IBS

Published by NHC on January 5, 2021January 5, 2021

Irritable Bowel Syndrome (IBS)

Info
Description	A functional bowel disorder charaterised by abdominal cramping/pain and altered bowel motions. Three main subtypes: IBS-C – IBS with constipation IBS-D – IBS with diarrhoea IBS-M – IBS with mixed constipation and diarrhoea
Signs & Symptoms	Abdominal pain/cramping Bloating Flatulence Diarrhoea/Constipation can be alternating Mucous in stool Dyspepsia (indigestion)
Causes & Contributors	Infection SIBO/LIBO/IMO Estimated between 35%-85% IBS sufferers have SIBO Parasitic infection Fungal infection Food allergies/intolerances/sensitivities Study shows IgG antibodies tested and removal of those foods resulted in 26% improvement Wheat and gluten Coeliac disease (misdiagnosed as IBS) Non-coeliac gluten sensitivity (often caused by microbial alterations) Dairy Lactose and/or protein FODMAP foods Coffee Alcohol Microflora alterations/Dysbiosis Stress
Pathophysiology/Aetiology	Multifactorial Theories: Dysregulation of gut-brain axis parasympathetic nervous system stimulates appropriate digestion and relaxes sphincter muscles in the digestive tract. Sympathetic does the opposite IBS patients are often seen to have sympathetic dominance Stress increases sympathetic dominance Altered serotonin signalling approximately 95% of serotonin in located in the GI tract Serotonin stimulates peristalsis and secretion Excess serotonin in the gut causes diarrhoea and too little causes constipation May be due to number of enterochromaffin cells, serotonin levels, tryptophan hydroxylase message levels and the expression of serotonin-selective reuptake transporter. Infection post gastroenteritis IBS is possible and likely infection related rates are likely between 4-31% of IBS patients Microflora alterations Antibiotics, anti-inflammatories, OCP between 35-80% of IBS patients have SIBO PPIs, H2 antagonists, GIT surgery, immune deficiency, malnutrition all cause/contribute >80% improvement after rifaximin, zinc and probiotics in IBS patients in one study Food hypersensitivity
Treatment
Best Therapeutic Treatment	Find Underlying Cause and Treat Accordingly 1st Appointment* Send away with 7 Day Diet Diary Consider Pathology Testing: SIBO breath test Microbiome mapping IgG Food panel Coeliac testing Serology and/or gene testing Nutritional Probiotics (L plantarum 299v) PHGG (4-25g/day) Dietary Consume these: Water intake of 2.5L/day Peppermint and/or chamomile tea Fish Salmon Tuna Sardines Mackerel Cooked vegetables Avoid these: Coffee Alcohol Lifestyle Exercise Meditation Decrease stress Find stress management techniques Ensure adequate sleep ———————————————————————————- 2nd Appointment (Allow time for test results if needed) Please note treatment will be specific to the findings on pathology testing. These are general treatment options Dietary Avoid known food triggers Follow Low FODMAP Diet (if positive for SIBO) Consume These Often: Vegetables Leafy green vegetables Water Important for healthy bowel movements Often dehydration due to diarrhoea Water helps with constipation 2.5L/day Fish Easily digested EFAs Herbal teas Chamomile Peppermint Avoid These: Known trigger foods Dairy Lactose and/or protein High FODMAP food and drinks Coffee Alcohol Sorbitol Diet soft drinks and other ‘diet’ products Combination products Iberogast Treatment of underlying causes will depend on test results.
Herbal	Turmeric Globe artichoke Peppermint Chamomile
Nutritional	Probiotics L rhamnosus 10-50 billion CFU Study showed 42% improvement L casei, L plantarum, L acidophilus, L delbrueckii supst. bulgaricus, B longum, B breve, B infantis, Streptococcus salivarius subs. thermophilus. Psyllium (1 Tbsp/day) Fibre Psyllium Ensure adequate water
Dietary	Avoid known food triggers Follow Low FODMAP diet Consume These: Water Important for healthy bowel movements Often dehydration due to diarrhoea Water helps with constipation 2.5L/day Fish Easily digested EFAs Herbal teas Chamomile Peppermint Avoid These: Trigger foods FODMAP food and drinks Wheat and gluten Dairy Lactose and/or protein Coffee Alcohol Egg Corn Onion Potato Yeast Citrus Fructose Sorbitol Diet soft drinks and other ‘diet’ products *Give food swap ideas if necessary
Lifestyle	Exercise Been shown to reduce symptoms Decreases stress which is a contributor to IBS Meditation Decrease stress Find stress management techniques Ensure adequate sleep
Pharmaceutical	SSRIs Rifaximin (if SIBO is cause) Rifaxamin + Neomycin (if IMO is cause)
Combination Products	Iberogast Bioclinic Naturals IBS relief Bioceuticals Ultrabiotic IBS Immunobiotic Enterocare
More
Differential Diagnosis	Structural deformity Infection Parasitic Bacterial Viral Coeliac disease SIBO/IMO Dysbiosis IBD Diverticulitis
Diagnostic Criteria	ROME IV criteria Recurrent abdominal pain, on average of at least 1 day per week in the last 3 months, associated with two or more of the following: Related to defecation Associated with a change in stool frequency Associated with a change in stool form (appearance) Criteria should be fulfilled for the last 3 months with symptom onset over 6 months prior to diagnosis Absence of a structural or biochemical explanation
Testing/Examinations	SIBO breath test CDSA IgG Radioallergosorbent test (RAST) Tests blood IgG4 reactions to 90+ foods Colonoscopy Rule out other disorders eg. IBD, diverticulitis Lactulose/Mannitol test useful for identifying intestinal permeability

