Irritable bowel syndrome (IBS)

Introduction

Irritable bowel syndrome (IBS) is a relatively common pathology affecting the digestive system, particularly the lower portion of the gastrointestinal tract, including the small and large intestines. Worldwide, it is estimated that 11% of the general population suffers from IBS, whereas in Australia, about 30% of the general population experience symptoms of IBS, according to official figures (1, 12).

IBS is classified into four subtypes (2):

• IBS with predominant constipation (IBS-C)
• IBS with predominant diarrhea (IBS-D)
• IBS with mixed bowel habits (IBS-M) and
• IBS that cannot be classified (IBS-U, unsubtyped).

Symptoms of Irritable Bowel Syndrome include cramping, abdominal pain, bloating, gas, and changes in bowel movements, leading to either diarrhea or constipation (Figure 1).

Some people who are diagnosed with IBS experience severe and debilitating symptoms, whereas in other patients, symptoms are moderate or even mild. Understanding the many potential factors involved in the development and severity of IBS is essential to treat and manage this condition.

Figure 1. General characteristics of IBS.

2. Drivers of IBS

Currently, multiple factors have been identified as potential drivers of IBS. These include factors such as:

• Peripheral neuropathy – alteration to the nervous system outside the brain and spinal cord can affect the function of the digestive system. This pathology can occur due to one or more different factors, such as traumatic injuries, infections, metabolic problems, faulty genes or exposure to toxins. Peripheral neuropathy can lead to symptoms like weakness, numbness and pain in the hands and feet. Within the digestive system, peripheral neuropathies can cause symptoms like gut pain, diarrhea or constipation (3).
• Malfunction of intestinal muscles – Abnormal function of the muscles lining the intestines can cause altered contractions, leading to symptoms like gas, bloating and diarrhea (4). In some cases, a chronic musculoskeletal disorder called fibromyalgia might be involved. This disorder occurs in about 60% of patients with IBS and causes symptoms like muscle stiffness, pain, fatigue and abnormal sleep patterns (5).
• Gut Microbiota dysbiosis – alterations to the optimal composition of gut microorganisms are associated with developing and intensifying IBS (6).
• Environmental factors
  1. Infections – specific pathologies associated with infections can act as a driver or trigger of IBS. For example, viral or bacteria-associated diarrhea, known as gastroenteritis, can lead to the development of IBS (7).
  2. Diet – following a diet rich in specific food components, like carbohydrates and fats, has been shown to worsen some IBS symptoms (8).
  3. Stress – Studies have shown that people with early life stress or who experience chronic stress tend to suffer from more severe IBS symptoms. At a functional level, stress can cause overactivity or underactivity of the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous (ANS). Stress can also affect the function of the metabolic and immune systems – all of which can translate into digestive system dysfunction, contributing to IBS pathology (9).
  4. Certain Medicines, such as broad-spectrum antibiotics, such as macrolides or tetracyclines, have been linked to IBS development (10).

3. Risk Factors

In addition to known drivers or IBS, several risk factors are associated with IBS. These are factors that, when present, increase your chances of developing IBS.

1. Age – People who are under 50 years of age have an increased risk of developing IBS compared to their older counterparts (13).
2. Gender – Studies show that being female is associated with an increased risk of developing IBS compared to males (13).
3. Family History / Genetics—Studies suggest that having a family history of IBS increases one’s risk of developing this condition, suggesting the potential involvement of one or more genes (14).
4. Mental health – People with IBS are at an increased risk of anxiety and depression, with studies showing that about 33% of people with IBS also suffer from either of these two conditions (15).

4. Diagnosis of IBS

Accurately diagnosing IBS requires a comprehensive approach, not just a brief assessment of symptoms, as conventional medicine does. At AUSCFM, we focus on identifying the root causes of IBS and associated pathologies to build a complete picture of a patient’s pathologies.

Patients suspected to suffer from IBS will first undergo a comprehensive assessment, including the ROME criteria (2), to understand their health background, current symptoms and potential drivers. Briefly, your AUSCFM doctor will follow these steps:

• First, one of our doctors will assess your health history using comprehensive questionnaires that examine every aspect of your health and lifestyle.
• We build a comprehensive list of past and present symptoms, which we link to potential disease drivers.
• We consider the medications and supplements a patient is currently taking or has taken in the past.
• We assess the potential influence of infections or gut dysbiosis.
• We evaluate the potential role of stress and mental health.
• Finally, we evaluate a patient’s medical history to identify any evidence of allergies or immune reactivity to foods or other factors.

