IBS … when diarrhea is the problem


Riyadh: Dr. Abeer Mubarak

Within the current August issue of the Cleveland Clinic Journal of Medicine, medical researchers from the Digestive Health Institute at University Hospitals at the Cleveland Medical Center presented their medical review of a number of hypotheses put forward to explain the pathological mechanisms and how to treat the troublesome diarrhea. In cases of “irritable bowel syndrome”. Irritable Bowel Syndrome and


Under the title «Irritable Bowel Syndrome with Diarrhea: Treatment is a Continuous Action», the researchers said: «Irritable Bowel Syndrome is a disease with a non-homogeneous functional disorder, and has a large prevalence with a significant impact on the quality of life. It is traditionally understood as purely as a disturbance in the interaction between the intestine and the brain, but it is very clear that IBS includes various pathological mechanisms.

This is despite the assertion of Dr. Michael Corin, a physician at the Cleveland Clinic and one of the researchers involved in writing this medical review, that our understanding of the mechanisms of irritable bowel syndrome is already advancing, and that treatments increasingly target those pathogens, the diagnosis of this disease is still a “clinical diagnosis.” Its treatment is still “experimental” in most cases according to the condition of each patient, and it focuses exclusively on relieving symptoms without achieving the elimination of the disease itself. Specifically, first-line treatments still include anti-diarrhea, regular exercise, psychotherapy, and a traditional diet for these conditions, the researchers said.

Types of cases

The researchers added, “Irritable Bowel Syndrome is divided into cases of diarrhea, cases of constipation, and cases of a mixed type of them, based on the predominant state of the stool shape.” We are reviewing the diagnosis and treatment of diarrhea among the types of Irritable Bowel Syndrome, by carefully examining the mechanisms of pathophysiology in the emergence of these cases, with attention to recent developments in the approach of dealing that go towards the mechanical approach in treatment.

And they clarified other basic aspects in the types of Irritable Bowel Syndrome, in which symptoms appear at times and disappear at others, by saying: “Irritable Bowel Syndrome is classified as IBS – Diarrhea when it is in at least 25 percent of the times of excretion during the days of complaint from The symptom is stool type 6 or 7 on the Bristol Faecal Scale. ” (Clarification of the Bristol stool scale in the explanatory box attached to the article).

And they presented one of the recent explanations about the pathological mechanisms of Irritable Bowel Syndrome, other than the traditional information that the matter has an exclusive relationship with the disorder of the interaction between the intestine and the brain, saying: “New research indicates that IBS has various pathological mechanisms, which have contributed to diversifying our understanding of it. Among the most important are five hypotheses, which are: enteritis, post-microbial disorder, food allergy, microbiome changes, and bile acid malabsorption. Therefore, treatments are increasingly targeted for one or more of these pathological mechanisms, but the benefit remains: encourage patients to eat small, healthy meals more frequently and exercise, the researchers said.

Although the medical review indicated that treating the type of “diarrhea” in Irritable Bowel Syndrome, it should be aimed at dealing with its underlying causes, but in the absence of a clear understanding of the mechanisms that produce symptoms in this case, traditional treatments remain focused on relieving diarrhea with anti-inflammatory drugs. Diarrhea, which is one of the best drugs that slows down the movement of the intestine, and thus gives it the opportunity to absorb water and electrolytes of minerals, which helps to increase the hardness of the stool, and in the end, reduce the need to defecate. An example is the drug loperamide, which has been clinically studied for its positive effects in these cases.

Enteritis hypothesis

Inflammation of the intestine. According to this hypothesis, it is noticed that patients with IBS have a slight, but abnormal, increase in the presence of inflammatory cells in the intestine and an increase in the secretion of cytokine compounds, especially near the nerve endings. Based on this hypothesis, the Cleveland Clinic researchers said, a variety of anti-inflammatory therapies have been used in trials of irritable bowel syndrome, but they have shown mostly negative results. Surprisingly, patients who, for other reasons, are taking a type of steroid anti-inflammatory drug, have a lower risk of developing irritable bowel syndrome. However, when IBS patients took this drug, no significant positive results were observed compared to taking a placebo.

The same thing, the researchers said, applies to drugs from the 5-aminosalicylic acid class that are anti-inflammatory to the intestine, such as Mesalazine, as it is noted that patients who take it are less likely to have IBS, but those who suffer from IBS diarrhea do not. It gives them a clear benefit.

Post-microbial infection. The hypothesis of “post-microbial infection” is based on the fact that during acute gastrointestinal infection, there is a transient increase in lymphocytes and neuroendocrine cells in the digestive system, which can change the pattern of bowel movement through the occurrence of both: An increase in the production of serotonin Serotonin and increase intestinal permeability for a continuous period, and thus the emergence of irritable bowel diarrhea as a result of the increased production of certain types of antibodies resulting from the previously infected microbial infection and the reaction of the body’s immune system with microbes and intestinal cells accordingly.

According to this increase in the production of certain types of antibodies, a state of three things occurs: poor adhesion compacting between intestinal cells, increased permeability of the intestinal wall, and bowel movement pattern disturbance. As an example, the researchers point to an increased presence of antivinculin antibodies, which causes lower levels of phenoclin in the intestine, and the aforementioned changes in adhesion and permeability as a result. To date, there are no drugs that work to control this issue, despite some poor results in the study that used Glutamate for this.

