There’s an intruder in our midst, a shape-shifter with no known origin that many hesitate to discuss. The mysterious culprit, code name IBS, has infiltrated as much as 15 percent of the U.S. population, hiding deep in the GI tract. Since our mission is to ensure you can identify the top health offenders, we’ve enlisted Roper St. Francis Healthcare gastroenterologist Dr. Andrew Wolf as an expert informant.
The target: IBS
Irritable bowel syndrome (IBS) involves intermittent abdominal pain that occurs weekly for at least three months. “This cramping is associated with changes in the frequency or consistency of stools and typically improves with bowel movements,” says the doctor. The symptomatic condition manifests as constipation, diarrhea or an uncomfortable combination of the two. Bloating is also common.
While research suggests IBS could be related to the gut microbiome, GI infection or food sensitivity, “we don’t know exactly what causes it,” notes Dr. Wolf. “We do know that anxiety and depression, chronic fatigue and other diseases like fibromyalgia can worsen the issue.” The impetus for about half of referrals to a GI specialist, IBS impacts people of all races, ethnicities and sexes, though it affects women more than men and typically hits those younger than 50.
Mistaken identity
Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) get confused a lot because of the similarity of their names,” explains Dr. Wolf. IBS is a functional disorder without any obvious inflammation, ulcers or tumors to explain symptoms. “This is a sensory and motility issue that rests with how your body interprets movement of the GI tract.” While potentially detrimental to a person’s quality of life, IBS poses no long-term health risks.
IBD, on the other hand, is a chronic condition with obvious inflammation that can lead to dangerous consequences and surgery down the road. In addition to gastrointestinal distress, patients with the disease usually encounter complications such as bleeding, weight loss, arthritis, eye irritation, jaundice and more.
Understanding which agent is at work directs the doctor’s next move.
Detective work
If you experience abdominal pain off and on for three months or longer, check in with a gastroenterologist. “The presence of fever, chills, weight loss or bleeding along with GI symptoms raises concerns and requires further evaluation,” Dr. Wolf explains. If a patient presents symptoms consistent with IBS and doesn’t have any “alarm” symptoms, the doctor then conducts a health history and full physical to rule out anemia, celiac disease, hypothyroidism and stool infection, which can mimic IBS. “If all are negative, I start by making dietary adjustments before turning to medication.”
Finding relief
To flush IBS out of hiding, Dr. Wolf begins with a FODMAP* diet, which temporarily eliminates troublesome foods like dairy, wheat, beans, lentils and certain produce. While it takes weeks or even months to work through a full FODMAP program, if a food trigger is identified, relief follows fairly quickly.
Medications form the second line of defense. The doctor might recommend taking a soluble fiber such as psyllium or prescribe an anti-spasm medication to reduce cramping. Low-dose antidepressants can also reset communication between the brain and gut. Beyond that, behavioral therapy to reduce anxiety or depression may be beneficial.
While treatments can improve a patient’s quality of life, there’s no cure for this syndrome without a cause. In some patients, IBS becomes a constant but tolerable companion; in others, symptoms go into hiding for years only to make an unwelcome return. “We can’t always eliminate the problem entirely, but we’re very effective at getting symptoms under control,” says Dr. Wolf.
*Know Your Stuff: FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. The small intestine can’t properly absorb these carbohydrates.