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"Did
you know?" Quick facts about IBS...
| 1.
Irritable bowel syndrome – or IBS – is a common
problem. Millions of Americans experience IBS every day. Not
everyone who has IBS chooses to see their doctor about it –
but many do. It is estimated that over 10% of visits to primary
care physicians and almost 30% of visits to gastroenterologists
are for IBS. |
10%-15%
of the US population experiences IBS |
| 2.
Information about IBS and how to manage it is available and
helpful. There are steps you can take yourself to manage IBS
which may help you improve your quality of life. These are called
self-care approaches which we describe in this guide to IBS.
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| 3.
If you have IBS, there are ways your doctor can help you. If
you wish for information and assistance from a doctor, you will
want one who understands the condition, its management and follow-up.
In this guide to IBS we include information for you to share
with your doctor. In this guide we have also included some addresses
of websites that may be of help to you as well. |
4.
Making choices that are right for you depend on many factors
–
•
How many symptoms you have, how severe your symptoms are and
how frequently you have them.
• Your individual circumstances and preferences.
• How effective medication might be for you. People
react differently to the same medication – a medication
that works well for one person might not be the best choice
for you – and vice versa. |
5.
Many choices can be used in combination.
We
have put together the following information to help you understand
your options and make treatment decisions. This information
is based on the best research available today that has been
analyzed by scientific and medical experts. Some of these
sections are best shared with your doctor. |
How
We Prepared This Information for You
We have reviewed the medical literature, as of March 2003, to evaluate
the scientific quality of published research studies. We do this
to find the best available evidence so far for the treatment of
IBS.
Medical
research ranges in quality and results. Research is done to try
and find the truth of what will help people. Not every person responds
to treatment in the same way. High quality scientific studies can
best help you and your doctor understand your chances of benefit
and risk.
Poorly
done scientific studies sometimes do get published, even in high
quality medical journals. Using them can result in wrong information
which may mislead you and your doctor about your chances of being
helped or harmed – or to know the right thing to do.
Also
there are many areas in medicine where no good scientific studies
have been done or the results of the studies are weak or contradictory.
When there is no evidence or weak evidence, we are uncertain about
how to best help you learn your chances of what might work for you
or what might put you at risk of harm.
We
use a rating system to tell you how good we believe the research
is or our confidence in the results. (You can read more about our
ranking system in the section, “Delfini Evidence and Usability
Scale,” if you want more detailed information.) We also give
you our interpretation of what we believe the research says.
The
fact that there is little or no evidence, or even uncertain evidence,
does not mean something will not work. It just means we are uncertain
and do not know.
Delfini
Information Quality Ratings
 |
Grade
A – Useful: To the best of our belief, we are
reasonably certain that these research results can be relied
upon as true.
This is the highest quality research we can find. High quality
research helps us feel more certain that the research findings
are actually true. |
 |
Grade
B – Possibly Useful: We are somewhat less certain
that these research results are true.
We have some questions or concerns about the research or results
that keep us from giving it top rating, but we believe it might
possibly be of help. For Grade B evidence, we feel less confident
that the research results can be relied upon. |
 |
Grade
U – Uncertain Usefulness: We are not certain
how true these research results may be.
We have so many questions or concerns about the research that
we feel the research results might not be accurate. This continues
to be an area of medical uncertainty. Lack of evidence, however,
is not proof that a drug or intervention is not effective.
In those instances where there is no evidence of known harms,
you might choose to try certain strategies anyway in case they
are helpful to you. |
Information
About IBS
| Question |
Answer |
Information
Quality |
| What
is IBS? |
- IBS
is a medical condition of the intestinal tract.
- Frequent
symptoms of IBS include abdominal discomfort or pain, urgency
to go to the bathroom, altered bowel habits, gas, bloating,
diarrhea and/or constipation.
- These
symptoms can be in combination.
|
Grade
B
Fair evidence and consensus of medical experts |
| What
causes IBS? |
The
cause of IBS is unknown. Many experts believe that contraction
patterns in the intestinal tract become altered (“out
of sync”) in many patients with IBS, and the abnormal
contractions lead to cramping, pain, diarrhea and constipation.
Not all patients with IBS have abnormal contractions, however.
There
is no evidence that IBS does any damage to the intestinal
tract or other parts of the body.
Worry, stress, anxiety and depression may make the symptoms
of IBS worse, but studies have not shown that stress causes
IBS.
Certain foods appear to make the symptoms of IBS worse and
eliminating certain items from your diet may be helpful —see
“For You & Your Doctor: Information About
Treating IBS” [PDF].
However, diet does not appear to be the cause of IBS.
|
Grade
B
Fair evidence and consensus of medical experts |
| Do
I need blood or stool tests or an examination of my intestines? |
Screening
for colon cancer is a separate issue, and you should discuss
it with your physician. There is no evidence that patients
with IBS have a higher chance of getting colon cancer.
If any of the following are true for you, or if your doctor
wishes to test for any alarm symptoms, he or she will probably
order blood and/or stool tests and may possibly arrange for
an examination of your intestinal tract:
- Age:
Onset age 50 or older
- Any
change in progression or in expected pattern of symptoms
- Unintended
weight loss >5-10 lbs.
