Probiotics and Irritable Bowel Syndrome

It is not Colonoscopy Chronicles’ intention to provide specific medical advice to users of its blog, instead we provide users with information to help them better understand their health, diagnosed conditions, and the current approaches related to treatment, prevention, screening, and supportive care. Colonoscopy Chronicles urges users to consult with a qualified health care professional for diagnosis and answers to their personal medical questions.

Two topics that are very hot in the world of Gastroenterology are: 1) Probiotics 2) Irritable Bowel Syndrome. How are they related? Irritable Bowel Syndrome, while it is the most common Gastrointestinal problem in America, is still not well understood. It is what we call a functional disorder of the bowel, meaning that you cannot see it on x-ray, endoscopy, or biopsy. Rather than a structural issue, it is more a disorder of how the bowel functions. My own view is that Irritable Bowel Syndrome (IBS) is probably multiple different disorders that we lump together under one name, essentially because we don't know any better at this point.

If you accept my position that IBS is probably multiple different disorders rather than a single entity, then   it follows that there may be multiple different mechanisms for the various disorders. One such mechanism is probably an imbalance in the normal bacterial flora of the gut. We all have billions of bacteria in the gut-principally in the colon. These bacteria live in a certain harmony and balance. One likely mechanism for bowel dysfunction is imbalance in the normal flora. Possible causes of such imbalance could include intestinal infections, antibiotics, and chemotherapy agents.

The idea of a probiotic is to add "good" bacteria to the gut, and rebalance the flora. I often recommend probiotics to patients with IBS. Since IBS is not always due to bacterial imbalance, it doesn't help everyone. It is not possible, in my opinion, to know up front who will benefit and who will not. However, probiotics are safe, easily accessible, and fairly inexpensive(although if you want to drop some serious cash on a probiotic, there are no shortage of expensive ones!!).

As far as which probiotic is best, there is really not a tremendous amount of data to help us. My own practice is to recommend a probiotic that contains lactobacillus acidophilus(most probiotics do contain this strain of bacteria). If someone is already taking a probiotic and not getting the results they hoped for, I often recommend switching to Florastor. Florastor, rather containing bacteria, contains a yeast called saccharomyces boulardii. I am not implying that Florastor is better than probiotics that contain bacteria, it is simply different, so if bacteria-containing probiotics don't work, try yeast-containing probiotics.

Colonoscopy Prep Can Be Fun!!

As we have discussed in previous posts, the preparation for a colonoscopy is one of the most vital, yet annoying, parts of the entire process.

Sometimes, however, we have to take these things with a little sense of humor!  I thought I would share this clever, and funny video with you. I hope you enjoy it, and use it to spread the word about colon cancer screening.

Kudos to Dr. David Rosenfeld for using his imagination!!

Hilarious Colonoscopy Prep Video

Irritable Bowel Syndrome

Irritable Bowel Syndrome

It is not Colonoscopy Chronicles’ intention to provide specific medical advice to users of its blog, instead we provide users with information to help them better understand their health, diagnosed conditions, and the current approaches related to treatment, prevention, screening, and supportive care. Colonoscopy Chronicles urges users to consult with a qualified health care professional for diagnosis and answers to their personal medical questions.

Tackling the topic of Irritable Bowel Syndrome(IBS) is ambitious, for many reasons. For one, it is the most common gastrointestinal disorder in America, affecting up to 10-15% of the population. Another reason it is a difficult topic to manage is the fact that IBS means different things to different people, including health care professionals. While there are well defined diagnostic criteria for IBS(Rome Criteria), not all healthcare providers utilize these criteria. To make matters even more dicey, IBS is what can be considered a "functional" disorder, meaning that it is a disorder of how the bowel functions rather that a structural abnormality.  What this means is that you can't see it with a scope, you can't see it with an x-ray, you can't detect it with a blood test(tho there is some excitement about a new blood test that might be promising), and you can't prove it via a biopsy. 

The elusive nature of the diagnosis sometimes creates the illusion that this is an imaginary illness. It is not. Patients with IBS sometimes get frustrated with healthcare providers, feeling that they are being treated as if the disorder is psychosomatic. Indeed, sometimes physicians do treat patients as if IBS is not a legitimate medical illness. I like to use the following analogy with patients: I explain IBS can be likened to migraine headaches, in the sense that you can't really demonstrate a migraine on an x-ray, blood test, or biopsy. Yet, we know that migraines are a legitimate disorder, and just because we can't see or touch them doesn't minimize the grief they cause. The same goes for IBS. 

Another feature of IBS that presents a challenge is the fact that, despite its prevalence, it is poorly understood. This lack of  understanding about some of the most basic features of IBS, such as what causes it, leads to a number of unfortunate consequences. For one, when the medical establishment doesn't understand a disease entity, and has challenges treating it, there is a tendency to pawn it off as a psychosomatic disorder, or to try to avoid seeing such patients, whom they may perceive as a nuisance. A second unfortunate consequence is that IBS patients become prey to charlatans who hawk unproven, useless, and costly remedies, that waste their time and money. It is understandable, however, that patients look outside the mainstream when they feel that their needs are not being met. 

In reality, IBS is probably not a single illness, but rather a multitude of different disorders that we lump together under a single banner, because we currently don't know any better. The different individual disorders probably each have a separate underlying cause, and thus should probably be treated differently. The state of the art, however, is such that currently it is difficult to really distinguish between these "variations" of IBS. I truly believe that one day we will be able to pinpoint the type of functional gastrointestinal disorder a patient has(versus lumping them together under the IBS umbrella), and focus our treatment in a much more effective manner. There is definitely progress being made.

This series will outline some of the variants of IBS that are currently recognized, as well as the current state of the art as far as treatment goes. Along the way I will interject my observations and personal experiences, having cared for IBS patients for over 25 years. I hope you find it helpful and meaningful for yourself or someone you care about.