From Proyar Laboratory queremos compartir con ustedes la 1º parte de un artículo exclusivo para nuestros clientes, redactado por el Dr. Jorge Alonso. Médico, MN 67.640, Director del posgrado de Fitomedicina de la U.B.A. y Presidente de la Sociedad Latinoamericana de Fitomedicina.

Irritable Bowel Syndrome (Part 1)

Irritable colon, whose more exact denomination is «Irritable Bowel Syndrome» (IBS), is a chronic and recurrent condition characterized by the existence of abdominal pain and/or changes in intestinal rhythm, accompanied or not by a sensation of abdominal distension, without demonstrating an alteration in intestinal morphology or metabolism, nor infectious causes that justify it. It has also been called nervous colitis, spastic colitis or spastic colon. All these denominations are considered today erroneous and incomplete.

Causes
Until today, no single mechanism is known that explains why patients with irritable colon suffer these symptoms chronically and recurrently. From a general point of view, what is most accepted and demonstrated is that there are alterations in motility and/or digestive sensitivity, influenced by psychological factors. In addition, other different alterations have been proposed that could also influence this disease: gastroenteritis, food intolerances, hormonal alterations and genetic factors.

People who suffer from it
It shows a clear predilection for women (14-24% versus 5-19% in men). It usually appears before age 35, decreasing its incidence after age 60. It is more frequent in patients with other functional digestive pathologies (especially dyspepsia, intestinal microbiota alterations), in women with gynecological alterations (dysmenorrhea) or sufferers of fibromyalgia, and in patients with psychiatric diseases (bulimia, depression, schizophrenia).

Symptoms
The characteristic digestive symptoms are pain and abdominal distension, and alteration of the intestinal evacuatory rhythm.

• Abdominal pain: it is usually diffuse or localized in the lower hemiabdomen, habitually non-irradiated, of colicky, oppressive or stabbing type, generally mild or moderate intensity, with a duration of less than two hours, which relieves after defecation and usually respects sleep. The onset or presence of abdominal pain is habitually associated with desires to defecate or with changes in the frequency or consistency of stools and frequently, the patient relates its beginning with the intake of some food.

• Alterations of the intestinal rhythm: they can manifest with predominance of constipation (mostly) or diarrhea, or in an alternating diarrhea-constipation form.

• Others: Abdominal distension and meteorism develop progressively throughout the day. Early satiety after intake, nausea, vomiting and chest burning (pyrosis) are frequent. Other symptoms are the sensation of incomplete evacuation (tenesmus) and the presence of mucus in stools.

Diagnosis
The diagnosis is based on a meticulous clinical history together with a complete physical examination, which will guide us toward the possibility of it being an irritable colon. Then, to complete the suspected diagnosis, we must perform various complementary tests that allow us to rule out the existence of organic pathology (diagnosis by exclusion). Among these complementary tests we can include general and specific analyses of blood, urine and feces, radiological studies of abdomen with and without contrast, abdominal ultrasound and videosigmoidoscopy/colonoscopy. Depending on the symptoms and the patient's age, we will determine in each case the most appropriate tests to reach the diagnosis.

Differential diagnoses
The most common is to differentiate irritable colon from other conditions that present with similar symptoms. Among them we highlight:

• Diverticular disease
• SIBO (Small Intestinal Bacterial Overgrowth)
• Megacolon

The complementary studies indicated in the previous paragraph can help us rule out some of these conditions. In the case of SIBO, the breath test or lactulose test can be used (it measures the amount of hydrogen and methane exhaled after drinking a mixture of water and glucose).

Continued in second part.