Lifelong Health by Dr. David Lipschitz

The American College of Gastroenterology recently issued new recommendations on how to diagnose and treat irritable bowel syndrome, a condition that affects 7 to 10 percent of Americans. With guidelines for traditional and nontraditional therapy, this new report offers some hope for the millions of adults struggling with this difficult illness.

Symptoms of IBS include abdominal pain, bloating, gas, diarrhea, constipation or a combination of any of those symptoms. More than 80 percent of cases occur in women, typically between the ages of 15 and 40. Only 10 to 15 percent of cases occur after the age of 50. The syndrome is more common in individuals with high stress, significant emotional problems or depression.

Sensitivity to dairy products, wheat, fructose, sorbitol, carbonated beverages, alcohol or fatty foods can aggravate or cause the syndrome. Certain antibiotics, antidepressants and drugs containing sorbitol also can lead to the syndrome. Some suggest that IBS can occur as a complication of food poisoning or traveler's diarrhea.

In order to diagnosis the syndrome, physicians typically perform a colonoscopy to obtain a biopsy of the colon. The new guidelines indicate that if the only symptoms are abdominal pain, bloating and constipation or diarrhea, a major work-up to exclude more serious conditions is not necessary.

This is a particularly important finding because it can seriously limit unnecessary procedures. However, more testing typically is needed for those older than 50 or in cases in which there is weight loss, blood in the stool, anemia or a family history of colon cancer, celiac disease or inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis.

Abdominal pain accompanied by severe diarrhea with blood and a great deal of mucus is indicative of a more serious condition. Any patient with IBS who experiences diarrhea or a combination of diarrhea and constipation should have a blood test to screen for celiac disease, an illness caused by a hypersensitivity to gluten.

Because the symptoms of IBS vary from patient to patient, therapies must be tailored to their specific problems. In recent years, there have been several new medications that seem to help certain patients struggling with the syndrome.

For patients with constipation, the guidelines suggest prescribing Amitiza, which increases the secretion of fluid in the intestines and stimulates bowel motility.

The non-absorbable antibiotic rifaximin can be helpful for patients who experience bloating. If the pain is severe, antispasmodics, such as hyoscyamine, Bentyl and peppermint oil, should be considered.

Immodium should be the mainstay treatment for patients with diarrhea. But for those in whom Immodium is unsuccessful, treatment with Lotronex could be considered. This drug blocks the release of serotonin from the intestines, slowing motility and helping reverse diarrhea; however, it only should be used under close supervision, as serious side effects have been reported. In general, patients with the syndrome should consider treatment with selective serotonin reuptake inhibitors, such as Prozac, Zoloft, Celexa and Lexapro, which have been shown to be helpful in relieving the symptoms. Finally, a probiotic called bifidobacteria may help some IBS patients.

In addition to medical therapies, there are many lifestyle problems that should be addressed. Stress reduction — through counseling, relaxation exercises or increased physical activity — can be a powerful tool in the management of IBS. Also, patients always should maintain careful diets, avoiding any foods that can aggravate the condition. Many suggest keeping a food record in hopes of correlating intake of specific foods with the development of symptoms.

For those with constipation, gradually increasing dietary fiber can be beneficial. People with IBS must slowly increase the amounts of fruit (including prunes), vegetables, whole-grain bread and cereal containing dietary fiber (including oatmeal) they eat. While 80 percent of patients with IBS find relief with the addition of fiber, for the remaining 20 percent, additional fiber could make symptoms worse. Adults with the syndrome should avoid refined foods, such as white bread, white rice, potato chips and cookies. Eating slowly and regularly also appears to be of benefit.

Although IBS is not a life-threatening medical problem, it causes a great deal of discomfort and suffering. While there is no single medical treatment guaranteed to solve the problem, a comprehensive strategy with medical and lifestyle components can help alleviate the symptoms.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.drdavidhealth.com.

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