What are the causes of IBS? What is its impact on life expectancy or the quality of life?
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Dr Pere Clave
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The pathogenesis of IBS is not fully understood and involves the interaction between genetics and external factors that may alter bowel physiology, mainly motility and sensation, changes in mucosal permeability, enteric microbiota and microinflamation. It may also may alter the psychosocial profile of subjects and their susceptibility to gut dysfunction and symptoms through connections between the enteric and central nervous system, the brain-gut axis. Therefore, the symptoms of the patients with IBS are caused by motility disorders, by alterations in perception and visceral hypersensitivity, and also by psychological and psychosocial factors. IBS causes severe symptoms in 25 per cent patients and is associated to impaired quality of life and high healthcare costs as patients with IBS visit many physicians and are submitted to multiple explorations before a proper diagnosis and treatment of the condition.
What is the incidence rate of this disease? How susceptible are Indians to this disorder?
IBS as a chronic functional bowel disorder in which abdominal pain or discomfort is associated with a change in bowel habit and clinical symptoms of disordered defecation or distention. The prevalence among general population is high (up to 25 per cent), mainly in females (3 females/1 male). Studies found similar prevalence among countries and ethnic groups.
What can be done to prevent the onset of this disease? Are there any lifestyle changes needed?
Some patients develop IBS following an acute episode of acute gastroenteritis; however the majority present a more insidious onset of IBS symptoms. IBS is a chronic and relapsing disease, and the natural history of the condition is characterised by cyclic periods of symptoms over time and, in addition, a significant group of patients with IBS develop symptoms of other functional gastrointestinal disorders such as dyspepsia or gastroesophageal reflux. Studies found a significant increase in the stressors (daily hassles, stress, stress coping styles, changes in eating habits, reduction in sleeping time or psychological abuse) score just before relapses than earlier average scores.
How can it be diagnosed? Are there any tests that help to do it?
The first step of the diagnosis is to identify the symptom complex of IBS. This can be done by using the international criteria that have evolved in the last 30 years from Manning criteria to the Rome criteria and now the Rome III criteria. The Rome IV version is now in preparation. The second step is to identify alarm features and exclude organic diseases, which have similar clinical presentations, mainly inflammatory bowel diseases and malabsorptive diseases in young patients, and colon cancer in middle aged patients.
The Rome III criteria appeared in 2006 and the IBS symptom complex is defined by recurrent abdominal pain or discomfort associated with two or more of the following symptoms: a) improvement with defecation; b) onset associated with a change in frequency of stool, and c) onset associated with a change in form of stool. The diagnosis of IBS requires symptoms during the last three months and onset in the previous six months. The experience with the Rome criteria has demonstrated that IBS is a safe diagnosis and patients diagnosed with this condition seldom suffer an organic disease during follow up.
The likelihood of diagnosing an alternative GI organic disease during prolonged follow-up of IBS patients is very low, two to five per cent during the six year follow-up, and 2-9 per cent at the 30 year follow-up.
How can it be cured or managed? What are the challenges in handling this disease effectively?
In patients with mild symptoms, a positive diagnosis of IBS can be established using the Rome III criteria and a therapeutic trial guided by primary symptom characteristics should be maintained several (8-12) weeks. It includes fibre and osmotic laxatives in patients with constipation, antidiarrheal agents in patients with diarrhoea, as well as antispasmodic drugs and smooth muscle relaxants in patients with pain and bloating. This therapeutic trial is a very relevant step in management of IBS and up to 75 per cent patients will present mild symptoms and respond to treatment.
Who are more susceptible to this disease? (age group, social strata, etc) Is it a hereditary condition?
Overall, there is very limited evidence of a genetic association with IBS; the most replicated association is with some genes potentially involved in the minimal degree of inflammation and changes in gastrointestinal mucosal permeability. So, in most patients IBS in ‘NOT’ a hereditary condition.
Any new treatments or drugs that assist in treating the condition more effectively?
I’m visiting India to explain a new study with the compound otilonium bromide. The OBIS study is an International, phase IV, randomised, double blind, parallel group, and placebo-controlled study that were performed following the regulations of the European Medicines Agency. The OBIS study was conducted in 38 centres in 8 European countries including 356 adult patients of both genders diagnosed of IBS. This placebo-controlled double-blind study shows that otilonium bromide is safe, well tolerated and superior to placebo in reducing the frequency of abdominal pain, severity of abdominal bloating and protecting from symptom relapse in IBS. These results further confirm that patients with IBS can improve during and following treatment with otilonium bromide.
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