IRRITABLE BOWEL SYNDROME (IBS) PATIENTS

DON’T WORRY ANY LONGER, IT IS NOT ALL IN YOUR HEAD 

IBS is one of the most encountered chronic gastro-intestinal disorders. It comprises almost 50 percent of referred patients to a Gastroenterologist’s office for diagnosis and management.

IBS presents itself with abdominal pains, bloating, gas, abdominal distention, diarrhea, or constipation which most often occurs after eating (post prandial). These symptoms are non-specific, meaning that they can be seen in many diseases that involve the gastro-intestinal tract, especially cancers and colitis. There is another characteristic of IBS symptoms that go away after a bowel movement and are nor associated with any of what we doctors call in medicine “alarm symptoms,” in the form of bleeding and significant weight loss. We gastroenterologists, after determining these specific characteristics in patients’ complaints, do a battery of tests including gastroscopy, colonoscopy, capsule-enteroscopy, blood tests, stool tests for culture and sensitivity, and ova and parasite to rule out any infection, and stool test for occult blood which could be a sign of polyps and/or cancer.

All these tests usually come back as normal. When we tell the patients the good news, IBS patients instead of feeling better, become upset, and more anxious and ask, “so doctor if everything is normal, why do I have all these complaints, and feel miserable?” This is usually a difficult and stressful situation for both the patients and the doctors.

I personally believe that IBS patients complaints are real. I never tell them like some doctors do, that “nothing is wrong with you, it is all in your head.” I tell them that medical science doesn’t know what is causing IBS yet. And that we should try together “to control your symptoms with diet and medications at least after all these tests, we know that you don’t have a serious disease.”

I also believe that all IBS patients have some underlying psychological problems like worry, anxiety, clinical depression, or PTSD that interferes with the harmony of mind-and-body connections. As I doctor, I believe that we must take the patient as a whole, with their body as well as their mind. We shall discuss mind and body connections in an upcoming article.

As medical science progresses, our reasoning and understanding about diseases change and become clearer. For example, a recent research study about IBS published in the Journal of Nature, January 2021, showed that IBS symptoms are produced by allergic reactions to certain consumed food proteins. Researchers initially observed that IBS complaints mostly started following a bout of gastro-intestinal infection. They theorized that this infection damaged the integrity and the defense mechanisms of intestinal epithelium, causing some food proteins to be prematurely absorbed and trigger a local   allergic reaction in the gut that induced all IBS symptoms.

Scientists tested their theory in mice. They first infected rodents’ gut with a bacteria, following this bout of infection, and then fed rodents with a high protein diet. Scientists documented that it created antibodies in their blood, which cross-reacted with food proteins, and caused IBS like symptoms in rodents.

Researchers than studied 12 patients with documented IBS. When allergens like gluten, milk, or soy were given to these patients with enemas, it produced different degrees of symptoms of IBS in all patients, with specific antibodies in their blood.

From this study, which must be verified by other researchers, it could be assumed that IBS and other functional gastrointestinal disorders may be due to allergic reaction to food proteins, just like Eosinophilic Esophagitis is. Therefore, it is possible that high dose of antihistamine drugs (both H1 and H2 blockers, like Benadryl and Zantac) treatment could be helpful. In addition, IBS patients should follow a FODMAP diet that eliminate all fermentable starches and sugars. And then gradually add in non-allergenic foods to their diet. Keeping a food dairy and eliminating symptom-producing foods could be very helpful and self-assuring.

Already some new drugs that target and block allergic reaction pathways are in clinical trials for this purpose. In the meantime, IBS patients should never be told that “it is all in their head.”