Dyspepsia, Irritable Bowel Syndrome (IBS) By Dr. Sanjiv Haribhakti What is dyspepsia? Dyspepsia means indigestion which manifests itself as bloating, abdominal distension or fullness especially after meals, which can also lead to decrease in appetite. This affects a large number of people around the world. What are the causes of dyspepsia? This is a very common problem encountered in today’s world, due to sedentary lifestyle and unhealthy eating habits. Unhealthy eating habits include eating large volumes of food at a quick pace without adequately chewing the food, unable to reduce volume of food as age advances, eating fatty, spicy and oily food, eating a lot of fried and sweet food and beverages. Sedentary habits include absence of regular exercises, too much dependence on vehicles and machines for routine use i.e. excessive use of lifts for climbing 1-3 storeys, absence of sporting activities, laziness by nature to walk or perform household activities. What are the symptoms of dyspepsia? Symptoms of dyspepsia mainly include upper abdominal bloating or gassy feeling which sometimes can escalate to dull pain and stretching pain in the abdomen. Frequently this is associated with excessive passage of gas as burps, or excessive flatulence or uncommonly as hiccoughs. Some patients also experience nausea and have to induce vomiting rarely. Dyspepsia may be a manifestation of underlying acid peptic disorder such as gastritis, pylori infection, GERD or even peptic ulcer. Such patients would need to have an upper GI Endoscopy test to rule out organic disorder of this form. Dyspepsia can rarely be due to gallstones or inflammatory bowel diseases (IBD). Once all these disorders are ruled out, such dyspepsia can be labelled as functional dyspepsia. How can dyspepsia be treated? Dyspepsia is best treated by altering lifestyle and dietary habits in the long term. Immediate relief can be obtained by antiflatulent agents or prokinetic agents which increase the gastric motility. This agents are available in chewable form which can give instant relief. People are encouraged to walk which also helps in expelling excess gas. Herbal medicines in form of pudinhara may also give some relief. How can functional dyspepsia be prevented? The best way to prevent dyspepsia is to change dietary and lifestyle habits. People are encouraged to take consume small meals in divided proportions rather than large meals. They should cut down on excess oil, ghee and butter in their diet. Some people develop such symptoms after consuming sprouts and beans are advised to avoid them or restrict their usage. Excessive spicy food, restaurant food as well as fatty food is best avoided by such people. They are encouraged to pursue an active lifestyle with regular periods of exercise for long term prevention. Overweight persons are advised to loose weight. What is Irritable Bowel Syndrome (IBS)? Irritable bowel syndrome (IBS)is a functional disorder of the intestine and is a symptom-based diagnosis. It is characterized by chronic abdominal pain, discomfort, bloating, and alteration of Dr. Sanjiv Haribhakti
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bowel habits. Diarrhoea or constipationmay predominate, or they may alternate (classified as IBSD, IBS-C, or IBS-A, respectively) What are the cause of IBS? As a functional gastrointestinal disorder, IBS has no known organic cause. The most common theory is that IBS is a disorder of the interaction between the brain and thegastrointestinal tract.For at least some individuals, abnormalities in the gut bacterial flora occur, and it has been theorised that these abnormalities result in inflammation and altered bowel function. The stress response in the body involves thesympathetic nervous system, which has been shown to operate abnormally in IBS patients. How is IBS classified? IBS can be classified as either diarrhoea-predominant (IBS-D), constipation-predominant (IBS-C), or with alternating stool pattern (IBS-A) or pain-predominant. How can we make a diagnosis of IBS? The primary symptoms of IBS are abdominal pain or discomfort in association with frequent diarrhoea or constipation and a change in bowel habits. There may also be urgency for bowel movements, a feeling of incomplete evacuation (tenesmus), bloating, or abdominal. In some cases, the symptoms are relieved by bowel movements. Up to 60% of people with IBS also have a psychological disorder, typically anxiety or depression. The Rome III criteria for the diagnosis of irritable bowel syndrome require that patients have had recurrent abdominal pain or discomfort at least 3 days per month during the previous 3 months that is associated with 2 or more of the following: 1. Relieved by defecation 2. Onset associated with a change in stool frequency 3. Onset associated with a change in stool form or appearance No specific laboratory or imaging test can be performed to diagnose irritable bowel syndrome. Diagnosis involves excluding conditions that produce IBS-like symptoms, and then following a procedure to categorize the patient’s symptoms. Ruling out parasitic infections, lactose intolerance, small intestinal bacterial overgrowth (SIBO), celiac disease and inflammatory bowel disease (IBD) is recommended for all patients before a diagnosis of irritable bowel syndrome is made. How is IBS treated? Although no cure for IBS is known, treatments to relieve symptoms exist. These include dietary adjustments, medication, and psychological interventions. Patient education and good doctor– patient relationships are also important.Dietary measures that have been found to be effective include increasing soluble fiber intake. IBS has no direct effect on life expectancy. It is, however, a source of chronic pain, fatigue, and other symptoms, and contributes to work absenteeism.It is common and its effects on quality of life make it a disease with a high social cost.Psychiatric disorders such as anxiety and major depression are common in IBS. Diet – A diet restricted in fermentable oligo – di and monosaccharides and polyols (FODMAPs) now has an evidence base sufficiently strong to recommend its widespread application in conditions such as IBS andIBD.70% of people benefit from low FODMAP diet for managing IBS when other dietary and lifestyle measures have been unsuccessful. This diet restricts various carbohydrates as well as fructose andlactose, which are poorly absorbed in the small intestine. No evidence indicates digestion of food or absorption of nutrients is problematic for those with IBS at rates different from those without IBS. However, the very act of eating or drinking can provoke an overreaction of the gastrocolic response in some patients with IBS owing to their increased visceral sensitivity, and this Dr. Sanjiv Haribhakti
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may lead to abdominal pain, diarrhoea and/or constipation. Fiber – Some evidence suggests soluble fiber supplementation (e.g. psyllium/isapgula husk) is effective. It acts as a bulking agent, and for many IBS-D patients, allows for a more consistent stool. For IBS-C patients, it seems to allow for a softer, moister, more easily passable stool. Laxatives – For patients who do not adequately respond to dietary fiber, osmotic laxatives such as polyethylene glycol, sorbitol, and lactulose can help avoid “cathartic colon” which has been associated with stimulant laxatives. Medicationsmay consist of: • Stool softeners andlaxativesin IBS-C and anti-diarrhoeals (e.g., opiateor opioid analogs such as loperamide, codeine, diphenoxylate) in IBS-D. • Serotonin stimulates the gut motility and so agonists can help constipation-predominate irritable bowel, while antagonists can help diarrhoea-predominant irritable bowel. • Selective serotonin reuptake inhibitors, SSRIs, frequently prescribed for panic and/or anxiety disorder and depression, affect serotonin in the gut, as well as the brain. • Antispasmodicdrugs (e.g., anticholinergicssuch as hyoscyamine or dicyclomine) may help patients, especially those with cramps or diarrhoea. • PPIs used to suppress stomach acid production may cause bacterial overgrowth leading to IBS symptoms. Discontinuation of PPIs in selected individuals has been recommended as it may lead to an improvement or resolution of IBS symptoms. • Strong evidence indicates low doses oftricyclic antidepressants can be effective for IBS. • Rifaximin can be used as an effective treatment for abdominal bloating and flatulence,giving more credibility to the potential role of bacterial overgrowth in some patients with IBS. • Domperidone, a dopamine receptor blocker and a parasympathomimetic, has been shown to reduce bloating and abdominal pain as a result of an accelerated colon transit time. • Psychological treatment strategies such as cognitive behavioural therapy [CBT], hypnotherapy and/or psychological therapy.Reducing stressmay reduce the frequency and severity of IBS symptoms. Techniques that may be helpful include relaxation techniques such as meditation, Yoga, Pranayama and regular exercise such as swimming, walking, or running. • Probiotics – may exert their beneficial effects on IBS symptoms via preserving the gut microbial flora, improving the intestinal transit time, and by treatingsmall intestinal bacterial overgrowth of fermenting bacteria. Author- Dr Sanjiv Pravin Haribhakti is a well known, senior and qualified GI surgeon from Ahmedabad, India, practicing for 18 years. He is the First M.Ch. GI surgeon of Western India. He is an avid academician and is an editor of textbook – “Haribhakti’s Surgical Gastroenterology”, and has produced “DVD Atlas of Laparoscopic GI Surgery” for surgeons. He has successfully treated more than 40,000 patients and operated on more than 9,000 patients till date. For more information, Visit at Gisurgery.info Source- https://sanjivharibhakti.wordpress.com/2015/06/12/dyspepsia-irritable-bowel-syndromeibs/
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