What is Irritable Bowel Syndrome?

Irritable bowel syndrome (IBS) is a functional disorder of the large intestine that affects bowel habits. The prevalence of this condition is high, and it presents with varied symptoms. The exact cause of the disorder is still not completely understood, but there are multiple theories which account for symptoms.

Signs and Symptoms of Irritable Bowel Syndrome

 

The diagnostic assessment tool for IBS used in current practice is the Rome IV criteria. For more information, a link has been provided below

(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5704116/).

The classical symptoms of IBS are

1. 1)Abdominal Pain or bloating that subsides after defecation (passing stools)
2. 2)A change in bowel frequency (i.e increase or decrease in the number of times of passing stools)
3. 3)A change in bowel consistency (i.e hard to soft or soft to hard, differing characteristics compared to normal)

 

Other symptoms

1. 1)Mucus in stools, giving a whitish appearance
2. 2)Abdominal bloating, flatulence, and sense of incomplete evacuation even after passing stools
3. 3)Increased stool urgency

On the basis of bowel habits, IBS has been subclassified into IBS-D i.e., diarrhea (increased stool frequency with watery stools) , IBS-C i.e., constipation (decreased stool frequency with hard pellet like stools), IBS-M i.e., mixed (diarrhea and constipation) and IBS-U i.e., undefined.

Signs and symptoms suggestive of other diseases

The features of IBS overlap with many other diseases of the GI tract. Therefore, it is important to know some signs and symptoms suggesting an alternate diagnosis.

 

1. 1)Rectal bleeding
2. 2)Excessive fatigue and joint pain
3. 3)Iron deficiency anemia
4. 4)Excessive weight loss
5. 5)Any symptom disturbing sleep i.e awakening due to stool urgency, or abdominal pain occurring at night
6. 6)Age of onset > 50 years
7. 7)Fever, chills and rigors

Management of IBS

IBS is a diagnosis given based on a very carefully taken history. There is no specific diagnostic test which can confirm IBS. Certain tests are done to rule out other conditions especially inflammatory bowel disease

 

1. 1)Complete blood count
2. 2)C-reactive protein
3. 3)Erythrocyte sedimentation rate
4. 4)Colonoscopy
5. 5)Sigmoidoscopy
6. 6)Abdominal CT with contrast
7. 7)Upper GI endoscopy

In some cases hydrogen breath test, D-xylose test, calculation of stool osmotic gap is done to rule out malabsorption disorders.

Treatment

The treatment of IBS is highly focused on lifestyle modifications which include reducing stress, dietary modifications, sleep hygiene, physical exercise for patients who have mild symptoms. Some patients require medical therapy.

 

Medical therapy for Irritable Bowel Syndrome

 

1. 1)Anti-diarrheal in IBS-D agents like loperamide or diphenoxylate
2. 2)Anti-spasmodics like dicyclomine, peppermint oil
3. 3)Laxatives for constipation predominant IBS polyethylene glycol
4. 4)Tricyclic anti-depressants like nortriptyline, imipramine
5. 5)Selective serotonin re-uptake inhibitors like escitalopram
6. 6)Antibiotics like rifaximin to reduce IBS-D symptoms

Refractory symptoms are treated with fecal microbiota transplant. It is a procedure which has recently introduced and is yielding promising results.