Irritable Bowel Syndrome

Functional changes in bowel patterns are the hallmark of irritable bowel syndrome (IBS). It was a condition that was described by Hippocrates as the triad of abdominal discomfort, irregular bowel movements, and various degrees of bloating and rectal urgency — this description still holds true today. IBS is a chronic relapsing disease in which symptoms vary significantly over time. The waxing/waning course of its symptom complex has limited the ability of studies to distinguish between treatment effects and normal variation. It’s also why IBS has been considered to have a psychosocial overlay.

IBS has been considered a “diagnosis of exclusion,” defined by the presence of symptoms (abdominal pain/discomfort, bloating, and diarrhea or constipation) and a lack of clearly defined pathology. However, this understanding has evolved significantly over the past 10 years, with the emergence of a view that the cause of IBS is multifactorial, involving diet,1,2 digestive function,3 modified permeability,4 enteric infection,5 altered gastrointestinal flora,6 food sensitivities/allergies,7 visceral hypersensitivity,8 altered motility,9 neuroendocrine dysfunction,10 psychosocial factors,11 stress,12 and other factors.13

Numerous studies and surveys have reported that the vast majority of individuals with IBS (65%–90%) indicate that their symptoms are triggered by specific foods.14 A detailed dietary history can often provide insight into common food triggers for IBS, including gluten, lactose, fructose, fatty foods, and fiber15; as well as the role of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMaPs).16

Author Michael Pollan offers—“Eat food. Mostly plants. Not too much.”17 Many IBS patients will experiment with their diet before seeking medical attention, particularly by removing wheat, corn, dairy, eggs, coffee, tea, and citrus.18

The gastrointestinal (gut) microbiome plays a critical role in the normal development and functioning of the gastrointestinal tract and is broadly influenced by genetics and environment. The fecal microbiota of IBS patients differs significantly from controls due to diet, antibiotics, infection, and stress.19

IBS is no doubt a complex disease. At RMRM, we will have you meet with our nutritionist, undergo relevant testing, and develop a therapeutic plan specific to your needs. We’ll be glad to follow your course closely and work with you to overcome your symptoms.

  1. W.D. Chey, J. Kurlander: Eswaran S. Irritable bowel syndrome: a clinical review.JAMA. 313 (9):949-958 2015
  2. S. Eswaran, J. Tack, W.D. Chey: Food: the forgotten factor in the irritable bowel syndrome. Gastroenterol Clin N Am. 40:141-162 2011
  3. J.S. Leeds, A.D. Hopper, R. Sidhu, et al.: Some patients with irritable bowel syndrome may have exocrine pancreatic insufficiency. Clin Gastroenterol Hepatol. 8 (5):443-4482010
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  7. P. Mansueto, A. D’Alcamo, A. Seidita, A. Carroccio: Food allergy in irritable bowel syndrome: the case of non-celiac wheat sensitivity. World J Gastroenterol. 21(23):7089-7109 2015
  8. V. Theodorou, A. Ait Belgnaoui, S. Agostini, H. Eutamene: Effect of commensals and probiotics on visceral sensitivity and pain in irritable bowel syndrome. Gut Microbes. 5(3):430-436 2014
  9. M. DiStefano, E. Miceli, P. Tana, et al.: Fasting and postprandial gastric sensorimotor activity in functional dyspepsia: postprandial distress vs. epigastric pain syndrome.Am J Gastroenterol. 109 (10):1631-1639 2014
  10. E. Coss-Adame, S.S. Rao: Brain and gut interactions in irritable bowel syndrome: new paradigms and new understandings. Curr Gastroenterol Rep. 16 (4):379-391 2014
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  14. P.A. Hayes, M.H. Fraher, E.M. Quigley: Irritable bowel syndrome: the role of food in pathogenesis and management. Gastroenterol Hepatol. 10:164-174 2014
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  17. M. Pollan: Food rules: an eater’s manifesto. 2009 Penguin Books NY, NY 1-88
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  19. S.M. Collins: A role for the gut microbiota in IBS. Nat Rev Gastroenterol Hepatol. 11(8):497-505 2014