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Irritable Bowel Syndrome

IBS is an important disease entity because of its high prevalence (1 in every 10 persons), poor quality of life, and enormous cost of treatment. IBS is the most common diagnosis where no or minor pathological changes are found in various clinical investigations.

Diagnosis is based on a careful history and physical examination, that specific diagnostic tests are not needed. Nonetheless only symptom-directed therapy and not disease modifying treatments are available in allopathy.

Definition

IBS is a condition characterized by abdominal pain, bloating or discomfort occurring in association with disturbed bowel pattern in the absence of organic caused that can be detected by routine medical test.


The patient’s description of diarrhea or constipation can be fallacious because it is usually based on the frequency of the stool and on stool type. Patient should be asked if their symptoms are relieved with defecation, is their straining at stool, if there is feeling of incomplete evacuation, urgency or any association with a change in stool frequency or consistency.

Diagnosis

Rome III Criteria Recurrent abdominal pain or discomfort at least 3 days/month in the last 3 months associated with 2 or more of the following:


1. Improvement with defecation.
2. Onset associated with a change in frequency of stool.
3. Onset associated with a change in form (appearance) of stool.


Clinical Features

History

Abdominal Discomfort or Pain Discomfort/pain in IBS is typically relieved by defecation, or its onset is associated with an increase or decrease of the stool frequency or with looser or harder stools.

Constipation and Diarrhea

Constipation, diarrhea or mixture of these symptoms is found in patients. Therefore, IBS is classified on the basis of predominant symptom as:


a) Constipation Type -IBS-C
b) Diarrhea Type – IBS-D
c) Mixed Type – IBS-M; where mixed symptoms are found.

The term “constipation” and “diarrhea” can reflect a wide range of different symptom experiences to different patients.


Bloating and Visible Distention

A feeling of bloating is very common. Visible abdominal distention is characteristic more in women then bloating.


Chronicity

Symptoms of IBS are present for at least 6 months; IBS may accompany other chronic disorders such as migraine, backache, impaired sleep, musculoskeletal pain including fibromyalgia, weight loss, acute stress etc.


Pathophysiology

Psychological factors account for 95% in coexisting or causing IBS. Other 5% includes hereditary and altered bowel habits.

Anxiety, depression and stress causes changes in intestinal secretion and permeability responses. Sustained stress is therefore, be important in both onset and persistence of IBS. Stress also leads to production of proinflammatory cytokines which further causes intestinal inflammation leading to IBS.


Risk Factors

IBS can lead to

a) Bacterial gastroenteritis.
b) Poor quality of life i.e depression, anxiety and loathing.
c) Food intolerance/allergies.
d) Extra-intestinal somatic symptoms such as headaches.
e) Gallstones.


Impact on Quality of Life and Costs

IBS impacts quality of life with loss of work and spending more on medicines, investigations and visit to doctors. According to a survey, IBS is the 5th leading disease diagnosis around the world. People suffering from IBS spends 50 % of their income in treating only just the symptoms of IBS, while the root cause persist. Allopathy provides a limited support and drugs cause side effects such as sleeplessness, anxiety and hypertension.


Treatment

Education and Support :
IBS tends to be a life-long disorder and establishing of a strong patient-physician relationship is key to providing best clinical care. Patients perceive their physicians as having a highly negative medical belief about the disorder, and this perception itself impedes best care.
Diet and Lifestyle :
High-fiber diet i.e. highly soluble fiber such as ISPAGHULA (psyllium hydrophilic mucilloid; ispaghula husk).
Fiber is not helpful for pain, but it can benefit constipation and can sometimes firm up loose stools. Fiber supplements should begin at a low dose and be increased very slowly in order to reduce the bloating, gas and pain that are typically aggravated by their use. 3gram every 1 to 2 weeks.
Exercise has been shown to improve symptoms in IBS.
High FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) should be AVOIDED.
A few examples of food sources high in each of the FODMAPs are listed below.
Excess Fructose: Honey, Apples, Mango, Pear, Watermelon, High Fructose Corn Syrup
Fructans: Garlic (in large amounts), Leek, Onion (brown, white, Spanish, onion powder), Wheat (in large amounts), Rye (in large amounts), Barley (in large amounts).
Lactose: Milk, ice cream, dairy desserts, condensed and evaporated milk, milk powder, yoghurt.
Galacto-Oligosaccharides (GOS): Legume beans and lentils
Polyols: Apples, Pears, Plums,Mushrooms.


Medication

1. Anticholinergic and Antispasmodic agents.
2. Laxatives – Does not act on pain.
3. Antidiarrheal agents – Does not act on pain.
4. Serotonin-Receptor Drugs – Induces constipation and burning in anus.
5. Antidepressants and Anxiolytics – Drowsiness and dizziness with dry mouth.
6. Antibiotics – Damages intestinal flora.
7. Probiotics – No possible effect seen, a marketing gimmick.
8. Drugs acting on pain receptors – Palliative therapy.


Role of Advanced Homeopathy

Homeopathy is a popular system of medicine. Homeopathy is based on treating patients with remedies prepared from substances that have been potentized. It was first developed by Samuel Hahnemann in the 18th century in Germany and works on the principle of “like cures like” whereby a substance that would cause symptoms in a healthy person cures those same symptoms in illness.
Homeopathic treatment varies among different practitioners and four main types can be identified:
• Advanced Homeopathy
the type practiced, involving a series of in-depth consultations to assess symptoms, the effects of remedies and other issues that may affect the patient, in order to select appropriate “remedies”. Advanced homeopathy includes both a consultation and a remedy, whereas clinical homeopathy consists of a remedy without the in-depth consultation.
• Clinical Homeopathy
where the same homeopathic medicine is used for a group of patients all presenting with the same clinical condition (e.g. lycopodium for IBS, arnica for bruising). This kind of homeopathy is effective in immediate relief of local symptoms.
• Complex Homeopathy
where a number of different homeopathic medicines are given either in a fixed combination or concurrently.
Among all kinds of homeopathic practices, advanced homeopathy is highly effective and has most desirable results. Nevertheless, it not only relieves symptoms of the disease but improves quality of life by mind-body healing process.
A rightly selected homeopathic medicine based on “Advanced Homeopathy” acts on the Psycho-Neuro-Endo-Immune (PNEI) axis of the individual and auto-corrects the troubled areas found at any level. It evaluates trouble at: a. Psychological i.e. in respect to stress and anxiety leading to IBS.
b. Neurological i.e. in respect to pain and its responses by individual in IBS.
c. Endocrine i.e. in respect to correct any hormonal disturbances and
d. Immune i.e. a lifetime immunity is restored for IBS.
In a nutshell, advanced homeopathy provides an overall solution for IBS with an relief rate of 85% further improving “quality of life”.