When a patient is suspected to have IBS, we can prescribe one or more of the following diagnostic tests:

• Antinuclear antibody (ANA) test – this approach uses state-of-the-art clinical testing for the presence of antinuclear antibodies or ANA, which are a signature of autoimmune diseases. Patients with elevated levels of ANA are likely to have an autoimmune disease. However, this test alone cannot establish that you suffer from autoimmunity. Hence, additional tests are performed.
• Inflammatory markers—This approach relies on identifying markers of inflammation in the blood. The most common test used here is the erythrocyte sedimentation rate (SR) test.
• Blood count abnormalities—Your AUSCFM doctor will use specific blood tests to check for evidence of anaemia (low red blood cells) or leukopenia (low white blood cells), two hallmarks of autoimmunity.
• Complete a thyroid panel—this approach will assess the health of your thyroid gland and test your levels of thyroid hormones and antibodies.
• Autoimmune serologies – this approach relies on testing the blood serum for markers associated with autoimmunity.
• Gluten antibodies—This approach relies on state-of-the-art blood testing that detects the presence of antibodies against gluten. Patients who test positive for this test may suffer from celiac disease or other related conditions and require further testing to confirm their condition. Follow-up testing may involve endoscopy or biopsies of the small intestinal tissue to confirm or rule out celiac disease.
• Blood count abnormalities—This approach involves testing for multiple aspects related to health, including liver and kidney function, heavy metal toxicities, and vitamin and mineral leve
• Gut testing—This approach uses stool samples to establish if you have an imbalance in the composition of your gut microbiome. Alterations to the optimal balance of your gut microbiome are strongly linked to a wide range of potential pathologies. This test can point to the presence of Gastrointestinal Inflammation, Dysfunction of the Gastrointestinal Tract, infections, and abnormal Intestinal Permeability (also known as leaky gut).
• Autoimmune reactivity test—This approach employs a state-of-the-art antibody-based test for the presence of 24 different antigens associated with autoimmune conditions. Using this test, we can obtain evidence for the involvement of dozens of potential autoimmune diseases.
• Advanced imaging studies (X-ray, ultrasound, and MRI) would provide further evidence of damage occurring on your GIT.
• Colonoscopy or endoscopy—these tests involve the use of a flexible tube fitted with a camera to assess the internal condition of your GIT.

This vast array of tests will allow us to assess the potential drivers of your IBS and exclude the possible role of other pathologies.

5. IBS treatment options for adults (and children)

At AUSCFM, we employ a holistic approach to treating IBS and its associated root causes. Based on their personalised clinical picture, we provide patients with different IBS treatment options. This is a crucial difference between the “conventional approach” and the Functional Medicine approach to health care.

Based on our comprehensive diagnostic approach, we create a patient-centred IBS treatment and management plan that will tackle your condition from the inside out. Our ultimate goal is to resolve the underlying pathologies driving your symptoms so you can be restored to optimal health.

Our IBS treatment plan depends on your specific condition and associated pathologies and may involve the use of the following:

• Certain conventional medications.
• Supplements to correct any micronutrient deficiencies.
• Lifestyle changes
• Dietary interventions include implementing a Low–Fermentable Oligosaccharide, Disaccharide, Monosaccharide, and Polyol (FODMAP) Diet (11).
• Botanicals or probiotics to normalise the balance of the gut microbiota.
• A personalised nutrition plan aims to restore your body’s optimal function.

At AUSCFM, you will be treated by doctors who have ample experience using high-quality dietary supplements and can prescribe the type and dosage that is right for you. Our doctors will also monitor your nutritional status with advanced testing approaches, ensuring your body has the nutrients it needs.

Our goal is to identify and treat the root causes of your IBS. Our holistic approach to treating IBS may include:

• Dietary changes for IBS relief
• Probiotics for IBS treatment
• Exercise routines to alleviate IBS symptoms
• Managing IBS with stress reduction techniques
• FODMAP diet for IBS treatment
• Acupuncture for IBS symptom relief
• Antispasmodic drugs for IBS treatment,

Ultimately, a successful IBS treatment or management approach will rely in the prompt assessment of diagnostic tests and the effective implementation of prescribed treatments.

References

1. Irritable bowel syndrome (IBS) – symptoms, triggers, management | healthdirect
2. Rome Criteria and a Diagnostic Approach to Irritable Bowel Syndrome – PMC (nih.gov)
3. Irritable Bowel Syndrome (IBS) – NIDDK (nih.gov)
4. Irritable bowel syndrome – Symptoms and causes – Mayo Clinic
5. A systematic review of the association between fibromyalgia and functional gastrointestinal disorders – PMC (nih.gov)
6. Microorganisms | Free Full-Text | Gut Dysbiosis in Irritable Bowel Syndrome: A Narrative Review on Correlation with Disease Subtypes and Novel Therapeutic Implications (mdpi.com)
7. Risk of Irritable Bowel Syndrome After an Episode of Bacterial Gastroenteritis in General Practice: Influence of Comorbidities – ScienceDirect
8. Self-Reported Food-Related Gastrointestinal Symptoms in IBS…: Official Journal of the American College of Gastroenterology | ACG (lww.com)
9. Impact of psychological stress on irritable bowel syndrome – PMC (nih.gov)
10. Use of Broad-Spectrum Antibiotics and the Development of Irritable Bowel Syndrome. WMJ.
11. History of the low FODMAP diet – Gibson – 2017 – Journal of Gastroenterology and Hepatology – Wiley Online Library
12. Global burden of irritable bowel syndrome: trends, predictions and risk factors | Nature Reviews Gastroenterology & Hepatology
13. Global Prevalence of and Risk Factors for Irritable Bowel Syndrome: A Meta-analysis – ScienceDirect
14. Lessons learned — resolving the enigma of genetic factors in IBS | Nature Reviews Gastroenterology & Hepatology
15. Irritable bowel syndrome and mental health comorbidity — approach to multidisciplinary management | Nature Reviews Gastroenterology & Hepatology