Irritable Bowel Syndrome - Cause, Symptoms, Options

IBS is a catch term to describe a wide range of digestive symptoms. In fact 1 in 6 people are said to suffer from IBS and it is the number 1 reason patients seek out a gastroenterologist. To be clear IBS is different from inflammatory bowel disease which includes Crohn’s disease and ulcerative colitis. IBD causes inflammation, ulcers or other damage to the intestinal lining whereas IBS does not. IBS is considered a functional disorder (the digestive system looks normal, but doesn’t function as it should).

IBS symptoms include: gas, bloating, fullness, abdominal pain, diarrhea, constipation, sometimes alternating, and mucus in stool. Reports of back pain, headaches, anxiety, sleeping problems and fatigue are not uncommon.

The cause of IBS is still not known, but it is suspected that 1 in 3 cases began with a bout of food poisoning or gastroenteritis. Severe traveler’s diarrhea is also a culprit. Since less than half of IBS and PI-IBS (post infectious) sufferers recover within six years the best course is to prevent it in the first place. Taking a probiotic concurrently when prescribed antibiotics or soon after, after an intestinal insult such as food poisoning, before and during foreign travel will go along way to prevent PI-IBS.

For those suffering now the first step is to see your doctor, blood work and usually a colonoscopy can rule out other potential causes of your symptoms. If no structural problems are found and symptoms dictate you will likely be given a diagnosis of IBS. Generally doctors will treat the symptoms since the root cause is unknown. Treatment often involves stress reduction techniques, acid reducers, occasionally motility drugs for diarrhea or constipation and dietary changes.

At the USC Keck School of Medicine a unifying explanation (considering the various symptom complaints associated with IBS) may have been found since 92 % of IBS patients complain of bloating. The possibility that small intestine bacterial overgrowth (SIBO) may be responsible for the bloating was supported by hydrogen breath tests that found 84% of IBS patients tested to have abnormal levels and further supported by a 75% improvement in symptoms after SIBO eradication. The gastrointestinal and immune effects of SIBO provide a possible unifying framework for the frequent observations of IBS.

This leads one to conclude that a hydrogen breath test would be a good starting point in treatment of IBS followed by antibiotic therapy when appropriate. 7 days of Xifaxan (non-systemic antibiotic) followed by probiotics would rebalance intestinal bacterial levels. Since an insult to the digestive system can cause microscopic damage to the intestinal wall, intestinal permeability of the tight junctions may be compromised. This Leaky Gut syndrome could account for ongoing systemic symptoms of fatigue, muscle weakness, headache, joint pain and visceral sensitivity.

Seeing a dietician for a protocol to heal the gut would be wise. Zinc, fish oil, and Glutamine have all been indicated as beneficial.    

For those who don’t remedy from SIBO eradication probiotics would also be of benefit. Further, the spice turmeric relieved symptoms in two-thirds of subjects in a recent pilot study.

Finally, a food elimination diet may be necessary for those still symptomatic. Food sensitivity tests are highly inaccurate so, the diet may be the better bet. Your dietician can help you pick the right one.

Update March 2016

Evidence continues to pile up that L-glutamine can do wonders to relieve the symptoms of IBS-D. This is the diarrhea predominant type. L-glutamine helps relieve bloating and pain normally associated with this disease. Another benefit appears to be lowering inflammation and decreasing intestinal wall permeability often referred to as leaky gut. Glutamine is normally produced in the digestive track. Supplementation appears to help those who's system fails to produce a sufficient amount. For best results use 5 -10 grams in powder form per day on an empty stomach.

Another supplement melatonin (normally used as a sleep aid) has been found in multiple studies to help significantly lessen IBS - C symptoms. It does this in three important ways: 1) regulating and increasing motility. 2) It works as a potent anti-inflammatory and immune booster. 3) It helps moderate visceral sensation (reducing feeling of pain and distention.) Most studies used 3-6 mg at night for 8 -12 weeks.