Thu, 05/15/2014

Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) is a disease which quite often goes unrecognized. To raise awareness of IBS a patient day was held during the 120th Congress of the German Society of Internal Medicine in Wiesbaden at the end of May, during which a variety of diseases were introduced to the interested public. There a lecture series about the irritable bowel syndrome could generate particularly great interest. Speakers included Prof. Dr. Hubert Mönnikes, Chief Doctor at Martin Luther Hospital's Department of Internal Medicine, Berlin, as well as his teammates Dr. Miriam Stengel, physician and study coordinator and Dr. Marco Schmidtmann, Specialist in Internal Medicine and Gastroenterology.

The problem with IBS is that not all people go to see their doctor and not all the doctors take the disease as serious as it is advised. The patient sometimes even as to deal with lack of understanding because the classical investigations of irritable bowel patients do not bring any tangible results. Basically, irritable bowel syndrome can be diagnosed only by the exclusion of all other causes of abdominal pain and other symptoms. "An important criteria in irritable bowel syndrome is the fact that the symptoms are so relevant that there is an impaired quality of life," says speaker Dr. Marco Schmidtmann, "also other diseases certainly must have been excluded to finally reach the diagnosis of 'irritable bowel syndrome'." (we have already addressed the topic of IBS earlier).


What Causes Irritable Bowel Syndrome?

The so-called "enteric nervous system" also called "gut brain" is a complex system and permeates the entire gastro-intestinal tract. There are many interactions and compounds between the intestinal nervous system and the central nervous system that, amongst others, are seen as causes of the clinical picture of irritable bowel syndrome.

But there are a number of detectable changes or disturbances in the intestinal tract, which cause the same symptoms. This includes an impaired barrier function of the intestine, which means that that may lead to disturbances in cell structure of the intestinal mucosa. Also impaired movement or a disrupted coordination of these processes in the intestine, called motility disorders, play a role in irritable bowel syndrome. It is known that the secretion of digestive secretions in irritable bowel patients is also impaired, such as electrolytes and digestive enzymes also resorptive processes, as the recovery of fluids and electrolytes may be impaired in individuals with irritable bowel syndrome. In addition, many patients report disturbances in pain perception. Recent study data for irritable bowel show minimal inflammatory changes in the intestinal mucosa, an increased occupation of the intestinal wall with white blood cells and a disturbance in the composition of the intestinal flora. Finally, a gastrointestinal infection can cause the symptoms that show up in the context of the infection and as a result remain in place permanently.


Irritable Bowel Syndrome – Is it Caused by Stress?

It is known that acute or chronic stress can be seen as an important exogenous co-factor in irritable bowel syndrome. Even in laboratory experiments it could be proven that stress can cause changes in bowel function, which also play a role in irritable bowel syndrome. However, stress can not be seen as the only cause of irritable bowel syndrome.


Or is The Psyche to Blame for Irritable Bowel Syndrome?

As a mental disease irritable bowel syndrome is not defined. The various connections between the central nervous system and the enteric nervous system, however, lead to the conclusion to clarify the issue of the psyche associated with irritable bowel syndrome, at least. This is supported by the fact that irritable bowel syndrome is frequently comorbid. Not infrequently, irritable bowel patients additionally suffer from mental or somatoform disorders, especially anxiety disorders and depression are mentioned here, but also an increased need for sleep and sleep disorders, appetite disorders and cravings etc..

Also other disorders such as Fibromyalgia, pain syndromes, chronic fatigue syndrome or post-traumatic stress disorders are important aspects in the development or persistence of irritable bowel syndrome. Also found in irritable bowel syndrome patients are changes in the serotonin metabolism of the intestine, as they are also found in various mental disorders.

Studies have shown that in irritable bowel syndrome patients one can often observe a significantly reduced quality of life, even in comparison to patients with other chronic diseases.


Which Therapy Will Help With Irritable Bowel Syndrome?

For the treatment of irritable bowel syndrome there is no fixed regimen. "It is important," said Dr. Schmidtmann, "that the attending physician along with the patient develops a plausible individual disease model and then provide a suitable and understandable treatment plan." The aim is to achieve a symptom-free or at least a better quality of life. Depending on the symptoms, the focus of treatment can be laid on diet, stress reduction, drug therapy or psychotherapeutic treatment.

For symptom-oriented drug treatment there is a number of drugs available, many of which must be used "off label", since they are effective for IBS but are approved for other diseases. These include anticonvulsants for pain, tricyclic antidepressants that, however, lead to clogging, and selective serotonin reuptake inhibitors against pain.

With constipation the new active prucalopride and linaclotide have proved successful.


Irritable Bowel Syndrome – Is There a "Right Diet"?

"Studies have shown that there is a significant symptom reduction at about 75 percent with irritable bowel patients if they renounce FODMAP–containing foods" said Dr. Miriam Goebel-Stengel, specialist in Internal Medicine at Martin-Luther-Hospital in Berlin. FODMAP stands for "f

ermentable oligo-, di- and monosaccharides and polyols", which describes a group of carbohydrates, that are sugars and alcohols.

The F, for "fermentable" applies to all FODMAP ingredients. All of them are – for various reasons – poorly absorbed in the small intestine, which favors decomposition by intestinal bacteria and the formation of gases. Likewise, the poor absorption leads to FODMAP being osmotically active by pulling water into the bowel lumen, which in turn triggers diarrhea.

Components of FODMAP are contained in a variety of food products, as well as in final products. For example in legumes and, accordingly, particularly in the Indian and Mexican cuisine. Even onions, garlic and artichokes have FODMAP ingredients. The food industry uses parts of FODMAP as a fat substitute, food supplements or dietary fiber enrichment.

Also, lactose, fructose, sorbitol and mannitol are components of FODMAP. Lactose is found in all dairy products, but also in many industrial products, while fructose is found in nearly all fruits, honey and dried fruit. Sorbitol is a component of many fruits, such as of peaches, mannitol is found in mushrooms and both substances are often used in sweets as well as in diet and light products.