MYS­TERY STOM­ACH PAIN RE­SOLVED

Up to one fifth of Cana­di­ans may suf­fer from ir­ri­ta­ble bowel syn­drome. Are you among them?

Reader's Digest (Canada) - - Front Page - BY ANNE MULLENS AD­DI­TIONAL RE­SEARCH BY REBÉA KABBAJ IL­LUS­TRA­TION BY DAVE MUR­RAY

DI­GES­TIVE IS­SUES, BLOAT­ING, stom­ach pain, con­sti­pa­tion and di­ar­rhea—San­dra David’s child­hood and ado­les­cence were dom­i­nated by gas­troin­testi­nal dis­tress. Fi­nally, at the age of 23, she saw a doc­tor. But it would take three more years and a suc­ces­sion of dif­fer­ent spe­cial­ists be­fore the ad­min­is­tra­tive as­sis­tant from Mon­treal, now 43, found out what was ail­ing her.

David’s af­flic­tion? Ir­ri­ta­ble bowel syn­drome (IBS). The 2013–2014 Cana­dian Com­mu­nity Health Sur­vey, re­leased by Sta­tis­tics Canada, re­vealed that mu­cous col­i­tis—the other name for IBS—af­fects 2.7 per cent of Cana­di­ans over the age of 12. But ac­cord­ing to the GI So­ci­ety (the Cana­dian So­ci­ety of In­testi­nal Re­search), the ac­tual num­ber of suf­fer­ers is closer to 13 to 20 per cent. The rea­son for the dis­par­ity could be that just one quar­ter to one half of peo­ple who suf­fer from IBS symp­toms seek med­i­cal at­ten­tion and, on av­er­age, wait a decade be­fore do­ing so.

PAIN, CON­STI­PA­TION AND di­ar­rhea are the most com­mon re­cur­ring symp­toms of IBS, a chronic dis­or­der of the gas­troin­testi­nal tract, the ex­act cause of which is un­known. It can also lead to heart­burn, nau­sea, sweat­ing, chills, bloat­ing, flat­u­lence and other changes in bowel func­tion.

“It’s quite easy to di­ag­nose,” says Dr. Mick­ael Bouin, a gas­troen­terol­o­gist at Hôpi­tal Saint-Luc du CHUM and an as­so­ciate clin­i­cal pro­fes­sor at the Univer­sité de Mon­tréal. “While the symp­toms are com­mon to other ill­nesses, their emer­gence and re­cur­rence are rather spe­cific to IBS. In the vast ma­jor­ity of cases, a family physi­cian will make the di­ag­no­sis after ex­am­in­ing the pa­tients and ask­ing them to com­plete a ques­tion­naire.”

Long over­looked, IBS re­search is grow­ing rapidly, but Bouin ac­knowl­edges that sci­ence has yet to fully com­pre­hend why pa­tients suf­fer from these symp­toms. “There’s a lot of drug de­vel­op­ment re­search, but we still know very lit­tle about the mech­a­nisms of the dis­ease,” he ex­plains.

For­tu­nately, most pa­tients can man­age or im­prove their symp­toms. Here are eight in­sights to help suf­fer­ers bet­ter un­der­stand their di­ges­tive health.

1. Rule out other dis­or­ders

Some ill­nesses, from celiac dis­ease— a re­ac­tion to gluten—to cer­tain types of can­cer, can feel a lot like IBS. While much less com­mon, they must be elim­i­nated as po­ten­tial cul­prits in or­der to make a fi­nal di­ag­no­sis.

“Ap­prox­i­mately six per cent of pa­tients who suf­fer from IBS de­velop symp­toms that may be mis­taken for the signs of celiac dis­ease, which can be de­tected with a sim­ple blood test,” says Bouin.

Gas­troen­terol­o­gists now have a new test to iden­tify in­testi­nal in­flam­ma­tion

mark­ers and ex­clude Crohn’s dis­ease and ul­cer­a­tive col­i­tis, both ma­jor cat­e­gories of in­flam­ma­tory bowel dis­ease (IBD): fe­cal cal­pro­tectin dosage, a stool test that can help eval­u­ate the sever­ity of the in­flam­ma­tion through the pres­ence of a par­tic­u­lar pro­tein. But ac­cord­ing to Bouin, it is used only in cases in which the doc­tor is de­ter­min­ing be­tween a di­ag­no­sis of IBS or an in­flam­ma­tory bowel dis­ease.

