Expert advises individuals not to ignore digestive symptoms  

Mohamad Mouchli, MD

Many individuals are hesitant to discuss digestive complaints and bowel symptoms with their physicians, so they suffer needlessly in silence for years, says a gastroenterologist from global health system Cleveland Clinic speaking in April, which is designated as Irritable Bowel Syndrome (IBS) Awareness Month by the International Foundation for Gastrointestinal Disorders.

“We need to normalize talking about digestive and bowel symptoms with healthcare providers,” says Mohamad Mouchli, MD. “Whether it is due to fear, stigma, embarrassment or societal norms, research shows that many individuals are either reluctant to raise these symptoms with their doctor, or else they discuss them only when asked about them directly or when the situation worsens. Patients often prefer to search for information online, which can be counterproductive.”

Dr. Mouchli adds, “Symptoms related to the digestive tract often indicate IBS, which is uncomfortable, but nothing to fear as it doesn’t damage your digestive tract or raise your risk for colon cancer. In very rare cases, we might find the patient’s symptoms are the result of a more serious condition, such as colon cancer, in which case early diagnosis and treatment improve outcomes. So, either way, it is best to seek help from a healthcare provider if you have persistent digestive symptoms.”

IBS is a functional gastrointestinal disorder – also known as disorder of the gut-brain interaction – which is related to problems in how the gut and brain work together, says Dr. Mouchli. These problems cause the digestive tract to be very sensitive and also change how bowel muscles function, resulting in abdominal pain, gas, diarrhea, and constipation.

The International Foundation for Gastrointestinal Disorders (IDGD) estimates that 5-10% of the world’s population has IBS. According to the Foundation, women have the condition more often than men; most patients are under the age of 50; and many are diagnosed only years after their symptoms begin. An IDGD survey of nearly 2,000 IBS patients found that their diagnosis of IBS was typically made 6.6 years after their symptoms began.

“An IBS diagnosis is made when someone has three or more bouts of unexplained pain or abdominal discomfort – for example, bloating, cramping and diarrhea – for at least three months in a row with clear periods of no symptoms in between bouts,” says Dr. Mouchli. “Depending on the symptoms, a blood test, stool samples and a colonoscopy might be undertaken to exclude other possible diagnoses.”

Causes, triggers and treatments

Dr. Mouchli says the exact cause of IBS remains unclear, but researchers believe that a combination of factors can lead to IBS, including dysmotility, which refers to problems in how the GI muscles contract and move food through the gastrointestinal (GI) tract; visceral hypersensitivity, meaning that nerves in the GI tract are extra sensitive; and a miscommunication between nerves in the brain and gut referred to as brain-gut dysfunction,.

Studies also suggest that people may be at risk of IBS if they have a family history of IBS, emotional stress, tension or anxiety, a history of abuse or childhood trauma, food intolerance or have had a digestive tract infection.

There are effective ways to manage the condition and reduce a flare-up so that patients can enjoy a better quality of life, says Dr. Mouchli. Triggers for an IBS flare-up vary from person to person and can be inconsistent, so he works with his patients to identify their personal triggers, which can then be minimized or avoided. Common triggers include various types of food as well as medication and stress.

In the case of food, elimination diets, undertaken in consultation with a doctor, can help ease discomfort and identify which foods trigger an attack. Foods typically eliminated include gluten, dairy, sugar and packaged and processed foods.

Carbohydrates called FODMAPS – an acronym for fermentable oligosaccharides, disaccharides, monosaccharides and polyols – appear to have the most impact on wellbeing, and many individuals find relief following a long-term, low-FODMAP diet.

“There is no cure for IBS, but working with a medical expert to make lifestyle changes such as diet and stress-management – and medication to address symptoms where needed – can make a great difference to improving patients’ quality of life,” Dr. Mouchli concludes.