Written by Dr. Captain Nikolaos
Gastroenterologist – Hepatologist
Scientific Head of Gastroenterology Department ANASSA
Professor at A.U.Th.
- What is Irritable Bowel Syndrome (IBS)?
Irritable bowel syndrome is a chronic, functional disorder, not accompanied by anatomical or histological lesions of the intestine. It usually manifests itself with abdominal pain, defecation disorders and often with a feeling of abdominal distention (bloating).
Irritable bowel is also referred to as “spastic colon” or “spastic colitis”.
- What percentage of the population is affected by the disease?
Epidemiological studies have shown that irritable bowel is a very common disease. It is estimated that 15-20% of the population in Western countries have symptoms of irritable bowel syndrome. Epidemiological data from Greece showed that the frequency of the disease in the urban population is about 21%.
The disease is more common among city dwellers. Its frequency is twice as high in women as in men and decreases after the age of 65.
- Which factors influence it?
The patients with I.B.S. are more sensitive than healthy people to factors such as stress, depression, certain foods, gastroenteritis, drugs, etc.. The excessive response to these stimuli triggers pain and the other symptoms of the syndrome.
Psychosocial factors and stress
Up to 80% of patients with I.B.S. show mental disorders such as anxiety, depression, phobias, panic attacks, as well as somatization disorders, such as a feeling of pressure in the chest, shortness of breath, a feeling of distension of the abdomen or a dull ache in the abdomen.
It has long been known that stress due to events in social and family life causes the appearance, recurrence or worsening of the symptoms of irritable bowel syndrome. Problems in marriage, tension in relationships with parents or children, professional difficulties, the loss of a parent (due to divorce or death), physical or sexual abuse are more often observed in patients with irritable bowel syndrome.
Limited intestinal inflammation, bacterial overgrowth
It has been observed that approximately 20% of patients with I.B.S. report the onset of symptoms after an episode of acute gastroenteritis (post-infectious irritable bowel), while the administration of antibiotics significantly improved the symptoms of these patients.
Food intolerance due to incomplete absorption of carbohydrates
Many patients report intolerance to foods such as bread, pasta, potatoes, legumes, fruit, milk or fiber. These foods contain significant amounts of carbohydrates (starch, fructose, sorbitol, lactose), which are incompletely absorbed by the small intestine of healthy individuals. In particular, 70% of Greek adults show hypolactation and have abdominal symptoms after a glass of milk or ice cream.
Intake of plant fiber and carbohydrates is often associated with the onset of symptoms in patients with irritable bowel syndrome.
- Which symptoms will disturb the patient?
The clinical features of the disease are abdominal pain and disordered bowel movements. The diagnosis is based on the “diagnostic criteria of Rome” .
The intensity of the pain varies from person to person, but even in the same patient there are periods of remissions and exacerbations. It is usually located in the lower abdomen but occasionally it can be located in different areas of the abdomen and is relieved by emptying or passing gas. It almost never wakes the patient from sleep. Some patients report a feeling of abdominal distension.
The majority of patients show alternating periods of diarrhea and constipation, while several patients show during the exacerbation period either only constipation or only diarrhea. During phases of constipation the stools are hard and passed out in small pieces (goat stool), while during periods of diarrhea they can be mushy or thin like a film. Some patients pass a lot of mucus in their stools, which does not contain blood.
It is also common to have symptoms outside the digestive system such as headaches, dizziness, precardiac pain or palpitations. In some patients there are overt psychiatric features, such as depression, anxiety and carcinophobia.
The presence of characteristic alarm symptoms, such as onset of symptoms after the age of 50, nocturnal abdominal pain or diarrhea that wakes the patient, large-volume diarrhea, visible blood in the stool, fever or weight loss and a family history of organic disease of the digestive tract (cancer, idiopathic inflammatory bowel disease, celiac disease) direct the investigation to organic disease of the digestive system and remove from the diagnosis of irritable bowel syndrome.
- Treatment
Because the etiology of the syndrome is unknown, treatment is empirical and individualized for each patient.
Diet
During periods of constipation it is recommended to increase the intake of vegetable fibers (green vegetables, kiwi, etc.) and drink 1.5-2 liters of water a day. During periods of diarrhea it is recommended to avoid legumes, vegetable fibers and fruits, milk and ice creams.
Drugs
If the manifestations of anxiety or depression predominate, appropriate treatment is given. Some antispasmodic drugs help relieve abdominal pain and flatulence (bloating). In patients with possible postinfectious irritable bowel, the administration of poorly absorbed antibiotics often has a beneficial effect. The treatment should be given for 2-3 months.