Irritable Bowel Syndrome

• Irritable Bowel Syndrome, or IBS, is a relatively common syndrome of abdominal discomfort or pain, bloating, and changes in bowel habits.
• IBS is the most common gastrointestinal (GI) complaint in the United States, affecting up to 40 million people.
• It can affect men and women of all ages, but for unknown reasons, it most often strikes the young and female. IBS generally first appears in people in their 20s to 40s, and women are roughly three times more likely than men to suffer from it.
• It is estimated that 24% of women in the United States suffer from IBS.
• Women with IBS seem to have more symptoms during their periods, suggesting that reproductive hormones may play a role.
• The pain or cramping can be a dull ache over one or several areas of the abdomen.  For some, the pain can be intolerable and without relief. 
• Some people with IBS suffer predominantly from constipation, others suffer predominantly from diarrhea, and some have alternating bouts of both.
• Fewer than 5% of IBS cases are considered severe.
• IBS involves an abnormality of the muscular action that passes food along the colon, as well as an increased sensitivity of the nerves in the colon.
• IBS is NOT a disease. It is called a "syndrome" because it represents a collection of symptoms. IBS is considered a "functional disorder" because there is no identifiable pathology and it can strike otherwise healthy people.
• Biological, psychological, and social factors can all contribute to symptoms. 
• While IBS often causes a great deal of discomfort and distress, it does not cause permanent harm to the intestines, it dens't lead to intestinal bleeding, and it doesn't cause cancer or inflammatory bowel diseases (such as Crohn's disease or ulcerative colitis).
• IBS symptoms vary in frequency. Some people can go for weeks or months with no symptoms while others may experience symptoms daily.
• Some patients can identify the triggers of their symptoms and can make lifestyle changes, such as dietary modifications and stress reduction, to improve their symptoms. Medication may also help.
• Certain medicines and foods, such as chocolate, high-fat foods, milk products, or large amounts of alcohol, may trigger attacks. Caffeine can cause loose stools even in some people without IBS, but it is particularly problematic for people with IBS.
• IBS can be successfully managed, but it cannot be cured.
• IBS may include other symptoms -- constant fatigue or feeling  tired, and even depression.
• Depression and anxiety disorders can aggravate IBS and IBS can contribute to depression and anxiety disorders. 
• Some research indicates that IBS may be more common among people who were abused as children.
• While stress may aggravate IBS symptoms, other factors - particularly colon motility and sensitivity of the nerves in the colon - play an important role.
• The GI tract contains a network of nerves.  A chemical neurotransmitter, serotonin, regulates the movement and sensitivity of the bowel. Abnormalities in serotonin levels may be related to IBS.  Abnormalities in serotonin levels are also related to depression. 
• IBS is rarely debilitating, but in some cases it can restrict the ability to attend school or social functions, go to work, or even travel short distances.
• IBS has been called many names, including colitis, mucous colitis, spastic colon, spastic bowel, and functional bowel disease. Some of these terms are inaccurate. Colitis, for instance, means inflammation of the large intestine. IBS, however, does not cause inflammation and should not be confused with ulcerative colitis. There is no evidence that IBS leads to more serious medical problems such as colitis or cancer or that it affects life span in any way. However, if left untreated, the symptoms will often persist, leading to pain and discomfort.
• To diagnose IBS, the patient must have had 3 months or more of abdominal discomfort or pain relieved by defecation, or associated with a change in stool frequency or constipation, plus two or more of the following symptoms (25% or more of the time):  a change in stool frequency or form, altered stool passage, mucus in the stool, and/or bloating. 
• New medicines to treat IBS:
• Lotronex (alosetron):  This is now FDA-approved for the treatment of IBS in those with moderate to severe diarrhea as their predominant symptom.  This medication had been pulled from the market due to severe adverse reactions (ischemic colitis) in a few patients with constipation-predominant IBS.  Doctors who prescribe Lotronex must participate in a special program aimed to avoid this complication.  Pharmacists can only fill prescriptions with a sticker indicating the physician is enrolled in the program. 
•   Zelnorm (tegaserod maleate):  Approved in July 2002 for the treatment of IBS in those whose primary symptom is constipation.  The major side effect is diarrhea, usually in the first week of treatment.
• Celexa (citalopram):  This is an antidepressant in the SSRI (selective serotonin reuptake inhibitor) class.  This may help women with IBS who are constipated, anxious, and who have difficulty sleeping. Side effects may include weight gain and decreased libido.

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Created: 3/24/2001  -  Donnica Moore, M.D.