What Gastroenterologists Should Know About Managing IBS
Author:
Brian E. Lacy, MD, PhD
Gastroenterologist
Mayo Clinic, Jacksonville, Florida
Citation:
Lacy BE. What Gastroenterologists Should Know About Managing IBS [published online August 22, 2019]. Gastroenterology Consultant.
Diagnosing irritable bowel syndrome (IBS) entails multiple factors. One is that the patient’s symptoms should be chronic; they cannot have experienced just 1 week of symptoms but rather 6 months of symptoms, which must be active in the last 3 months. The cornerstone of the diagnosis of IBS is abdominal pain with disordered bowel habits, such as a change in stool form, a change in bowel movement frequency, or a relationship of the abdominal pain with the disordered bowel habits. Some patients can have pain and constipation-type symptoms, and while others can have abdominal pain with diarrhea-type symptoms. Some patients can also experience pain by exhibiting alternating symptoms of constipation and diarrhea.
Overlapping Symptoms
Oftentimes, patients can have overlapping symptoms of a variety of disorders. For example, if a patient presents with IBS with diarrhea, is it just IBS, or could it be IBS along with lactose intolerance? Or can it be IBS with—though rare—celiac disease? The mistake a provider or patient can make is focusing on only one of the disorders or not checking for celiac disease. To avoid this mistake, I like to think about prevalence, or the epidemiology of the disorder. With 14% of the US population having it, IBS is fairly common, presenting in 14% of the US population. Lactose intolerance is pretty common as well, with a 35% prevalence rate among US adults. Celiac disease, however, is not common. Only 1 in 250 people have celiac disease—that is 0.4% of the population. Of course, the overlap is possible so physicians should think about that and analyze symptoms logically.
Current guidelines are vague on how to approach the possibility of a patient with IBS having celiac disease. Some recommendations indicate that everyone with suspected diarrhea-predominant IBS (IBS-D) have laboratory values checked for celiac disease. Some believe this approach is not cost-effective, suggesting that a patient be checked for celiac disease only if they fail standard therapy and symptoms are persistent.
Something else to keep in mind is that IBS is a heterogenous disorder. IBS-D is often discussed as one disorder, but it is probably at least 9 or 10 separate disorders under that one large umbrella. I can see 50 patients in a row with IBS-D and have the underlying pathophysiology be different for many, if not all of them. So, while a diagnostic treatment algorithm would make life easier, developing one will be difficult.
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Author:
Brian E. Lacy, MD, PhD
Gastroenterologist
Mayo Clinic, Jacksonville, Florida
Citation:
Lacy BE. What Gastroenterologists Should Know About Managing IBS [published online August 22, 2019]. Gastroenterology Consultant.
Diagnosing irritable bowel syndrome (IBS) entails multiple factors. One is that the patient’s symptoms should be chronic; they cannot have experienced just 1 week of symptoms but rather 6 months of symptoms, which must be active in the last 3 months. The cornerstone of the diagnosis of IBS is abdominal pain with disordered bowel habits, such as a change in stool form, a change in bowel movement frequency, or a relationship of the abdominal pain with the disordered bowel habits. Some patients can have pain and constipation-type symptoms, and while others can have abdominal pain with diarrhea-type symptoms. Some patients can also experience pain by exhibiting alternating symptoms of constipation and diarrhea.
Overlapping Symptoms
Oftentimes, patients can have overlapping symptoms of a variety of disorders. For example, if a patient presents with IBS with diarrhea, is it just IBS, or could it be IBS along with lactose intolerance? Or can it be IBS with—though rare—celiac disease? The mistake a provider or patient can make is focusing on only one of the disorders or not checking for celiac disease. To avoid this mistake, I like to think about prevalence, or the epidemiology of the disorder. With 14% of the US population having it, IBS is fairly common, presenting in 14% of the US population. Lactose intolerance is pretty common as well, with a 35% prevalence rate among US adults. Celiac disease, however, is not common. Only 1 in 250 people have celiac disease—that is 0.4% of the population. Of course, the overlap is possible so physicians should think about that and analyze symptoms logically.
Current guidelines are vague on how to approach the possibility of a patient with IBS having celiac disease. Some recommendations indicate that everyone with suspected diarrhea-predominant IBS (IBS-D) have laboratory values checked for celiac disease. Some believe this approach is not cost-effective, suggesting that a patient be checked for celiac disease only if they fail standard therapy and symptoms are persistent.
Something else to keep in mind is that IBS is a heterogenous disorder. IBS-D is often discussed as one disorder, but it is probably at least 9 or 10 separate disorders under that one large umbrella. I can see 50 patients in a row with IBS-D and have the underlying pathophysiology be different for many, if not all of them. So, while a diagnostic treatment algorithm would make life easier, developing one will be difficult.
