Living with Irritable Bowel Syndrome
Saturday, December 08, 2007
Living with Irritable Bowel Syndrome.
HLE 11th September 2006
Dr. Andrew Thillainayagam, Consultant gastroenterologist at Charing Cross Hospital.
Irritable Bowel Syndrome (IBS) is a very common
condition, affecting as many as one in five people at some time in
their lives. It is not a disease, it is a collection of signs and
symptoms due to an abnormality of function and, because it is an
abnormality of function, you would see no abnormality, for example in a
post mortem examination. It is simply that the system is not behaving
normally. Symptoms vary widely and include abdominal pain, bloating,
diarrhoea and/or constipation. It can cause patients considerable
distress and seriously diminish their quality of life, but it is not a
life-threatening condition. However, similar symptoms can be due
to other serious disorders, such as colorectal cancer and Crohn’s
disease, so that it is essential for doctors to consider these
possibilities in order to exclude them.
Although we know that patients suffering from IBS
have some abnormality of the system and we can identify the condition
if it satisfies well-recognised international criteria, we do not know
exactly what is going on. We do not know cause and effect but we
can identify some of the precipitating factors, for example IBS can be
triggered by a life event, or by suppressed physical or sexual abuse;
in a small group of cases it can be food related, due to food
intolerance (which is not the same thing as an allergy). Many adults
are lactose intolerant, no doubt because mankind is not designed to
drink milk after the baby stage! And stress can be an important
precipitating factor as the mind and the gut are inter-related although
we do not exactly know how.
Until comparatively recently there was no
treatment for IBS. We now have the technology to enable us to
investigate the disorder more thoroughly. We can stimulate the brain to
see how the gut reacts and we can stimulate the gut to see how the
brain reacts, but we are still seeking answers. Real research requires
hard work.
Investigations are complicated as there are more
than five metres of intestine and five different receptors. Because the
receptors are non specific it is difficult to identify the source of
pan, which may be anywhere in the intestine. In our present state of
knowledge, it is as if we had taken the back of the television set and
can see all the wires but we don’t know what they do!
However, we can treat some of the symptoms, such
as diarrhoea, by the use of medication to slow down the gut, and
constipation by medication or by recommending dietary changes. A
healthy life-style should include eating five portions of fruit and
vegetables every day and drinking two and a half litres of water. Other
treatments include hypnotherapy, acupuncture and cogitative therapy.
Treatment by targeting serotonin is only used in the USA and is not
available here.
Most patients are looked after by their GPs, or
they are able to cope with the symptoms without professional help. It
is only when the symptoms seriously interfere with the quality of life
that patients are referred to a consultant. As a result, relatively few
patients are seen by consultant gastroenterologists.
Questions and answers
Dr. Thillainayagam
said life style and environment played a very big part in controlling
the potentially devastating phenomena of IBS. He again emphasized that
a healthy life-style was of utmost importance.
Another questioner asked when you should go to the
doctor if you thought you might be suffering from IBS to discuss
possible symptoms. Dr.Thillainayagam said that you should trust your
instincts.
Dr. Thillainayagam ended by saying that research
into cause and effect and treatment for IBS was making some progress
but that there was much more hard work to be done before we could claim
to have found satisfactory answers to the problems raised by this
complicated disorder.
The Patients’ Group would like to thank Dr.
Thillainayagam for taking the time out of his schedule to present his
extremely informative and detailed talk.
Henry Palmer
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