The daily disorder of irritable bowel syndrome
“We must clarify – says the also president of the Spanish Society of Gastroenterology – that circumstantial diarrhea, which can distress us for a few days after eating something in bad conditions, or, for example, enduring constipation while traveling, does not are symptoms of irritable bowel. This syndrome it must be chronicendure in time”.
This digestive pathology is located in the small intestine, a tube nine meters long with three parts: duodenum, jejunum and ileum, folded in the lower area of the abdominal cavity, with a smaller diameter than the colon, where they end after swallowed food and drinks.
“The small intestine has an internal surface covered with villi full of cells, where they absorb the majority of nutritional molecules destined for the blood; body fluid that distributes this vital energy, together with oxygen, throughout all human tissues”, he explains.
The waste will pass to the colon, where billions of microorganisms, basically bacteria, benefactors of our health and immune system work for free.
“In this last duct of the digestive tract, of greater caliber, but of shorter length (approximately one and a half meters), food absorption is concluded through the filtering of the intestinal flora. The remains, more liquid or more solid, will be expelled through the anal orifice”, he adds.
Diagnosis and treatment of irritable bowel syndrome
Intestinal problems, at a general level, are often related to three very common symptoms in people: abdominal pain, diarrhea (feces with a significant water content, softer than normal or liquid) and constipation (feces hard, or infrequent or difficult to pass stools).
These symptoms, diarrhea, constipation, or both, with pain, are the root cause of one of the most common stomach problems, IBS or irritable bowel syndrome, a digestive problem suffered by two out of ten people.
“The intensity of these symptoms is very variable, from mild cases, the most common, which barely interfere with the patients’ quality of life, and the disease is tolerated without any problems, to intense cases that are associated with absences from work and not being able to enjoy free time”, emphasizes Dr. from Madaria.
Doctor, Why do up to 20% of people suffer from this intestinal syndrome?
“It is not known with certainty – he answers – but what does seem clear is that there is no single cause that explains all the range of cases that are found in irritable bowel syndrome”, he says.
“Some people develop the syndrome after an acute bacterial or viral gastroenteritis, with severe diarrhea due to the infection; then, when they heal, they are left with intestinal discomfort for life,” he says.
“In other cases, the intestine is more sensitive to pain; for example, with the presence of a certain amount of gas in the intestine that in any other person would not produce any symptoms. This is called visceral hypersensitivity; stomach ache, let’s go”, he declares.
“Also, there are studies that show under the microscope small inflammatory changes in the intestine of some people with the syndrome. In other patients, spasms have been detected in their intestine that produce the corresponding discomfort”, adds the gastroenterologist.
“The relationship between what we eat and digestive discomfort is close; but, again, neither can we prevent all symptoms by controlling what we eat, nor can all symptoms be explained by the composition of the food”.
“In addition, many patients get worse with the intake of foods that produce gas, such as those rich in fiber, milk, legumes, etc.; even so, eliminating foods from the diet without the advice of a doctor and a nutritionist is not at all advisable”.
“Also, one theory proposes that a group of patients develop a series of symptoms by not being able to absorb certain carbohydrates included in food, the FODMAPs (sugars, starches and fibers) when they reach the intestinal digestive phase”.
“In any case, very restrictive diets rarely improve 100% in patients with irritable bowel syndrome, and are sometimes dangerous.”
Dr. Enrique de Madaria Pascual
With this same aim, to unravel the origin of the syndrome, the relationship between the microbiotamicroscopic germs that live in the intestine, and this chronic disease.
“We have verified that some patients have bacterial overgrowth in the small intestine, an area of the digestive tract that should normally have a very low bacterial load,” he says.
“Finally, many times both the pain and the changes in bowel movements worsen with stress… Who does not know students and opponents who suffer from discomfort and diarrhea during exam periods!”, he expresses.
Doctor, So how do you diagnose irritable bowel syndrome?
The diagnosis is based, above all, on observing typical symptoms of this disease, the presence of abdominal pain associated with changes in the frequency and/or shape, appearance and consistency of stool.
“There is no medical test that diagnoses IBS with certainty, on the contrary; what we do is rule out other diseases with similar symptoms: for example, gluten allergy, lactose or fructose intolerance, infections, diseases such as Crohn’s and ulcerative colitis, or thyroid problems,” he explains.
“But the first step is to perform a blood test and rule out infections in the stool, along with a fecal calprotectin test, a marker of a substance that rises in the stool if there is inflammation in the intestine, which is normal to the syndrome,” he explains.
“With the breath tests we analyze the gases that the patient expels when blowing into a tube after taking different substances. They are useful to check intolerance to lactose, fructose or bacterial overgrowth”, he explains.
In this diagnostic sense, it is necessary to review and emphasize that not everyone with irritable bowel syndrome needs an endoscopic study, this will always be decided by the doctor after evaluating each case based on symptoms and signs”, he clarifies.
Of course, some symptoms advise, bluntly, an endoscopy.
“Discard important diseases, such as the presence of blood in the stool, nocturnal diarrhea, progressive abdominal pain or unmotivated weight loss,” he exemplifies.
And once intestinal syndrome is diagnosed, what is the treatment?
“The treatment of IBS is sometimes not easy. There are people who improve a lot with treatment, and others who do not so much and who may feel disappointed. We don’t have a magic formula, and in most patients we try different strategies, seeing how it works best”, he says.
Physical exercise is usually positive for all patients.
In terms of food diets, those who benefit the most are those who suffer from lactose intolerance, fructose or gluten allergy.
“These disorders are different from irritable bowel syndrome, but even so, some IBS patients without such intolerances improve on dairy-free diets, and others on carbohydrate-free diets, the FODMAP media,” he points out.
A minority can also improve without consuming gluten despite not having celiac disease.
“This is a controversial debate between specialists, since sometimes it is more due to the placebo effect, to make the patient believe that his health will improve with a gluten-free diet, than due to the true result of suppressing this very important protein from our diet”, warns
“We must not lose sight of the fact that fiber and other gas-producing foods often worsen the discomfort of IBS, particularly in those who suffer from diarrhea; but we must bear in mind that fibers are useful against constipation”, he underlines.
Doctor de Madaria, Do we have effective medicines against irritable bowel syndrome?
“Medicines should be reserved for treating intense symptoms, as their effectiveness is occasionally small. There are patients who get better with medicines that relieve intestinal spasms and others with medicines that promote bowel movement”, he testifies.
“The discomfort – he continues – can be alleviated with antidepressant drugs, in certain cases, by modulating intestinal sensitivity and hypersensitivity to pain. Antidiarrheals and laxatives are useful to treat diarrhea and constipation”, he points out.
“In addition, antibiotics can be effective in some patients, especially if there is an intestinal bacterial overgrowth”, completes the specialist in the digestive system.
To conclude, doctor, When should you consult a doctor for a person suffering from intestinal pain?
“Whenever women and men suffer from persistent abdominal pain, they should make an appointment with their general practitioner to rule out some type of undiagnosed intestinal disorder, especially if the stools show a strange appearance,” he says.
“No one should have to endure chronic diarrhea and constipation without the help of medicine. Improving our intestinal and evacuation capacity is never too much, on the contrary, it allows us a superior quality of life”, concludes Dr. Enrique de Madaria Pascual.