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International

International
consultations

with Dr. Jacques Duff are welcomed via SKYPE or Telephone. Please call the clinic on
+613 9848 9100
for an appointment.
Note that international appointments need to be pre-paid at time of booking.

IBS - SYMPTOMS AND DIAGNOSIS

IBS - Symptoms and Diagnosis

Symptoms of IBS are common

Irritable Bowl Syndrome (IBS) is a more common gastrointestinal condition than most people realise. Studies have estimated that IBS affects up to 30% of the US population (5-20% of men and 15-25% of women). The classic gastrointestinal symptoms of IBS are chronic or recurrent abdominal pain and/or discomfort and associated changes in bowel habits (diarrhea and/or constipation).

Rome II Diagnostic Criteria for IBS:

At least 12 weeks (which need not be consecutive) in the preceding 12 months of abdominal discomfort or pain with two of the following features:

  • The abdominal discomfort or pain is relieved with defecation and/or
  • the onset is associated with a change in frequency of stools and/or
  • the onset associated with a change in the form (appearance) of stool

Symptoms that cumulatively support the diagnosis of IBS:

  • Abnormal stool frequency (perhaps more than 3 bowel movements per day or less than 3 bowel movements per week)
  • Abnormal stool form (lumpy/hard or loose/watery)
  • Abnormal stool passage (straining, urgency, feeling of incomplete evacuation)
  • Passage of mucus
  • Bloating or feeling of abdominal distension

 

Two categories of IBS

although the Rome criteria, the de facto standard for diagnosing IBS, does not make the distinction, Irritable Bowel Syndrome can be subdivided into two major categories, In our experience, after having looked at hundreds of faecal microbiology profiles, each is associated with a different profile of intestinal bacteria balance. The profiles can only be identified by a Faecal Microbiology Analysis from Bioscreen Medical. To our Knowledge this Laboratory is the only commercial lab that refrigerates the faecal sample and transports it in an anaerobic (oxygen free) chamber prior to analysis. They have also developed unique techniques for growing and counting the main species of both Aerobic and Anaerobic gut bacteria.

Constipation-predominant:
  • Symptoms tend to alternate between constipation and normal stools.
  • Symptoms of lower abdominal cramping or aching or discomfort are commonly triggered by eating.
  • This profile is more likely to be associated with a low E-Coli count in the Faecal analysis. We think that this is probably due to the fact that E-Coli makes the amino acid Tryptophan which is a precursor to the Neurotransmitter Serotonin. Serotonin is not only the "feel good" Brain Neurotransmitter but is also needed to initiate and maintain the peristaltic activity, responsible for good gut motility.
Diarrhea-predominant:
  • The person may tend to experience diarrhea early in the morning or after eating.
  • The need to void the bowel is typically urgent, and cannot be delayed.
  • There may also be an incontinence problem.

IBS AND WORK DISRUPTION

  • Studies in the United States indicate that people with IBS miss 3-4 times more work days annually as the US national average of 5 days a year.
  • This makes IBS one of the most common reasons for work or school absenteeism, second only to the common cold.

IBS AFFECTS WOMEN MORE THAN MEN

  • Women are 2-3 times more likely to suffer from IBS than men.
  • Among women, IBS is most prevalent during the menstruation years.
  • Over 50% of women seeing a gynecologist for lower abdominal pain have IBS.
  • Women with IBS are three times more likely to undergo a hysterectomy than those without IBS.
  • Women with IBS are more likely to be eventually diagnosed with endometriosis than women with other bowel symptoms, suggesting the possibility of a common denominator.
  • Over 60% of patients with IBS report rheumatological symptoms, such as skin rashes, muscle spasms, headaches, muscle aches or Fibromyalgia.
Hormonal changes and IBS
  • Menstruation is associated with exacerbation of IBS symptoms in the majority of women.
  • Pregnancy appears to improve IBS symptoms temporarily for many women.
  • Oral estrogen and progesterone supplements do not seem to have any effect on IBS symptom levels.
  • Hysterectomy or tubal ligation appear to have little effect on IBS severity.
  • Endometriosis increases bloating symptoms but not other IBS symptoms.

UNC Center for Functional GI & Motility Disorders: National Survey of the Effects of Changes in Female Sex Hormones on Irritable Bowel Symptoms.

Sexual or physical abuse as a risk factor in IBS.

Among women in a referral-based gastroenterology clinic:
  • 51% reported a history of sexual and/or life threatening physical abuse
  • Patients with functional disorders (e.g., IBS and unexplained abdominal pain) had experienced more severe types of abuse such as rape and life threatening physical violence
Those with abuse history (compared to patients without abuse):
  • had on average three more medical symptoms (e.g., pelvic pain, headaches, genitourinary complaints, shortness of breath)
  • Patients with functional disorders (e.g., IBS and unexplained abdominal pain) had experienced more severe types of abuse such as rape and life threatening physical violence
  • reported greater pain
  • Had twice the number of days spent in bed due to illness
  • Greater disability in all areas of functioning (e.g., physical work, home management, psychosocial) more physiological distress

UNC Center for Functional GI & Motility Disorders: