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Irritable Bowel Syndrome - Part 2
- 1. IBS – Part 2 Dr Vivek Baliga Consultant Internal Medicine Baliga Diagnostics
- 3. Adverse Reactions to Food • Above-average intake of certain foods is probably not the cause of IBS symptoms • Significant difference between individuals with functional GI disorders & healthy controls IBS patients, consumed greater proportion of energy as fat & smaller proportion as carbohydrate • Adverse Reactions to Food 20% to 67% of individuals with IBS Referred to as “trigger foods” or “dietary triggers” Prevalent in female IBS patients & correlates with anxiety level 58% to 75% reacting to specific foods did not react when consuming food unknowingly - Possible psychosocial in origin WILLIAMD.HEIZERetal.TheRoleofDietinSymptomsofIrritableBowel SyndromeinAdults:ANarrativeReview.JAmDietAssoc.2009;109:1204-1214.
- 4. Food Allergy • 6-8% children & 1-4% adults • Rapid onset reactions mediated by IgE • Usually within < 2 hours Swelling, itching, hives, wheezing, nausea, vomiting, diarrhea, abdominal pain, and/or collapse • Slow-onset food allergy Mechanisms that involves not only IgE but also T lymphocytes, mast cells, eosinophils & other mucosal immune cells Celiac disease, food protein– induced enterocolitis, eosinophilic esophagitis/gastroenteritis/ proctocolitis • Mucosal role allergy Abnormal increases in mucosal eosinophils & mast cells Close association of these cells with enteric nerves in mucosa • No validated to detect non–IgE- mediated immune reactions to foods As not sensitive or specific enough for clinical use • Although IBS prevalence higher among asthmatics Food allergy not shown to be associated mechanism Evidence suggests immunemediated reactions to food are probably responsible for IBS symptoms in small proportions WILLIAMD.HEIZERetal.TheRoleofDietinSymptomsofIrritableBowel SyndromeinAdults:ANarrativeReview.JAmDietAssoc.2009;109:1204-1214.
- 5. Food Poisoning & Food Intolerance Food Poisoning • No evidence that microbial contamination of food is cause of IBS symptoms • Few individuals develop postinfectious IBS following a bout of food poisoning Food Intolerance • Nontoxic & nonimmune adverse reactions to food • Pharmacologic reactions Presence in food histamine, monosodium glutamate, serotonin, norepinephrine, & tyramine • Metabolic reactions in colon or distal small intestine to unabsorbed carbohydrate Lactose, sorbitol, fructose, & fermentable fiber WILLIAMD.HEIZERetal.TheRoleofDietinSymptomsofIrritableBowel SyndromeinAdults:ANarrativeReview.JAmDietAssoc.2009;109:1204-1214.
- 6. Lactose • Disaccharide that is not well digested & absorbed • Attributed to low enzyme lactase • Lactose malabsorpton Not appear to cause of IBS or more prevalent in IBS Based on milk challenge Eliminating high-lactose–content products from diet Lack of improvement sufficent to exclude diagnosis • Adverse reactions to milk More prevalent So may improve when milk excluded Some have true cow’s milk allergy • Trials of lactose restricted diets 40-85% of IBS patients reported significant improvement, probably due to lactase Lactase supplementation did not improve IBS symptoms allergy WILLIAMD.HEIZERetal.TheRoleofDietinSymptomsofIrritableBowel SyndromeinAdults:ANarrativeReview.JAmDietAssoc.2009;109:1204-1214.
- 7. Other Poorly Absorbed Carbohydrates • Some carbohydrates are poorly absorbed & may enter distal small bowel and colon Fructose, fructose-containing compounds, sorbitol and other sugar- alcohols • This increase osmotic load & provides substrate for bacterial fermentation Resulting in gas production, change in bacterial populations, motility, and possibly other effects • A diet low of fermentable oligo-, di-, and monosaccharides and polyols suggested for IBS WILLIAMD.HEIZERetal.TheRoleofDietinSymptomsofIrritableBowel SyndromeinAdults:ANarrativeReview.JAmDietAssoc.2009;109:1204-1214.
- 8. Gas-Forming Foods • Foods reported to produce large amounts of gas Beans, brussels sprouts, onions, celery, carrots, raisins, bananas, prune juice, apricots, wheat germ, and bagels • Hypothesis that reducing intestinal fermentation would improve IBS Compared fiber-free liquid diet, standard diet + antibiotic, metronidazole, to a standard diet This significantly reduced methane & hydrogen excretion and improved symptoms Eliminating highly gas-forming foods may be appropriate WILLIAMD.HEIZERetal.TheRoleofDietinSymptomsofIrritableBowel SyndromeinAdults:ANarrativeReview.JAmDietAssoc.2009;109:1204-1214.
- 9. Wheat & Gluten Alcohol Wheat & Gluten • Gluten hypersensitivity in form of celiac disease can mimic IBS • Prevalence of celiac disease among IBS - 0-32% • Screening IBS patients for celiac disease by serological tests, not gluten-restricted diet • Mechanism of nonceliac adverse reactions to wheat is unknown Related to fructan level in wheat or placebo effect Alcohol • Consumption not significantly associated with IBS • 21% with IBS, report intolerance to various alcoholic beverages • Reintroduction studies showed alcohol caused recurrence in 9-14% WILLIAMD.HEIZERetal.TheRoleofDietinSymptomsofIrritableBowel SyndromeinAdults:ANarrativeReview.JAmDietAssoc.2009;109:1204-1214.
- 10. Fat & Caffeine Fat • Individuals with IBS may consume Higher proportion of energy as fat Have increased intestinal sensitivity to fat • Infusion of fat into duodenum slows gas movement in jejunum & increases rectal sensitivity significantly more • Not clear evidence of high-fat meals exacerbating IBS symptoms Coffee/Tea/Chocolate • Stimulates gastrointestinal motility & causes diarrhea • 26% IBS patients report limiting/avoiding coffee • Study with improvement on exclusion diet & recurrence once reintroduced Reported in 14-33% WILLIAMD.HEIZERetal.TheRoleofDietinSymptomsofIrritableBowel SyndromeinAdults:ANarrativeReview.JAmDietAssoc.2009;109:1204-1214.
- 11. Dietary changes that may be worth trying Recommendations regarding food or diet changes WILLIAMD.HEIZERetal.TheRoleofDietinSymptomsofIrritableBowel SyndromeinAdults:ANarrativeReview.JAmDietAssoc.2009;109:1204-1214.
- 12. Conclusion Irritable bowel syndrome greatly impacts daily life , generates substantial health-related fears & concerns, and remains poorly understood by patients Absence of warning signs, diagnosis of IBS made at 1st clinic visit & treatment Key aspect of any treatment regimen involves educating patient about his/her condition Improvement achieved by increasing intake of soluble fiber by 10 to 20 g/day Daily use of peppermint oil is effective Usefulness of probiotics is unproven Elimination diet & followed by stepwise re-introduction useful in diagnosis
- 13. Thank You!