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The common symptoms of IBS are abdominal pain or discomfort, diarrhea or constipation - sometimes both, bloating, gas, distention are all symptoms of irritable bowel syndrome.
The common symptoms of IBS are abdominal pain or discomfort, diarrhea or constipation - sometimes both, bloating, gas, distention are all symptoms of irritable bowel syndrome.
The abdominal pain is often in the form of cramping pain and it could be in multiple different parts of the abdomen. One time it's here, on time it's there - it moves around. It's confusing to patients because first they felt it on this side, then it was on this side - but that's very typical of irritable bowel syndrome. The diarrhea is typically unpredictable and so is the constipation. When you ask a patient with irritable bowel syndrome "do you know what your bowel movements are going to be like tomorrow?" They often say "no" because they could have normal bowel movement, they can have multiple bowel movements in the case of diarrhea predominant irritable bowel syndrome, or they could have no bowel movements in the case of a patient with constipation predominant irritable bowel syndrome. It's really unpredictable and that's one of the hallmarks of irritable bowel syndrome that differentiates it from other conditions such as inflammatory bowel disease or Crohn's Disease, where in those patients it's very predictable. In addition, typically patients with irritable bowel syndrome don't have symptoms while they're asleep. They usually have daytime symptoms but once they're asleep, they're not in severe abdominal pain. They're not having nocturnal bowel movements. That's really important in terms of differentiating irritable bowel syndrome from other conditions. Also, there are a number of alarm symptoms that we look for to differentiate. If a person has weight loss, if a person is having rectal bleeding, if a person is anemic, and there are other red flags - we need further evaluation in those patients because there may be something more going on.
One of the most common and now well-studied causes of IBS is post-infectious, meaning that a person develops a gastroenteritis and a large percentage of people go on to then develop irritable bowel syndrome. We define that as post-infectious irritable bowel syndrome. When you look at epidemiologic studies of outbreaks of foodborne gastroenteritis, a certain percentage of those people will go on to develop irritable bowel syndrome. So that's very, very important cause of irritable bowel syndrome. In some studies and in some research articles, it is believed that a majority of irritable bowel syndrome starts off with an actual infection. Sometimes people are on vacation, they're on a cruise, they specifically remember that "ever since I got sick in this country, on this trip, on that cruise, my bowels haven't been the same." Sometimes, however, people can't remember. They may have had a mild gastroenteritis and they didn't think much of it and several months later their bowels just weren't normal and it persisted. Post-infectious irritable bowel syndrome is a very, very important cause. Gastroenteritis is a loose term that we use for inflammation of the digestive tract. Usually it's due to some form of either foodborne or viral infection. When a person eats out at a restaurant, and eats food that wasn't so great, and they have nausea, vomiting, abdominal pain, diarrhea - most of the time, that's a self-limited form of gastroenteritis.
An infection is thought to be the underlying cause of a lot of irritable bowel syndrome nowadays. Think of it like this: a person gets an infection - whether it's food poisoning or a virus that they caught from a friend or a loved one. They get sick - nausea, vomiting, abdominal pain, diarrhea. That bug does something to the digestive tract and after that, the bowels are never the same. People can have symptoms of IBS (bloating, cramping, diarrhea, constipation) and it's as a result of that original insult, an original infection that they had. The infection's gone but the effects on the digestive tract can last months or years.
There are a number of risk factors for irritable bowel syndrome. Being female seems to be a very important risk factor. Having an underlying psychiatric condition such as depression or anxiety is also very, very important. Thirdly, a prior episode of gastroenteritis. What that means is a prior episode of either food poisoning or a GI flu bug - something of that sort. The more severe the episode of gastroenteritis, the more likely one is to develop irritable bowel syndrome.
Another very important cause of irritable bowel syndrome is an imbalance in the brain-gut connection. We know that there is a central nervous system, but there's also what we call an enteric nervous system, which is a nervous system that's specific to the digestive tract. If that nervous system of the digestive tract is somehow imbalanced or it doesn't connect properly with the nervous system of the brain, people can feel a lot of the symptoms of irritable bowel syndrome. Oftentimes people with irritable bowel syndrome may have underlying depression or anxiety or a lot of stress and that all plays a very important role in the symptoms of irritable bowel syndrome.
The whole concept of small intestinal bacterial overgrowth is a very exciting one. For the first time, we have a specific target in irritable bowel syndrome that we can test and treat. I would highly encourage patients with irritable bowel syndrome to ask their doctors about small intestinal bacterial overgrowth - SIBO. I encourage their doctors to test for it and to treat them for it if they have it because I've seen tremendous, tremendous improvement in people's irritable bowel syndrome after treatment of SIBO.
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