Irritable bowel syndrome

Irritable bowel syndrome (IBS) is the most common disease, affecting approximately 10-20% of the world's population.

IBS is defined as a functional disorder of the intestine, manifested by recurrent abdominal pain that occurs at least once a week and is associated with defecation, as well as with changes in the frequency and shape (appearance) of the stool. Symptoms of the disease should be noted in the patient for the last 3 months with a total duration of at least 6 months.

• According to most studies, women experience IBS symptoms 1.5-3 times more often than men.
• The average age of patients is 30-40 years.
• About 2/3 of IBS patients do not seek medical help.

IBS is not a psychiatric or psychological disorder. However, psychological factors can play a significant role in the development of symptoms and affect their severity, and therefore significantly worsen the quality of life, prompting patients to often seek medical help. The most common psychological disorders in IBS include anxiety, depression, somatization, hypochondria, obsessions, and fears.

In patients with IBS, the leading symptom is abdominal pain, which is formed as a result of a violation of the interaction between the intestine and the brain, which leads to a change in the regulation of intestinal motor function and the development of visceral hypersensitivity (HHV).

HCV is detected through the use of a balloon-dilation test, which involves the introduction of a latex balloon into the rectum, which is gradually filled with air. According to the level of appearance of unpleasant sensations during the test, the degree of HHF is characterized.

Irritable bowel syndrome is diagnosed only if the symptoms meet the requirementsThe Rome Consensus-IV (2016) and the absence of specific causes of the disease, making it a diagnosis of exclusion. 

It is important to note that IBS can be a consequence of a previous infectious disease, which also requires monitoring.

Classification

The classification is based on changes in both the frequency and consistency of the stool according to the Bristol Scale.

There are four variants of IBS:

1.      IBS with constipation-hard or rough stools ≥ 25% and relaxed (mushy) or watery < 25 % of the number of bowel movements.

2.      IBS with diarrhea - mushy or watery stools ≥ 25 % and hard or rough stools ≤ 25 % of the number of bowel movements.

3.      IBS mixed-hard or rough stools ≥ 25 % and mushy or watery stools ≤ 25 % of the number of bowel movements.

4.      Unclassifyedsc-insufficient severity of deviations in the consistency of the stool for the mixed variant.

Clinical manifestations:

1. IBS with a predominance of diarrhea - loose stools from 2 to 5 times a day, more often in the morning, accompanied by pain, bloating, which decreases after the discharge of gases and bowel emptying,
2. IBS with a predominance of constipation - absence of stool for three or more days, defecation may be accompanied by abdominal pain, flatulence, subsiding after defecation and gas discharge; the act of defecation is accompanied by straining.
3. IBS mixed-hard or rough stools ≥ 25 % and mushy or watery stools ≤ 25 % of the number of bowel movements.
4. Unclassifiable IBS - insufficient severity of deviations in the consistency of the stool for the mixed variant.

Symptoms that exclude the diagnosis of IBS (symptoms of anxiety, " red flags»):

1. complaints about: unmotivated weight loss, fever, nocturnal diarrhea, blood in the feces, constant intense abdominal pain as the only leading symptom of gastrointestinal tract damage;
2. the onset of the disease in old age;
3. colon cancer in relatives;
4. increased ESR, leukocytosis, signs of anemia in laboratory tests.

Differential diagnosis should be made with celiac disease, lactase deficiency, chologenic diarrhea, intestinal infections, helminth infestations, inflammatory bowel diseases, diverticular colon disease, tumors, chronic pancreatitis, etc.

Treatment

Complete recovery from the disease is difficult due to the fact that, as a rule, it is caused by a complex of causes.

Many people who have been diagnosed with IBS gradually get used to their symptoms and are treated independently, or adjust their lifestyle so that the disease would not interfere with it.

However, the disease should not be ignored, and symptomatic therapy of the disease is more than desirable. 

In IBS, treatment is often conservative. It can include both medicinal and non-medicinal methods.

Non-drug methods include diet. 

The main groups of drugs:

• Antispasmodics
• Antidiarrheal agents (for a variant of the disease with persistent diarrhea)
• Laxatives (for the constipated version)
• Enterosorbents
• Nonabsorbable antibiotics
• Intestinal microflora regulators (probiotics and prebiotics)
• Antidepressants

In order to determine which treatment plan is preferable in a particular case, you should consult a doctor.