Irritable Bowel Syndrome (IBS) is one of the functional bowel disorders. The term irritable bowel is no longer used because the small intestine also plays a role in this syndrome.
It is a chronic pathology (at least 6 months of evolution) associating abdominal pain and intestinal transit disorders such as episodes of diarrhea or constipation or even an alternation of the two.
Irritable bowel syndrome is a so-called “functional” pathology. This means that no abnormality of the organs in question is identified by means of routine examinations (no abnormality of the intestinal mucosa, for example).
Pain (spasms, twists, sometimes burning) is often in the foreground, of varying intensity in the same person, very frequently associated with bloating. They can sit anywhere in the abdomen, mainly around the navel (peri-umbilical region, in the flanks and the iliac fossae, the pelvic region...) or even be a frame pain, that is to say following the course of the colon. These pains, sometimes intermittent, are often accentuated a few hours after meals and can be relieved or, on the contrary, aggravated by the emission of stools and/or gas.
Possible extra-digestive symptoms should not be overlooked (headaches, hot flushes, muscle pain, asthenia (fatigue), etc.).
All the symptoms of irritable bowel syndrome are mild but they can significantly alter the quality of life, whether it is food, sleep, self-image, life in society, professional and sexual.
What are the causes ?
Irritable bowel syndrome, a multifactorial disease
Different factors, of varying importance depending on the individual, are involved in irritable bowel syndrome. Motor disorders in the small intestine and colon are the cause of an acceleration or a slowing down of transit. The intestine is also often too sensitive to its contents (gas and stools), resulting in unpleasant sensations and discomfort that are not normally perceived.
In addition to these intestinal sensitivity disorders found in 60% of patients, there are sometimes abnormalities in the visceral pain control mechanisms in the central nervous system as well as an imbalance in the composition of the intestinal bacterial flora (microbiota) . This is called dysbiosis, observed in two thirds of people suffering from irritable bowel syndrome.
The "porous intestine" theory describes an increase in intestinal permeability (in 50% of patients), allowing the passage of bacterial fragments which would cause minimal inflammatory reactions and thus make the intestine hypersensitive.
Anxiety, stress or regular exposure to stressful events, authentic axio-depressive syndromes, a history of painful life events (divorce, bereavement, sexual abuse) can trigger the syndrome and/or accentuate the symptoms.
Fibromyalgia, clear urine (interstitial) cystitis, dyspepsia (set of symptoms of epigastric pain or discomfort, gastroesophageal reflux disease (GERD) are some of the conditions sometimes associated with irritable bowel syndrome (comorbidities For example, irritable bowel syndrome is present in about half of people with fibromyalgia.
Who is at risk?
Women, three times more affected than men
In France, Europe and North America, irritable bowel syndrome affects three women for every man. A western peculiarity still unexplained. Leads exist, such as a slower colonic transit time in them, a lower visceral sensitivity threshold or even the fact that women are more likely to retain sequel symptoms of gastroenteritis or "post-infectious irritable bowel syndrome ". In fact, even mild gastrointestinal infections increase the risk of irritable bowel syndrome by two to three times. We find in 15 to 20% an irritable bowel syndrome following an intestinal infection.
In addition, depression is twice as common in women. An anxiety-depressive syndrome is one of the contributing factors of irritable bowel syndrome.
Finally, women with irritable bowel syndrome may have been more often exposed to a traumatic event (abuse, sexual harassment) in the past than men.
Male or female, there is a history of sexual abuse in 30 to 40% of cases of functional intestinal disorders.
Exams
No deterioration in general condition or abnormalities in biological examinations
By definition, examinations are normal in irritable bowel syndrome, which is a diagnosis of elimination, essentially clinical. The objectif complementary examinations are to exclude an organic, rectocolic affection or of the abdomino-pelvic region. In the event of suggestive symptoms or alarm, examinations can be proposed such as a complete blood count (NFS) to identify anemia, an endoscopy of the colon (colonoscopy), an abdominal ultrasound, stool analyzes in the event of diarrhea (coproculture ).
Treatments
Above all, reduce abdominal pain and discomfort
Regular physical activity, which accelerates gas transit, is recommended.
Diets are based on simple notions such as eating reasonably and regularly, reducing foods that have been identified as being poorly tolerated (about a quarter of patients are really intolerant to certain foods), avoiding foods that are too fatty, being wary of an excessive amount of fibers which have an effect on transit and can accentuate or trigger pain and bloating.
In addition, limiting FODMAPs is a diet that can be tried. FODMAPs are so-called fermentable sugars (carbohydrates or carbohydrates) that are poorly absorbed in the intestine where they will therefore ferment under the action of bacteria. It is this fermentation that causes the digestive symptoms experienced (with an increase in gas production). The English acronym FODMAPs stands for "Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols", sugars increasingly used by the food industry. The diet consists of reducing the overall quantity of foods high in FODMAPs without completely excluding them, based on the person's eating habits and tolerance (reduction in frequency and/or quantity). It seems effective in about one in two people.
The main foods high in FODMAPs are those that contain lactose, certain cereals such as wheat, barley and rye, certain vegetables (asparagus, cabbage, broccoli, leeks, artichokes, etc.), certain fruits (such as apple, pear , etc.), all synthetic sweeteners and industrial foods. However, this diet is restrictive and difficult to follow. Ideally, it should be carried out strictly and supervised for 4 to 6 weeks. If symptoms improve, a gradual reintroduction of food families can be carried out.
Probiotics act on the bacterial composition of the intestine in order to fight against dysbiosis. They should be tested as an adjunctive treatment, empirically on a case-by-case basis. In some people, digestive symptoms are improved. All marketed probiotics are not equivalent, some not having demonstrated their effectiveness. It is therefore preferable to take a probiotic that has demonstrated superior efficacy to placebo in humans in this indication.
The first-line drug treatment of irritable bowel syndrome is based on antispasmodic drugs. They minimize the intense and sudden contractions of the intestine and are effective on bloating and pain (alverine citrate, mebeverine, pinaverium bromide, trimebutine, phloroglucinol). The treatment also includes transit regulators (laxatives in case of constipation and antidiarrheals in case of diarrhoea) and hygiene and dietary recommendations. Gastrointestinal dressings have no clearly established efficacy.
Hypnosis can help reduce digestive symptoms and anxiety, a major component of irritable bowel syndrome, with some patients resistant to standard medical treatment, with positive repercussions on quality of life, psychological well-being and physical and digestive symptoms. Hypnosis is also recommended in France in the management of refractory irritable bowel syndrome.
Other techniques can be considered, such as cognitive behavioral therapies or mindfulness meditation, but their interest and effectiveness are less well supported by scientific studies. Osteopathy has yet to prove itself. No published study is in favor of acupuncture and reflexology in functional digestive pain.
Analgesic antidepressants (tricyclic class, low dose) are useful in certain stubborn and severe pain, because they act on visceral pain mechanisms and sensitivity.
Psychological care can be useful in the event of an anxiodepressive syndrome or significant psychological impact of digestive disorders.
Labels
irritable bowel syndrome