Irritable bowel syndrome (IBS) is a functional digestive disorder characterized by the presence of abdominal pain or discomfort associated with changes in stool frequency and/or consistency. As such a functional disorder, it is assumed that the patient does not present any biochemical or structural alteration that could justify the nature of the symptoms. Dr. Urquijo, specialist in Digestive System, talks about the symptom and its treatment.
What is irritable bowel syndrome?
This pathology is characterized by the presence of recurrent abdominal pain associated with alterations in the stool rhythm, either in the form of constipation, diarrhea, or both, in addition to bloating and abdominal distension, which are very common in IBS.
It is diagnosed by the presence of recurrent abdominal pain that must be present at least one day a week, with two or more of the following characteristics:
- It is associated with defecation
- It is associated with a change in the frequency of bowel movements
- It is related to a change in stool consistency.
Regarding the requirements for duration of discomfort, it should be noted that the criteria must be met within the last three months. Symptoms must have started a minimum of six months prior to diagnosis. They have a significant personal, health and social impact, affecting the quality of life of the patients who suffer from them.
The severity of these disorders depends not only on the intensity of intestinal symptoms, but also on other biopsychosocial factors: association of gastrointestinal and extraintestinal symptoms, degree of involvement and forms of perception and behavior.
The prevalence reaches 15% of the population in Westernized countries and even in people with chronic fatigue and fibromyalgia it can reach up to 50% of them.
Causes of irritable bowel syndrome
The precise mechanisms by which IBS occurs are not currently known. It seems unlikely that a single cause can be the reason for all the discomfort in such a heterogeneous syndrome. Motility alterations, visceral hypersensitivity phenomena, psychological factors, inflammatory mechanisms and a dysfunction of the cerebrointestinal axis, among others, have been postulated.
Recent research suggests that as in inflammatory disease, the host immune system may respond abnormally (in genetically susceptible individuals) to a number of factors including certain components of the diet, enteric infections or stress itself. Alterations in the intestinal microbiota may also play an important role.
Treatment of irritable bowel syndrome
It is helpful to instruct the patient to keep a symptom diary that can help identify which foods may be exerting a negative influence. Psychological interventions may be aimed at detecting the existence of any psychosocial factors that may be modulating the symptomatic perception.
Among the drugs available are: antidiarrheals, antispasmodics, serotonergics, psychotropic drugs such as tricyclic antidepressants, selective serotonin reuptake inhibitors, or atypical antipsychotics.
Therapeutic possibilities include certain non-absorbable antibiotics, behavioral therapies and therapies directed at the microbiota and inflammation such as the use of prebiotics, probiotics, synbiotics and drugs with anti-inflammatory properties.
Type of patients suffering from irritable bowel syndrome
The loss of work productivity is mostly concentrated among patients with associated comorbidities, including chronic fatigue and fibromyalgia, among others. To all this must be added the intangible costs attributable to personal suffering. Several studies suggest the existence of a genetic factor similar to what occurs in other gastrointestinal diseases such as inflammatory disease or celiac disease. It also occurs more frequently in patients with abdominal pain.