Do probiotics really work?
Gabrielle Fundaro, PhD, CISSN, CHC
|Irritable bowel syndrome|
|Other names||Spastic colon, nervous colon, mucous colitis, spastic bowel|
|Drawing of the pain of IBS|
|Symptoms||Diarrhea, constipation, abdominal pain|
|Usual onset||Before 45 years old|
|Diagnostic method||Based on symptoms, exclusion of other diseases|
|Differential diagnosis||Celiac disease, giardiasis, non-celiac gluten sensitivity, microscopic colitis, inflammatory bowel disease, bile acid malabsorption, colon cancer|
|Treatment||Symptomatic (dietary changes, medication, probiotics, counseling)|
|Prognosis||Normal life expectancy|
|Frequency||10–15% (developed world) and 15–45% (globally) |
Irritable bowel syndrome (IBS), referred to previously as spastic or nervous colon, and spastic bowel, is a functional gastrointestinal disorder characterized by a group of symptoms accompanied together that include abdominal pain and changes in the consistency of bowel movements. These symptoms occur over a long time, often years. It has been classified into four main types depending on whether diarrhea is common, constipation is common, both are common, or neither occurs very often (IBS-D, IBS-C, IBS-M, or IBS-U, respectively). IBS negatively affects quality of life and may result in missed school or work. Disorders such as anxiety, major depression, and chronic fatigue syndrome are common among people with IBS.
The causes of IBS are not clear. Theories include combinations of gut–brain axis problems, gut motility disorders, pain sensitivity, infections including small intestinal bacterial overgrowth, neurotransmitters, genetic factors, and food sensitivity. Onset may be triggered by an intestinal infection or stressful life event.
Diagnosis is based on symptoms in the absence of worrisome features and once other potential conditions have been ruled out. Worrisome features include onset at greater than 50 years of age, weight loss, blood in the stool, or a family history of inflammatory bowel disease. Other conditions that may present similarly include celiac disease, microscopic colitis, inflammatory bowel disease, bile acid malabsorption, and colon cancer.
There is no known cure for IBS. Treatment is carried out to improve symptoms. This may include dietary changes, medication, probiotics, and counseling. Dietary measures include increasing soluble fiber intake, a gluten-free diet, or a short-term diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs). The medication loperamide may be used to help with diarrhea while laxatives may be used to help with constipation. Antidepressants may improve overall symptoms and reduce pain. Patient education and a good doctor–patient relationship are an important part of care.
About 10–15% of people in the developed world are believed to be affected by IBS. It is estimated that 15–45% of people globally are affected by IBS. It is more common in South America and less common in Southeast Asia. It is twice as common in women as men and typically occurs before age 45. The condition appears to become less common with age. IBS does not affect life expectancy or lead to other serious diseases. The first description of the condition was in 1820, while the current term irritable bowel syndrome came into use in 1944.
- "Definition and Facts for Irritable Bowel Syndrome". NIDDKD. February 23, 2015. Archived from the original on April 2, 2016. Retrieved March 29, 2016.
- "Symptoms and Causes of Irritable Bowel Syndrome". NIDDK. February 23, 2015. Archived from the original on April 5, 2016. Retrieved March 29, 2016.
- Chey WD, Kurlander J, Eswaran S (March 2015). "Irritable bowel syndrome: a clinical review". JAMA. 313 (9): 949–58. doi:10.1001/jama.2015.0954. PMID 25734736. S2CID 205062386.
- Cite error: The named reference
LevyBernstein2014was invoked but never defined (see the help page).
- "Treatment for Irritable Bowel Syndrome". NIDDK. February 23, 2015. Archived from the original on April 6, 2016. Retrieved March 29, 2016.
- Quigley EM (2013). "Treatment level 1". Irritable Bowel Syndrome: Diagnosis and Clinical Management (First ed.). Chichester, West Sussex: Wiley-Blackwell. ISBN 9781118444740. Archived from the original on September 8, 2017.
- Maxion-Bergemann S, Thielecke F, Abel F, Bergemann R (2006). "Costs of irritable bowel syndrome in the UK and US". PharmacoEconomics. 24 (1): 21–37. doi:10.2165/00019053-200624010-00002. PMID 16445300. S2CID 45376327.
- Alexandros Hadjivasilis, Constantinos Tsioutis, Adamantios Michalinos, Dimitrios Ntourakis, Dimitrios K. Christodoulou, and Aris P. Agouridis (2019). "New insights into irritable bowel syndrome: from pathophysiology to treatment". Ann Gastroenterol. 32 (6): 554–564. doi:10.20524/aog.2019.0428. PMC 6826071. PMID 31700231.CS1 maint: uses authors parameter (link)
- Hulisz D (2004). "The burden of illness of irritable bowel syndrome: current challenges and hope for the future". Journal of Managed Care Pharmacy. 10 (4): 299–309. doi:10.18553/jmcp.2004.10.4.299. PMID 15298528. S2CID 9413379.
- Whitehead WE, Palsson O, Jones KR (April 2002). "Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications?". Gastroenterology. 122 (4): 1140–56. doi:10.1053/gast.2002.32392. PMID 11910364.
- Spiller R, Garsed K (May 2009). "Postinfectious irritable bowel syndrome". Gastroenterology. 136 (6): 1979–88. doi:10.1053/j.gastro.2009.02.074. PMID 19457422.
- Chang L (March 2011). "The role of stress on physiologic responses and clinical symptoms in irritable bowel syndrome". Gastroenterology. 140 (3): 761–5. doi:10.1053/j.gastro.2011.01.032. PMC 3039211. PMID 21256129.
- Moayyedi P, Quigley EM, Lacy BE, Lembo AJ, Saito YA, Schiller LR, Soffer EE, Spiegel BM, Ford AC (September 2014). "The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis". The American Journal of Gastroenterology. 109 (9): 1367–74. doi:10.1038/ajg.2014.195. PMID 25070054. S2CID 8076372.
- Cite error: The named reference
Rao2015was invoked but never defined (see the help page).
- Mayer EA (April 2008). "Clinical practice. Irritable bowel syndrome". The New England Journal of Medicine. 358 (16): 1692–9. doi:10.1056/NEJMcp0801447. PMC 3816529. PMID 18420501.
- Hatch MC (2000). Women and Health. San Diego, Calif: Academic Press. p. 1098. ISBN 9780122881459. Archived from the original on September 8, 2017.