Irritable Bowel Syndrome (IBS): Causes and Treatments

irritating catgut Syndrome (IBS) Ca rehearses and TreatmentsLucy CrawshawIrritable Bowel Syndrome What is IBS and what be the interpositions?The aim of this report is to brook entropy on Irritable Bowel Syndrome (IBS) and in salmagundi those diagnosed with IBS active the treatments getable.IBS is a unwashed condition of the small and large catgut, or bowel. It affects about 15% of the population and of those affected, about 9% atomic number 18 female and 6% argon male. IBS is a functional condition, meaning that it disrupts bowel function but does non cause detectable abnormalities in the structure of bowel. This digest lead to doctors and the in the public eye(predicate) trivialising the condition, even though it affects perseverings quality of spirit by causing pain, problems associated with exit faeces and psychological issues such as slump.The Digestive SystemThe forms cells require many different molecules and ions to function it is the digestive agreement (sh own in Figure 1) which supplies these nutrients. The term digestion encompasses ingestion, digestion (the segmentation of food into its component nutrients), ducking of nutrients and excretion of waste products.During ingestion, food is placed into the mouth, chewed and mixed with saliva to form a soft mass, or bolus. Saliva contains enzymes which catalyse, or speed up, the breakdown feather of food. After the bolus is swallowed, it chokes down the oesophagus into the stomach, aided by peristalsis (muscular contractions which travel down the particular organ).In the stomach, gastric juices including hydrochloric acid and enzymes break down the bolus into a liquid called chyme. The chyme enters the small intestine along with pancreatic juices containing enzymes, and rancour (which is produced by the liver and269 wordsstored in the gall bladder), where it is fully digested. The nutrients rel quietusd atomic number 18 absorbed through blood vessels in the small intestine. Peristal sis pushes the undigested matter, including fictitious character, resistant starch and bacteria into the large intestine (which is divided into the cecum, colon and rectum). Once in the colon, water is absorbed, turning the matter into faeces. The faeces moves into the rectum by peristalsis, after which it is excreted from the anus.What ar the symptoms?The severity of IBS symptoms vary but are commonly worse in the morning and after eating. Typical symptoms include horrible abdominal cramps, which ease after passing faeces, abdominal bloating, flatulence, changes in the agreement of faeces (ranging from diarrhoea to constipation) and passing mucus with faeces. Sufferers whitethorn in any case sprightliness the sudden need to empty their bowels or feel that their bowels are not empty despite having been to the toilet. Other symptoms chiffonier include feeling sick, backward ache, lethargy, bladder problems including the urgent need to urinate, difficulty emptying the bladde r and head trip and dyspareunia, or pain during sex.IBS is unpredictable in that sufferers whitethorn experience no symptoms for months, then experience a flare-up for no discernible reason. Symptoms whitethorn settle within 2 to 3 days or can take months to settle.IBS has also been conjugated with psychological problems such as depression and anxiety. It has been estimated that 3 in 4 sufferers will develop depression and about 50% will develop Generalised Anxiety Disorder (GAD).What are the causes?The exact cause of IBS is unknown although several theories have been proposed. Some experts remember that IBS is caused by a change in the speed at which chyme is neat through the bowel slower processing allows the colon more(prenominal)(prenominal) clip to absorb water, causing constipation by making faeces harder and more difficult to excrete. If processed more quickly, less water is absorbed, resulting in diarrhoea. A second possibleness is that IBS is caused by disruption t o nerve signals between judgement and bowel, change magnitude sensitivity to pain, so that mild indigestion to a non-sufferer may cause severe pain to IBS sufferer.Both of these changes may be tie ined to food poisoning or intolerance to certain foods. Another theory suggests that these changes may be caused by stress, anxiety or trauma during childishness (such as abuse or neglect), which decreases the level of the neurotransmitter serotonin in the body. serotonin is produced by the brain and intestines, and is important in controlling mood and digestion. lessen serotonin levels have been linked to depression and slow peristalsis in the bowel, leading to constipation. Higher levels of serotonin in the body can ontogenesis peristalsis, causing diarrhoea this theory may help to explain the link between IBS and depression.IBS may also be related to Small enteral Bacterial Overgrowth (SIBO), where bacteria from the large intestine migrates to the small intestine and ferment the indigestible components of chyme, and giving off hydrogen, carbon dioxide and methane gas.How is IBS