Irritable Bowel Syndrome (IBS) is a chronic disease that lasts longer than 3 months, irregularity in bowel habits and accompanying abdominal pain and aching. The reason why it is called a syndrome is that other complaints besides the digestive system accompany IBS.
The cause of the disease is not known exactly. According to the common theory, internal organ pain called “visceral hyperalgesia” is felt more exaggerated than normal in IBS patients. In addition, the patient’s exposure to emotional trauma during childhood, wrong toilet training, and in some cases, an intestinal infection can be found in the history. In recent years, disruption of the intestinal microbiota (dysbiosis) has been suggested as one of the causes of IBS.
The complaints of the patients can be divided into three groups: IBS with diarrhea-predominant, constipation-predominant or variable form, constant diarrhea in diarrhea-predominant cases, constipation and flatulence-flatulence in cases with predominant constipation, diarrhea for one week in patients with variable form, constipation for one week, and constipation the next week. it could be. In addition, especially in patients, complaints may increase in stressful, exciting situations or after a sad event. There is no specific test for the diagnosis of IBS, the diagnosis is reached by excluding other diseases. These diseases are celiac disease, inflammatory bowel diseases (ulcerative colitis and Crohn’s Disease), lactose intolerance, chronic pancreatic enzyme deficiency.
When patients have complaints called ALARM SYMPTOMS, it is necessary to move away from the diagnosis of IBS. These complaints are:
- Weight loss
- Complaints that wake you up at night
- Family history of cancer
- Palpable mass in the abdomen
- Beginning complaints
- Complaints occurring over the age of 40
- Abdominal pain not relieved after using the toilet
In these cases, advanced tests such as endoscopy, colonoscopy, and computed tomography should be performed.
The diagnosis of IBS is usually not difficult for experienced gastroenterologists. The personality traits of the patients also support this diagnosis. It can be seen more frequently in people with sensitive, detail-oriented and anxiety disorders, which are generally called Type A personality. In addition, diseases of other organ systems may accompany: Fibromyalgia, headaches, interstitial cystitis, panic attacks, anxiety disorders, depression, sexual dysfunctions, dysmenorrhea (painful menstrual period) can be seen.
In patients diagnosed with IBS, treatment is arranged according to the predominant symptom of the patient. Anti-diarrheal drugs, anti-spasmodics, probiotics can be used in patients with diarrhea. In patients with predominant constipation, drugs containing PEG (Polyethylene glycol), psyllium husk, lactulose, and anti-spasmodics can be used. There is no permanent cure for IBS. Patients have to take the drugs constantly. If the patient is accompanied by psychosomatic disorders, anti-depressants should be added. The most used (most experienced) anti-depressant is amitriptyline (like Laroxyl). Here, it is possible to benefit not only from the anti-depressant effect, but also from the constipation-inducing effect of the drug.
Much work has been done on diet in IBS. Patients are also very meticulous about their diet. Currently, the scientifically proven diet is the FODMAP diet. FODMAP can be summarized as:
Fermentable – Foods that ferment in the large intestine
Oligosaccharides – Small chain carbohydrates
Disaccharides – Double chain carbohydrates
Monosaccharides – Single chain carbohydrates
And Polyols – and sugar alcohols
Reducing this food group in the diet reduces complaints such as gas, bloating and pain in a short time. But the problem is that these foods are usually healthy, fibrous foods. Studies have shown that the diversity of the intestinal microbiota decreases and becomes unhealthy. For this reason, it is not recommended to do it for a very long time.
Gluten has been shown in some publications to increase IBS symptoms. In studies, gluten sensitivity is present in some subgroups, not all IBS patients. In some publications, it has been shown that the problem is not in gluten, but in whole FODMAP-containing foods such as bread. As a result, scientists do not recommend cutting out gluten in IBS patients.
As a result, IBS is a disease that does not actually kill, but sustains, that is, ruins the quality of life. Although there is no definitive treatment, with the right approach (patient-specific approach-individual treatment) and educating the patient, this situation can be made so that it does not affect life. Doctor-patient cooperation and the patient’s trust in his doctor are very important in treatment. IBS, which is seen with a frequency of 10-15% in Turkey, is actually a public health problem and new hopes have emerged in treatment with new approaches (microbiota-based, gut-brain axis, etc.).