- Anorexia
- Vomiting
- GI
bleeding
- Nocturnal
symptoms
- Fever
- Any
signs of infection
- Other
diseases of the colon (e.g., colitis)
- Anemia
- Any
abnormal findings upon exam
|
Grade
B
Fair evidence and consensus of medical experts |
| Can
I treat this condition myself? |
Self-care
can play a role in IBS. See “Self-care Options”
[PDF]
|
Grade U to B
See below in "Self-care Options." |
| Are
there medications my doctor can prescribe for IBS? |
Yes.
If you are suffering from the symptoms of IBS and self-care
is not working, your physician can prescribe medications.
It is important for you to know the benefits, risks and uncertainties
about these medications. See “Physician-directed
Care” [PDF]
|
Grade U to A
Evidence varies from drug to drug:
Uncertain Usefulness to Useful depending on the problem. |
| Where
can I get more information about IBS? |
The
goal of the following websites is to provide useful information
about IBS and other medical conditions, but be aware that there
is great variability in the accuracy, balance and completeness
of the medical information even when it comes from respected
associations and governmental agencies. Sometimes
even poorly done research studies do get published, even in
high quality medical journals or on websites, and using them
can result in wrong information which may mislead you and
your doctor about your chances of being helped or harmed –
or to know the right thing to do.
It
is best that all medical information first be evaluated by
persons who have expertise both in medicine and in scientific
methods before it is used.
National
Library of Medicine’s Medline Plus
http://www.nlm.nih.gov/medlineplus
The
American Gastroenterological Association
http://www.gastro.org
The
American College of Gastroenterology
http://www.acg.gi.org
International
Foundation for Functional Gastrointestinal Disorders
http://www.iffgd.org/
|
All
sites are ungradable —
Accuracy, quality and usefulness of information may vary. |
Quick
Reference Guide about the Scientific Evidence on Treatments for
IBS (see above for quality grades)
| Treatment
Options for IBS |
Abdominal
Pain |
Constipation |
Diarrhea |
Gas
&
Bloating |
| Dietary
Change |
|
|
|
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Herbal
Preparations
STW 5 (9 herbs sold under the name IberogastAA, Steigerwald
Arzneimittelwerk GmbH, Darmstadt, Germany; distributed in the
United States by Enzymatic Therapy, Green Bay, WI [independent
health food stores] and PhytoPharmica, Green Bay, WI [pharmacies
and healthcare professionals]). STW 5 contains bitter candytuft
plant (a.k.a. clown’s mustard; Iberis amara L., Brassicaceae),
German chamomile flower (Matricaria recutita L., Asteraceae),
peppermint leaves (Mentha x piperita L., Lamiaceae), caraway
fruit (Carum carvi L., Apiaceae), licorice root (Glycyrrhiza
glabra L., Fabaceae), lemon balm leaves (Melissa officinalis
L., Lamiaceae), celandine herb (i.e., aerial parts of Chelidonium
majus L., Papaveraceae), angelica root and rhizome (Angelica
archangelica L., Apiaceae), and milk thistle fruit (Silybum
marianum [L.] Gaertn. Asteraceae). |
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Bulking
Agents (Bulking Agents (IBS symptoms may initially worsen)
Psyllium
Wheat bran
Corn fiber
Calcium polycarbophil
Ispaghula husk
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Antispasmodics
(e.g. anticholinergics)
Dicyclomine
Hyoscyamine
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Anti-diarrheals
Imodium (loperamide)
Lomotil (diphenoxylate hydrochloride 2.5 mg with atropine sulfate
0.025mg)
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Range
to
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| Gas-X,
Mylicon (simethicone) |
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Tricyclic
Antidepressants, (TCAs) e.g. –
Nortriptyline (e.g., Pamelor)
Desipramine (e.g., Norpramin)
Amitriptyline (e.g., Elavil)
Doxepin (e.g., Sinequan)
|
|
Caution
is advised when using TCAs in IBS patients with constipation |
|
|
SSRIs
(selective serotonin reuptake inhibitors) e.g. –
Fluoxetine (e.g., Prozac)
Paroxetine (e.g., Paxil)
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Serotonin
Receptor Antagonists for Diarrhea
Lotronex (alosetron)
|
(urgency)
(See
Cautions)
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|
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| Behavioral
Health Interventions |
Grade
B for certain individual symptoms |
Information
About Treating IBS — Self-care Options and Physician-Directed
Care
For
a complete listing of treatment options and for details about specific
treatments, go to the accompanying Delfini
Information & Decision Aid for
Adult Patients and Clinicians [PDF].
We include in this guide information
about dosing, benefits and risks of various treatment choices.
Scientific
Information — About the principles and processes we used to
analyze this information
Most
people think that medical decisions are made very scientifically.
But frequently that is not the case. But many of us are working
to improve this by practicing "evidence-based medicine"
or EBM. We used principles of evidence-based medicine to create
this information on IBS. If you would like to better understand
this, click here to learn more about Evidence-based
Medicine for Consumers and Their Clinicians. We also
describe important information about medications here as well. To
return to this IBS information page, use your BACK
button on your browser.
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