| "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.
|
| 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 and updated
it as noted above, 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
To access, copy the following into an internet search engine: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 |
|
|
|
|
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). |
|
|
|
|
Bulking
Agents (Bulking Agents (IBS symptoms may initially worsen)
Psyllium
Wheat bran
Corn fiber
Calcium polycarbophil
Ispaghula husk
|
|
|
|
|
Antispasmodics
(e.g. anticholinergics)
Dicyclomine
Hyoscyamine
|
|
|
|
|
Anti-diarrheals
Imodium (loperamide)
Lomotil (diphenoxylate hydrochloride 2.5 mg with atropine sulfate
0.025mg)
|
|
|
Range
to
|
|
| Gas-X,
Mylicon (simethicone) |
|
|
|
|
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)
|
|
|
|
|
Serotonin
Receptor Antagonists for Diarrhea
Lotronex (alosetron)
|
(urgency)
(See Cautions)
|
|
|
|
| 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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