IBS

Irritable Bowel Syndrome (IBS) afflicts at least 15 per cent of the population (a conservative estimate) and is pretty common among the corporate workforce. It is essentially a group of bowel disorders without any detectable physical or chemical cause.
The symptoms range from constipation to diarrhea, sometimes accompanied by pain, feeling of bloating, flatulence and a few other abdominal complaints continued over a prolonged period of time.

If it is a gut wrenching problem for the chronic sufferer, it's an equally frustrating condition for the medical community to tackle because there is no single unifying symptom or a single solution. "Each case is unique," says Dr Vivek Raj, consultant gastroenterologist, Max Healthcare. "IBS is not one entity. There is no single blanket therapy," says Dr Paramvir Singh, consultant gastroenterologist, Artemis Healthcare.

Yet, of late, a significant amount of research is emerging on IBS and its causes that is helping doctors tackle the condition better. Indeed, what causes IBS is a most vexing issue for researchers and several explanations have been put forth.

There's the recent brain gut axis theory, for one, which focuses on how factors that affect the functioning of the central nervous system can have a bearing on the function of the intestines. The new hypothesis is that symptoms of IBS result from not just a disordered gut but could happen due to disturbances in any of the pathways along the brain gut axis. So, stress, anxiety, trauma can all trigger off symptoms of IBS – a fact that as Dr Anil Arora, consultant gastroenterologist, Sir Gangaram Hospital, says, has been known for long by gastroenterologists, but now scientifically proved by studying neurotransmitters and the brain-gut route.

This is pointing the way towards psychotherapy and gut-focused hypnotherapy as well as the use of anti-depressants, all of which are now being tried out by Indian doctors. As Dr Samir Parikh, head of department of psychiatry, Max Healthcare says often simple relaxation techniques and counseling along with anti-depressants like SSRIs (selective serotinin reuptake inhibitors) works well - but as some doctors caution, they only refer a patient for psychotherapy, after gauging whether the trigger was stress or anxiety, or some other cause. Then, again, as Dr Raj points out specifically trained psychotherapists in the area of gut behaviour are not easily available in India. Sometimes counselling by the gastroenterologist himself works as well.

On the other hand, another body of research on probiotics (friendly or good bacteria) and IBS is also picking up steam. Although manufacturers of probiotic foods and drugs have been projecting a lot of health claims, doctors are still wary of prescribing them because as yet evidence based data on effect of probiotics on IBS is insufficient.

This August, a paper presented in the World Journal of Gastroenterology reported the effects of probiotic strain Lactobacillus casei Shirota in the fermentation pattern in the intestine among IBS suffers. Essentially, the hypothesis in this paper was that small intestinal bacterial overgrowth (SIBO) occurs in 78 per cent patients with IBS (One theory in gastro circles is that SIBO is a causative factor in certain cases of IBS – though that is not conclusive, still).

Usually, antibiotics (nowadays a targeted antibiotic like Rifaximin which acts only in the gut and nowhere else) and diet change are recommended to weed out the bad bacteria from the gut.

In this pilot study, researchers used probiotic strain Lactobacillus casei Shirota and the findings suggest that this had a beneficial effect. The golden method to test SIBO is to put a small tube into the small intestine through mouth and place through endoscope and aspirate the fluid and culture. However, this is cumbersome so in this pilot study overgrowth was monitored indirectly through the use of lactulose hydrogen breath test or C-xylose breath test.

Other studies are also pouring in from all parts of the world on probiotics, but as many doctors here point out, the data is still limited to act on it. Also, an additional problem is that there are many strains of probiotics – and research is still going on to identify which strain has an effect on which symptom. For instance, probiotic strain Bifidobacterium infantis has been shown to have a beneficial effect in tackling flatutence and abdominal pain. Similarly, another strain will act on another symptom. There's no strain as yet that has demonstrated an overall beneficial effect in tackling all the symptoms of IBS, although research is still on in this area.

http://www.businessworld.in/index.php/Pharma/Gut-Instinct.html
kumarkumar