diagnosed?As IBS causes no physical changes to the bowel, doctors must rely on patients describing their symptoms. A diagnosis can be made if the patient has been suffering from the typical symptoms for the previous 6 months. However, doctors may wish to carry out tests including blood tests and faeces tests, to get out other conditions which cause similar symptoms, ilk inflammatory bowel disease, 1eliac disease or infections.What are the treatments?As yet, no cure has been set up for IBS, however symptoms can be allotd.One of the easiest treatments is modification of the aliment. Dietary advice is surmount provided by healthcare professionals on an idiosyncratic basis, based on the patients symptoms and reactions to certain foods. Recording a food diary flesh out what is eaten and any ill-effects is an legal way of identifying the changes which are needed. Seeking viandsar y advice may also benefit other aspects of patient health, including ensuring a balanced diet, and encumbrance worry.Fibre, from components of plants a want cellulose, lignin and pectin which are resistant to digestive enzymes, is an important factor in the diet. Soluble persona dissolves in water, causing it to swell and form a gel, softening faeces and stimulating peristalsis. It is though that increasing soluble fibre and water in the diet can ease the symptoms of IBS. In contrast, insoluble fibre acts as an irritant to IBS sufferers as it remains intact during digestion, increasing the speed at which faeces travels through the bowel.Soluble fibre is plant in foods like rice, pasta, oats, root vegetables and fruits including bananas and mangoes. Generally, foods which are stringy, have tough pelt or contain seeds are high in insoluble fibre. proper(postnominal) examples include cereals, wholegrain foods, nuts and seeds, salad and dried fruit. Insoluble fibre should not be c ompletely excluded from the diet but should be consumed in small quantities on board soluble fibre. Cooking, chopping and pureeing foods containing insoluble fibre may help to flash back their ill-effects.To reduce flatulence, a low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) diet is recommended. FODMAPs are carbohydrates which are resistant to digestion and as a result, ferment in the bowel. Foods containing FODMAPs include processed wheat products, dairy products containing the sugar lactose, beans and some fruit and green vegetables, including peaches, nectarines, apples, cherries, cabbage, broccoli and peas.Other blow up foods that should be avoided include red meat, dark poultry meat and skin, virginal fats (such as butter and lard), sulphur-rich foods including onions and garlic, acidic foods like vinegar and citrus fruits, levulose (fruit sugar) and artificial sweeteners.IBS sufferers are advised to eat regularly, avoid skipping meals and take their magazine whilst eating. Drinking about 2 litres of non-caffeinated, non-alcoholic liquid per day is also recommended.It is though that probiotic products like yoghurts and capsules may ease IBS symptoms in some patients. It is currently recommended that patients should use a product for 4 calendar weeks before deciding whether it is beneficial. Other suggested ready-made products include remedies containing herbs like peppermint, fennel and acacia.Another effective way to manage IBS, whilst also benefiting other aspects of a patients health, like saddle management and fitness, is to conduct about 150 minutes of moderate-intensity exercise per week (like cycling and walking). Exercise reduces stress by increasing serotonin levels and also pumps blood away from the bowel and towards other muscles, which may help to ease IBS symptoms both during exercise and in the long-term.Stress can also be reduced with relaxation techniques such as breathing exercises and meditat ion and activities like yoga. Other methods to reduce stress or treat IBS-linked depression are counselling, hypnotherapy and Cognitive behavioural therapy (CBT), which teaches people to alter their thinking and behaviour.Alternative treatments like acupuncture and reflexology are not recommended.When other treatments fail, doctors may recommend medication. eyepatch medication can ease the symptoms of IBS, it may also pose a risk to health due to possible side effects.Antispasmodics such as Mebeverine are prescribed to relax the bowel muscles and then reducing unnameable abdominal cramps. For patients with constipation, bulk-forming laxatives, like Normacol or Fybogel, can make bowel movements easier and more regular, due to the insoluble fibre contained within these drugs. In contrast, antimotility medicines such as Loperamine slow peristalsis allowing faeces time to solidify in the bowel, thus easing symptoms for patients with diarrhoea.Finally, irrespective of whether a patien t is displaying psychological symptoms of IBS, antidepressants may be prescribed. Tri-Cyclic Antidepressants (TCAs), like Amitriptyline, interact with neurotransmitters (including serotonin) in the brain where they reduce anxiety and pain, and in the intestines