Irritable Bowel Syndrome

Irritable Bowel Syndrome

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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.