It’s no easy feat to diagnose Irritable bowel syndrome (IBS) as it involves a widely-varied constellation of symptoms that can include cramps, abdominal pain, bloating, constipation, and urgent diarrhea.
What is irritable bowel syndrome?
Irritable bowel syndrome, or IBS, is a collection of symptoms that affect the digestive tract. IBS is a common condition affecting between 25 million and 45 million people in the United States, according to the International Foundation for Gastrointestinal Disorders. It is a type of functional gastrointestinal (GI) disorder caused by a malfunction in the gut-brain interaction rather than a structural defect.
Your gut health & irritable bowel syndrome
Irritable bowel syndrome is difficult to diagnose. Because it is a functional disorder, diagnostic tests will not show any obvious or even physiologic abnormalities. For this reason, probiotics are not as helpful for treating IBS.
To diagnose IBS, your healthcare provider will first exclude other conditions. They may then recommend an elimination diet to discover foods that trigger your symptoms and then help you develop an IBS-friendly dietary plan, which will likely include restricting caffeine and alcohol consumption. Lifestyle modifications, such as quitting smoking, will also be recommended.
In addition to dietary and lifestyle modifications, antispasmodics and bulking agents may be helpful in treating IBS symptoms. Probiotics have been studied in the context of IBS, and we will discuss that as well! Spoiler: we will also cover different alternatives to probiotics as new postbiotics are entering the gut health arena right now.
Diarrhea and IBS
Diarrhea is a common complaint when it comes to gut health and disorders like IBS. However, it is usually a symptom of infectious gastroenteritis, aka stomach flu. As diarrhea can be chronic or accompanied by bleeding or abdominal pain, further investigation is needed.
Bloody diarrhea and pain are characteristic of colitis; the infectious causes can be:
- Invasive E Coli
- Entamoeba histolytica, or C difficile
- Inflammatory bowel disease (ulcerative colitis or Crohn’s colitis) or ischemia
Blood tests or Stool wet-mount and culture are used to diagnose the infectious causes.
Sigmoidoscopy or colonoscopy can be helpful in diagnosing inflammatory bowel disease or ischemia. Importantly, if someone has abdominal tenderness, particularly with peritoneal signs, or any other evidence of perforation, an endoscopy will be contraindicated (not used).
Chronic diarrhea may present a more difficult diagnostic problem. The causes of chronic diarrhea include:
Chronic ulcerative colitis (large intestine)
Short gut syndrome
Carcinoid syndrome (rarely – colon cancer)
Islet Cell Tumors
All of the above cause a change in bowel habits.
IBS with diarrhea can cause havoc on even the most toughened digestive system. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) suggests the following for IBS Treatment:
Probiotic therapy for irritable bowel syndrome
Research has in the past suggested probiotics may be useful in treating people with IBS. The exact mechanism for exactly how probiotics may reduce IBS symptoms is largely unknown at this time. It is speculated that the effects of probiotics on alterations in gut bacteria are involved.
What causes irritable bowel syndrome?
The causes of irritable bowel syndrome are multifactorial and may include:
Alterations in gut motility
Within the gut, there is a cyclic pattern of motility known as the major migrating complex, which consists of periodic, luminal contractions that propel intestinal contents from the stomach to the terminal ileum. Several studies in the literature have shown that patients with IBS tend to have abnormalities in these contractions.
Small-bowel bacterial overgrowth
A large study of 202 patients with IBS found that 78% showed evidence of bacterial overgrowth via breath testing. 25 of 47 patients experienced eradication of bacterial overgrowth on follow-up after treatment with antibiotics. Analysis of this subset of patients revealed that those who were successful in the eradication of bacterial overgrowth reported improvement in their IBS symptoms. (2)
It has been postulated that the release of certain inflammatory mediators, including interleukins and histamine, may affect nearby enteric nerves, causing alteration in gut function and sensory perception.
Visceral hypersensitivity is recognized as a candidate. VH contributes to pain associated with this syndrome.
Pathophysiology of IBS and how we view probiotics
First, disordered physiological processes associated with disease or injury or – pathophysiology of IBS – will be discussed. Then, we will review evidence for using probiotics in treating irritable bowel syndrome (IBS). Finally, an alternative to probiotics in the form of postbiotics (specifically, Tributyrate) will be presented.
IBS is the most common GI condition, which accounts for approximately 30 percent of all referrals to GI doctors! The kicker? The actual process remains uncertain!
Despite multiple investigations, data have been conflicting, and no abnormality has been found to be specific to this disorder. (1)
Probiotics and the evidence in IBS
According to a recent publication analysis by the Canadian Society of Intestinal Research, multiple studies on probiotics in patients with IBS still show that the results are mixed. This is not surprising, the society concludes, as different probiotics are like different drugs. And they are correct!
Here is the summary:
- Lactobacillus plantarum 299V; overall symptoms improved for patients in one of two studies, whereas pain and gas improved in one of two studies. There was no significant improvement in constipation.
- Lactobacillus acidophilus SDC 2012 and 2013 strains; improvement in pain and straining, but no change in frequency.
- Lactobacillus acidophilus LB strain; all 18 patients found improvement in “overall symptoms” after 6 weeks.
- Lactobacillus acidophilus species in combination with other probiotics; the probiotic mix was significantly more effective in improving overall IBS symptoms, pain, and gas but not bloating.
- Lactobacillus rhamnosis strains (GG and Lc705) plus Propionibacterium freudenreichii (subspecies shermanii JS) plus a strain of Bifidobacterium; One study showed an improvement in gas or quality of life. Both studies showed an improvement in IBS symptoms and pain. There was no change in constipation/diarrhea.
- Bifidobacterium infantis 35624; No quality of life improved with one ‘overall symptoms improved’, and one of two studies reported positive effects on bowel movement frequency.
- Bifidobacterium animalis DN 173010 (Activia® yogurt); overall results were negative however, the study should remain inconclusive.
- Escherichia coli DSM 17252; improvement in overall symptoms and pain. One study showed an improvement in bloating.
- Bacillus coagulans GBI-30 6086; First, after treatment in IBS patients first, we note that abdominal pain scores were improved in all 7 weeks in the treatment group next, bloating improved with treatment in all 7 weeks where finally, none of 7 weeks with placebo.
Conclusion and what can be done about IBS now?
This blog post covers what is reported to date. The report is for a total of nine probiotic organisms. The nine probiotic species spans 14 studies. On a large scale, research is required over a longer period of time.
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NOTE: this does not replace the advice of your physician, whom you should always consult for specific treatment recommendations.
Citations & References:
1. AGA technical review on irritable bowel syndrome. Douglas A Drossman 1, Michael Camilleri, Emeran A Mayer, William E Whitehead. PMID: 12454866 DOI: 10.1053/gast.2002.370952. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Pimentel M, Chow EJ, Lin HC Am J Gastroenterol. 2000 Dec; 95(12):3503-6.
3. Increased rectal mucosal expression of interleukin 1beta in recently acquired post-infectious irritable bowel syndrome. Gwee KA, Collins SM, Read NW, Rajnakova A, Deng Y, Graham JC, McKendrick MW, Moochhala SM Gut. 2003 Apr; 52(4):523-6.