Irritable Bowel Syndrome : Treating IBS

by Food and Drug Administration (FDA)

(Page 3 of 3)

Nearly all people with IBS can be helped, but no single treatment works for everyone. The first step is a personal evaluation of history, stress level and diet. People who can identify particular foods or types of stress that bring on the problem should avoid them. For most, especially those who tend to be constipated, regular physical activity helps keep the gastrointestinal tract functioning normally.

In general, doctors say a normal diet is best. People with abdominal distension and increased gas should avoid beans, cabbage, and other foods that are difficult to digest. Sorbitol, an artificial sweetener used in dietetic foods and in some drugs and chewing gums, should not be eaten in large amounts. Fructose (a common sugar found in fruits, berries, and some plants) should be eaten only in small amounts. A low-fat diet helps some people.

Hoffman spent years eliminating foods from his diet in a desperate effort to relieve the excruciating abdominal pain that gripped him after meals. "I went from cutting certain things out of my diet to cutting the right things out," Hoffman says. Although he's been in remission for five years, he says the awful truth is, "If I eat a bowl of spaghetti, I'll be in pain by tomorrow night."

Mike Hoffman's symptoms of alternating constipation and diarrhea began when he was 8 years old. Through the years, he has tried over-the-counter remedies and some doctor-prescribed medicines, popping as many as 20 pills a day. "By the time I was 40, I was a gastrointestinal cripple." After a bout with IBS, Hoffman says his internal organs would ache for days, as though he'd been beaten with a baseball bat. For the last five years, as long as he eliminates certain foods from his diet, he remains symptom free.

But a substantial number of Americans with IBS have more severe symptoms that often do not respond to dietary or lifestyle changes alone. Drugs that slow the function of the gastrointestinal tract and are considered to be antispasmodics, such as Bentyl (dicyclomine hydrochloride), are frequently prescribed. Antidiarrheal drugs, such as Lomotil (diphenoxylate) and Imodium (loperamide), may help people with diarrhea. Antidepressant drugs, mild tranquilizers, psychotherapy, hypnosis, and behavior modification techniques also may bring relief to some people with IBS. Newer brain imaging techniques could help doctors understand the relationship between altered emotional states with pain enhancement and other gastrointestinal symptoms.

But doctors say the real key to achieving relief is for people to understand that IBS is a complex disorder with physical and stress-related dimensions. A strong partnership between the informed patient and a knowledgeable doctor can help improve outcomes.

"Confidence in the diagnosis and educating and reassuring the patient are vital therapeutic tools," says Edy Soffer, M.D., from Ohio's Cleveland Clinic. People who have not responded to lifestyle changes and careful use of over-the-counter medicines, such as fiber supplements, laxatives and antidiarrheal drugs, should consider being evaluated by a gastroenterologist.

The Future

The FDA and the drug industry currently are developing guidance for clinical trials involving people with IBS that would address many of the safety and effectiveness issues associated with the use of drugs for IBS. Meanwhile, support groups, research organizations, and patient education and advocacy groups, such as the Wisconsin-based International Foundation for Functional Gastrointestinal Disorders (IFFGD), are escalating efforts to educate doctors and patients about the disease.

"IBS patients have lived with a juggling act of symptoms," says Nancy J. Norton, president of IFFGD. "But research is targeting very specific things now, and the most important thing to come out of all this is that people are finally recognizing the burden of illness that's associated with IBS."

Nancy Norton, 51, started having cramps and diarrhea as a teenager. In her 30s, the symptoms plagued her two weeks out of every month. She only learned she had IBS 15 years ago. Norton founded the International Foundation for Functional Gastrointestinal Disorders (IFFGD), a nonprofit organization that provides practical information and the results of clinical studies to people with IBS. IFFGD brings together leaders in gastroenterology to conferences that attract worldwide professionals. "We're making progress, but we need to continue the research. We can't stop," she says.

Once the factors that cause the symptoms and the mechanisms of their production are fully understood, different treatment options will enable people to deal more effectively with the disorder.

What Makes Irritable Bowel Syndrome (IBS) Different?

Understanding IBS is important because it is often confused with other similar digestive disorders, such as inflammatory bowel diseases. Below are the most common digestive disorders, with some characteristic differences that help distinguish one from another.

Functional Intestinal Disorders:

IBS

• affects large intestine (colon or bowel)
• causes abdominal pain, bloating, diarrhea, constipation
• does not cause inflammation
• does not lead to other complications

Dyspepsia

• affects upper abdomen or chest
• causes feeling of fullness, gas, and burning pain
• can be caused by stomach ulcers, stomach inflammation or stomach cancer
• can be early warning of a serious disease

Inflammatory Bowel Diseases:

Crohn's disease

• affects any area of gastrointestinal tract
• causes inflammation sporadically throughout intestine
• causes diarrhea, crampy abdominal pain, loss of appetite, loss of weight, or skin sores
• can lead to other complications, such as intestinal obstruction

Ulcerative Colitis

• affects all or part of only the large intestine
• causes inflammation and ulcers of the large intestine
• causes bloody diarrhea, abdominal cramping, fever
• does not affect the small intestine

About the Author

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