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Treatment of Irritable Bowel Syndrome.There is no one treatment of Irritable Bowel Syndrome thatis effective in a majority of IBS sufferers. |
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Treatment of IBS.By Dr. Phil Hariram.At present treatment of Irritable Bowel Syndrome is in the form of Patient Education. Dietary modification. Medication. Behaviour and psychological therapy. Education is mainly info on IBS to help sufferers to understand the signs and symptoms of Irritable Bowel Syndrome, diets for IBS, and other IBS treatment. This education is often delivered by a specialist or the Family Doctor. It is very likely that the patient is given information on IBS in the form of leaflets or handouts. Education and support is an important aspect in treatment.
Dietary modification is mainly done by the patient. Patients list foods for Irritable Bowel Syndrome that are likely triggers and exclude them. Sufferers know the foods that give them abdominal pains, bloating and diarrhoea. They are also advised to include fibre preferably soluble fibre in their planned diet for IBS. Some feel that lactose intolerance and Irritable Bowel Syndrome are linked and tend to have a lactose restricted diet. Psychosocial therapies include psychotherapy, biofeedback, cognitive behavioural therapy, and hypnotherapy. Drugs for IBS are mainly directed to specific symptoms. The most frequently used group are the antispasmodic drugs but their effectiveness and consistency of benefits make them unreliable. They also have side effects. Antidepressants have shown beneficial effects. Tricyclics are use to control Irritable Bowel Syndrome pain and slow down transit time. Antidiarrhoeal drugs will help in diarrhoea of IBS. Tranquillisers such as the Benzodiazepine group will reduce acute anxiety in Irritable Bowel Syndrome, but because of the risk of habituation, this group of drugs should only be used on a short term basis. The newer drugs, 5HT3 receptor agonists and 5HT4 antagonists work on the serotonin level in the blood. High levels cause diarrhoea and lower than normal levels result in constipation. The 5HT3 antagonists, Alosetron and Cilansetron reduce serotonin level and are used to treat IBS when diarrhoea is predominant. Alosetron was found in trials to be effective in women. It was licensed in the USA in 2000 but was subsequently withdrawn in November 2000 because many patients developed ischaemic colitis and severe constipation. In June 2002 it was reapproved by the FDA in a restricted manner. It is to be used only among women with severe diarrhoea from Irritable Bowel Syndrome and have failed to respond to conventional treatment. Tegaserod, a 5HT4 receptor agonist and prokinetic, is effective in women with constipation in IBS. The therapeutic gain over placebo is 20%, while cognitive behaviour therapy provides an impressive therapeutic gain of 33% over control. . Irritable Bowel Syndrome is a life long illness and medical treatment should be on a short term basis and if possible, avoided completely. At this moment in time there is no one medical treatment that has proved to be effective in a large number of IBS patients. It is therefore no surprise that sufferers turn to alternative treatment for IBS. According to Giese, 2000; Spanier et al 2003, between 11 and 43% of patients with gastrointestinal problems use complimentary and alternative treatment for IBS. These include
Hypnotherapy and Irritable Bowel Syndrome. In 1984 Whorwell et al described gut directed hypnotherapy. This comprised 7 half hour sessions of hypnotherapy weekly over a 3 month period. After the third session, the patients were given a self hypnosis tape to use at home. When the patients were deeply under hypnosis, the patients were asked to place a hand on the abdomen and to notice the warm feeling passing from the hand. They were reassured that the warm feeling is the body asserting control over the gut function. Various studies have been carried out since then. Some utilising Prof. Whorwell’s gut directed hypnotherapy. The results are very encouraging. It could be argued that it is time consuming and costly but the outcome could be an Irritable Bowel Syndrome patient living comfortably for years with little or no symptoms. A survey of 200 patients that had hypnotherapy for Irritable Bowel Syndrome showed 71% responded well to hypnotherapy and the benefits lasted at least 5 years. All IBS patients on the trial had one hour of hypnotherapy weekly for 12 weeks. Assessment was based on IBS symptom improvement and quality of life and mood. This assessment was carried out soon after the 12 sessions and six years later. (W. Gonsalkorale. GUT.) Probiotics and Irritable Bowel Syndrome. Metchnikoff in 1907 first suggested that ingesting bacteria in yoghurt or other fermented food could benefit normal gut flora. One trial showed that probiotics reduce the duration of infectious diarrhoea in children. This is important when considering post infective Irritable Bowel Syndrome. By shortening the duration of the initial gastroenteritis or preventing colonisation by bad bacteria, it is possible to reduce the risk of developing subsequent Irritable Bowel Syndrome. Several studies have claimed beneficial effects on functional bowel disorders. Unfortunately most of these studies are hampered by low numbers of patients in the trial or dubious statistical analysis. In addition there are the problems with different inclusion criteria, heterogenicity of the patients and the use of different probiotic agents for Irritable Bowel Syndrome. Larger trials will provide more useful information. The Mayo Clinic reviewed seven randomised controlled trials on the effect of probiotics on bloating and concluded that probiotics showed only modest improvement. On the other hand Prof. Quigley, University College, Cork, in the March 2005 Gastroenterology, reported that patients who consumed a malted milk containing Bifidobacteria infantis 35624 daily for eight weeks had fewer overall symptoms than those taking a placebo. The benefits were comparable to those seen by the newer drugs Alosetron and Tegaserod. Probiotics are live microbial food supplement and must be stored effectively or the organisms will die. Herbs for IBS. Peppermint and IBS: Peppermint oil reduces spasms in the colon because of it's antispasmodic properties. It can be taken as a capsule or tea. The capsule is more effective but can cause heartburn and anal irritation. This is good herbal remedy for Irritable Bowel Syndrome. Camomile and IBS: Camomile soothes the alimentary canal. It has some antispasmodic properties. It can be taken as a tea or as a capsule. This gives only mild IBS relief. Oil of Evening Primrose and IBS: Used by women where IBS symptoms are worse during the menstrual period. Ginger, caraway and fennel all have mild antispasmodic properties and provide some relief for Irritable Bowel Syndrome. Dr. Phil Hariram.
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Irritable Bowel Syndrome(IBS).