Irritable Bowel Syndrome
Irritable bowel syndrome (IBS), is a common disorder of the intestines that affects nearly one out of five people in the United States. According to the book, Irritable Bowel Syndrome & the Mind-Body-Brain-Gut Connection by William B. Salt II, IBS is the most common functional gastrointestinal disorder. The symptoms include constipation, diarrhea or alternating bouts of both, bloating, abdominal pain and many other problems.
Symptoms of irritable bowel syndrome usually begin during adolescence or early adulthood. Altered bowel movements occur over periods of days to weeks. Occasionally, symptoms may be continuous. In a given individual, both constipation and diarrhea can occur, or either can be the recurring symptom. The course of the disease varies from patient to patient, but individually, it can follow a consistent pattern.
The diarrhea of irritable bowel syndrome is usually of small volume, but frequent. Episodes commonly occur during periods of stress. The initial morning movement may be normal, but followed by successively loose bowel movements throughout the rest of the day. Bowel movements may be associated with extreme urgency. The diarrhea rarely awakens patients from sleep and there is usually no associated fever or rectal bleeding.
The abdominal pain of irritable bowel syndrome can vary in severity from mild to severe. It is usually felt in the lower abdomen, especially on the left side. The pain may be dull, sharp, crampy or continuous. It is commonly relieved by the passage of gas or by defecation *1*.
Each year, 2.6 million people seek treatment for symptoms related to functional gastrointestinal disorders, and visits to physicians total 3.5 million (Salt xiv). The average age of onset of IBS is between 20 and 29 years of age, and IBS is prevalent throughout the world including China, the United Kingdom, Australia, New Zealand and Scandinavia (Salt xiv, xv). The public is made aware of cases of HIV, heart disease, various forms of cancer, etc., on a daily basis, yet IBS is relatively unheard of. Because of this, millions of people who suffer from IBS feel there is a stigma attached to their disease and they must suffer in silence.
IBS is not a rare disease. In fact, it is the second leading cause of absenteeism in the workplace, coming in behind the common cold *2*. Unlike the common cold, however, there is no over-the-counter drug that can be picked up at the local drug store at the first sign of symptoms. Furthermore, there are few prescription drugs that have been used to treat IBS with positive results. The first prescription drug specifically developed for diarrhea-predominant IBS, Lotronex, was released to the market in March of 2000. Glaxo Wellcome, maker of Lotronex, says the precise mechanism of action of the drug is not fully understood. However, the working hypothesis is that the experimental drug blocks the action of the neurotransmitter serotonin and 5-HT3 receptor sites in the gastrointestinal track.
The thinking is that serotonin and 5-HT3 receptors play a role in increasing the sensations of pain and affecting bowel function in IBS patients. In addition, nerves that control the muscles in the gut may overreact to stimuli such as gas and the passage of food after a meal. This may cause painful spasms and contractions and speed up or slow the passage of stool through the colon, resulting in diarrhea or constipation *3*.
Lotronex has only been shown to work in women, and there is presently no medication available for men suffering from Irritable Bowel Syndrome. Lotronex works by blocking the level of serotonin in the intestinal system in order to reduce the cramping abdominal pain and discomfort, urgency and diarrhea.
The first step in determining if the bowel problems in question are caused by IBS is to visit a physician for a check up. Chances are, he will refer the patient to a gastrointerologist, who will then order outpatient testing to be done at a hospital. This battery of tests can include an upper and lower GI, a barium enema/X-ray, an EGDwhich consists of sticking a scope down the throat to look into the stomach, an ultrasound, and any other deemed necessary by the specialist. IBS will be diagnosed after it is determined that the patients organs are functioning properly and