Irritable Bowel Syndrome (IBS)

03 Jun
Irritable bowel syndrome (IBS) is a functional disorder of the gut. It affected about 11 percent of adults in Singapore in 2004 and it is on rising trend.

What are the Symptoms?

IBS is characterized by a symptom complex of abdominal pain and abnormal bowel habits that present as diarrhea or constipation in the absence of abnormal morphological, histological or inflammatory markers.

The symptoms of IBS are involving both biological and psychological factors. Although there is no specific physiological mechanism, there are at least three main factors related to symptoms in patients with IBS. These are:

  • Altered gut reactivity (motility and secretion) in response to psychological stress factors or luminal factors such as meals, gut distension (gas), inflammation, bacteria. This altered gut reactivity will result in symptoms of diarrhea and/or constipation.
  • Hypersensitive gut with increased perception of pain.
  • Brain-gut axis dysregulation associated with greater stress-reactivity and altered perception of stimuli coming from gut.

How is it diagnosed?

Previously, IBS was regarded as a “diagnosis of exclusion”, but its current definition is based on positive symptom complex (Rome III criteria) involving abdominal pain associated with changes in bowel habit and stool characteristics.

IBS is the best recognised part of functional gastrointestinal disorders. Other functional gastrointestinal disorders which do not fulfil the strict Rome III criteria are functional bloating, functional diarrhea or functional constipation. These disorders behave similarly and symptom-targeted therapy is used regardless of the precise label.

Patients with IBS can present with broad range of gastrointestinal and non-gastrointestinal symptoms. Clinical diagnostic criteria are the most important to establish the diagnosis since there is not any specific biological marker to confirm the diagnosis.

The most common symptom of IBS is abdominal discomfort or pain which is often colicky in nature (cramps) at variable location and intensity. Emotional stress and eating often exacerbate the discomfort whereas defecation and passing gas relieves the pain.
The pain or discomfort is associated with changes in stool frequency and/or stool appearance which may vary from watery to semisolid or even a hard stool.

Several “supportive” symptoms associated with IBS are bloating, defecation straining, urgency, a feeling of incomplete evacuation and passage of mucus. Patients often describe other associated gastrointestinal symptoms such as nausea, reflux, early satiety, indigestion and non-gastrointestinal symptoms like lethargy, headache, chronic fatigue, backache, urinary symptoms etc.

Psychological distress is very common in patients with IBS. About 50 percent of patients feel depressed or anxious.

What is the treatment?

Diet plays an important role in patients with IBS. Many patients have associated lactose intolerance, and they tolerate poorly wheat, fat and some fruits. A food diary associated with symptoms description is often useful to identify the triggering food intolerance.

It is important to identify the alarm features which prompt for further investigations. The alarm features are weight loss, malnutrition, blood loss, anaemia, severe diarrhea, recent change in bowel habit, severe abdominal pain, any abnormality on physical examination. These patients need to be investigated further for gastrointestinal problem other then IBS.

Because the pathophysiology and causes of IBS are poorly understood, treatment approaches are mainly focused on symptom management to maintain everyday functioning and improve quality of life for persons with IBS. The mainstay of treatments is symptomatic relieve with antispasmodics and antidiarrheals for diarrhea, prokinetics and high-fibre diets for constipation, probiotics and digestive enzymes, and supportive therapy with low-dose antidepressants to normalise gastrointestinal motility.

Dr. Andrea

Dr. Andrea Rajnakova is our Consultant Gastroenterologist and Physician.
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