What is Celiac Disease?
Irritable Bowel Syndrome (IBS) is a gastrointestinal disorder characterized by the presence of chronic abdominal pain, and changes in bowel habits in the absence of any organic cause. This disease affects 10 to 15% of people around the world. Of these patients, only 15% seek medical help, but as the number of people compromised by the disease becomes greater, the SII represents 25-50% of medical consultations. Abdominal pain and intestinal discomfort experienced by patients with IBS cause deterioration in quality of life, and inevitably make these patients seek medical help. IBS is the second cause of absence from work for medical reasons, followed by the flu and common colds.
IBS occurs in varying ages, but is most common in adolescents and young adults. The onset of symptoms after age 50 is unusual. Women are twice more affected than men, and the association with periods of psychosocial stress is evident.
Symptoms of Irritable Bowel Syndrome are abdominal pain (colic), abdominal distension (flatus), diarrhea and constipation. Abdominal pain may be of medium to high intensity and can relate to diet and stress, and will be located most commonly in the lower abdomen. Diarrhea is a common symptom and will cause an inconvenience, since it changes the patients lifestyle (frequent trips to the bathroom), fecal incontinence (involuntary loss of feces), defecation urgency and anxiety. Diarrhea occurs predominantly after waking and after meals, and may be preceded by abdominal discomfort. The evacuation of stools with mucus may be present in 50% of cases. Constipation is associated with abdominal distension, flatulence, abdominal pain and aesthetic change. Patients may also refer to the sensation of incomplete evacuation, even when the rectum is empty. In some cases there is an alternation of symptoms, ie, at a time the patient complains of diarrhea, and during constipation.
Some other gastrointestinal symptoms are described, such as dyspepsia (bad digestion), gastroesophageal reflux, early satiety and nausea. Furthermore, one of the most common symptoms reported is the presence of intestinal flatulence. For non-gastrointestinal manifestations, the most common are chest pains not associated with heart problems, increased frequency of urinary urgency, pain during intercourse (women), worsening of sexual function and trigger symptoms of rheumatic diseases (such as fibromyalgia).One should always remember that IBS is a functional disorder, meaning there is no associated anatomical injury. Thus, there is no reason for intestinal bleeding, fever, anorexia, anemia, malnutrition and weight loss. When these symptoms are present, other diseases should be investigated and medical help becomes essential. Thus, all additional tests such as blood tests and endoscopy showed normal results in IBS.
The cause of IBS is unknown, but it is believed to be associated with an increase in intestinal sensitivity and motor disorders of the intestine. Anxiety and psychosocial stress must always be considered, since they tend to trigger and sustain, intestinal and abdominal symptoms. The intestinal changes in sensitivity (hypersensitivity) are characterized by the onset of colic pain, and in certain conditions where intestinal pressure increases while there is flatulence and constipation. What catches the eye in patients with IBS is that the pressure could be tolerated in people without the disease, causing immense discomfort and pain in patients with this disease. A combination of genetic factors and environmental factors result in the alterations of gastrointestinal sensation and motor function that ultimately result in symptom manifestation.
In 10% of patients the symptoms of Irritable Bowel Syndrome started after an episode of bacterial intestinal infection, which is called post-infectious IBS, also known as “post-dysentery intestinal disorder.” This process is most common in patients with severe and prolonged diarrheal diseases, young people and women.
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The non-drug treatment is appropriate for many patients, and should be kept in consideration when opting for medical treatment. First, there must be a good doctor-patient relationship, since the disease is chronic and characterized by the presence of recurrent symptoms. Furthermore, the patient should be informed about the reasons for their symptoms and treatment options. The change in lifestyle should be taken into account, since stress and anxiety are the factors that trigger and maintain the intestinal symptoms. In this aspect, the physical exercises also have great value.
Attention to diet is important, and patients should avoid some types of foods, such as excess caffeine, fatty foods, and lactose (milk, cheese). In the case of lactose, 25% of patients with IBS may have an intolerance to this substance, and hence reduction of consumption can evolve with the improvement of symptoms in some cases. In patients with constipation, they should stimulate a high-fiber diet. In cases where there is abdominal distension due to intestinal gas, food such as beans, lentils, carrots, raisins, apricots, broccoli, cauliflower and onions should be avoided.
The use of fiber supplements is encouraged in IBS patients. During these cases, the feces become more viscous and lubricated, and bowel movements are more efficient, resulting in less traumatic evacuation. As for fiber options, water soluble ones are more effective than insoluble. Some studies show that fiber supplements are beneficial to patients with constipation, but can worsen symptoms in patients with diarrhea.
Psychotherapy is used in those patients in which emotional factors are strongly related to symptoms. In patients with diarrhea and abdominal pain, psychotherapy shows good results. Unfortunately, the same is not observed in patients with constipation.
Drug treatment of Irritable Bowel Syndrome includes measures that control symptoms related to constipation, diarrhea, and abdominal pain, as it comes to chronic disease and with no definitive cure. In patients with constipation, the treatment goal is to make the evacuation a no trauma event, which would reduce the abdominal pain and bloating, and consequent bloating. In cases of diarrhea, the goal is to reduce the defecation urgency and stool frequency.The treatment of constipation is the use of fibers and accelerate intestinal transit. In patients with diarrhea, it uses anti-diarrhea drugs. It should be remembered that these drugs should only be used after performing an accurate diagnosis of IBS and prescribed by a physician.
In cases of intestinal colic, the use of anti-spasmodic medication relaxes the bowel musculature, leading to a decrease in pain condition. However, it must be remembered that these medications are effective for abdominal pain, but have little effect in relation to diarrhea and constipation.
Some patients benefit from the use of antidepressants in low doses, probably due to the decrease in intestinal sensitivity. The use of antidepressants bring better results for patients with diarrhea, since one of the side effects of antidepressants is constipation. The use of antidepressants is mainly indicated in cases in which abdominal pain is prominent or when other therapies have failed.
Currently new drugs are being tested, especially agonists and antagonists of serotonin, which is a substance stimulating the intestinal function. However, these drugs may exhibit cardiovascular side effects, constipation, and severe ischemic colitis, their use is still very limited and controlled. With respect to flatulence, some studies have suggested the use of antibiotics to reduce the intestinal flora, which could be responsible for the formation of gas. However, it failed to prove that there is an increase of this flora in patients with IBS, and so this approach is not adopted by me in relation to patients.
How to diagnosis Celiac Disease?
The diagnosis is made based on the symptoms presented by the patient. In order to confirm the diagnosis, there should be no changes to the clinical examination or laboratory tests.
Generally, the doctor requests general blood and stool, and can detect the most common parasitic diseases.
These tests are not intended to confirm the diagnosis of Irritable Bowel Syndrome, but to rule out other causes of similar symptoms, as there is no test that can prove the diagnosis of IBS.
In individuals with the onset of these symptoms after age 40 and those with a family history of colon cancer, an evaluation by colonoscopy or, less frequently, barium enema with double contrast, is indicated to rule out this possibility.The presence of fever, bleeding, anemia, weight loss, symptoms overnight and large volume and frequency of diarrhea are not Irritable Bowel Syndrome characteristics and should trigger investigation of other causes.