All About IBS: An Increasingly Prevalent GI Disorder

A few years ago, celiac disease was the popular gastrointestinal (GI) disorder. In the last year or so, though, irritable bowel syndrome (IBS) has seemingly taken over.

IBS is an increasingly prevalent GI disorder that affects the large colon, spurring symptoms like cramping, gas, abdominal pain, constipation, diarrhea, mucous-filled bowel movements, and bloating. Although we don’t know what causes it yet, we do know the GI tract isn’t functioning properly, preventing normal rhythmic movement.

Classification

IBS is classified as IBS-C (constipation) and IBS-D (diarrhea). Those with IBS-C lack GI tract movements, which weakens intestinal contractions and prevents the passage of food, resulting in hard stools and often leading to hemorrhoid development. Meanwhile, patients with IBS-D have overactive GI tract movements that cause abdominal pain, bloating, and diarrhea, leading to frequent and urgent bathroom trips.

Risk Factors

These include family history, female sex, mental health disorders, and young age. IBS is most commonly diagnosed in females younger than 45. In fact, females are twice as likely as males to have IBS, and their symptoms commonly worsen during menstruation and pregnancy due to hormone fluctuations.

Many patients with IBS say symptoms come and go in waves, similar to Crohn’s disease or ulcerative colitis, rather than occurring daily. However, it isn’t uncommon for patients to experience long periods of time where their IBS pains occur daily until they get it under control.

Diagnosis

IBS is essentially diagnosed by ruling out other GI disorders and environmental factors. GI specialists run tests for sugar, bacteria, diary, and wheat allergies with various blood panels, breath tests, endoscopies, and colonoscopies. If the results are negative, patients are then diagnosed with IBS-C, IBS-D, or mixed IBS, depending on symptoms.

Treatment

Diagnosed IBS patients are treated through not only symptom management, but also trigger avoidance. Because triggers can vary by patient, it’s often difficult to identify them and create a plan of attack. However, common triggers are stress, dairy, caffeine, spicy foods, alcohol, hormone irregularities, or higher bacteria levels in the GI tract. As a result, diet and lifestyle changes is usually first-line treatment.

First-Line

IBS patients should first eliminate gaseous foods, wheat, and/or dairy. Many patients will attempt to cut out one potentially harmful food group from their diet for 2 to 4 weeks, and then reintroduce it to see if their IBS worsens again. If it does, they’ve successfully uncovered one of their triggers and essentially need to limit or avoid that type of food.

IBS is particularly confusing to patients because it’s one of the few conditions where eating healthy doesn’t necessarily solve the problem. Because of their high gaseous content, foods like arugula, kale, broccoli, black beans, edamame, lentils, chickpeas, and soy can actually worsen IBS. Therefore, it’s important for IBS patients to learn what their bodies can or can’t tolerate.

Second-Line

When lifestyle changes fail, the next step for IBS symptoms is usually medication. Patients with IBS-C can take fiber supplements like Metamucil, PEG, or Milk of Magnesia with large amounts of water to help treat constipation. Because fiber supplements are known to cause less gas pain than high-fiber foods, many providers recommend them. Lubiprostone (Amitiza) can also be prescribed to treat IBS-C because it increases fluid secretions in the intestines to aid the passing of stool.

Patients with IBS-D can take antidiarrheals like loperamide (Imodium) and anticholinergics like hyoscyamine (Levsin) or dicyclomine (Bentyl) to prevent painful bowel spasms and movements. For those with comorbid depression, selective serotonin reuptake inhibitors like fluoxetine (Prozac) and paroxetine (Paxil) can not only treat depression, but also inhibit activity in the GI tract, essentially treating IBS. Patients with IBS due to high bacteria levels in their GI tract can take rifaximin (Xifaxan), but it’s not always covered by insurance plans.

All IBS patients should also take probiotics on a daily basis to encourage positive bacteria growth to aid in digestion.

Because there’s no cure for IBS, patients will most likely have to manage their IBS symptoms for the rest of their lives. Therefore, pharmacists must educate patients on IBS triggers and medication therapy to manage symptoms, as well as encourage them to make lifestyle changes.