April is Irritable Bowel Syndrome (IBS) Awareness Month in Canada. Did you know that 13-20% of Canadians are living with IBS? That’s ~5-7.5 million people or roughly 1 in 5 people (GI Society)! Despite this, IBS remains a perplexing gastrointestinal disorder with a persistent cloud of ambiguity surrounding its symptomatology, etiology, and management. In this comprehensive exploration, we aim to dissect the complexities of IBS, drawing upon scientific evidence to elucidate its symptoms, potential causative factors, and effective management protocols.

IBS manifests as a chronic functional gastrointestinal disorder characterized by recurrent abdominal pain, bloating, and alterations in bowel habits, without any structural abnormalities. Its symptoms often fluctuate in severity and can significantly impede the individual's quality of life and daily functioning. These symptoms encompass a spectrum of manifestations, including:

1. Abdominal pain or discomfort, typically alleviated following defecation.

2. Distension and bloating.

3. Alterations in bowel habits, ranging from diarrhea to constipation, or an alternating pattern of both.

4. Passage of mucus in the stool.

5. Associated symptoms such as fatigue, nausea, and urinary symptoms in some cases (Patel N, et all; 2022).

The etiology of IBS is multifactorial, involving intricate interplays between biological, psychological, and environmental factors. Several potential contributors have been identified, including:

1. Altered gastrointestinal motility and visceral hypersensitivity.

2. Dysregulated brain-gut axis signaling, implicating aberrations in neuroendocrine and neuroimmune pathways.

3. Disruptions in the gut microbiota composition and functionality.

4. Low-grade inflammation within the gastrointestinal tract.

5. Genetic predisposition and familial clustering of IBS cases.

6. Psychological comorbidities such as anxiety, depression, and stress, which can exacerbate symptomatology (Patel N, et all; 2022).

IBS is a diagnosis of exclusion - this means that all other gastrointestinal conditions have been ruled out. This necessitates a meticulous evaluation of clinical symptoms, physical examination, various investigations (bloodwork (complete blood count, inflammatory markers, and stool studies), endoscopic procedures (colonoscopy or flexible sigmoidoscopy), and radiological imaging studies in select cases (Patel N, et all, 2022).

While curative therapies for IBS remain elusive, an array of management strategies aims to ameliorate symptom burden and optimize patient outcomes. These include:

1. Addressing the Gut Microbiota - it has been seen in various studies that the microbiota of those with IBS differs from the normal population (Lewis ED, et al; 2020). Therefore, addressing the dysbiotic picture of IBS can improve the quality of life and mental health of those suffering from this condition as see in the study by Lewis ED, et al; 2020.

   • Small Intestinal Bacterial Overgrowth (SIBO) is also extremely common in those with IBS. Again this stresses the importance of nourishing a healthy microbiota, by eliminating the pathogenic overgrowth of the bacteria and inoculating healthy, beneficial bacteria.

2. Decrease inflammation - there is evidence that people with IBS have mucosal inflammation present in their intestine, and due to the gut-brain axis - the brain as well, resulting in neuroinflammation. This is especially true if their IBS started after an infection, like infective gastroenteritis. This inflammation results in an increase in mast cell density and activity in the gut and may cause visceral hypersensitivity (Ng QX, et al; 2018).

3. Supporting mental health - there is a very strong association between stress, psychiatric and mood disorders, and IBS (Fond G, et al; 2014. Császár-Nagy N, et al; 2022).

   • There have been studies showing the benefit of Hypnotherapy on symptoms such as anxiety and depression and improved quality of life and cognitive function (Császár-Nagy N, et al; 2022).

4. Lifestyle changes - encouraging healthy foundations of health (sleep, activity, stress management, nutrition) can also be helpful to patients with IBS. Having a Naturopathic Doctor to support you and give you more tailored recommendations would be ideal since everyone is different and your experience of IBS can be different from others.

In conclusion, navigating the complexities of IBS mandates a multidimensional approach encompassing comprehensive clinical evaluation, evidence-based interventions, and patient-centered care. By leveraging scientific insights and tailored management strategies, Naturopathic Doctors can empower individuals with IBS to attain symptom relief, enhance their quality of life, and embark on a journey towards holistic well-being.

~Dr. Charmagne

References:

1. Patel N, Shackelford KB. Irritable Bowel Syndrome. 2022 Oct 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30521231.

2. Lewis ED, Antony JM, Crowley DC, Piano A, Bhardwaj R, Tompkins TA, Evans M. Efficacy of Lactobacillus paracasei HA-196 and Bifidobacterium longum R0175 in Alleviating Symptoms of Irritable Bowel Syndrome (IBS): A Randomized, Placebo-Controlled Study. Nutrients. 2020 Apr 21;12(4):1159. doi: 10.3390/nu12041159. PMID: 32326347; PMCID: PMC7230591.

3. Fond G, Loundou A, Hamdani N, Boukouaci W, Dargel A, Oliveira J, Roger M, Tamouza R, Leboyer M, Boyer L. Anxiety and depression comorbidities in irritable bowel syndrome (IBS): a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci. 2014 Dec;264(8):651-60. doi: 10.1007/s00406-014-0502-z. Epub 2014 Apr 6. PMID: 24705634.

4. Császár-Nagy N, Bókkon I. Hypnotherapy and IBS: Implicit, long-term stress memory in the ENS? Heliyon. 2022 Dec 30;9(1):e12751. doi: 10.1016/j.heliyon.2022.e12751. PMID: 36685398; PMCID: PMC9849985.

5. Ng QX, Soh AYS, Loke W, Lim DY, Yeo WS. The role of inflammation in irritable bowel syndrome (IBS). J Inflamm Res. 2018 Sep 21;11:345-349. doi: 10.2147/JIR.S174982. PMID: 30288077; PMCID: PMC6159811.