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| IRRITATION BOWELS DEEP |
Dr. Leena Mahana Kapoor,
Internal medicine specialist, Zulekha Hospital, Dubai. |
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Irritable Bowel Syndrome (IBS) is one of several functional disorders,
characterized by abdominal bloating and pain, altered bowel habits which
include diarrhea, constipation or both of them one after the other, and
other significant disabilities. It is commonly seen among young adults,
especially young women. "It’s very common, being one of the
commonest conditions seen by primary care physicians as well as gastroenterologists," says
Dr. Leena Mahana Kapoor, Internal Medicine Specialist, Zulekha Hospital,
Dubai.
IBS is a costly disorder. "People have to miss three times more working
days than those without these symptoms. It stays for life with remissions
and exacerbations. Several patients have psychiatric symptoms including
depression, anxiety, somatisation and personality disorders." No physical
findings or diagnostic tests can confirm the diagnosis. "Diagnosis
involves identifying certain symptoms which are consistent with the diagnosis
and excluding other medical conditions which may have a similar clinical
presentation," says Dr. Leena.
" The Rome-2 diagnostic criteria for IBS emphasize a positive diagnosis
rather than exhaustive tests to rule out other diseases. Detailed history, physical
examination and limited diagnostic testing help to confirm this diagnosis with
a high level of confidence. Extensive testing is reserved only for specific situations." Symptoms
usually consist of abdominal pain and bloating which is relieved by defecation,
change in frequency and/or consistency of stool, passage of mucus and abnormal
stool passage. Upper GI symptoms may also be reported like heartburn, feeling
of early satiety and nausea. However, IBS is not caused by stress or is not all
in the mind," says Dr. Leena. IBS is not a serious disease like cancer.
IBS can, however, seriously compromise a person’s quality of life. Chronic
and recurrent symptoms can disrupt personal and professional life, upset emotional
well-being and limit individual potential. "After making a clinical diagnosis,
a limited workup is done to exclude certain other similarly presenting disorders.
More extensive testing is reserved for people with alarm symptoms," says
Dr. Leena.
Treatment involves, firstly, education of the patient by a sympathetic
doctor, reassurance and counseling. These help to increase a patient’s
sense of well-being and reduce the number of visits to a doctor. Dietary
advice consists of eliminating specific foods that trigger symptoms (e.g.,
coffee, chocolate, alcohol, gas-producing beans, legumes, lactose, sorbitol).
Addition of fiber to diet in people with constipation (e.g., raw fruits,
whole wheat, bran, psyllium etc) and maintenance of a food dairy is highly
beneficial. Stress Management techniques (e.g., exercise, yoga, hypnosis,
bio-feedback). In severe cases, low dose antidepressants maybe helpful.
" Drug therapy consists of pain relief (antispasmodics), anti diarrheas,
laxatives and some newer agents for severe cases. A comprehensive plan of management
helps to decrease morbidity of this chronic and recurrent disorder," says
Dr. Leena. The bottom line: A healthy doctor-patient relationship must be cultivated. |
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