Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD)

“Dr. B, what is the difference between irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD)?” asks Susan.

Irritable bowel syndrome is a condition where the symptoms are due to disturbance in the movement and sensation of the bowel. The person is otherwise well but presents with chronic or recurrent abdominal pain, change in bowel habit (constipation and/or diarrhea) and bloating.

Inflammatory bowel disease is a condition where symptoms are due to inflammation (redness, swelling, ulcers) of the lining of the bowel. This result in abdominal pain, bloody diarrhea, and loss of weight and feeling unwell.

The exact cause of either condition is not known. Sometimes the symptoms are such that it is difficult to differentiate between the two conditions.

“Dr. B, can you tell me more about irritable bowel syndrome (IBS)?”

IBS affects about 15 percent of the population. Only 30 percent of the people affected by the condition seek help from their family physicians.

Usually a diagnosis is made after extensive and uncomfortable investigations to rule out other conditions like inflammatory bowel disease and cancer. This is called diagnosis by exclusion!

Couple of years ago, internationally recognized experts in IBS held a consensus conference to develop recommendations on diagnosis, patient education, psychosocial management, dietary advice and treatment. This is to help physicians understand and manage the condition better.

For diagnosis without investigations, the most reliable symptoms criteria used are 1. Abdominal pain 2. Pain relieved by defecation 3. Pain relieved with looser stools 4. Pain associated with more frequent stools.

Bloating is more common in women.

Using these symptom criteria, the chances are that the physician’s diagnosis of IBS is correct in 60 to 80 percent of cases. Physical examination is usually normal. In some cases there may be some abdominal tenderness or palpable colon.

Investigations are required in patients who have weight loss, rectal bleeding, anemia, family history of inflammatory bowel disease or bowel cancer, new symptoms in patients over 50 or the physician is uncertain of diagnosis of IBS.

These patients should have complete blood count and colonoscopy (a day surgery procedure under sedation in a hospital). Instead of colonoscopy, one can have air-contrast barium enema and flexible sigmoidoscopy (a 60-cm version of a colonoscope done without sedation in a doctor’s office).

Management of this condition is not always easy. Patient needs education and reassurance. It is a chronic, relapsing but benign condition although in some it can cause significant psychosocial problems.

Advice on balanced diet, exercise, and “toilet training” is important.

Most patients do not need drug therapy. No single medication has been shown to be beneficial for IBS. Symptomatic treatment of constipation, diarrhea, abdominal pain, and bloating is required.

Associated conditions like depression and anxiety should be recognized and treated.

As you can see, lot more research is required to unlock the mystery and frustration of this condition. In the meantime, we have to deal with the problem with patience and perseverance.

Physicians and patients have to understand each other’s limitations and difficulties and work together to relieve pain, anxiety and discomfort.

“Thank you Dr. B., this will certainly help me understand my problem!” says Susan as she gets ready to leave.

This series of articles explore the health problems of Dave and his family. They are composite characters of a typical family with health problems.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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