Q: I was diagnosed with irritable bowel syndrome. Will I have to live with the symptoms forever or is there a cure?
The characteristic symptoms of irritable bowel syndrome – abdominal pain, constipation, diarrhea, bloating, and gas – are difficult to ignore.
So it’s no wonder that millions of people with this disease in the United States are hoping for a treatment that can help them make a full recovery.
But Dr. Brian Lacy, a gastroenterologist and professor of medicine at the Mayo Clinic in Jacksonville, Florida, says there is no cure for IBS, just as there is no cure for other chronic diseases such as diabetes or high blood pressure. said.
For Beth Rosen, a New York dietitian who was diagnosed with irritable bowel syndrome in 2010, that reality was hard to swallow.
“It took me a while to accept the fact that this situation is never going to go away,” Rosen said. “How was I going to survive this situation?”
She went to three gastroenterologists before finding one who took her symptoms seriously and helped her “get through the trial and error of finding a way to feel better.” She said she went to see a doctor.
Dr. Baha Moshily, a gastroenterologist and professor of medicine at Atrium Health Wake Forest in Charlotte, North Carolina, says one reason IBS is so difficult to treat is that we don’t know exactly what causes it. Stated.
IBS is the result of a communication failure between the intestines and the brain, and the nerves in the intestines are very sensitive and carry pain signals from the normal digestive process.
Changes in the microbiome, gastrointestinal infections, stress and issues with the way food moves through the gut can also contribute, Dr. Mosily said.
What could help?
Finding effective treatments often involves understanding the unique factors that contribute to each patient’s symptoms and trying a combination of dietary, behavioral, and drug treatments, Dr. Moshily said.
Rosen often advises clients to temporarily avoid foods high in certain sugars called FODMAPs, which are fermented by bacteria in the colon and cause gas and bloating that worsen IBS symptoms.
Many vegetables, fruits, dairy products, legumes, nuts, seeds, and grains are considered high FODMAP foods, making them highly restrictive and best attempted under the guidance of a registered dietitian, and are recommended for eating disorders. She said it was inappropriate for some people.
Rosen guides clients through three stages of weight loss. First, eliminate high FODMAP foods for 2-6 weeks (but not after that because of the risk of nutritional deficiencies, microbiome changes, and eating disorders). Then, if symptoms improve, reintroduce high FODMAP foods one by one to determine which foods trigger symptoms. Finally, she creates a personalized meal that includes all the foods the client is comfortable eating.
Rosen said commercially available enzyme supplements may make it easier to digest high-FODMAP foods such as dairy products, beans, lentils, garlic and onions.
Other nonprescription products that can improve IBS symptoms include enteric-coated peppermint oil capsules, which can relax the smooth muscles in the intestines, Dr. Moshily said. Rosen added that psyllium fiber supplements can also be helpful.
Alterations in the gut microbiome appear to play a role in irritable bowel syndrome, but there is not enough evidence to recommend probiotic supplements or other treatments such as fecal transplants for people with the condition. Dr. Moshily said.
If stress is a trigger for IBS symptoms, Dr. Moshily often recommends that patients see a therapist or psychologist who specializes in gastrointestinal issues.
Cognitive behavioral therapy and hypnotherapy have also been shown to reduce IBS symptoms, Dr. Lacey said. He would like to see these used more often, but certain barriers such as a lack of therapists and lack of insurance coverage limit their use.
Some studies support the use of smartphone apps to provide such psychotherapy. Dr. Lacey recommended Mahana IBS, a cognitive behavioral therapy app available by prescription. Some of Rosen’s clients have found the hypnotherapy app Nerva helpful.
Prescription drugs and tricyclic antidepressants such as lubiprostone, linaclotide, plecanatide, and rifaximin may also be effective. However, it usually works best when combined with other approaches.
However, the appropriate combination of treatments may vary from patient to patient. “That’s where medical technology comes in,” says Dr. Moshily.
Dr. Lacey said there are many options to help people manage irritable bowel syndrome symptoms.
If you’re one of these patients, he says it’s important to be prepared to explain your medical history, symptoms, past tests and treatments you’ve tried when you visit your health care provider. Stated.
If your provider “seems like they’re not very interested or struggling,” find another provider, he says. “Don’t give up. Keep working hard and find what’s right for you.”