where they slow peristalsis, making them effective for treating patients with diarrhoea. Selective Serotonin Reuptake Inhibitors (SSRIs), like Citalopram, increase serotonin levels in the body, proving them beneficial to patients with constipation.Is treatment effective?A study entitled Effects of a health weapons platform comprising reassurance, diet management, probiotics administration and regular exercise on symptoms and quality of life in patients with bothersome bowel syndrome found that such treatment significantly go the symptoms of 143 IBS patients who suffered from pain, diarrhoea-dominant IBS or constipation-dominant IBS (as shown in Figure 2). However, this study does not show the individual effect of each trea tment.With regards to probiotics, the NHS argues that little evidence supports their use, however studies such as those cited by probiotic manufacturer OptiBac suggest that their products can be highly efficacious. on that point is also little evidence to support the use of herbal remedies.A review of previous studies entitled Efficacy of antidepressants and psychological therapies in rough bowel syndrome systematic review and meta-analysis found that antidepressants were 34% more effective than placebo drugs in reducing the symptoms of IBS, while psychological therapies reduced symptoms in 33% of patients. The conclusion stated that both treatments are effective.What are the implications treatment?The ease of availability of information about self-help treatments, (especially on the internet) could be considered wrong as patients may fail to seek professional medical help. The implication is that patients may receive inadequate treatment for their IBS or that other causes of th eir symptoms may not be diagnosed, which could prove fatal.The lack of conclusive evidence livelihood the use of herbs and probiotics as self-help treatments raises questions as to the ethics of manufacturers promoting such products as they may give rise to false hope of a cure.There are also questions as to the ethics of prescribing medication for a functional condition. In addition, social stereotyping could lead to patients prescribed antidepressants being labelled as round the bend etcetera.Finally, the treatment of IBS has a significant economic impact on the UK the matter Institute of Health And Care Excellence (NICE) estimate that diagnosis and management of IBS cost the NHS 7,879000 in 2008.Evaluation of reference materialsWebsites like NHS Choices and Patient provide a useful overview on IBS and cover a wide cathode-ray oscilloscope of topics, however fail to fully explore many areas including how the different types of fibre affect IBS, why exercise is beneficial to su fferers and how certain drug treatments work. notwithstanding the ethical issues related to selling untested remedies, of all the references cited, sponsor for IBS provides the nearly practical advice on changing dietary fibre intake, including food planning tips. In contrast, other websites like NHS Choices purely state that changes should be made. Help for IBS also includes information on other trigger foods, which was not available in the other resources.BibliographySOANES, C., STEVENSON, A., (2009), Oxford Dictionary of English, Oxford, OUPhttp//www.bsg.org.uk/clinical/commissioning-report/ibs/functional-symptoms.html(12 Nov 2014)http//www.patient.co.uk/health/irritable-bowel-syndrome-leaflet (11 Nov 2014)http//www.nhs.uk/Conditions/Irritable-bowel-syndrome/Pages/Introduction.aspx(11 Nov 2014)http//www.bbc.co.uk/bitesize/standard/biota/animal_survival/the_need_for_ food/ revision/4/ (12 Nov 2014)PAUL, I., (2002), Digestive System Biology, USA, Macmillan Reference accomplishm ent Libraryhttp//www.medicalnewstoday.com/articles/232248.php (13 Nov 2014)http//ibs.about.com/od/medicationforibs/a/Antidepressants-For-IBS.htm(13 Nov 2014)http//digestivehealthinstitute.org/2013/05/10/resistant-starch-friend-or-foe/(14 Nov 2014)(2008), Diagnosis and management of Irritable Bowel Syndrome in primary care, London, NICEhttp//www.co-operativepharmacy.co.uk/Pharmacy/Medicine-Chest/NHS-Articles/L/Laxatives/ (13 Nov 2014)http//www.webmd.com/diet/fiber-health-benefits-11/insoluble-soluble-fiber(13 Nov 2014)http//www.helpforibs.com/diet/fiber2.asp (15 Nov 14)http//www.optibacprobiotics.co.uk/faq/which-probiotics-are-for-ibs (16 Nov 2014)http//www.sparkpeople.com/resource/fitness_articles.asp?id=840 (13 Nov 2014)http//www.lef.org/protocols/gastrointestinal/constipation/page-04 (16 Nov 2014)(2008), National Costing composing Irritable Bowel Syndrome, London, NICEEL-SALHY, M., LILLEBO, E., REINEMO, A., SALMELID, L., HAUSKEN., (2008), Effects of a health program comprising re assurance, diet management, probiotics administration and regular exercise on symptoms and quality of life in patients with irritable bowel syndrome, Gastroenterology InsightsFORD, A.C., TALLEY, N.J., SCHOENFELD, P.S., QUIGLEY, E.M.M., MOAYYEDI, P., (2008), Efficacy of antidepressants and psychological therapies in irritable bowel syndrome systematic review and meta-analysis, Gut