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Irritable Bowel Syndome

IBS: There is hope for those suffering from this often debilitating condition.

Matt Evans, Clinical Psychologist, has worked for several years in a specialist gastroenterology outpatient clinic providing psychological support services for people with Irritable Bowel Syndrom (IBS). Below he writes about what he has learned along the way.

There is hope for people suffering from IBS. Over the last decade, the evidence has mounted to support a variety of different pharmacological, non-pharmacological and psychological treatments to help with the management of this condition. Unfortunately, health professionals, sufferers and the general public are not fully aware of this evidence and IBS remains often misunderstood.

There are probably many people with IBS who could be feeling better, but, without the knowledge of some of these more recent findings, haven’t had the opportunity to access the kinds of supports that we now know might help. Below are a few findings that are well-worth knowing about and considering for people with IBS.

First, IBS is not as rare as some people might think. It has been found to affect about 1 in 10 Australians, although more than that suffer from unexplained gastrointestinal symptoms1. It is important to identify these problems to then access the appropriate treatments.

Second, the severity and impact of IBS varies from one individual to another; from quite manageable to almost intolerable. Despite this variation, studies have found that IBS has a significant impact on health-related quality of life with issues such as low energy/fatigue, role limitations caused by physical health problems, bodily pain, and negative general health perceptions being common consequences 2,3,4.

Third, IBS has clearly defined diagnostic criteria called the Rome criteria. In the past, clinicians tended to rule out all other possibilities before diagnosing IBS. This often involved lots of tests and procedures. With better definitions of IBS symptoms and improved identification of IBS, the need for extensive testing has decreased5,6. If concerned, see a doctor familiar with diagnosing IBS.

Fourth, it was originally thought that IBS was “psychosomatic”, which means caused by psychological distress. More recent research findings show that this is not the case. Although the exact cause of IBS not been identified, studies have now found reliable biological markers for the condition7. However, psychological distress does appear to make symptoms worse in people with IBS. Often distress about IBS symptoms can make those symptoms worse leading to more distress. Psychological treatments aim at helping patient break this “vicious cycle”.

Finally, it is no longer the case that there is nothing that can be done to help alleviate the symptoms of IBS. It is true that IBS is a chronic disease, in that it is ongoing and there is no cure. However, there exist several pharmacological and non-pharmacological treatments that have been shown to significantly help manage the symptoms and improve quality of life8,9.

There is also increasing research showing that psychological interventions can be effective. Despite not knowing exactly how they work, psychological interventions do seem to work in improving quality of life in people with IBS. Psychological interventions often recommended include cognitive behavioural therapy, psychodynamic psychotherapy and hypnotherapy.

The American College of Gastroenterology, following their review of the research evidence for the treatment of IBS concluded, “use of psychological therapies can be strongly recommended for most patients in most circumstances”11 It is, of course, vital to have IBS properly assessed, diagnosed and medically treated. Psychological treatments can also offer added benefits that complement these medical treatments, providing further hope for people suffering with IBS.

References:

1 Lovell RM, Ford AC (2012). Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol , 10:712-21.

2 Gralnek IM, Hays RD, Kilbourne A, Naliboff B, Mayer EA (2000). The impact of irritable bowel syndrome on health-related quality of life. Gastroenterology. Sep;119(3):654-60.

3 Chang L. (2004). Review article: epidemiology and quality of life in functional gastrointestinal disorders. Aliment Pharmacol Ther. Nov;20 Suppl 7:31-9.

4 El-Serag HB (2003) Impact of irritable bowel syndrome: prevalence and effect on health-related quality of life. Rev Gastroenterol Disord.;3 Suppl 2:S3-11.

5 Ford AC, et al. (2008).Will the history and physical examination help establish that irritable bowel syndrome is causing this patient’s lower gastrointestinal tract symptoms? JAMA, 300:1793-1805.

6 Ford AC, et al. (2009) Yield of diagnostic tests for celiac disease in subjects with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis. Arch Intern Med, 169:651-58.

7 Ford AC, Talley NJ. (2011). IBS in 2010: advances in pathophysiology, diagnosis and treatment. Nat Rev Gastroenterol Hepatol, 8:76-78.

8 Brandt et al. (2009). An evidence-based systematic review of the management of IBS. The American Journal of Gastroenterology, 2009, vol 4, supp 1, s1-s25

9 Johannesson E, Simrén M, Strid H, Bajor A, Sadik R. Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol 2011;106:915-22.

10 http://s3.gi.org/patients/ibsrelief/treatmentmatrix/treatment_matrix.pdf, pg2

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