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Irritable Bowel Syndrome: Patients
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In gastroenterology, irritable bowel syndrome (IBS) or spastic colon is a functional bowel disorder characterized by abdominal pain and changes in bowel habits that is not associated with any abnormalities seen on routine clinical testing. It is fairly common and makes up 20-50% of visits to gastroenterologists. There are two forms, dependent on which symptom predominates: Lower abdominal pain IBS and Non-ulcer dyspepsia. The abdominal pain type is usually described in a patient as either diarrhea-predominant (IBS-D), constipation-predominant (IBS-C) or IBS with alternating stool pattern (IBS-A). An important new IBS subtype, post-infectious IBS (IBS-PI), is drawing much clinical investigation.
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Gitnick, a gastroenterologist who has treated thousands of people with irritable bowel syndrome and other functional GI disorders, believes that most people can get rid of the syndrome -- or at least keep it under control -- through lifestyle changes alone. To figure out what foods may be playing havoc with their digestion, he encourages keeping a food and mood diary for several weeks. The key, he writes in a recent book, is to write down your symptoms and what you were doing before the symptoms started. Keep track of your mood, the cause of any stress, and ... everything that goes into your mouth, including food, drink, and even candies and chewing gum. Then look for patterns. If something seems to start trouble over and over, consult your doctor to determine whether you should try to avoid it. In his book, Gitnick recounts that one IBS patient who had begun suffering from mysterious daily attacks of diarrhea was able to trace them back to the sugar-free gum sweetened with sorbitol that she chewed every day.
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In gastroenterology, irritable bowel syndrome (IBS) or spastic colon is a functional bowel disorder characterized by abdominal pain and changes in bowel habits which are not associated with any abnormalities seen on routine clinical testing. It is fairly common and makes up 20–50% of visits to gastroenterologists. Lower abdominal pain, and bloating associated with alteration of bowel habits and abdominal discomfort relieved with defecation are the most frequent symptoms. The abdominal pain type is usually described in a patient as either diarrhea-predominant (IBS-D), constipation-predominant (IBS-C) or IBS with alternating stool pattern (IBS-A). In some individuals, IBS may have an acute onset and develop after an infectious illness characterised by two or more of the following: fever, vomiting, acute diarrhea, or positive stool culture. This post-infective syndrome has consequently been termed "post-infectious IBS" (IBS-PI) and is acute onset Rome II criteria positive.
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Enteric inflammatory cells may ... play an important role in the pathophysiology of Irritable Bowel Syndrome. Clinicians have for many years recognized that the onset of IBS often follows an episode of acute gastroenteritis. Inflammation may alter intestinal cytokine milieu and motility, both of which can result in an increase in a patient’s pain sensation. The menstrual cycle may also affect gut sensation and motility. Other factors, such as malabsorption of sugars (lactose, fructose, and sorbitol), probably aggravate underlying IBS, rather than serving as root causes of the disorder. In patients with rapid transit times, short or medium chain fatty acids can reach the right colon and cause diarrhea.
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In some people... the colon can become extremely sensitive, leading to the collection of symptoms known as irritable bowel syndrome. Small contractions or gas can cause cramps and pain in the lower abdomen. The pain often appears after a meal and goes away after a bowel movement. The colon may go into spasms, causing diarrhea during the daytime (people with IBS rarely suffer from diarrhea during the night). Conversely, the spasms may hamper the normal movement of waste, causing constipation. Some patients experience mostly diarrhea and others mostly constipation; many alternate between the two extremes.
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In irritable bowel syndrome, the muscles of the bowel wall go into spasm. During normal digestion, regular contractions of the muscles in the wall of the digestive tract propel contents along—an action called peristalsis. In IBS... this motion (or motility) is hindered by spasms that result in diarrhea or constipation. While things like diet and stress can trigger intestinal spasms, the root of the problem appears to be the way the brain and bowel communicate. Recent research suggests that IBS patients have a more heightened awareness of pain in their digestive systems than do people without IBS. This sensitivity seems to be what triggers the intestinal spasms, and is the basis of abdominal pain/discomfort.
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