Irritable bowel syndrome (IBS)
Causes and risk factors
IBS is characterized by chronic abdominal pain, the localization and frequency of which is very variable, and its improvement or deterioration is usually associated with evacuation. Emotional stress and eating can worsen the symptoms. Changes in bowel function can be diarrheal, constipated, or both, and emptying can be diurnal, non-emetic and is often preceded by a sense of urgency or incomplete emptying.
· Abdominal pain
· Constipation and/or diarrhea
· Urge to defecate
· Feeling of incomplete evacuation
Which are the symptoms?
The first diagnostic step is to exclude any underlying organic pathology. Later on, with account of the absence of specific biological markers, the diagnosis is made on the basis of clinical symptoms using the Rome IV criteria, according to which IBS is defined as the presence of recurrent abdominal pain at least one day a week for the last three months, connected with two or more of the following criteria: association with evacuation, a change in the frequency of evacuation or stool consistency. Based on how the patient reports the type of bowel movements, four subtypes of IBS can be distinguished: diarrheal, constipated, mixed or unclassified variant.
· Exclusion of organic pathologies
· Rome IV criteria
How is it diagnosed?
The cornerstone of IBS therapy is a strong doctor-patient relationship and continuity of treatment. In patients with mild, intermittent symptoms that do not impair the quality of life, the initial therapeutic approach is to change the diet and lifestyle. In particular, it is recommended to avoid lactose, gluten and legumes, conduct allergy tests, keep to a diet low in fermentable mono-di-polysaccharides and polyols (FODMAP) and increase physical activity. If clinical improvement does not occur, there are a number of pharmacological interventions available for various subtypes of IBS. In case of constipations, it is possible to take soluble fiber (psyllium), polyethylene glycol or drugs such as lubiproston, linaclotide, plekanatide and tegacerod. In case of the diarrheal variant, in addition to classical antidiarrheal drugs (loperamide, cholestyramine), alosetron, spasmolytics, tricyclic antidepressants in low doses and non-absorbable antibiotics (rifaximin) can be used. All these drugs should be selected based on the type of patient and clinical response, with great therapeutic individualization.