Categories: Diseases & Treatment Plans

IBS

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
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
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
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
NHC

Share
Published by
NHC
4 years ago

Recent Posts

Excel Test Page

No content found

11 months ago

Naturopath Handouts – Natural Health Connections

Natural Health Connections is your ultimate destination for invaluable resources and support to improve your…

2 years ago

Low FODMAP Diet

Low FODMAP Diet Low FODMAP Diet 1 .PDF Low FODMAP Diet 2 .PDF Low FODMAP…

2 years ago

new content test

TEST Diet Diary .PDF .PDF .PDF .PDF

2 years ago

Children’s Herbal Dosage Calculator

Children's Herbal Dosage Calculator Formula Clarke’s Rule – Weight of child (kgs) / 70 *…

3 years ago

Alanine Aminotransferase Test Interpretation

Alanine Aminotransferase (ALT) MarkerFunctionResult/ConditionsALT(Alanine Aminotransferase)Enzyme found in the liverRaised levels:InflammationLiver diseaseHepatitisHaemochromatosisEBV, CMVParacetamolMethotrexate References Pagana, K.…

3 years ago