References

Atkinson W, Sheldon TA, Shaath N, Whorwell PJ. Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial. Gut. 2004;53(10):1459-1464. doi:10.1136/gut.2003.037697

Bone, K. (2007). The Ultimate Herbal Compendium. Phytotherapy Press

Braun, L., & Cohen, M. (2015). Herbs and Natural Supplements, Volume 2. Elsevier Health Sciences.
Crowell MD. Role of serotonin in the pathophysiology of the irritable bowel syndrome. Br J Pharmacol. 2004;141(8):1285-1293. doi:10.1038/sj.bjp.0705762

Hechtman, L. (2018). Clinical Naturopathic Medicine. Elsevier Health Sciences.

Ghoshal UC, Shukla R, Ghoshal U. Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy. Gut Liver. 2017;11(2):196-208. doi:10.5009/gnl16126

Jadallah KA, Nimri LF, Ghanem RA. Protozoan parasites in irritable bowel syndrome: A case-control study. World J Gastrointest Pharmacol Ther. 2017;8(4):201-207. doi:10.4292/wjgpt.v8.i4.201

Jadallah KA, Khader YS. Celiac disease in patients with presumed irritable bowel syndrome: a case-finding study. World J Gastroenterol. 2009;15(42):5321-5325. doi:10.3748/wjg.15.5321

Manabe N, Tanaka T, Hata J, Kusunoki H, Haruma K. Pathophysiology underlying irritable bowel syndrome–from the viewpoint of dysfunction of autonomic nervous system activity. J Smooth Muscle Res. 2009;45(1):15-23. doi:10.1540/jsmr.45.15

Pedersen N, Andersen NN, Végh Z, et al. Ehealth: low FODMAP diet vs Lactobacillus rhamnosus GG in irritable bowel syndrome. World J Gastroenterol. 2014;20(43):16215-16226. doi:10.3748/wjg.v20.i43.16215

Saadi M, McCallum RW. Rifaximin in irritable bowel syndrome: rationale, evidence and clinical use. Ther Adv Chronic Dis. 2013;4(2):71-75. doi:10.1177/2040622312472008

Takakura W and Pimentel M (2020) Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome – An Update. Front. Psychiatry 11:664. doi: 10.3389/fpsyt.2020.00664