Colon, stom­ach and ovar­ian can­cer screen­ing may also be nec­es­sary: “If the pa­tient’s IBS is some­what atyp­i­cal or when the pa­tient is a cer­tain age, they have to be ruled out,” he says.

2. There’s more than one type of IBS

Pa­tients gen­er­ally suf­fer from one of three types: IBS with di­ar­rhea, IBS with con­sti­pa­tion or IBS with al­ter­nat­ing con­sti­pa­tion and di­ar­rhea, which have vary­ing causes.

“Each pa­tient may have a dif­fer­ent prob­lem. The gut, how­ever, has only so many ways to com­plain,” ex­plains gas­troen­terol­o­gist Dr. John Mar­shall, a lead­ing IBS re­searcher at McMaster Univer­sity in Hamil­ton, Ont.

“Re­search is point­ing to a va­ri­ety of sub­tle changes that may each un­der­lie the de­vel­op­ment of IBS, such as an al­tered im­mune sys­tem, the pres­ence of low-grade in­flam­ma­tion, the pro­lif­er­a­tion of nerve fi­bres in the in­testi­nal wall or pre-ex­ist­ing ge­netic sus­cep­ti­bil­ity,” notes Dr. Gio­vanni Bar­bara, re­searcher and clin­i­cal gas­troen­terol­o­gist at the Univer­sity of Bologna, Italy.

3. Post-in­fec­tious IBS is com­mon

Al­most one third of IBS cases oc­cur fol­low­ing a gas­troin­testi­nal in­fec­tion or food poi­son­ing caused by a virus or bac­te­ria. Some of the world’s most ex­ten­sively doc­u­mented cases hap­pened 17 years ago in Walk­er­ton, Ont., when 2,500 peo­ple fell ill from wa­ter con­tam­i­na­tion caused by an out­break of E. coli and Campy­lobac­ter. A team of re­searchers, including Mar­shall, mon­i­tored the vic­tims for eight years. Among those af­fected, 36 per cent de­vel­oped IBS. While the symp­toms dis­ap­peared in most cases, some peo­ple, including Kevin Doyle, a farmer in his late 40s at the time of the in­ci­dent, still suf­fer today. “I have to be very care­ful. If I ex­pe­ri­ence any stress, it will flare up,” says Doyle.

The Walk­er­ton re­search, which is still un­der­way, has helped high­light cer­tain risk fac­tors of post-in­fec­tious IBS, including be­ing fe­male, suf­fer­ing from a se­ri­ous ill­ness, tak­ing an­tibi­otics or ex­pe­ri­enc­ing an anx­i­ety dis­or­der at the time of in­fec­tion and hav­ing a ge­netic pre­dis­po­si­tion.

4. Pin­point food trig­gers

Many pa­tients main­tain that cer­tain foods ag­gra­vate their symp­toms. “If I eat gar­lic, my stom­ach will bloat as

if I were six months preg­nant,” says San­dra David, who, for the past two years, has been care­ful about her eat­ing habits. On top of gar­lic, she no longer con­sumes onions, dairy prod­ucts, gluten, toma­toes or ap­ples.

In the past few years, the lowFODMAP diet de­vel­oped in Aus­tralia has made head­lines, as cer­tain stud­ies have re­vealed that 75 per cent of peo­ple who re­ceived an IBS di­ag­no­sis had fewer symp­toms while fol­low­ing these di­etary guide­lines. FODMAP is an acro­nym for fer­mentable oligo-, di-, monosac­cha­rides and poly­ols—a col­lec­tion of short-chain car­bo­hy­drates found in a num­ber of fruits, veg­eta­bles, grains and dairy prod­ucts that tend to fer­ment and trans­form into sug­ars in the in­tes­tine. Be­cause the diet is very limited—the com­plete list in­cludes over 100 high-FODMAP foods to re­strict or avoid—IBS suf­fer­ers are told to fol­low it for six to eight weeks and grad­u­ally rein­tro­duce dif­fer­ent items to fig­ure out what their body can han­dle.

