Sensitive Gut

Chapter 4: Irritable Bowel Syndrome Man should strive to have his intestines relaxed all the days of his life.-- Moses Maimonides Another common disorder of the intestines is irritable bowel syndrome (IBS). Its myriad of unpleasant symptoms affect tens of millions and have no known cause nor effective remedy.Irritable bowel syndrome is probably the number-one reason why people see gastroenterologists, accounting for as many as 3.5 million physician visits and 2.2 million prescriptions per year. It accounts for an estimated 28 percent of patients seen by gastroenterologists and up to 12 percent of patients seen in primary-care offices.The cost of all of this in dollars and cents is staggering. Studies have estimated the toll for caring for IBS patients at more than $8 billion in the United States alone. A Seattle study pegged the cost of caring for IBS sufferers at $4,044 per patient during the year in which they were diagnosed, a figure that is 35 percent higher than the average spent on treatment of patients with other illnesses.For patients and doctors alike, irritable bowel syndrome is probably the most challenging of all functional gastro-intestinal (GI) disorders. A recent study found that patients with IBS have a significantly lower quality of life than persons without the syndrome and that the illness is seriously underdiagnosed. In fact, only 4 percent of study participants who met the criteria for having IBS had been diagnosed with the condition by a physician.Medical historians credit John Howship, of St. George's Infirmary in London, with providing the first scientific description of IBS, in an 1830 article entitled "Spasmodic Stricture of the Colon as an Occasional Cause of Confinement of the Bowels." His theory was that the abdominal pain and altered bowel habits of IBS sufferers stem from colonic dysmotility or spasm of the colon. Through the years, the condition has been called by many names -- spastic colon, spastic bowel, colitis, mucous colitis, and functional bowel disease among them. None of these is quite accurate, however, hence the catchall termirritable bowel syndrome.Today, IBS affects 10 to 22 percent of otherwise healthy adults. While it is thought to affect both sexes nearly equally, men and women may actually suffer from different symptoms. In any case, women are three to five times more likely to see a doctor for the problem than are men.About 70 percent of patients who see physicians for IBS are considered to have "mild" symptoms, and their lives are minimally impacted. About 25 percent are said to have "moderate" symptoms, which may cause them to miss work occasionally. And roughly 5 percent of patients suffer from "severe" symptoms that considerably affect their daily lives. Symptoms usually begin in young adulthood, though they can occur in children as well.The causes of irritable bowel syndrome are obscure. Many believe it stems from an abnormality in the contractions of the muscles of the colon, which can result from any of several factors, including distension or stretching, food residues, intestinal hormones, and stress. They may all combine to induce an abnormality in the rhythm of the bowels. On the other hand, some experts think the problem is primarily psychological in origin. Still others believe IBS to be a heightened sensitivity to stress. Whatever the cause, IBS remains quite real to the millions who suffer its symptoms.Despite frustrating and sometimes debilitating symptoms that keep sufferers preoccupied with the toilet, most sufferers don't consult a doctor. There may be good reason not to; the cost of seeking out care may be high, and the drugs used to treat IBS not only are expensive, but also offer scarce evidence of effectiveness. And, in some cases, IBS patients are liable to undergo unnecessary surgeries. Many simply try to cope on their own, tolerating the symptoms or attempting toHarvard Medical School Staff is the author of 'Sensitive Gut' with ISBN 9780743215046 and ISBN 0743215044.