One reason IBS can be so challenging to treat is that we don’t know exactly what causes it. Photo / Claire Mueller, Unsplash
One reason IBS can be so challenging to treat is that we don’t know exactly what causes it. Photo / Claire Mueller, Unsplash
Q: I was just diagnosed with irritable bowel syndrome. Am I destined to deal with its symptoms forever, or is there a cure?
A: The hallmark symptoms of irritable bowel syndrome are difficult to ignore — abdominal pain, constipation, diarrhea, bloating, gas.
It’s no wonder, then, that the millions ofpeople who have the condition in the United States may wish for a treatment that helps them to completely recover.
But just as there is no cure for other chronic conditions like diabetes or high blood pressure, said Dr Brian Lacy, a gastroenterologist and professor of medicine at the Mayo Clinic in Jacksonville, Florida, there is no cure for IBS.
For Beth Rosen, a registered dietitian in New York who was diagnosed with IBS in 2010, that reality was hard to accept.
“It took a while to come to terms with the fact that this was never going away,” Rosen said. “How was I going to manage it and live this way?”
She saw three gastroenterologists before she found one who took her symptoms seriously and could help her “work through the trials and errors of finding ways to feel better”, she said.
One reason IBS can be so challenging to treat is that we don’t know exactly what causes it, said Dr Baha Moshiree, a gastroenterologist and professor of medicine at Atrium Health Wake Forest in Charlotte, North Carolina.
IBS is a result of impaired communication between the gut and the brain, with the nerves in the gut being exceptionally sensitive and signalling pain from what might be normal digestive processes.
Microbiome changes, GI infections, stress and issues with the way food moves through the gut can also contribute, Moshiree said.
Changes in the gut microbiome do seem to play a role in IBS.
What can help?
Finding effective treatments requires understanding the unique factors that contribute to each patient’s symptoms, Moshiree said, and often trying a combination of dietary, behavioural or pharmaceutical therapies.
Rosen often advises her clients to temporarily cut out foods that are high in certain sugars called FODMAPs, which are fermented by bacteria in the colon, resulting in gas and bloating that can worsen IBS symptoms.
Many vegetables, fruits, dairy products, legumes, nuts, seeds and grains are considered high-FODMAP foods, making the diet very restrictive — and best attempted with the guidance of a registered dietitian and inappropriate for people with eating disorders, she said.
Rosen coaches her clients through three phases of the diet. First, eliminating high-FODMAP foods for two to six weeks (and no longer, because of the risks of nutrient deficiencies, microbiome changes and disordered eating). Then, if their symptoms have improved, she has them reintroduce high-FODMAP foods, one by one, to determine which ones trigger symptoms. Finally, she creates a personalised diet that includes all of the foods her clients can eat comfortably.
Over-the-counter enzyme supplements may help people more easily digest some high-FODMAP foods like dairy products, beans, lentils, garlic and onions, Rosen said.
Other nonprescription products that can improve IBS symptoms include enteric-coated peppermint oil capsules, which can relax the smooth muscles of the gut, Moshiree said. Rosen added that psyllium fibre supplements can also be helpful.
Changes in the gut microbiome do seem to play a role in IBS, although there’s not enough evidence to recommend probiotic supplements or other therapies like fecal transplants for those with the condition, Moshiree said.
If stress is a trigger for IBS symptoms, Moshiree often recommends that patients see a therapist or psychologist who specialises in gastrointestinal issues.
Cognitive behavioural therapy and hypnotherapy have also been shown to reduce IBS symptoms, Lacy said. He would like to see these used more often, although certain barriers, including therapist shortages and lack of insurance coverage, have limited their use.
Some studies support the use of smartphone apps to deliver these psychotherapies. Lacy recommended Mahana IBS, a cognitive behavioural therapy app available by prescription, and some of Rosen’s clients have found the hypnotherapy app Nerva helpful.
Prescription medications — including lubiprostone, linaclotide, plecanatide and rifaximin — as well as tricyclic antidepressants can also be effective. But they usually work best when combined with other approaches.
The right mixture of therapies may be different for every patient, however. “That’s where the art of medicine comes in,” Moshiree said.
There are plenty of options to help people manage IBS symptoms, Lacy said.
If you’re such a patient, he said, it’s important to be prepared to describe your history, symptoms, previous testing and therapies you have tried at healthcare appointments.
If your provider “doesn’t seem that interested or is stumped”, he said, find another one. “Don’t give up. Let’s keep plugging away, and let’s find the right thing for you.”
