Dr John P Wright
Updated: 28 April 2013
Of all gastrointestinal conditions irritable bowel syndrome (IBS) is the most misunderstood. It is a physiological disturbance rather than a disease. Most people will have some symptoms of IBS but view these as a normal consequence of life itself. Others are highly stressed by them and further aggravated by their understanding of a normal diet. Unfortunately the perceived healthy diet includes lots of vegetables and fruit, the two factors that commonly aggravate IBS symptoms. While the medical profession struggles with the physiology and treatment of IBS legions of health shops, alternative practitioners, nutritionists and popular magazines claim to have the answer. A certain distrust of the profession at the health promotion level gives disproportionate power to these alternative sources and the lady in the checkout queue(1).
We, the traditional scientific medical practitioners, have spent too much effort on defining the condition. The Rome Criteria are regularly refined in an attempt to encapsulate the clinical presentation of these patients(2).. This misses the point that IBS is a syndrome of disturbed intestinal physiology with deranged processes that lead to the clinical symptoms. The clinical approach is therefore to identify the disturbed physiology, exclude other pathology and manipulate the physiology back towards normal. To achieve this, the most important investigation is the clinical history. The aim is not to check the boxes of diagnostic criteria but understand where and how the symptoms originate. The clinical history therefore needs to concentrate on the pathophysiology demonstrated by the patient.
The 4 pillars of IBS pathophysiology are
Numerous studies have addressed the above problems and a logical all-encompassing model has not yet been formed or accepted by the scientific community. Based on the above factors treatment is usually random and ineffectual with a sub-conscious nod to a perceived hypochondriacal patient.
The first factors to elucidate are
Let us now associate these symptoms with the underlying pathophysiology.