Irritable bowel syndrome , also known as IBS , is a common condition of the gastrointestinal tract (GI) tract that results in symptoms of constipation, diarrhea, gastric upset, and bloating. With constipation being the most common symptom. Although the exact cause of IBS is unknown, it believed to have a genetic component and is found more often in women and those with a western diet. Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders. Worldwide around 11.2% of people have IBS. One risk factor for IBS is a western diet that includes processed foods. For this reason, IBS is much more common in the western world. It is estimated that 10-20% of the population in the Western World have IBS, while only 6.5-10.1% of people in Asian countries. IBS also occurs more often in women and between the age of 18-50 years old. Risk Factors for Irritable Bowel Syndrome Age:  IBS is seen in all age groups, but typically occurs in the first half of life. Around 50% of patients with IBS report having symptoms before the age of 35 years and most sufferers are typically between the age of 18-50. Sex:  Women are at higher risk for IBS than men.

IBS is diagnosed based on patient reported symptoms and stool patterns. According to guidelines these criteria, patients with IBS patients will have the following symptoms: Must Have Abdominal discomfort at least 3 days per month in the last 3 months Along with some or all of these change in either frequency or form of stool abdominal discomfort that improves after going to that bathroom passage of mucous in stool The following tests are used to confirm or rule out diagnosis Hydrogen breath test (HBT),  is a non-invasive test used to for small intestinal bacterial overgrowth called H.pylori. H.pylori is often thought to be related to IBS symptoms. Stool analysis, is a non- invasive test to rule out bleeding, parasites, etc Blood tests, invasive test where needle is inserted into the vein and blood sample is removed. WBC (abnormal WBC would indicate possible infection) Sed rate ( abnormal would indicate possible inflammation). Most of the time IBS will not test positive for these two. Colonoscopy, is an invasive test where they insert a small camera into the anus and view the lower intestines.

Symptoms of Irritable Bowel Syndrome Symptoms of IBS vary per case but can include some combination of the following Chronic abdominal pain and discomfort Frequent loose watery stools (diarrhea) Infrequent hard to pass stools (constipation) Bloating If you experience these symptoms see your medical provider. These symptoms can also be related to other gastric disorders and even colon cancer. In addition, IBS patients suffer from multiple comorbidities such as dyspepsia, fibromyalgia, gastro-esophageal reflux disease, interstitial cystitis, chronic fatigue, chronic back pain, insomnia, and headache/migraine. A strong association of psychiatric disorders occurs in IBS patients suggesting the role of psychological factors in the etiology of IBS. Types of Irritable Bowel Syndrome The pathophysiology and underlying mechanisms of IBS are not clearly understood. BS appears to be multi-factorial. Some factors thought to play a role in the development of IBS include infectious gastroenteritis, altered gut motility, inflammation, altered gut microbiome, hypersensitivity, altered gut immune responses, food intolerance, and dysregulated gut-brain axis. There are three main types of IBS, which are based on stool formation. Although some patients will not fall into any of these three categories and will be “unclassified.” Constipation-predominant Irritable Bowel Syndrome Majority of stools are hard or lumpy Minority of stools are loose/mushy or watery Diarrhea-predominant Irritable Bowel Syndrome Majority of stools are loose/mushy or watery Minority of stools are hard or lumpy Mixed-Irritable Bowel Syndrome Equal amount of loose/mushy and hard or lumpy stools

What is Gut-brain axis (GBA)? The gastrointestinal tract communicates bi-directionally with the central nervous system (CNS) by means of enteric nervous system or the ENS(also called the GI brain), the autonomic nervous system (ANS), the neuroendocrine (HPA axis), and neuroimmune systems. This communication is responsible for many important physiological processes such as gut motility, regulation of digestive processes, modulation of the gut-associated immune system, secretion, visceral sensations, and control of bowel movements. The third arm of the gut- brain communication is the gut microbial community. The role of gut bacteria in mediating changes in the brain is exemplified by a study where the introduction of a pathogen Citrobacter rodentium induced anxiety-like symptoms that were likely mediated by the vagus nerve. Gut microbes are known to release neurotransmitters such as serotonin, which is responsible for the feeling of well-being and happiness. Gut microbiota interacts with the CNS via the vagus nerve.  It is the interplay between the GI system, the CNS and the gut microbiota that forms the basis of gut-brain axis. Gut-brain axis in Irritable Bowel Syndrome Homeostasis in the gut-brain axis is critical to gastrointestinal tract physiology and also for a balanced emotional state. Disruptions in the gut-brain communication have been considered as one of the underlying mechanisms of IBS and manifestation of comorbid physiological conditions.

Treatment of Irritable Bowel Syndrome with Medications Probiotic: are “good bacteria” that are normally found in the GI tract.  Many studies have investigated the efficacy of probiotics in IBS patients, which is why it is considered a staple in the treatment of IBS. However, there is a discrepancy in factors such as bacterial strain, dose, dosage form. Probiotics can be found in food or taken in pill form. Talk to your medical provider before starting on Probiotics. Antispasmodics Help reduce cramping No clinical evidence of effectiveness Medications To Modify Bowel Habit Imodium for uncontrollable diarrhea Increased fiber and stool softeners for constipation Antibiotics Have been commonly used in treatment of IBS Typical antibiotics include neomycin, metronidazole, amoxicillin, and rifaximin. Rifaximin has been found very effective at improving symptoms of diarrhea-predominant IBS. Patients with H.Pylori who are treated with rifaximin reported no only sure of H.pylori, but improvement in IBS symptoms. Alternative medicine Peppermint oil for gi upset Treatment of Irritable Bowel Syndrome with Lifestyle Remedies Most cases of IBS are mild and treatment is focused on diet and lifestyle changes. Diet: There are many diets aimed at reducing IBS symptoms. IBS patients often complain that their symptoms worsen upon consumption of certain types of foods.