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IBS - Imperative Bathroom Situation.

August 15, 2007

Matthew Vasey, MD



While IBS is actually, an acronym for Irritable Bowel Syndrome, not Imperative Bathroom Situation the title was catchy. If there is anyone who underestimates just how common IBS is, just think about how much money I would make if I were going to reveal and patent the cure in this very article. IBS is essentially the Kevin Bacon of Hollywood, you are never more than a few degrees of separation from the former. While you may not have it yourself, you inevitably know someone who does given as much as one-fifth of the United States population carries the diagnosis. (1) IBS is one of the most common medical conditions diagnosed in the Western world accounting for more than one-fourth of the gastroenterology referral traffic. (2) So what is it?

Well, the American College of Gastroenterology recommends that doctors use a broad definition when considering IBS as a diagnosis. That is abdominal pain or discomfort associated with altered bowel habits and importantly, the absence of "red flags" suggestive of other known diseases. Specific criteria for diagnosis do exist in the form of the Rome III criteria. (4) The purpose of this, however, is not to result in self-diagnosis, rather a worldwide understanding of IBS, given the potentially billions of readers that will surf across this article. While IBS may have been considered hocus pocus in its early days, there is real scientific evidence to support the syndrome by way of the Brain-Gut Axis (3).

The medical literature from scientific experiments shows it is not just one factor that results in IBS. Those guilty as charged in the physiologic creation of IBS include altered gut motility, enhanced visceral sensitivity with changes in central nervous system processing (3). Basically, that translates from abnormal activity of intestines, variations in intra-abdominal sensory, and changes in brain understanding of what in the world is going on behind your belly-button, to hand placed over stomach, gggrrrrrrbllllbbbuhhhhhh, bllllpppppppug!

IBS is an incredibly complex entity truly encompassing the bio-psycho-social theory of medicine. Yes, there is a physiological component to IBS, it is not hocus pocus, or "all" in your head. Yes, there is a psychological component to IBS, some of it is in your head. Yes, there is a sociological component to IBS, some of it is the situation around you. Any successful treatment approach should target the entire spectrum as the "magic bullet cure" for IBS remains elusive and I believe will always be such given the complex nature of the syndrome. IBS can be frustrating for both the patient and the doctor but it doesn't have to be. It is a positive, cooperative, proactive and an empathetic approach to management by all parties involved that will produce the best possible outcome for every individual case of Irritable Bowel Syndrome.

REFERENCES:

1. Drossman DA, Li Z, Andruzzi E, et al. US householder survey of functional gastrointestinal disorders: prevalence, sociodemography and health impact. Dig Dis Sci. 1993;38:1569-1580.
2. Drossman DA, Camilleri M, Mayer EA, Whitehead WE. AGA technical review on irritable bowl syndrome. Gastroenterology. 2002;123:2108-2131.
3. Lacy BE. Irritable bowel syndrome: The brain-gut axis. Primary Care Q. 2007(1).
4. Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders. Gastroenterology. 2006;1301480-1491.

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