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5 Things You Need to Know about IBS

New findings about this chronic GI ailment are leading to better treatments.

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Dr. Bani Chander Roland is the director of Gastrointestinal Motility at Lenox Hill Hospital, part of Northwell Health.

We’ve all had the occasional bellyache—you eat something that doesn’t agree with you, and you feel bloated or crampy for a few hours afterward, but then you feel fine again.

But if your gut problems are an everyday occurrence, you may have irritable bowel syndrome (IBS). Here are 5 things you need to know:

1. IBS is one of the most common conditions gastroenterologists treat.

IBS is a common gastrointestinal condition characterized by chronic abdominal pain, gas, cramps and bloating, as well as diarrhea or constipation, or sometimes alternating bouts of both. In many cases, the symptoms can be so debilitating that they severely impact your quality of life. In the U.S., an estimated 7 to 16 percent of people have IBS, and it’s more common in women than men.

In the past, our thinking about IBS was that it was purely a functional disorder, meaning there wasn’t any structural or organic problem in the GI tract that was causing the symptoms. While we still don’t completely understand why IBS occurs, there’s growing evidence that there are, indeed, specific physiologic causes for the condition.

2. You might also have SIBO.

Studies show that in many people with IBS, they also have a condition called small intestinal  bacterial overgrowth, or SIBO, that is accounting for their symptoms. This means that there’s an increase in “bad” gut bacteria and a decrease in “good” gut bacteria in your upper gastrointestinal tract. Most of the time, people with SIBO complain of diarrhea, but some people have constipation.

While more and more GI doctors are becoming aware of SIBO, it’s still a relatively new diagnosis, which is why some patients aren’t diagnosed correctly until they’ve seen a number of gastroenterologists.

“While we still don’t completely understand why IBS occurs, there’s growing evidence that there are, indeed, specific physiologic causes for the condition.”
Bani Chander Roland, MD, Gastroenterologist

The gold standard for diagnosing SIBO involves a test called an endoscopy, where your doctor passes a thin flexible tube down your throat in order to take a sample of the bacteria in the duodenum, which is the first part of your small intestine. But because endoscopies are invasive and expensive, we can usually make a definitive diagnosis for SIBO with a simple breath test we do in the office. This test measures levels of hydrogen, which are elevated when there’s an overgrowth of bad bacteria in your GI tract.

Once we confirm the diagnosis with the breath test, the treatment for SIBO is typically a two- to three-week course of antibiotics to eradicate the bad bacteria, and even more importantly, allow the good bacteria to regrow. This may sound counterintuitive to many, but it works.

3. You could have delayed motility.

For years, patients were told that their IBS symptoms were “all in their head.”  Of course, that isn’t really true for all patients. We do know that our brains and our gastrointestinal tracts are closely connected. In fact, about 95 percent of our body’s serotonin—the neurochemical that regulates mood—is found within the gastrointestinal tract rather than in the brain.

What we’re now finding is that the neurochemical signaling that occurs within the GI tract can lead to problems with motility—the speed at which food moves through our intestines. If you have IBS, the time it takes for food to move through your GI tract might be slower than normal, causing many of your symptoms.

Today, we often diagnose GI motility issues using a Smart Pill. This is a fairly new technology that is available at specialized GI motility centers, like what we have at Lenox Hill Hospital.

The Smart Pill is a multivitamin-sized wireless ingestible capsule that can determine how quickly (or slowly) food moves through your GI tract.

After fasting overnight, you come to the hospital and we first give you a standardized meal bar to eat. Then, you swallow the capsule and also get a receiver that you carry on your body. Using radiotelemetry, the capsule and the receiver communicate with each other, and the receiver measures and records changes in pH pressure and temperature as the capsule moves through your GI tract. Five days later, you return the receiver and we use the measurements to calculate transit times as food moves from your stomach through your small intestine and into your colon. (There’s no need to recover the capsule! It’s so small that it will pass through your stool without you noticing it.)

If your transit time is found to be slower, we can give you a medication called a prokinetic that helps move food through your intestines more quickly. The Smart Pill is so new that not all insurance companies cover it. In some cases, your health insurer might require you to undergo other diagnostic tests first.

4. A low FODMAP diet can help.

No matter what the cause of your IBS, research suggests that eating a low FODMAP diet can help reduce symptoms in about 75 percent of patients.

FODMAP stands for fermentable oligo-dimonosaccharides and polyols. These are foods that aren’t easily digested by the body, and so when they reach your colon, they’re more likely to ferment, which can cause gas, bloating and pain.

The low FODMAP diet is really more about what to avoid rather than what to eat. It’s a long list of foods that includes onions, artichokes, lentils, apples and pears. Grains such as wheat and rye are also high in FODMAPs, which is why many people with IBS feel better when they are on a gluten-free diet.

Even popular natural sweeteners like honey and agave are high in FODMAPs. I often see patients with IBS who tell me that they’ve cleaned up their diets and switched from refined sugar to more natural sources, but many have no idea that these kinds of sweeteners are actually high FODMAP foods that are leading to symptoms.

5. Probiotics may also be beneficial.

I also recommend that patients with IBS take a daily probiotic supplement, since there’s a lot of evidence that it can help ease symptoms, especially bloating and gas. Probiotics are live bacteria derived from milk or yeast that are very similar to the good bacteria that normally reside in your intestines. The brands I typically recommend are Align, Florastor, Culturelle and VSL#3.

The hypothesis is that probiotics ease symptoms by helping to restore levels of good bacteria in the gut, while diminishing the bad bacteria. In addition to being beneficial for GI health, there’s also some evidence to suggest that probiotics are good for other ailments, including endocrine diseases and even psychiatric disorders such as anxiety and depression.

Finally, if you’re experiencing symptoms of IBS, don’t suffer in silence; book a visit with a gastroenterologist. Today more than ever before, there’s a lot we can do to help you feel better and live a normal and happy life.

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Published April 24th, 2018
A smiling patient in a light blue shirt sits on an examination table. A doctor wearing a white lab coat places her hand on the patient's shoulder.

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