In this episode of PodMD, experienced gastroenterologist and founder of Universal Gastroenterology Dr Arun Gupta will be discussing the topic Irritable Bowel Syndrome (IBS), including what IBS is, how IBS is diagnosed, recent developments for treatment, when a GP should refer and more.
Please note this is a machine generated transcription and may contain some errors.
*As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.
Today I’d like to welcome to the PodMd studio Dr Arun Gupta
Dr Gupta is an experienced gastroenterologist and founder of Universal Gastroenterology. He has a particular interest in the diagnosis and management of inflammatory bowel disease and irritable bowel syndrome, as well as a broad depth of knowledge about general gastroenterology.
Today, we’ll be discussing the topic of Irritable Bowel Syndrome
*We do hope you enjoy this podcast but please remember that the advice here is of a general nature and is not intended as specific advice about a given patient. The views and opinions expressed in this podcast are those of the doctor, not PodMD.
If you do have a patient on whom you require specific advice, then please seek advice from a colleague with appropriate expertise in that area.
Arun, thanks for talking with us on Pod MD today.
Arun: Thank you for having me.
The topic of today’s discussion is Irritable Bowel Syndrome. Arun, can you describe for our listeners what IBS technically is?
Arun: Irritable bowel syndrome is a really common condition, actually perhaps affecting 10 to 15% of the population. I think a fair comment is that irritable bowel syndrome is frequently misdiagnosed and poorly understood. Uh, the cause of irritable bowel syndrome may relate to different factors, such as visceral hypersensitivity, meaning that the nerves and the gut get over sensitive to stimulation and increased intestinal permeability causing diarrhea. However, in reality, the cause is likely to be multifactorial.
How would a patient with IBS typically present?
Arun: Well, a classic presentation is that of alternating diarrhea and constipation. There’s also a sensation of fecal urgency, lower abdominal cramping, and a sensation of abdominal bloating and distension. Having said that, this represents a classic presentation and not all patients fit into this classic description.
How is Irritable Bowel Syndrome diagnosed?
Arun: Yeah, this is a really good question. And actually it is not straightforward, the diagnosis. I think a good approach is to look for evidence that something else might be going on. For example, not just bowel cancer, but other causes of diarrhea, such as coeliac disease, inflammatory bowel disease, pancreatic insufficiency, and so forth. So what you’re looking for is alarm signs such as loss of weight, family history of bowel cancer, nocturnal diarrhea, and so forth. There may well be a role for blood tests, including C-reactive protein and coeliac serology and possibly a role for fecal calprotectin in low risk patients.
Have there been any developments in treatment in the last years or are there any in trials or development now?
Arun: There definitely has, and most of our audience will be familiar with the low FODMAP diet, which has made a lot of difference to patients with mild to moderate irritable bowel syndrome. Patients with more severe symptoms may be candidates for second line therapy, such as low dose tricyclic antidepressants, or SSRIs. However, this would usually be under the care of a gastroenterologist.
Are there any warning signs a GP or their patient can look out for?
Arun: Yes. I touched on some of the alarm symptoms beforehand, but one other thing to keep in mind is the age of the patient. We’re now seeing bowel cancer more commonly in patients aged under 50 years old now. So I think a good rule of thumb is that anyone over the age of 40 presenting with a change of bowel habits should have a colonoscopy performed to rule out alternative pathology.
Is there anyone that is at a predisposition to IBS?
Arun: Yeah. Interestingly those with a background of depression, anxiety, or even a high degree of stress in their lives are predisposed to IBS. In addition, we do see cases of post-infectious IBS after a series of gut infections, such as Campylobacter, for example.
When should a GP refer?
Arun: I think it’s reasonable to have a trial of dietary therapy in those with low risk symptoms and those who are younger in age. However those who are older or who have alarmed symptoms or failed to respond to dietary therapy should probably be referred to a gastroenterologist for a second opinion.
Thank you for your time here today in the PodMD studio. To sum up for us, could you please identify the three key take home messages from today’s podcast on Irritable Bowel Syndrome.
Arun: Sure. I think number one, in patients presenting with altered bowel habit always consider, could this be irritable bowel syndrome. Number two, think about alarm symptoms, such as loss of weight, age over 40 or family history of bowel cancer. And three, an empirical trial of the low FODMAP diet may be of benefit in low risk patients. However, there are second line therapies, some patients with refractory symptoms. These patients should be referred for a second opinion.
Thanks for your time and the insights you’ve provided.
Arun: Thank you for having me