Irritable bowel syndrome (IBS) is one of the most common ailments of the
bowel (intestines) and affects an estimated 15% of persons in the US.
The term, irritable bowel, is not a particularly good one since it
implies that the bowel is responding irritably to normal stimuli, and
this may or may not be the case. The several names for IBS, including
spastic colon, spastic colitis, and mucous colitis, attest to the
difficulty of getting a descriptive handle on the ailment. Moreover,
each of the other names is itself as problematic as the term IBS.
IBS is best described as a functional disease. The concept of
functional disease is particularly useful when discussing diseases of
the gastrointestinal tract. The concept applies to the muscular organs
of the gastrointestinal tract; the esophagus, stomach, small intestine,
gallbladder, and colon. What is meant by the term, functional, is that
either the muscles of the organs or the nerves that control the organs
are not working normally, and, as a result, the organs do not function
normally. The nerves that control the organs include not only the
nerves that lie within the muscles of the organs but also the nerves of
the spinal cord and brain.
Some gastrointestinal diseases can be seen and diagnosed with the naked
eye, such as ulcers of the stomach. Thus, ulcers can be seen at
surgery, on x-rays, and at endoscopies. Other diseases cannot be seen
with the naked eye but can be seen and diagnosed with the microscope.
For example, celiac disease and collagenous colitis are diagnosed by
microscopic examination of biopsies of the small bowel and colon,
respectively. In contrast, gastrointestinal functional diseases cannot
be seen with the naked eye or with the microscope. In some instances,
the abnormal function can be demonstrated by tests, for example,
gastric emptying studies or antro-duodenal motility studies. However,
these tests often are complex, are not widely available, and do not
reliably detect the functional abnormalities. Accordingly, by default,
functional gastrointestinal diseases are those involving the abnormal
function of gastrointestinal organs in which abnormalities cannot be
seen in the organs with either the naked eye or the microscope.
Occasionally, diseases that are thought to be functional are ultimately
found to be associated with abnormalities that can be seen. Then, the
disease moves out of the functional category. An example of this would
be Helicobacter pylori infection of the stomach. Many patients with
mild upper intestinal symptoms who were thought to have abnormal
function of the stomach or intestines have been found to have an
infection of the stomach with Helicobacter pylori. This infection can
be diagnosed by seeing the bacterium and the inflammation (gastritis)
it causes under the microscope . When the patients are treated with
antibiotics, the Helicobacter, gastritis, and symptoms disappear. Thus,
recognition of Helicobacter pylori infection removed some patients'
diseases from the functional category.
The distinction between functional disease and non-functional disease
may, in fact, be blurry. Thus, even functional diseases probably have
associated biochemical or molecular abnormalities that ultimately will
be able to be measured. For example, functional diseases of the stomach
and intestines may be shown ultimately to be caused by reduced levels
of normal chemicals within the gastrointestinal organs, the spinal
cord, or the brain. Should a disease that is demonstrated to be due to a
reduced chemical still be considered a functional disease? I think not.
In this theoretical situation, we can't see the abnormality with the
naked eye or the microscope, but we can measure it. If we can measure
an associated or causative abnormality, the disease probably should no
longer be considered functional.
Despite the shortcomings of the term, functional, the concept of a
functional abnormality is useful for approaching many of the symptoms
originating from the muscular organs of the gastrointestinal tract.
This concept applies particularly to those symptoms for which there are
no associated abnormalities that can be seen with the naked eye or the
microscope.
While IBS is a major functional disease, it is important to mention a
second major functional disease referred to as dyspepsia, or functional
dyspepsia. The symptoms of dyspepsia are thought to originate from the
upper gastrointestinal tract; the esophagus, stomach, and the first
part of the small intestine. The symptoms include upper abdominal
discomfort, bloating (the subjective sense of abdominal fullness
without objective distension), or objective distension (swelling, or
enlargement). The symptoms may or may not be related to meals. There
may be nausea with or without vomiting and early satiety (a sense of
fullness after eating only a small amount of food).
The study of functional disorders of the gastrointestinal tract often
is categorized by the organ of involvement. Thus, there are functional
disorders of the esophagus, stomach, small intestine, colon, and
gallbladder. The amount of research on functional disorders has been
focused mostly on the esophagus and stomach (such as dyspepsia),
perhaps because these organs are easiest to reach and study. Research
into functional disorders affecting the small intestine and colon (for
example, IBS) is more difficult to conduct and there is less agreement
among the research studies. This probably is a reflection of the
complexity of the activities of the small intestine and colon and the
difficulty in studying these activities. Functional diseases of the
gallbladder, like those of the small intestine and colon, also are more
difficult to study.
Most individuals are surprised to learn they are not alone with
symptoms of IBS. In fact, irritable bowel syndrome (IBS) affects
approximately 10-20% of the general population. It is the most common
disease diagnosed by gastroenterologists (doctors who specialize in
medical treatment of disorders of the stomach and intestines) and one
of the most common disorders seen by primary care physicians.
Sometimes irritable bowel syndrome is referred to as spastic colon,
mucous colitis, spastic colitis, nervous stomach, or irritable colon.
Irritable bowel syndrome, or IBS, is generally classified as a
"functional" disorder. A functional disorder refers to a disorder or
disease where the primary abnormality is an altered physiological
function (the way the body works), rather than an identifiable
structural or biochemical cause. It characterizes a disorder that
generally can not be diagnosed in a traditional way; that is, as an
inflammatory, infectious, or structural abnormality that can be seen by
commonly used examination, x-ray, or blood test.
Irritable bowel syndrome is understood as a multi-faceted disorder. In
people with IBS, symptoms result from what appears to be a disturbance
in the interaction between the gut or intestines, the brain, and the
autonomic nervous system that alters regulation of bowel motility
(motor function) or sensory function.
Irritable bowel syndrome is characterized by a group of symptoms in
which abdominal pain or discomfort is associated with a change in bowel
pattern, such as loose or more frequent bowel movements, diarrhea,
and/or constipation.
Treatment options are available to manage IBS—whether symptoms are mild, moderate, or severe.
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