Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome is one of the most common functional disorders of the gastrointestinal tract and affects a great many people.
Irritable bowel syndrome is a chronic bowel disease in which symptoms can vary from person to person. They usually include abdominal pain or cramping, bloating, diarrhea, constipation, or an alternating combination of both. Some people may also experience additional symptoms such as fatigue, nausea, back pain, or psychological symptoms such as anxiety or depression.
Irritable bowel syndrome - Diagnostics
As a first step, organic causes should have been ruled out with the help of previous (hopefully thorough and detailed) conventional medical examinations.
For me, this includes the following:
- Endoscopic examinations including sample collection for histological evaluation (gastroscopy and colonoscopy with collection of step biopsies)
- Imaging procedures (abdominal sonography, if necessary computer and magnetic resonance tomography)
- A detailed medication (e.g. pre-existing antibiotic therapies) and travel history.
The following medical conditions should have been ruled out:
- Chronic inflammatory bowel diseases (Chron’s disease and ulcerative colitis) as well as other rare diseases of the colon (e.g. lymphogenic or collagenous colitis)
- Histamine intolerance (What is a histamine intolerance?) and celiac disease (the latter serologically and by histology)
- Food allergies of the IgE type and, in regard to complementary medicine, also of the IgG type (not yet recognized by conventional medicine).
- In the case of diarrhea, exclusion of bile acid malabsorption or pancreatic insufficiency with digestive enzyme deficiency.
- A non-celiac wheat sensitivity (NCWS) should be clarified by an exclusion diet (What is a NCWS?)
- Exclusion of bacterial overgrowth in the small intestine (SIBO) (What is SIBO?), lactose intolerance or fructose malabsorption
- Infectious diseases of the gastrointestinal tract (e.g. Helicobacter pylori, parasites e.g. Lambliasis , Intestinal parasitoses, etc.)
Irritable Bowel Syndrome - Therapy options
Many patients are prescribed proton pump inhibitors for irritable bowel syndrome (40% of patients, according to the Barmer health insurance company). The benefit and sense are questionable – often flatulence symptoms are increased, because the lack of hydrochloric acid leads to a maldigestion. This results in fermentation of undigested food components in the deeper sections of the small intestine (jejunum and ileum) with severe flatulence, abdominal cramps, belching of air and the discharge of winds. These may be odorless (fermentation) or malodorous (putrefaction).
Similarly, opiate-containing painkillers are often prescribed (44% more often than a comparison group, according to Barmer).
Patients with irritable bowel syndrome often receive double or multiple examinations, especially endoscopic examinations. This is not only pointless, but is also associated with an increased risk of complications from the examinations and does not lead to an increase in confidence on the part of the patient with regard to conventional medical diagnosis and therapy.
Treatment options that are now recognized by conventional medicine but are not yet sufficiently applied include the use of probiotics (according to the S3 guideline of the German Society for Digestion and Metabolism/DGVS Evidence Level A = highest evidence level). However, the society points out that only a few strains currently have a sufficiently proven effect based on studies. Especially Bifidobacteria and Lactobacilli are currently used.
Due to research into the human microbiome (the aggregate of all microbiota that live on and inside the human body), we are gaining new insights into the development of diseases and, with regard to the intestinal microbiome, also into the interaction of the intestine with other organ systems.
The gut-brain axis has now been proven beyond doubt. Anxiety disorders or depression occur in 50 to 90 percent of patients with irritable bowel syndrome. This also reveals very specific changes in the intestinal microbiome. The administration of some probiotic strains could lead to an improvement of psychological symptoms in studies.
There is also a close interaction with the immune system (intestinal-immune axis). Approximately two-thirds of the immune system is located in the intestine (MALT: mucosa associated lymphoid tissue). The development and function of the mucosal immune system in the intestine depends on the presence of intestinal bacteria. According to the latest findings, the importance of the intestine in autoimmune diseases and chronic diseases is much greater than previously assumed (see also Leaky Gut Syndrome).
Interactions with other organs, e.g. with the liver (intestinal-liver axis) and many other interactions are increasingly becoming the focus of current research and the findings are far-reaching, so that we can look forward to many new and exciting insights in the coming years.
Irritable Bowel Syndrome - Consultation Dr. med. univ. Stefan Rohrer
Within the framework of my consultation hours, I care for patients with what I consider to be an unfortunate diagnosis of irritable bowel syndrome (Clinical pictures that have not yet been understood by conventional medicine are often grouped together under the term “irritable bowel syndrome”). Unfortunately, the medical conditions described by those affected are all too often dismissed as psychosomatic or inevitable.
Within the scope of the diagnostics in my consultation, I analyze, among other things, the intestinal microbiome together with various functional parameters in the stool (calprotectin, EPX, elastase, zonulin, etc.).
I also look for holistic causes of an “irritable bowel syndrome”. Afterwards, I create a therapy plan in synopsis of all findings. This usually consists of herbal products and supplements. Frequently, environmental toxins must also be considered regarding the therapy. Changes in dietary habits are also indispensable for the success of the therapy.
If you have further questions about IBS and/or would like to schedule a consultation, please feel free to contact us at any time.