IBS is bloating, pain, diarrhea, constipation, acid reflux and frustration. Unrelenting frustration.
This is the face of irritable bowel syndrome, a condition that is too often thought to have no answer or solution. Fortunately, we now have more answers and solutions to IBS than used to. Unfortunately, these answers and solutions are being underutilized.
Irritable bowel syndrome is classified as a “functional” bowel disorder because it has not been thought to have a disease basis or know etiology. It has been defined more from the standpoint of its uncomfortable symptoms of abnormal gut function rather than as a worrisome disease.
Common problems associated with IBS include: gut motility (movement) problems, increased pain sensitivity related to the intestines, associated psychological symptoms, an initiating bacterial gastroenteritis, altered neurotransmitter and GI hormone levels, and food sensitivities. People with IBS can also suffer from GERD, chronic pelvic pain and chronic pain or chronic fatigue syndromes.
IBS frequently affects women younger than 50, and women twice as much as men. Though study reports vary, it affects up to 20% of the US population. Less than 1/3 of people with IBS are reported to actually have seen a health care provider and been diagnosed.
IBS and Small Bowel Bacterial Overgrowth
We now know that at least some people have IBS because of an overgrowth of gut microbes, and, how those microbes react with food in the intestines. We also have some reasonable emerging standards for diagnosis and treatment of IBS related to this small bowel bacterial overgrowth.
In December 2000, doctors Pimentel and Lin published a study in The American Journal of Gastroenterology reporting that many people with IBS tested positive for small bowel overgrowth and that treating them with an antibiotic, Xifaxan, resolved both the bacterial overgrowth and the IBS symptoms.
In 2004 Dr Lin published an article in the Journal of The American Medical Association outlining the idea of small bowel overgrowth syndrome as a reason for irritable bowel syndrome.
The world of conventional medicine has not embraced this diagnostic and treatment paradigm on a widespread scale, but it is a relatively common approach in functional medicine and integrative medicine practice models.
Traditionally, the diagnosis has been one of exclusion, focused on ruling out other problems by using routine blood and stool testing, lower GI x-ray series and flexible sigmoidoscopy or colonoscopy.
IBS Diagnosis & Treatment Should Consider Bacteria and Food Intolerances
We have enough evidence from various different studies at this time for bacterial overgrowth and food intolerance to become mainstream and first line thinking in IBS.
It may be overly simplistic to blame the entire complex that is IBS on bacteria and food intolerances, but these are important starting elements that have actionable steps for diagnosis and treatment. I believe we should be using those steps more routinely. There is available testing such as breath testing and stool testing, as well as appropriate antimicrobial treatments, probiotics and diet modification.
IBS is a very stressful and life disrupting condition. Part of what we should consider with every patient we see with irritable digestive and intestine complaints is small bowel bacterial overgrowth, food sensitivities and diet, and how we can treat or modify those things.