Is Irritable Bowel Syndrome out of date and misleading as a diagnosis?

Abstract

Aim: This study aimed at assessing the efficacy of targeted interventions addressing common food sensitivities and lifestyle factors that commonly contribute to the presentation of gastrointestinal problems identified as Irritable bowel syndrome (IBS).

Background: IBS has served to cover the expression of multifactorial disorders with variable aetiology and pathophysiology. Food antigens implicated in the modern lifestyle, acting as strong epigenetic factors is strongly implicated in pathophysiology of conditions under IBS. Identifying and addressing food sensitivities in patients presenting with IBS like symptoms are currently underemphasised in clinical guidelines yet have the potential to provide major benefits for patients.

Methods: Information was collected from the medical records of patients that were referred to the Gastroenterology Unit of Palmerston North DHB with unexplained gastrointestinal (GI) symptoms with or without other GI comorbidities between September 2018 and November 2021.

Results: The main management option offered to the 121 patients included in this study, was lifestyle adjustment and/or a trial of 6 weeks, eliminating gluten and lactose from the diet. The most prevalent symptoms were abdominal pain 96/121 (79%), diarrhoea 83/121 (69%), followed by bloating and constipation. Seventy-eight patients had the outcomes of their improvement available. A total of 42 out of 78 patients (54%) were treated exclusively with gluten and lactose-free diet, in this group of patients 86% (36/42) reported a significant improvement in their symptoms with a score in the range of 40-100%.

Conclusion: Our study illustrates the importance of focusing on triggering factors when assessing patients with IBS. We suggest that careful identifying and eliminating the triggering food antigens as monotherapy or in addition to the lifestyle adjustment where appropriate should be the main objective in symptomatic patients fulfilling the IBS diagnostic criteria. These combinations and holistic approach in treating IBS' patients' symptoms are less expensive, non-toxic, and highly effective in achieving optimal outcomes and improving these patient's quality of life.

Keywords: Gluten; IBS; Lactose intolerance; Non-coeliac gluten sensitivity.

Figure 1

Bottom left represents the total no. of patients with the corresponding symptom. The middle bar chart represents no. of patients with the corresponding intersection of symptoms. The most frequent symptoms in this group of patients are abdominal pain, diarrhoea and constipation. Box plot represents the distribution of the percentage of improvement across the various symptom intersections

Figure 2

Bottom left represents the total no. of patients with each extraintestinal symptom. The middle bar chart represents no. of patients with the corresponding intersection of symptoms. The majority of patients had no extraintestinal symptoms, the most common intersection of extraintestinal symptoms, however, had headaches only, followed by those with headache, fatigue, joint pain and a foggy mind. Box plot represents the distribution of the percentage of improvement across the various symptom intersections

Figure 3

Bottom left represents the total no. of patients offered dietary interventions (gluten-free diet, lactose-free diet and low FODMAP diet), also those treated with medication. The middle bar chart represents no. of patients with the corresponding intersection of offered treatment. The most commonly offered treatment was a gluten and lactose-free diet, followed by gluten and lactose-free diet with medication. Box plot represents the distribution of the percentage of improvement across the various treatment intersections