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Gluten-sensitive enteropathy

Treatment of IBS

Since the cause of irritable bowel syndrome hasn’t been identified, only symptomatic treatment is used, which includes:


Diet and nutrition

diet_nutrition_ibsFirst of all, all food should be consumed in 5-6 meals evenly spaced throughout the day. Large meals often cause people with IBS to have diarrhea or cramping. Meals that are high in carbohydrates and low in fat, such as, whole-grain breads, cereals, pasta, rise, vegetables and fruits are good for easing the symptoms.

Foods to avoid if you have irritable bowel syndrome:

  • A number of milk products, first of all including milk, since fermented foods, such as kefir, hard cheeses, and yogurt contain less lactose, so they are better tolerated.
  • Foods high in fat
  • Drinks with caffeine or alcohol
  • Drinks with excessive amount of artificial sweeteners
  • Cabbage, beans, Brussels sprouts, broccoli, peas, cauliflower, bagels, onions, and other foods that usually cause a minor discomfort in a healthy gastrointestinal tract may trigger abdominal pain and bloating in patients with IBS.

Other foods may also cause discomfort, which is why it is a good idea to keep a food diary, in order to remember which products to avoid. People that have IBS with constipation are advised to consume at least 30 grams of fiber per day (or as much as the person can tolerate). Fiber allows for the stool to move easier through the colon, though it might not reduce the pain. It is important to increase fiber intake gradually (by 2-3 grams per day), since too much fiber can cause bloating and gas.

If the high-fiber diet fails and the patient continues to experience bloating, gas, or diarrhea, a FODMAPS elimination diet is advised. FODMAPS is a short for fermentable oligo-, di-, and monosaccharides and polyols. This diet excludes a number of carbohydrates, including galactans, sugar alcohols, fructans, fructose, and lactose, from the diet. A dietitian should be consulted to create a diet that is suitable for you but excludes all these carbohydrates. If the FODMAPS carbohydrates were the cause of IBS, then the symptoms will quickly disappear in just a couple of days. Then the FODMAPS carbohydrates are gradually introduced back into the diet to find out which one causes the IBS. This way a person can find out the exact type of carbohydrates to exclude from the diet to keep the symptoms of IBS at bay.

Gluten-free diets seem to be popular among people with IBS. However, that might be the case because glutted-free diet excludes wheat, which contains fructans (one of the FODMAPS carbohydrates).

Foods that are usually tolerated quite well by people with IBS include reduced-lactose or lactose-free products; small servings of citrus fruits and berries, corn products, oats, rice, and potatoes; poultry, fish and lean meat; plant-based oils and salad vegetables. Maple syrup and small servings of granulated sugar can be used as sweeteners. Keep in mind that even the foods that are forbidden can be eaten in very small quantities.

Unfortunately, many people with IBS notice that the “healthier” they eat (by including whole grains, vegetables, and milk into their diet) the worse they feel. This can cause a person with IBS to develop mineral and vitamin deficiencies. This is the reason why the diet should be constructed by an experienced dietitian.


Medications

medicationsDepending on the symptoms the patient has, the medical practitioner will prescribe different medications:

  • Fiber supplements – if the patient has constipation, it is recommended to gradually increase the daily fiber intake. Fiber supplements come in many different flavors and forms, including chewable tablets, capsules, wafers, and powders. Fiber supplements are created by isolating or extracting “functional” fibers from plants and animals. Most common functional fibers include:
  1. Psyllium – is used mainly to treat symptoms of irritable bowel syndrome and constipation of different genesis.
  2. Oligofructose and inulin – stimulate growth of “good” bacteria and improve the gastrointestinal health.
  3. Other functional fibers include acacia fibers, fructooligosaccharides, resistant dextrins, polydextrose, beta-gucans, methylcellulose, cellulose, chitosan, pectin, and guar gum.
  • Laxatives – if additional fiber doesn’t help with constipation, the doctor may resort to using laxatives to help the patient.
  • Loperamide – is a medicine used to reduce diarrhea (antidiarrheal) in patients with irritable bowel syndrome. However, it does not reduce bloating, pain, and other symptoms. This drug acts by slowing down the peristalsis of the intestine, decreasing the number of stools per day.
  • Antispasmodics – reduce the abdominal pain that is caused by colon muscle spasms.
  • Antidepressants – low doses of selective serotonin reuptake inhibitors and a number of tricyclic antidepressants relieve many symptoms of IBS including abdominal pain. Some studies suggest that tricyclic antidepressants are better for patients with irritable bowel syndrome with diarrhea, while selective serotonin reuptake inhibitors are recommended for patients with constipation. TCAs alleviate the symptoms of IBS by normalizing gastrointestinal secretion and motility, and by reducing the patient’s sensitivity to pain.
  • Lubiprostone and Linaclotide – are drugs used by patients with IBS-C, since it decreases the severity of constipations and reduces the abdominal pain.
  • Antibiotics – sometimes wide-spectrum antibiotics help decrease the symptoms of IBS by treating bacterial overgrowth in the small intestine. Antibiotics should be used selectively, since bacterial overgrowth is not always the cause of IBS.

