martes, 13 de agosto de 2019

Treatment of Irritable Bowel Syndrome

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By Dr. Ananya Mandal, MDReviewed by April Cashin-Garbutt, MA (Editor)

There is no specific cure for Irritable Bowel syndrome. However lifestyle and diet changes are important in reduction of symptoms in most patients.

When the patient presents with symptoms, care should be taken to exclude other diagnoses like bowel cancer and inflammatory bowel diseases.

Once this is done the patient is reassured and primary advice is given to the patient on diet, relaxation, medication, probiotics, alternative approaches and counselling and behavioural therapies. (1, 2, 3, 4)

Diet

The patient is asked to make a concomitant food and diet diary along with his or her symptom diary. Sometimes it gives clues into the foods that trigger aggravation of symptoms of IBS.

Normally the intestines contract in response to a particular diet. This response may be high in response to fat and low in response to dietary fibers. Persons with IBS may need to cut down on fats in diet and increase fibers.

Those with intolerance to milk and milk products may also avoid such foods in their diet.

Persons with IBS are often advised to avoid large meals that promote pain and bloating. They are asked to eat small meals in short spans of time instead.

Soluble fiber in diet may help persons with diarrhea. They raise the bulk of the food while reducing spasms. However, persons with constipation may often develop worsen symptoms.

In most persons soluble fibers help soften hard stools and bulk up loose watery stools to normalize bowel movements. Psyllium derivatives, or polycarbophil (20–30 grams/day) may be prescribed to IBS patients.

Soluble fibers are found in fruits like apples and citrus fruits, vegetables like potatoes, oats, barley and dried beans.

Insoluble fibers are prescribed in individuals with constipation. Good sources of these include whole grains, cereals, peels of fruits and vegetables and wheat bran or seeds.

Patients are advised to eat slowly, avoid food triggers, caffeine, sweeteners, alcohol and gum.

They are advised to consult a diet expert or nutritionist to draw up a healthy eating list for themselves. Diet should include plenty of liquids and water. This prevents constipation and prevents dehydration from diarrhea.

Relaxation

Since stress, anxiety, depression and lack of sleep often trigger worsening of symptoms of IBS relaxation therapies may help patients of IBS.

Regular exercise and deep breathing is one of the best ways for stress relief.

Medication

Some drugs that relieve the spasm may be prescribed in patients of IBS. Drugs include those that stop diarrhea (antidiarrheals), smooth muscle relaxants that relieve pain, psychotropic agents for pain and stress relief.

There are newer agents like Alosetron which has a Serotonin like action. It is effective in women with diarrhoea.

In women with more constipation another Serotonin related agent called Tegaserod Maleate may be tried effectively.

Smooth muscle relaxants like Dicyclomine have been shown to be effective in relieving cramps and pain. However, they must be used on an “as-needed” basis since they tend to lose their efficacy on long term use.

Antidiarrhoeal agents like Loperamide along with adequate fluids may stop diarrhoea. They also reduce abdominal pain and reduce urgency.

Some patients benefit from antidepressant agents that reduce symptoms of depression. These include tricyclic antidepressants like Amitriptyline. They help patients with anxiety and panic attacks as well who also suffer from IBS.

Probiotics

Probiotics are preparations that contain natural bacteria that are present normally in the gut.

These are helpful bacteria that help in digestive functions. A good probiotic is yoghurt. Probiotic preparations are often prescribed to IBS patients where they may provide relief.