Or Irritable Bowel Syndrome (IBS)
Definition
Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder. It is considered a functional digestive disorder because it alters certain functions of the body, such as intestinal transit. However, individuals with IBS generally do not show any structural, biochemical, or histological abnormalities.
Etiology
The exact cause of IBS is unknown. Various psychosocial and physiological factors may be involved. These factors include alterations in the enteric nervous system, intestinal hypersensitivity, abnormal gastrointestinal motility, disorders of the brain-gut interaction, low-grade inflammation, immune system activation, increased intestinal permeability, and alterations in the gut microbiota.
Symptoms
IBS symptoms may include chronic abdominal pain, altered bowel habits (diarrhea and/or constipation), a sensation of incomplete evacuation, abdominal distension, bloating, flatulence, and the presence of mucus in the stool. Symptoms can be triggered by certain foods or emotions (e.g., stress, anxiety, etc.). Symptoms may also vary within the same individual and between individuals.
Diagnosis
IBS diagnosis is based on the presence of standardized symptoms, called the Rome criteria, and the exclusion of other pathologies.
Rome Criteria
IBS diagnosis according to the Rome criteria is made in individuals who have experienced abdominal pain at least one day per week in the last three months, with at least two of the following points:
- Pain associated with defecation
- Pain related to a change in stool frequency (diarrhea and/or constipation)
- Pain related to a change in stool consistency
Exclusion of other pathologies
It is also important to perform additional tests to rule out other conditions that resemble IBS, such as celiac disease, Crohn's disease, diverticular disease, lactose intolerance, intestinal cancer, etc. These tests are especially important in individuals who present certain warning signs, such as rectal bleeding or anemia, nocturnal bowel movements, unintentional weight loss, persistent daily diarrhea, recurrent vomiting, advanced age, or fever.
Classification
There are four IBS subtypes, classified according to the predominant transit: IBS with predominant constipation (IBS-C), IBS with predominant diarrhea (IBS-D), IBS with alternating constipation and diarrhea (IBS-M, mixed), and unclassified IBS when there are insufficient criteria.
Nutritional Treatment
Nutritional treatment of IBS varies from one individual to another depending on symptoms (e.g., diarrhea, constipation, etc.) and triggering factors (e.g., foods and emotions). Depending on the individual, treatment may include dietary modification, exclusion diets (e.g., FODMAP), changes in fiber intake, supplements, probiotics, and prebiotics.
Dietary Recommendations
Depending on symptoms and their triggers, dietary recommendations may include:
- Increasing dietary fiber intake and hydration, especially in the presence of constipation
- Splitting meals and avoiding drinking large amounts during meals
- Eating at regular times and not skipping meals
- Eating slowly and chewing well
- Reducing gas-producing foods and habits that may promote aerophagia (e.g., drinking through a straw or chewing gum), especially in the presence of bloating and flatulence
- Avoiding foods high in fat
- Avoiding or reducing gastrointestinal stimulants (e.g., caffeine, nicotine, alcohol), especially in the presence of diarrhea
- Encouraging regular physical activity and stress reduction
- Maintaining an elimination routine (e.g., FODMAP).
Finally, it is important to remember that dietary recommendations should always be personalized to meet the specific needs of each individual.
References
- Bouthillier, Lise. January 2019. “Digestive Tract Diseases.” NUT 2047 – Clinical Nutrition 2. Montreal: University of Montreal.
- Schwartz, L., and C. E. Semrad. “Irritable Bowel Syndrome.” Modern Nutrition in Health and Disease, by A. Catharine Ross, Wolters Kluwer/Lippincott Williams & Wilkins, 2014, pp. 1096–1099.
- https://www.merckmanuals.com/fr-ca/professional/troubles-gastro-intestinaux/syndrome-de-intestin-irritable/syndrome-de-intestin-irritable?query=Syndrome%20de%20l%E2%80%99intestin%20irritable%20(SII)#
- https://www.merckmanuals.com/fr-ca/accueil/troubles-digestifs/syndrome-de-l-intestin-irritable-sii/syndrome-de-l-intestin-irritable-sii?query=Syndrome%20de%20l%27intestin%20irritable