Q: I have just been diagnosed with irritable bowel syndrome. Am I destined to deal with its symptoms forever, or is there a cure?
The hallmark symptoms of irritable bowel syndrome are hard to ignore: abdominal pain, constipation, diarrhea, bloating, gas.
It’s no wonder, then, that the millions of people with the disease in the United States want treatment that helps them make a full recovery.
But just like there’s no cure for other chronic conditions like diabetes or high blood pressure, said Dr. Brian Lacy, a gastroenterologist and professor of medicine at the Mayo Clinic in Jacksonville, Florida, there is no cure for IBS.
For Beth Rosen, a dietitian in New York who was diagnosed with IBS in 2010, this reality was hard to accept.
“It took a while to come to terms with the fact that it was never going to go away,” Ms Rosen said. “How was I going to handle this and live this way?”
She saw three gastroenterologists before finding one who took her symptoms seriously and who could help her “through trial and error to find ways to feel better,” she said. .
One of the reasons IBS can be so difficult to treat is that we don’t know exactly what causes it, said Dr. Baha Moshiree, gastroenterologist and professor of medicine at Atrium Health Wake Forest in Charlotte, Utah. North Carolina.
IBS is the result of impaired communication between the gut and the brain, with the nerves in the gut being unusually sensitive and signaling pain from what could be normal digestive processes.
Changes in the microbiome, gastrointestinal infections, stress and problems with how food moves through the gut can also contribute, Dr. Moshiree said.
What can help?
Finding effective treatments requires understanding the unique factors that contribute to each patient’s symptoms, Dr. Moshiree said, and often trying a combination of dietary, behavioral or pharmaceutical therapies.
Ms. Rosen often advises her clients to temporarily cut out foods high in certain sugars called FODMAPs, which are fermented by bacteria in the colon, leading to gas and bloating that can worsen IBS symptoms.
Many vegetables, fruits, dairy products, legumes, nuts, seeds, and grains are considered high-FODMAP foods, making the diet very restrictive — and best attempted with the advice of a registered dietitian, and inappropriate for people with eating disorders, she said.
Ms. Rosen walks her clients through the three phases of the diet. First, eliminate high-FODMAP foods for two to six weeks (and no longer, due to risks of nutrient deficiencies, microbiome changes, and eating disorders). Then, if their symptoms have improved, she has them reintroduce high-FODMAP foods, one at a time, to see which are triggering the symptoms. Finally, she creates a personalized diet that includes all the foods her clients can comfortably eat.
Over-the-counter enzyme supplements can help people digest certain high-FODMAP foods like dairy products, beans, lentils, garlic and onions more easily, Rosen said.
Other over-the-counter products that can improve IBS symptoms include enteric-coated peppermint oil capsules, which can relax the smooth muscles of the bowel, Dr. Moshiree said. Ms. Rosen added that psyllium fiber supplements can also be helpful.
Changes in the gut microbiome appear to play a role in IBS, although there isn’t enough evidence to recommend probiotic supplements or other therapies like fecal transplants for people with the disease, said Dr Moshiree.
If stress is a trigger for IBS symptoms, Dr. Moshiree often recommends 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. Lacy said. He would like to see them used more often, although some barriers, including a shortage of therapists and lack of insurance coverage, have limited their use.
Some studies support the use of smartphone apps to deliver these psychotherapies. Dr. Lacy recommended Mahana IBS, a cognitive behavioral therapy app available by prescription, and some of Ms. Rosen’s clients have found the Nerva hypnotherapy app helpful.
Prescription drugs — including lubiprostone, linaclotide, plecanatide, and rifaximin — as well as tricyclic antidepressants can also be effective. But they generally work best when combined with other approaches.
However, the right combination of therapies may be different for each patient. “This is where the art of medicine comes in,” said Dr. Moshiree.
There are many options to help people manage IBS symptoms, Dr. Lacy said.
If you’re such a patient, he said, it’s important to be prepared to describe your history, symptoms, previous tests and therapies you’ve tried during medical appointments.
If your supplier “doesn’t seem interested or confused,” he said, find another one. ” Do not abandon. Let’s keep plugging in and find the right thing for you.