Wednesday, December 31, 2008

How to Be Better with IBS, take home messages from the American College of Gastroenterology’s latest Review

Irritable bowel syndrome is characterized by diarrhea or constipation, or a mixture, altered bowel habits and frequency of these, bloating and abdominal discomfort. Diagnostic criteria has been around since the following reports - by Manning in 1978, then Kruise in 1984, and Rome 1 1990, Rome 11 1999 and the latest Rome 111 2006.
IBS affects 7-10% of the world’s population, with a prevalence of 7% in North America and is one of the most common reasons for consulting a gastroenterologist or Primary care physician. It has profound affects on daily life for those unfortunate to suffer from this condition.After an extensive review of all the evidence related to various treatments for IBS the American College of Gastroenterology concluded that
Further investigations are unnecessary in young patients with no alarm features except serology of celiac sprue and colonoscopy is only indicated in those over 50, making a diagnosis more straight forward and avoiding unnecessary testing.
• Psyllium fiber, certain antispasmodics and peppermint oil are effective although evidence is poor.
• Wheat bran and corn had no effect
• Chinese herbs may help but there are concerns over purity and safety of these.
• Probiotics (such as live yogurts) may improve symptoms but more data is needed, lactobacilli are not effective and bifidobacteria showed some efficacy.
In regard to diet there is insufficient evidence that food allergy testing or exclusion diets are beneficial although 60% of IBS sufferers believe food exacerbates their symptoms. 8 studies assessed symptomatic response to exclusion diets in 540 IBS subjects, studies reported a positive response in 12.5-67% of patients but absence of control groups makes it unclear whether it was a placebo effect. Also there was no correlation between food that patients identify as a cause of symptoms and allergy testing.
Cognitive behavioral therapy, dynamic psychotherapy and hypnotherapy but not relaxation therapy are more effective than usual care in relieving global symptoms of IBS
So are we any closer to more definitive recommendations? It would appear that in some areas, such as medication usage but overall IBS remains a complex condition and very individualized.
It is best for sufferers to work closely with their physician and consider consulting a dietitian to have a general review of their diet and lifestyle to ensure they are following a balanced diet and active lifestyle for over good health. While evidence for trigger foods is weak, if it is felt that certain foods aggravate symptoms it is fine to limit or omit these foods, as long as the diet is adequate overall.
The dietitian can also work with the sufferer to add in Psyllium fiber to the diet and trial Probiotics, with the use of a food and symptom diary. It is also advantageous to evaluate stress and consider psychological therapies as needed.
One thing is for sure it will continue to be a condition affecting many people across the globe, new treatment options and drugs are in development, hopefully in time we will have a clearer picture of how best to approach Irritable Bowel Syndrome.

References:
Brandt L J et al A Evidence Based Systematic Review on the Management of Irritable Bowel Syndrome. American College of Gastroenterlogy Task Force on IBS. American Journal of Gastroenterology 2009; 104 Supplement (1): 1-40

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