Irritable Bowel Syndrome (Ibs)

Symptoms

IBS is based on functional disorders of the intestines, which are manifested by characteristic symptoms:
•    Pain in the abdomen - differs in location, degree of intensity and character (it can be acute stabbing or dull diffuse), usually the pain is associated with defecation and almost does not disturb during sleep;

•    Intestinal disorders - usually manifested in the form of diarrhea or constipation (sometimes replace each other), bloating, discomfort, heaviness in the abdomen, a feeling of incomplete emptying of the intestine are also disturbing.
The course of the disease can be compared to a snowball. The first manifestations of the disease occur at the level of the small intestine: duodenum, jejunum and ileum. It is with their defeat that flatulence, diarrhea and sharp pains, colored by vegetative reactions (changes in skin color, increased sweating and worsening of mood), are associated.
After the small intestine, the large intestine is involved in the pathological process. Undigested substances get into it, which leads to constipation, which can be replaced by diarrhea, and less severe pain that radiates to the back.
At night, patients usually do not worry about anything [9] . The course of the disease is accompanied by a succession of exacerbations and remissions, the duration of which depends on the intensity of the symptoms and the individual characteristics of the patient.
 

Causes

The cause of the development of IBS is still unclear, but there are factors that contribute to the formation of the syndrome:
•    Unbalanced diet, abuse of foods that irritate the intestinal mucosa (spices, smoked meats, marinades, salinity, vinegar, alcohol, coffee, carbonated drinks);
•    Psycho-emotional stress, stress, depression ;
•    Previous diseases, including infectious ones (usually these are infections that affect the gastrointestinal tract and are accompanied by vomiting and diarrhea, such as rotavirus infection , salmonellosis , etc.);
•    Taking certain medications (for example, omeprazole , metformin , antibiotics, laxatives, antidepressants, or oral hormonal drugs).
According to the mechanism of influence on the body, these factors can be divided into the following groups:
•    Factors affecting the change in intestinal motility;
•    Factors that increase intestinal sensitivity;
•    Various genetic and environmental factors.
The approach to the treatment of patients with IBS should cover all aspects of the causal relationship of the disease.
 

Treatment

The treatment of IBS is complex, the tactics depend on the period of the disease (exacerbation or remission) and includes several main points:
•    Diet and lifestyle modifications;
•    Taking medication;
•    Psychotherapeutic and physical rehabilitation.
Diet
The correct diet is selected over time, excluding different foods in turn and monitoring the reaction of the body. To do this, at the beginning of the disease, the patient is recommended to keep a food diary. As a result, he is assigned an individualized nutrition plan that does not contain individual ingredients that cause an increase in the symptoms of the disease (elimination diet).
Doctors recommend eating 4-5 small meals a day. Have occasional protein snacks, but avoid eating in a hurry or while you're at work.
High-protein foods such as turkey, chicken, eggs, salmon, milk, soy products, and cheese are rich in tryptophan, the amino acid from which serotonin is synthesized. The use of this substance does not mean that the body will absorb and use it. But the availability of tryptophan when needed will improve the synthesis of serotonin [8] .
It is also necessary to increase the drinking regimen: drink water fractionally and often, in case of exacerbation it is better to use warm water.
For constipation, it is necessary to add foods rich in fiber to the diet: vegetables and fruits (during an exacerbation, they need to be thermally processed, and consumed fresh during remission). With diarrhea, on the contrary, it is worth limiting their consumption, while you can add food sorbents.
In case of exacerbation, continuous and severe course of the disease, it is important to exclude products that irritate the intestines (spices, smoked meats, marinades, salinity, vinegar, alcohol, coffee, carbonated drinks, fast food, snacks, chips, canned food, energy drinks, packaged juices and compotes). Also, foods that stimulate gas formation are not recommended (all types of cabbage, legumes, potatoes, grapes, milk and fresh pastries).
Good nutrition is the foundation of human health and well-being. With IBS, nutritional adequacy is impaired, so it is important to monitor the quality of food.
To better regulate and optimize nutrition, dietary supplements (baa) may be recommended. They help eliminate the lack of proteins, vitamins, minerals and trace elements. The most useful are dietary supplements containing fiber (bran, pectin, psyllium) and enriched with b vitamins, which are necessary for the optimal functioning of the intestinal microbiota.
Conservative treatment:
Of the drugs used: antispasmodics, antidiarrheals, serotonin antagonists (namely 5-ht3 receptors), probiotics, antibiotics, antidepressants and selective serotonin reuptake inhibitors.
The choice of remedy depends on the predominant symptoms that cause more concern. The doctor prescribes all medications and dosage individually strictly for medical reasons.

