15% of the UK population have IBS at some time, and 67% of IBS sufferers are women. IBS accounts for 10% of all GP visits and 50% of all visits to gastroenterologists. However IBS is a condition for which the NHS has only limited treatment options.
Irritable Bowel Syndrome (IBS) is defined by the Rome III criteria as symptoms of recurrent abdominal pain or discomfort and a marked change in bowel habit for at least six months, with symptoms experienced on at least three days of at least three months. Two or more of the following must apply:
- Pain is relieved by a bowel movement.
- Onset of pain is related to a change in frequency of stool.
- Onset of pain is related to a change in the appearance of stool.
The Rome III Criteria is as defined by the Rome Foundation which is an independent not for profit organisation that provides support for activities designed to create scientific data and educational information to assist in the diagnosis and treatment of functional gastrointestinal disorders (FGIDs). The Rome Foundation’s mission is to improve the lives of people with functional GI disorders.
GPs tend to diagnose IBS by exclusion, rather than with formal diagnostic criteria. A diagnosis of IBS is made after ruling out other diseases such as Inflammatory Bowel Disease (IBD), Diverticulitis and Colon Cancer by undertaking testing as recommended by NICE (National Institute of Clinical Excellence). NICE guidelines (NICE 2008) recommend a full blood count, erythrocyte sedimentation rate (ESR) or plasma viscosity, C-reactive protein (CRP) and antibody testing for coeliac disease.
Other tests for thyroid function, a basic stool test (for parasites) might be offered and a barium enema, colonoscopy or sigmoidoscopy will be recommended if there is a family history of bowel cancer. Once these tests have been undertaken and found to be negative (about 97% of cases) the patient will be diagnosed as having IBS.
Many GPs consider IBS as an ‘unrewarding’ condition to treat
In a recent research paper the results of a survey of GPs on the treatment of IBS patients revealed that many GPs feel that IBS is an unrewarding condition to treat due to the lack of effective treatment options available.
The survey, which summarised the results of 30 qualitative semi-structured interviews with GPs, (15 based in the Netherlands and 15 in the UK) stated that “current consensus recommendations for treating and managing IBS emphasise education and support, dietary modification and sparing prescription of drugs including antispasmodics, laxatives, antidiarrhoeals and in some cases antidepressants”.
However, there is limited evidence for the efficacy and tolerability of therapies currently available in Europe for the treatment of IBS”. (Casidy et al).
Identifying the causes of IBS
The issue with the mainstream approach to IBS is that once pathologies are ruled out little is done to identify the underlying causes of a patient’s IBS.
This is further compounded by the fact that there are often multiple reasons for a person’s symptoms making a clear diagnosis even more difficult. The GP therefore can only offer palliative measures designed to alleviate the symptoms of IBS and does not address the causes.
Dixon-Woods M, Critchley S. Medical and lay views of irritable bowel syndrome .Fam Pract 2000;17:108-113.
Brilliant IBS Testing now available
The advent of a brilliant range of clinical tests enable Nutritional Therapists to identify hitherto unknown biological imbalances as well as infections of yeasts, bacteria and parasites which have been shown to negatively affect the gut, altering motility, promoting inflammation and otherwise impeding normal gut function.
The importance of testing and using the right kinds of tests!
Testing allows unique insight as to the goings-on at gut level. IBS Clinics offer a wide array of tests with varying costs to suit all pockets. Tests commonly recommended include: Comprehensive Stool Analysis (CSA), Breath tests for bacterial overgrowth, Lactose or Fructose intolerance, Food sensitivity tests and Adrenal Stress Tests. All tests are designed to be simple to do and can be done in the patient’s own home.
IBS Clinics approach to IBS
The approach used by IBS Clinics in identifying the cause of IBS is extremely comprehensive and includes the completion of a specially designed IBS specific questionnaire, a review of a three day food diary and key functional tests. Tests needed are recommended after a full review of the questionnaire is conducted (which can include additional questions) as well as a patient timeline and personal history. Tests are kept to a minimum (as they incur additional cost) and full details of the need to test, what the test shows and even samples of such test reports are available to the patient for review.