Irritable Bowel Syndrome (IBS) describes a gastrointestinal disorder characterized by abnormal pain/discomfort and anomalous bowel movement patterns. The definite cause of the disease is idiopathic. Wood (2019), suggests that problems in gut motility, overpopulation of bacteria in the intestinal microbiota, food hypersensitivity, and neuronal disorders promote IBS development. There are four broad categories of Irritable Bowel Syndrome: pain-predominant IBS, diarrhea-predominant (IBS-D), IBS with alternating bowel pattern (IBS-A), and constipation-predominant IBS. In most cases, the disorder has an acute onset and may only become evident following an infectious disease that causes a positive stool culture, diarrhea, or vomiting ( Vila, Imhann, Collij, Jankipersadsing, Gurry, Mujagic, & Dekens, 2018) . Most individuals living with this disorder have an underlying mental disorder. There is a causal relationship between IBS and psychological disorders such as depression, psychosis, and anxiety, according to Wood (2019).
Geographical Concentration
Most individuals living with Irritable Bowel Syndrome reside in North America, South America, and Europe, as suggested by Vila et al. (2018). This trend is attributed to increased life stressors within developed countries in these continents due to rapid urbanization and industrialization. Low life standards and low overall quality of life contribute to the high prevalence of IBS in countries such as Jamaica, Brazil, Uruguay, and Guyana. In Africa, few cases of IBS are reported every year since most people ignore mild signs of the disorder. In other cases, medical practitioners misdiagnose IBS as eosinophilic gastroenteritis or giardiasis.
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Incidence Rate
Mexico has the highest prevalence of IBS (46%), followed by Brazil, with a prevalence of 43% while Mexico City and Pakistan both have a prevalence rate of 34% according to Vila et al. (2018). It is hypothesized that the disorder is highly prevalent in these countries due to increased life stressors and reduced quality of life within these nations. In the United States, IBS prevalence rate stands at 15%, followed by the United Kingdom at 10.5%, then Canada at 6% (Vila et al., 2018). Relatively higher levels of stress and mental exhaustion among professionals in these countries contribute to the high incidence rate of IBS. In Africa, the incidence rate is relatively low due to the increased number of misdiagnosis and underreporting.
Risk Factors
There are several factors which can predispose an individual to the risk of Irritable Bowel Syndrome. These factors include, but not limited to, being young, a history of psychological disorders, being female, and having a history of the disease in the family lineage. IBS is more frequent among individuals aged below 45 years, according to Wood (2019). The disorder mostly affects women since high estrogen levels in the body can contribute to IBS development. Estrogen therapy after menopause also predisposes women to the risk of IBS. Transfer of SCN5A mutant genes from parents to offspring can also predispose children to IBS. As mentioned earlier, there is a causal relationship between psychological disorders and IBS. Therefore, individuals with mental disorders are more susceptible to Irritable Bowel Syndrome.
Signs and Symptoms
IBS often manifests itself as severe abdominal pain, constipation, excess gas in the stomach, and vomiting. In infants, the disorder may manifest as failure to pass meconium and loss of appetite. Patients report that IBS symptoms subside with 48 hours even without treatment. In some isolated cases, individuals living with IBS may experience periodic gastroesophageal refluxes after meals, headache, and stomach upset. Stool samples obtained from IBS patients may be hyperpigmented or have excess mucous. Decreased libido is also very common among people living with Irritable Bowel Syndrome. Backaches, chronic fatigue, and dysphagia are some less common signs, although reports indicate that some people with IBS experience these signs after the onset of the disorder.
Mechanism of Action
According to Wood (2019), mutations in the SCN5A gene can affect the Nav1.5 channel leading to gut motility problems and abnormal bowel movements due to disruption of pacemaker cells and smooth muscles within the small intestines. Disruption of bowel movement patterns can subsequently lead to constipation and bloating, which are the first signs of Irritable Bowel Syndrome. In other cases, a decrease in Bacteroidetes population in an individual’s gut microbiota and a proportional increase in Firmicutes can cause diarrhea and food sensitivity, which can cause IBS development ( Xu et al., 2019) . Immune-mediated inflammation within the lower section of the alimentary canal caused by a high concentration of mast cells and intraepithelial neutrophils can cause obstructions within the gut. Blockages within the small intestines and colon can interfere with bowel movements, thus causing Irritable Bowel Syndrome.