Tests Required for Diagnosis

The main symptom of IBS, which underlies the diagnosis, is the absence of significant changes in the patient's body with a large number of complaints. However, the doctor (therapist, gastroenterologist or surgeon) has to do a lot of research to rule out severe pathologies of the digestive tract.
Diagnosis of IBS is based on three points:
1.    Clinical picture and analysis of the medical history - the doctor is interested in the duration of the disease, the symptom that worries the most, provoking factors, etc;

2.    Examination of the patient - analysis of the physical condition (with obligatory probing of the abdomen) and the mental status of the patient;

3.    Laboratory and instrumental studies - are prescribed individually in accordance with clinical features and recommendations, but most often the patient undergoes general clinical studies of blood, urine, feces, biochemical blood tests and ultrasound of the abdominal organs.
If necessary, an in-depth additional examination is prescribed (MRI, X-RAY, endoscopic and extended serological examination).

Useful info

The small intestine is one of the most richly vascularized organs. Despite its constantly changing volume and position of the loops, it receives an uninterrupted blood supply from the abdominal aorta through a large number of arteries - arcuate anastomoses. It is because of the dense circulatory network that pain often has a diverse character and greatly affects well-being.
In addition to the rich network of blood vessels in the walls of the small intestine, there are also many nerve plexuses, therefore, when the intestine begins to expand or contract more or longer than usual, less blood begins to flow to the intestine, which causes pain.
In addition to a large number of arteries and veins, the walls of the small intestine contain many lymphatic vessels; its mucous membrane also contains about 80% of all immune cells, which makes the intestine an important organ of immunity [11] .
Not only the lymphoid tissue, located in close proximity to the mucous membrane, provides an adaptive immune response, but the epithelium also does not allow various substances with foreign genetic information to penetrate the gastrointestinal tract. Gut immunity also develops systemic tolerance to beneficial elements to create a healthy microflora.
That is why, in case of disruption of the intestinal mucosa, the resistance of the human body to bacterial and viral infections decreases, and the risk of allergies increases, which can contribute to the development of IBS. According to studies, people with allergies often have this syndrome, but how exactly they are related remains to be studies.
 
Why does IBS pain occur?
An important role in the development of IBS is played by the pathological relationship between the gastrointestinal tract and the mechanisms of pain perception [2] . For example, the process of synthesis and breakdown of neurotransmitters (glutamate, aspartate, adenosine triphosphate nucleotide and nitrogen dioxide) that transmit pain impulses from the intestines to the brain is changing. Patients suffering from IBS may also have a reduced effect of the pain-suppressing system due to a deficiency in the endogenous opiates that the brain produces (endorphins and enkephalins). In parallel, the emotional perception of nerve impulses from the intestines to the brain changes [10] .
In IBS, there is a lack of serotonin. Due to its incorrect exchange and restructuring of the nervous regulation along the “gut-brain” axis, the contraction of the intestine may be disturbed as a result, as well as the sensitivity of the intestine to the usual stretching and the normal amount of gases may increase [6] . Such changes lead to intestinal and extraintestinal symptoms: abdominal pain, stool changes, eating disorders (from decreased appetite to bouts of uncontrolled hunger) [12] .
Serotonin also promotes positive emotions and, as a precursor to melatonin, helps regulate the body's sleep cycle, wakefulness, and internal clock [12] . Therefore, the lack of serotonin in IBS contributes to the fact that a person's mood deteriorates and there are problems with sleep.
 
Classification and stages of development:
Currently, two classifications of the syndrome are used. The first is based on the predominant symptom:
•    IBS with intestinal dysfunction - with this type of syndrome, diarrhea or constipation occurs;
•    IBS with pain syndrome - patients suffer from pain in the abdomen of a different nature;
•    IBS with flatulence - patients experience bloating and heaviness in the abdomen, gas discharge from the intestines [4] .
In accordance with the nature of the patient's stool, they distinguish:
•    IBS with a prevalence of diarrhoea;

•    IBS with a prevalence of Constipation;

•    IBS with a mixed variant - diarrhea in equal proportions replaces constipation, the most common type;

•    Undifferentiated type of IBS - there is not enough data to determine one of the three main types.
Also, depending on the nature and severity of the symptoms, the course of the disease can be mild, moderate and severe.

Complications:
Patients with IBS may develop concomitant chronic diseases of organs located near the intestines, such as diseases of the liver, pancreas, organs of the genitourinary system and small pelvis (for women, these are cycle disorders, increased pms symptoms, for men, erectile dysfunction, changes in the prostate gland ). 
 Often with bowel diseases, chronic back pain occurs.
At the same time, IBS does not affect the development of cancer or inflammatory bowel disease.