanisms (alteration of permeability or alteration of the intestinal flora), inflammatory, as well as other mechanisms related to food intolerance have been postulated.
Differences between IBS and Inflammatory Bowel Disease
Unlike IBS, in intestinal inflammatory disease there is objective damage at the intestinal level, either in the small intestine or in the colon, which can be visualized by endoscopy, an endoscopic capsule or by other radiological tests such as CT, ultrasound , The entire RNM or the contrasts.
Inflammatory Bowel Disease occurs as a result of an anomalous inflammatory response sustained on a genetic basis in which infectious agents may also be involved. On the other hand, IBD may associate extraintestinal manifestations, such as arthritis, skin lesions (such as psoriasis, erythema nodosum or pyoderma gangrenosum) or ocular lesions (such as uveitis or episcleritis).
However, the hypothesis has recently been postulated that would establish a link between the two pathologies, since a similar chronic inflammatory infiltrate has been described in patients with IBS, although less significant than that observed in patients with IBD.
Treatment of IBS
The treatment of IBS is based on the detection and management of possible triggers (stress, food intolerances, etc.), dietary measures and sometimes drugs.
Ensure a good water supply when necessary in patients with predominance of constipation. The use of fiber, although it can be advised, can sometimes be a cause of bloating and flatulence, especially the fibers rich in psyllium. On the other hand, limiting caffeine can limit anxiety and exacerbation of symptoms.
On other occasions, low FODMAPS diets (oligo, monosaccharide disaccharides and fermentable polyols) or a gluten-free diet may be advised.
Probiotics, as food supplements, are also advised in the management of IBS. While l. Plantarum and Bifidobacterium infantis may alleviate some of the associated symptoms, we do not know precisely what strains and at what level should be used.
As for psychological interventions, both cognitive behavioral therapy and dynamic psychotherapy and hypnotherapy have been shown to have an efficacy superior to placebo.
On the other hand, a systematic Cochrane review found that the use of tricyclic antidepressants or selective serotonin reuptake inhibitors improved both symptoms associated with irritable bowel syndrome and overall health scores.
Also, there are numerous pharmacological agents used in the treatment of IBS, so it follows that the management is not always satisfactory that the doctor and the patient would want. Anticholinergics, antidiarrheals, antibiotics, or bolus-forming laxatives have been used.. However, as it could not be otherwise, progress has also been made in recent years, and new molecules are expected in the coming years that allow us to optimize the quality of life of our patients. Linaclotide, approved in 2012 by the FDA and marketed in our country under the name of Constella®, is indicated for the treatment of patients with moderate severe IBS with a predominance of constipation. In addition, a new treatment for severe moderate IBS with predominance of diarrhea will be commercialized soon.
For more information consult a specialist in Digestive System .