Diagnostic Tests
IBS signs and symptoms have a close resemblance to other gastrointestinal disorders such as colon cancer, dyssynergic defecation, giardiasis, eosinophilic gastroenteritis, and inflammatory bowel diseases, among others (Xu et al., 2019). Therefore, accurate diagnostic tests should be used to diagnose IBS. Physicians often apply the Rome criteria to ascertain the presence of IBS by reviewing a patient’s signs and symptoms. The Rome IV criteria for IBS diagnosis comprises of regular abdominal pain, which recurs every day for more than 12 weeks, rectal discomfort related to defection, and abnormal stool appearance (Wood, 2019). Doctors may also use the diagnostic algorithm based on the patient’s symptoms and their long-term experience to identify IBS. However, the diagnostic algorithm should include additional tests to rule out other gastrointestinal conditions which have the same signs and symptoms like Irritable Bowel Syndrome.
Treatment
Incorporation of fiber in the diet, psychological counseling, antispasmodic medication, peppermint oil, and antidepressants are effective treatments used to manage Irritable Bowel Syndrome (Wood, 2019). Fiber supplements such as ispagula husk allow for consistent stool among people with IBS-D since it adds bulk to stool. Among individuals with IBS-C, soluble fiber supplements can help to moisten and soften stool for more comfortable defecation. Physicians can also recommend osmotic laxatives such as lactulose and sorbitol for people who are unresponsive to dietary fiber. Antispasmodics (like dicyclomine) together with mast cell stabilizers, help to minimize abdominal pain. Tricyclics (antidepressants) can also be used to manage depression and anxiety among people living with IBS to prevent progression of the disorder (Xu et al., 2019).
Prognosis
IBS is a chronic gastrointestinal disorder which may last for a lifetime, but the signs and symptoms of the disease are recurrent. The disorder may also cause the development of other complications, but these complications are often not life-threating (Xu et al., 2019). Therefore, IBS alone cannot cause death. Unlike other diseases of the gastrointestinal tract (GIT), IBS does not damage the inner mucosal membrane of intestines. Moreover, there exists no causal relationship between IBS and colon cancer.
Research
Research studies into the efficiency of microbiota transplants in the management and treatment of IBS are underway. Over recent years, IBS has been associated with decreased diversity of symbiotic microorganisms in the gut, which contributes to balance with the gut microbiota. Researchers are devising methods to increase the population of Bacteroidetes in IBS patients’ gut microbiota by introducing fecal microbiota transplants with probiotic bacteria strains. Scientists are also conducting clinical trials to ascertain the effectiveness of 5-aminosalicylic acid in the management of Irritable Bowel Syndrome (Wood, 2019).
References
Vila, A. V., Imhann, F., Collij, V., Jankipersadsing, S. A., Gurry, T., Mujagic, Z., ... & Dekens, J. (2018). Gut microbiota composition and functional changes in inflammatory bowel disease and irritable bowel syndrome. Science translational medicine , 10 (472), eaap8914.
Wood, J. D. (2019). Neuropathophysiology of the irritable bowel syndrome. In Physiology of the Gastrointestinal Tract (pp. 1643-1668). Academic Press.
Xu, D., Chen, V. L., Steiner, C. A., Berinstein, J. A., Eswaran, S., Waljee, A. K., ... & Owyang, C. (2019). Efficacy of Fecal Microbiota Transplantation in Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis. The American journal of gastroenterology . Retrieved from https://www.docdroid.net/V7yHMdA/efficacy-of-fecal-microbiota-transplantation-in-irritable-bowel-syndrome-a-systematic-review-and-meta-analysis-supplementary-ma
