The Leeds Teaching Hospitals NHS Trust Irritable Bowel Syndrome

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1 n The Leeds Teaching Hospitals NHS Trust Irritable Bowel Syndrome Information for patients

2 Irritable bowel syndrome (IBS) is a common, long term condition of the digestive system (gut). It causes episodes of abdominal (tummy) pain that are accompanied by changes in the pattern of bowel movements (stools). The abnormal bowel pattern may involve constipation, diarrhoea or a mixture of the two. Symptoms are often made worse soon after eating. Many people with IBS also notice swelling of the tummy, known as bloating. Some will notice that they pass mucus from their back passage, or have a sensation that they never fully empty their bowel. Symptoms of IBS will affect about 1 in 10 people at some point in their lives. While most people with IBS have relatively mild symptoms, some people have severe symptoms that may affect their ability to work or socialise. What causes irritable bowel syndrome? The exact cause of IBS is unknown but changes both in the gut and in the communication pathways between the gut and the brain have been found in people with IBS. Some of these are discussed on the next pages. 2

3 IBS sometimes develops following an episode of gastroenteritis, or food poisoning. High levels of inflammatory cells, and the chemical messengers they produce, which are the body s normal response to an infection, have been found to continue even after the infection has settled in some people who develop IBS. The normal bacteria (bugs) that live in the gut also appear to be slightly different in some people with IBS, when compared with healthy people without IBS-type symptoms. These bugs may cause excessive gas production when food is being digested, causing bloating, or even produce substances that affect the movement of food through the gut, leading to diarrhoea or constipation. The brain communicates with the gut, and the gut communicates with the brain, through a complex system of nerves and chemical messengers. This communication pathway is known as the brain-gut axis, and we know that the function of the pathway can be disrupted in some people with IBS. This can affect the way in which the brain interprets normal everyday signals sent from the gut, mistaking them for painful sensations. It may also cause the muscles in the gut to be slightly overactive resulting in diarrhoea, or slightly underactive resulting in constipation. Many of the nerves and chemical messengers involved in the brain-gut axis also control how the body reacts to stress. 3

4 This explains why people with IBS often find their symptoms are worse during stressful periods. Anxiety, depression, and conditions such as fibromyalgia and chronic fatigue syndrome also occur in some, but not all, people with IBS. It is important that we identify those people who also have these, as it can be more difficult to improve the symptoms of IBS if these conditions are not treated. The above changes in people with IBS have all been found under experimental conditions in research studies, and would not be detected using the standard investigations that we do in the hospital setting. How do doctors diagnose irritable bowel syndrome? In most people with IBS, the diagnosis can be made quite easily by listening to the person s symptoms. Often these are typical, and therefore a diagnosis can be made using only these symptoms. This is called making a positive diagnosis. However, all people with symptoms that sound like IBS should have a blood test for coeliac disease, as sometimes this can mimic IBS. In some people, a limited number of other tests need to be performed, just to make sure doctors are not missing another disease that can cause similar symptoms, such as inflammatory bowel disease. However, ordering lots of unnecessary tests to rule out other much rarer conditions often makes people with IBS more worried, rather than providing reassurance. 4

5 How do we treat irritable bowel syndrome? People with mild symptoms may not require any treatment at all. Many people manage their symptoms by themselves, without the need to see a doctor. Although we do not think that food allergy causes IBS, certain types of food can make the symptoms of IBS worse. Removing these foods from the diet can therefore improve the symptoms of IBS in some people. For that reason we often offer people with IBS a referral to see a dietitian, to see if a change in diet is helpful. Antispasmodic drugs, such as hyoscine or peppermint oil, may help people with mild or moderate abdominal (tummy) pain. These drugs work on muscles in the gut, and can improve spasm of the gut, which can lead to pain, and also slow down the passage of food through the gut, which can help diarrhoea. Soluble fibre, such as psyllium or ispaghula, may help some people with constipation or alternating constipation and diarrhoea, by bulking up stools. We also use laxatives to treat constipation in some people. In people who continue to have constipation despite taking regular laxatives, we often use a new type of medication, called linaclotide. This drug is a pro-secretory agent, and increases water content in the gut, improving stool consistency and increasing the number of stools. Probiotics and certain antibiotics can help some people with IBS, perhaps because they alter the bugs in the gut. Probiotics are products that contain friendly bugs that seem to particularly help abdominal pain and bloating. They are not 5

6 available on prescription in the UK, and people have to shop around until they find one that suits them. Rifaximin, which is an antibiotic, has only been tested in IBS recently, but seems to help overall symptoms, and also bloating when taken for only 1 or 2 weeks. For people with more severe symptoms, we often use drugs that act on the brain-gut axis, such as amitriptyline. Many of these drugs are also used as antidepressants, but we are not using them to treat depression in IBS, and they do not have any addictive properties. In fact, the doses we use are about one-tenth of the dose used to treat depression. At these low doses, the drugs can work on muscles in the gut, and also improve the way in which the brain interprets normal everyday signals sent from the gut, helping with pain. In some people with very severe symptoms, none of these drugs seem to work. Treatment then becomes much more difficult, but certain types of psychological treatment such as cognitive behavioural therapy and hypnotherapy have also been shown to improve the symptoms of IBS. Again, we presume that they work by altering the communication between the brain and the gut, but these therapies may also help patients to develop coping strategies for dealing with their difficult symptoms. We therefore sometimes offer patients a referral to see a psychologist or psychiatrist to discuss these treatments. 6

7 Is there a cure for irritable bowel syndrome? Unfortunately, there is no cure for IBS, but there are many treatment options to help improve symptoms, in order to try to minimise the impact on people s lifestyle. It is important that you speak to the doctor in clinic about what treatment you think would be best for you. Will my irritable bowel syndrome symptoms go away on their own? The symptoms of IBS do tend to fluctuate over time, changing from being barely noticeable to being quite troublesome. Most people notice that their symptoms are worse during stressful periods. Research studies suggest that about 2 out of every 3 people will have symptoms that are long-lasting. Is irritable bowel syndrome life threatening? IBS is not a life threatening condition. Research has shown that people with IBS have the same life expectancy as people without IBS. Where can I get more advice about irritable bowel syndrome from a trusted source? There are many reliable sources of advice available on the internet. The UK s national charity for IBS, The IBS Network, provides information, advice, and support for people living with IBS. For more information, visit: 7

8 This document can be made available, by arrangement, in large print, Braille and community languages, from: Gastroenterology Patient Services Co-ordinator The Leeds Teaching Hospitals NHS Trust Beckett Street, Leeds LS9 7TF The Leeds Teaching Hospitals NHS Trust 1st edition (Ver 1) Developed by: Dr. Orla Craig and Professor Alex Ford Produced by: Medical Illustration Services MID code: _016/JG LN Publication date 05/2017 Review date 05/2019