Changes could be IBS symptoms

Dear Dr. Roach: My 18-year-old daughter has had digestive problems on and off. Her appendix was removed in March 2015. She had brutal abdominal pain. Summer 2018, she started having bad digestion problems. She could hardly hold anything in.

Our family doctor sent her to a pediatric gastroenterologist. They found nothing wrong with her. Now she has noticed that eating anything warm makes her feel “wobbly.”

Do you think it could be a problem with her vagus nerve? Our family doctor is not taking this possibility seriously. She now has diarrhea only once or twice a month. She occasionally still has vomiting. — J.M.

Abdominal pain and changes in the bowel should make the doctor consider irritable bowel syndrome. IBS is a disorder with how the bowel functions. It is extremely common. People with irritable bowel syndrome may have diarrhea, constipation or both, in addition to the abdominal pain.

The vagus nerve is the major nerve going to the abdominal organs, sending information to them and receiving information back. A major theory about the underlying cause of IBS is that there’s an increased sensitivity to intestinal distension. So, in a sense, IBS is at least partially brought on by the vagus nerve.

People with IBS generally find that certain foods trigger symptoms; however, I was able to find reports of people in whom meal temperature was a major catalyst. Both too-cold meals and too-hot meals can bring on IBS.

IBS is a diagnosis that should be made only after evaluation of other causes. Some of these are serious, such as inflammatory bowel disease. Celiac disease should also be considered.

Treatment for IBS needs to be individualized and starts with avoiding triggers.