Experts Looking For Answers To Bowel Disease

April Is Irritable Bowel Syndrome Awareness Month

Irritable bowel syndrome (IBS) is a disease that remains a quiet mystery despite the fact that physicians believe it affects an estimated 30 million people in the US, nearly 65 percent of whom are women.

Essentially, IBS is an intestinal disorder that causes chronic constipation or diarrhea with gas, bloating, and debilitating stomach cramps. It has not been shown to lead to serious, organic diseases, nor has a link been established between IBS and inflammatory bowel diseases such as Crohn's disease or ulcerative colitis.

Experts report that fewer than 50 percent of sufferers ever seek advice from a physician. On average, it takes more than three years to have IBS properly diagnosed, and patients will see up to three physicians before the correct diagnosis takes place, according to the International Foundation for Functional Gastrointestinal Disorders.

Trying To Understand Cause of IBS

And among health professionals, there is still no clear consensus on what causes the disorder, although a couple of successful medications have aided in its treatment.

That is why the foundation has designated April as Irritable Bowel Syndrome Awareness Month, to promote discussion of the disease's diagnosis and treatment as well as the way it affects people's lives.

"The disorder has been around for a long time, but it's been one that people haven't been willing to talk much about," says Dr. G. Richard Locke III, a gastroenterologist with the Mayo Clinic. "People don't like talking about their bowels."

People afflicted with IBS suffer from spasms in the colon, a 6-foot-long tube that connects the lower intestines to the rectum. This is the place where the waste matter from digestion forms into stool, and movements of the colon push the waste along until it's ready to exit the body.

The spasms are caused by a disturbance in the interaction between the gut, the brain, and the autonomic nervous system that regulates movement of the colon and bowels.

The nerve endings in the lining of the bowel become unusually sensitive, while the nerves that control the muscles of the gut become unusually active, Dr. Locke says.

"The bowels can be too slow," Dr. Locke says. "The bowels can be too fast. In addition, there's often bloating, mucus and the feeling you aren't finished even after you go."

The condition does not cause permanent harm to the intestines, and will not result in intestinal bleeding or a life-threatening disease such as cancer.

No one is sure what causes the syndrome. Physicians initially thought it was triggered by emotional upset, an extreme form of "nervous stomach."

They no longer believe that to be the case, although stress has been found to exacerbate or unleash certain IBS symptoms.

Researchers have focused on diet, genetics, or infection as the reason behind IBS.

"We've known for a long time that some people will develop IBS after an infection, and we're slowly understanding why," Dr. Locke says.

That line of research is focusing on whether the inflammation that accompanies infection affects the way the nerves that work the gut do their job, or whether a low-grade inflammation remains in the gut following the infection.

"The infection itself is gone, but it turns something on or in some way changes the body and that persists," Dr. Locke says.

Some Treatments Available, More Needed

Because so little is known about IBS, and because its symptoms are varied and unpredictable, physicians and patients struggle to find successful treatments.

"In general, IBS can be challenging to treat," says Dr. Lin Chang of the University of California, Los Angeles's Division of Digestive Diseases. "There are medications that can treat a specific symptom, but not many medications that can treat IBS overall."

Some people alter their diet to help relieve symptoms, while others use over-the-counter medications to combat constipation, diarrhea, and gas, Dr. Chang says.

Psychological counseling, relaxation training, and hypnosis also have proven effective as non-medicinal treatments.

Over the last few years, a couple of broad-spectrum medications have been approved for use in treating irritable bowel syndrome as a whole. Tegaserod, also known by the trade name Zelnorm^TM, is approved for use by women with IBS accompanied by constipation.

Alosetron, on the market under the name Lotronex^TM, is used to treat women with IBS with diarrhea, experts say.

"They both work by changing the way serotonin works in the gut and brain," Dr. Locke says. "By activating one type of receptor, you make the bowels move better. By blocking another type of receptor, you slow down the GI tract."

Lotronex^TM was taken off the market in November 2000, 10 months after the US Food and Drug Administration approved its use, because it was found to cause severe constipation that required surgery. Several deaths were reported.

However, the drug had proven so successful in treating severe cases that thousands of patients petitioned the FDA to place it back on the market. The agency relented in June 2002, but it is only available through physicians and only for people with severe diarrhea who have not responded to other treatments.

Always consult your physician for more information.

April 2004

Experts Looking For Answers To Bowel Disease

Trying To Understand Cause of IBS

Some Treatments Available, More Needed

Irritable Bowel Syndrome Symptoms

Online Resources

Irritable Bowel Syndrome Symptoms

The Office of Women's Health, US Department of Health and Human Services, provides information on irritable bowel syndrome in the following summary.

Symptoms may include:

• crampy pain in the abdomen

• constipation

• alternating diarrhea and constipation

• feeling that you have not finished a bowel movement

• gas, bloating

• mucus in the stool

Foods that may cause IBS include:

• fatty foods like French fries

• milk products like cheese or ice cream (especially in people who have trouble digesting lactose, or milk sugar)

• chocolate

• alcohol, caffeine (found in coffee, tea, and some sodas), carbonated drinks like soda

• Sorbitol, a sweetener found in dietetic foods and in some chewing gums

• gas-producing foods including beans and certain vegetables like broccoli or cabbage.

Treatments for IBS include:

• drinking lots of water and increasing your fiber intake

• a fiber supplement to add soluble fiber, often from psyllium seeds

• regular exercise

• occasional use of laxatives (for constipation)

• antispasmodics -medications that control colon muscle spasms and help with diarrhea and pain

• tranquilizers and antidepressants to help with stress, anxiety, and depression.

Always consult your physician for more information.

Online Resources

(Our Organization is not responsible for the content of Internet sites.)    

American College of Gastroenterology

Centers for Disease Control and Prevention (CDC)

HealthierUS.Gov

National Digestive Disease Information Clearinghouse

National Institutes of Health (NIH)

National Library of Medicine

National Women's Health Information Center

Office of Research on Women's Health