Irritable Bowel Disease (Syndrome) Flashcards
What do I need to know about Irritable Bowel Disease?
- To consider and clarify the definition of irritable bowel disease, and review the presentation and associated factors of the condition
- To consider dysbiosis, SIBO and leaky gut syndrome and how these might contribute to the picture of irritable bowel disease
What is Irritable Bowel Disease or Syndrome?
Definitions:
- ‘a chronic condition of recurring abdominal pain with constipation or diarrhoea or both’ Collins Online Dictionary
- ‘Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder characterized by abdominal pain and altered bowel habit in the absence of a specific and unique organic pathology’ Medscape CME (online)
- ‘Irritable bowel syndrome (IBS) is a common condition that affects the digestive system’ NHS Conditions (online)”
What are the signs and symptoms of Irritable Bowel Disease? What are the potential complications if any?
Signs and symptoms:
* Abdominal pain – diffuse, can localise to left lower quadrant
* Abdominal bloating
* Altered bowel habit which may be constipation, diarrhoea or a combination of both
* Mucorrhoea (passing mucus per rectum)
* Symptoms triggered by eating
* Nausea, dyspepsia and urinary frequency may accompany the condition
Dysbiosis – what is it and what does it cause?
Dysbiosis – alteration in the composition and/or balance of the gut microbiota. Not a simple binary ‘more bad bacteria, less good bacteria’ imbalance
Microbiome provides defence against
pathogens and helps regulate immune
response – disruption may leave GIT
vulnerable to hypersensitivity and
dysregulated activity.
How useful are probiotics in situations of
dysbiosis?
What likely causes of Irritable Bowel Disease?
Aetiology
* No precise cause yet identified
* Intestinal permeability, dietary intolerance, alterations in gut microbiome (and previous severe GIT infection), dysfunctional contractility and innervation, stress
What is the pathophysiology of Irritable Bowel Disease?
- Altered GI motility
- Hypersensitivity to pain and bowel movement
- Microscopic inflammation
- Psychological disorder
- SIBO
What is SIBO ?
Small intestinal bowel overgrowth.
Aetiology
- A slowing of flow and stagnation in the small intestine allowing bacteria to flourish (normally an area with lower bacterial populations)
- Risk factors include certain medical conditions e.g. Crohn’s disease, diabetes and coeliac disease (conditions slowing transit through the bowel), structural abnormalities of the bowel and abdominal surgery
Signs and Symptoms
* Loss of appetite
* Abdominal pain and bloating
* Nausea
* Diarrhoea – distinct from IBS as SIBO doesn’t
tend to present with constipation
* Malnutrition
* Unintentional weight loss
Diagnosis; Breath test to check for increased exhalation of hydrogen or methane. Aspiration and bacterial testing of small intestinal
fluid
Low FODMAP diet recommended: Avoids lactose, grains, starchy vegetables and some fruits.
What are the key diagnostic tests for Irritable Bowel Disease?
How IBS is diagnosed and treated
Case history
Blood tests and stool sample to exclude other causes
What are the convential treatments for Irritable Bowel Disease? How can herbs help?
Spasmolytic, anti-diarrhoeal and laxative medication may be given. Diet and lifestyle advice is the mainstay of conventional treatment.
Herbal considerations
Spasmolytics (Valeriana, Viburnum opulus…)
* Carminatives (Mentha pip., Foeniculum…)
* Anti-inflammatory (Filipendula, Calendula,
Chamomilla)
* Anxiolytics (Melissa, Scutellaria, Withania, Lavandula…)
What is leaky gut syndrome?
Leaky gut syndrome is - Hyperpermeability of the intestinal wall. Casued by Inappropriate
diet, poor gut circulation, infection which leads to Reduction in integrity of intestinal
barrier.. leads to Permeability to antigens.. leads to Systemic illness
Herbal considerations
* Astringents (Achillea millefolium, Rubus idaeus, Capsella bursa pastoris…)
* Vulnerary (Calendula, Plantago…)