It is important to know that excess fiber can bind magnesium, calcium, zinc, and iron, which can create their deficiency. Also, guar gum and pectin are known for reducing the absorption of lutein, lycopene, beta-carotene, and carotenoids. However, if the person consumes the recommended dose of fiber (35 grams/day for men and 25 grams/day for women), then there is very little chance that there is going to be a problem with nutrient absorption.


Probiotics

probioticsProbiotics are an array of live microorganisms that are usually found in the gastrointestinal tract. Researchers have found that large doses of probiotics help to treat symptoms of IBS. Probiotics come in the form of tablets, capsules, powders, and in some foods (however, the concentration of “good” bacteria in yogurts and similar products is not nearly enough to reach the large intestine without getting destroyed by the stomach acid, making them useless).

Usually probiotics are used after the person is treated using antibiotics, because antibiotics kill the beneficial bacteria along with the harmful bacteria within the gastrointestinal tract. This can lead to yeast infections (normally the yeast spores are suppressed by the good bacteria within our gut), diarrhea, and maldigestion. Probiotics are also used to treat intestinal inflammation, urogenital infections, diarrhea, and allergies; however, the results remain inconclusive.

In order to successfully pass the stomach, the good bacteria are placed within capsules that dissolve only when the pH is above 7-8 (which happens in the intestine). Alternatively, probiotics can be used in very high doses to ensure that some of the bacteria will survive the stomach’s acid and get to their destination.

Another method of introducing good bacteria to the intestine of the patient is fecal bacteriotherapy, otherwise known as fecal microbiota transplantation (FMT). It is a process during which fecal bacteria are transplanted from a healthy person to the recipient. This procedure has proven to be highly effective in comparison to probiotics.


Therapy for mental health problems

talk therapy

  • Talk therapy – can be used to relieve stress and decrease the symptoms of IBS. Interpersonal (psychodynamic) and cognitive behavioral therapy can be used to treat IBS. Cognitive therapy is more recognized throughout the world and is focused on actions and thoughts of the person. Psychodynamic therapy is focused on emotions that affect symptoms of IBS.
  • Cognitive therapy – is mainly focused on developing skills to modify beliefs, identify distorted thinking, and changing behavior. This type of therapy is often used by people with accentuations of character or personality disorders. These conditions are practically untreatable any other way and very often lead to a huge amount of stress. By identifying the distorted thinking and working on a new ways of viewing life, the patient is able to reduce the levels of stress and as a result reduce the symptoms of IBS.
  • Hypnotherapy is useful in relieving the pain associated with muscle tension. However, this technique will be most beneficial to non-analytical people (all people are divided into analytical and non-analytical depending on the type of hypnosis they respond to). Regretfully, analytical people are unable to go into a stage of hypnosis where analgesia can be achieved.
  • Mindfulness training – is a technique that came to us from Buddhism. It consists of focusing the attention on all the sensations that are occurring at the moment, while avoiding thinking too much about them (there is simply not enough room in our head to keep track of all the sensations and to think about them at the same time).


Prognosis

Irritable bowel syndrome is usually a lifelong condition. For some people the symptoms are so severe that they impede the ability to travel, work, and attend social events.

Treatment can greatly relieve the symptoms of the IBS.

IBS does not lead to any complications, does not harm the intestine and is not associated with cancer.