Cinzia Cu­neo, the co-founder of Mon­treal’s Sukha Tech­nolo­gies Inc. and the com­pany’s meal-plan­ning web­site SOS Cui­sine, is very well ac­quainted with the low-FODMAP diet. In con­junc­tion with a team of nu­tri­tion­ists, she re­cently pub­lished The Low-FODMAP So­lu­tion. “It’s not a diet that is de­signed to be fol­lowed for life for sev­eral rea­sons,” says Cu­neo. “Firstly, be­cause peo­ple aren’t usu­ally sen­si­tive to ev­ery FODMAP. Most only re­act to one, two or three fer­mentable car­bo­hy­drates, so there’s no use elim­i­nat­ing them all. Also, the foods have im­por­tant nutritional prop­er­ties, so they shouldn’t be elim­i­nated per­ma­nently.” The nutri­tion team pro­vides meal plans as well as ad­vice, es­pe­cially dur­ing the food elim­i­na­tion and rein­tro­duc­tion phases. The goal is for each in­di­vid­ual to de­ter­mine a level of tol­er­ance to the foods that are prob­lem­atic for them.

Ac­cord­ing to Bouin, there is a gen­eral con­sen­sus in favour of the FODMAP diet, but that doesn’t make it a cure-all. “It helps cer­tain pa­tients, but a per­son who stops eat­ing [trig­ger foods] will ob­vi­ously suf­fer less stom­ach pain. The ob­jec­tive is to halt as many symp­toms as pos­si­ble by elim­i­nat­ing a min­i­mum num­ber of foods. That’s the chal­lenge.”

5. Fo­cus on the right fi­bre

Doc­tors have rec­om­mended fi­bre for decades, but we now know not all kinds of fi­bre have the same ef­fects. A 2009 Dutch study co-au­thored by Dr. Niek de Wit at the Univer­sity Med­i­cal Cen­tre in Utrecht, Nether­lands, found that in­sol­u­ble fi­bre—present in wheat bran, whole grains and peas, for ex­am­ple—is to be avoided.

But sol­u­ble fi­bre, which can be found in oat bran, black beans, soy

and or­anges, among other foods, can some­times help lessen symp­toms. In pa­tients with di­ar­rhea, the fi­bre ab­sorbs ex­cess wa­ter and turns to gel, slow­ing di­ges­tion. For peo­ple who suf­fer from con­sti­pa­tion, it helps soften stool. “A daily sup­ple­ment of sol­u­ble fi­bre [psyl­lium husk is a good bet] is one of the most ef­fec­tive places to start for IBS,” says de Wit.

6. Delve into the braingut connection

While the the­ory that the dis­ease is rooted in a sin­gle psy­cho­log­i­cal source has been de­bunked, re­search re­veals that there is a brain-gut connection. Ac­cord­ing to Dr. James Whor­well, direc­tor of the South Manch­ester Func­tional Bowel Ser­vice in the U.K., stress and anx­i­ety ex­ac­er­bate symp­toms in most IBS suf­fer­ers.

“Stress will of­ten have an im­pact on the colon, which is ex­tremely sen­si­tive. If the per­son also suf­fers from IBS, the symp­toms will be even more se­vere and last longer,” says Bouin.

Treat­ment op­tions in those cases can in­clude cog­ni­tive be­havioural ther­apy, re­lax­ation tech­niques and hyp­no­sis.

7. Try a pro­bi­otic

In­creas­ingly—and es­pe­cially in cases of post-in­fec­tious IBS—physi­cians sus­pect pa­tients may have a dis­rup­tion in the bac­te­rial flora that nor­mally in­habit the gut and help with di­ges­tion. Cer­tain pro­bi­otics have proved rel­a­tively ef­fec­tive, and IBS re­searchers ex­pect de­signer pro­bi­otics will one day be able to tar­get spe­cific bac­te­rial deficits. “My hope is that ma­nip­u­lat­ing the mi­cro­biome and re­plac­ing miss­ing good bac­te­ria may lead to a sig­nif­i­cant im­prove­ment of symp­toms,” says Mar­shall.

8. Seek sup­port

Peo­ple who suf­fer from IBS can feel iso­lated—in­testi­nal prob­lems aren’t of­ten a pop­u­lar topic of con­ver­sa­tion. How­ever, com­mu­ni­ties of IBS pa­tients have cropped up across the In­ter­net. In Canada, for ex­am­ple, the GI So­ci­ety has a bilin­gual web­site, badgut.org, which pro­vides in­for­ma­tion on the most com­mon di­ges­tive dis­or­ders, including IBS.

“I al­ways put ed­u­ca­tion at the top of my list,” says Whor­well. “Pa­tients have to un­der­stand their con­di­tion if they’re go­ing to be able to man­age it.”

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