New Focus on Irritable Bowel Syndrome Leads to Comprehensive Treatment

Though irritable bowel syndrome (IBS) is a common condition that affects around 10% of the population, there is a lot that patients and physicians still don’t know about it. What is known is that it is more common in women and people younger than 60, and it is often associated with mental health conditions like anxiety and depression. And it can cause life-impacting symptoms if not treated properly.

In recognition of IBS Awareness Month in April, we spoke with Jennifer Czwornog, MD, assistant professor of gastroenterology in the University of Colorado School of Medicine and part of the UCHealth Digestive Health Center, about IBS and its diagnosis and treatment.

What exactly is irritable bowel syndrome, and how is it diagnosed?

Irritable bowel syndrome is a chronic disorder that encompasses abdominal pain and disordered bowel habits. Within irritable bowel syndrome, there are subtypes that include constipation predominant, diarrhea predominant, or a mixed subtype. IBS is determined clinically, meaning it's not based on one blood test or one CT finding but that it is diagnosed based on symptoms. IBS commonly impacts quality of life and potentially work productivity.

While IBS is a chronic condition that individuals may have long term, it can vary in terms of severity — there may be times when it flares up and other times when symptoms are more mild.

Are there any specific foods that aggravate the condition?

Everyone has somewhat different tolerances to foods, and it is common for patients with IBS to have adverse reactions to foods, or foods that may trigger their symptoms. For example, lactose intolerance is very common in adulthood because we make less of the enzyme that breaks up the lactose in food. Avoiding lactose is something that may be recommended as a first step in dietary management in IBS. Gluten intolerance is also seen commonly in individuals with IBS, and patients may try eliminating this to see if it helps to reduce symptoms. The low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet, which is a diet that is low in certain sugars that can cause intestinal distress, is also used in the treatment of IBS. This diet is ideally started with a GI nutritionist who can help develop a plan on how to initiate the diet and identify foods that may be triggering symptoms such as pain, diarrhea, or bloating.

Aside from dietary changes, what are other treatments for IBS?

A variety of different medications are used to treat IBS. Medications may include antispasmodics to reduce cramping, antidepressants that will help to modulate pain, and medications directed toward treatment of diarrhea or constipation. If someone has constipation, we may use things like fiber and laxatives; if someone has diarrhea, we’ll use antidiarrheal therapies. One of the areas that's been studied more in the past few years is how the microbiome impacts IBS and the possible role of “dysbiosis,” when the organisms in the gut become altered. While this is still an active area of study, some patients find a multi strain probiotic may be helpful.

What about treatment for the psychological issues that can contribute to IBS?

We now have a dedicated GI psychologist in the Digestive Health Center. She can help individuals manage IBS through different breathing techniques, development of coping strategies, and behavioral strategies. I think patients can benefit from a more comprehensive treatment of IBS that may include a combination of nutrition support, GI psychology, and medication.

The goal with IBS treatment is to reduce symptoms and improve daily activity and function. While symptoms may not fully resolve, I try to find a combination of things that will allow a patient to get through their day with minimal or no interruption due to IBS symptoms.

How has the COVID-19 pandemic affected diagnosis and treatment of IBS?

At the beginning of the pandemic, many people weren't necessarily seeking care for things that weren't emergent. Because of this, some people with IBS likely went undiagnosed or untreated longer than they normally would. However, this is a condition that is well suited to discuss via telehealth, so as more people began to access care remotely, I began to see more patients seeking care for IBS. Among individuals with IBS, many have expressed that there's been a worsening or flaring of symptoms with the pandemic and now some other global event-related stresses.

Can IBS develop into anything worse?

IBS is not a precancerous condition; it will not develop into anything worse or shorten one’s life. However, it can be challenging to manage and some people have severe symptoms that impact their life, though the majority of patients are able to manage their symptoms with medication and diet.

What else do you want people to know about the condition?

If people are struggling with IBS symptoms, and it's impacting their lives, there are things we can do to help and provide some relief – whether that is diet, medications, GI psychology, or a combination. Discussing gastrointestinal symptoms may be sensitive for some, it is important to find a provider that is a good fit so that issues can be discussed openly and comfortably.