Food “sensitivities”

Food allergy. Most IBS patients believe that their symptoms are related to a “allergy” from the diet, but unlike the well-known food allergy, there is no specific way to determine the extent of specific and real “food allergies” in cases of IBS. In the sense that the studies that examined this aspect by monitoring the proportion of antibodies in the blood to types of dietary antigens when eating meals containing certain foods, and comparing that to not eating them, there was actually a decrease in the severity of symptoms, but those foods that made this difference were known foods Originally, it causes increased symptoms in patients with IBS, such as wheat, milk and yeast.

The researchers added that avoiding products containing gluten is not necessary in cases of IBS because its usefulness has not been established. But because 40 percent of patients with IBS have difficulty digesting lactose maldigestion, some doctors advise avoiding products containing it to relieve symptoms of IBS.

A low-FODMAP diet is a diet: low-fat foods containing the fermentable varieties in the colon: Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. This is what medical guidelines recommend in dealing with cases of irritable bowel syndrome. These intended sugars are certain types and a few of the sugars that the digestive system cannot digest, and thus they reach the colon. In the colon it is digested, thus gas, abdominal pain and other colon disorders appear accordingly. These specific sugars are found in onions, types of fruits, grains and legumes. And many patients with irritable bowel syndrome respond when avoiding eating it carefully, but it should be done in follow-up with a nutritionist, and for a period not exceeding four weeks, because this causes another and unwanted disturbance in the balance components of the presence of the friendly bacteria microbiome in the colon.

Bristol stool scale … a practical medical diagnostic tool

The prevalence of IBS varies in different societies, but generally ranges from 12 to 21 percent among adults. And an incidence rate of 3 injuries among women for every infection among men. In the United States, complaints are reported to account for an average of 35 percent of all gastroenterology reviews.

There are three subtypes of irritable bowel syndrome, each of which affects a third of people with

IBS: For stool masses without visible edges) or Class 7 (completely liquid without solid) on the Bristol Stool Scale.

IBS – Constipation: This type is diagnosed when 25 percent of bowel movements are either Class 1 (hard and lumpy) or Class 2 (lumpy and sausage-like) on the Bristol stool scale.

Irritable Bowel Syndrome (IBS) – Mixed: This type is diagnosed when the two types alternate with the same advanced description that a person has on the Bristol stool scale.

There are broader subdivisions that can only be pointed out and there is no room for further extrapolation in their presentation, such as the “Rome IV IBS Classification” update, which is used in an advanced clinical fashion.

Therefore, the medical diagnosis of these subtypes is primarily based on the Bristol faecal scale. The Bristol Stool Scale is a standard medical diagnostic tool, in practice, in cases of stool disorders. It includes the classification of human form of defecation into seven categories.

According to medical sources, this scale was developed at the Royal Bristol Hospital in Britain in 1997, and its use has spread widely in clinical follow-ups of patients and in conducting medical research and studies.

According to this scale, we recognize the following seven categories:

> The first category: when the stool is in the form of separate solid lumps that are dark in color and difficult to pass, like small balls or pieces of nuts, and it indicates the presence of “severe constipation.”

> The second category: when the stool has a relatively solid and lumpy shape, similar to pieces of sausage. It indicates a moderate degree of constipation.

> The third category: when the stool is in the same shape as the second category, but with cracks on its surface, which indicates a relatively lower stiffness than the second category. This may be natural when you are careful to increase the intake of vegetable fibers in your meals.

> The fourth category: when the stool is in the shape of a sausage or a snake, and it is smooth and soft. This is the natural excretion of human stool. In terms of mass weight, it is normal to pass 200 grams of stool per day.

Fifth category: when the stool is in the form of sticky, round lumps. Although it is more ductile than normal, it still maintains clear and relatively smooth edges. This may indicate diarrhea.

> The sixth category: when the stool is in the form of very soft and soft pieces. It indicates the presence of diarrhea.

> The seventh category: when the stool is in a watery form and there is no solid mass for it at all. It indicates advanced diarrhea.

Irritable Bowel Syndrome … a heterogeneous symptom group

Irritable Bowel Syndrome is a disease with a functional disorder with a ‘group’ of ‘heterogeneous symptoms’. Gastroenterologists from Mayo Clinic report: “Irritable bowel syndrome is a common disorder that affects the large intestine. It is considered a chronic disease, but it does not cause changes in the tissues of the intestine and does not increase the risk of colon cancer, as it does not show symptoms and severe signs except in a small number of people with it.

“Some people can control their symptoms by managing diet, lifestyle and stress, and more severe symptoms can be treated with medication and medical advice.”

Irritable bowel syndrome signs and symptoms vary. The most common ones include:

> abdominal pain, cramps, or bloating, which usually goes away completely or partially after passing out

> excess gases

> diarrhea or constipation, and sometimes alternating bouts of diarrhea and constipation.

> Feeling of incomplete stool passage (Tenesmus)

> Mucus in the stool

> Most sufferers experience times when signs and symptoms get worse, and times when symptoms improve or disappear completely.

Heart palpitations and chest pain.

Also, people with IBS may suffer more than others from GERD, and a number of symptoms related to the genitourinary system such as interstitial cystitis, Chronic Fatigue Syndrome, Fibromyalgia, Migraine, Back Pain, Depression and Anxiety , A decrease in sexual desire.

But it is worth seeing a doctor when one of the following symptoms and signs are noticed:

– Weight loss

– diarrhea at night

– bleeding from the rectum

– anemia associated with iron deficiency

– Unexplained vomiting

– difficulty swallowing

– persistent pain that does not go away after flatulence or after a bowel movement.


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