Estimates about irritable bowel syndrome reveal that 11% of the Spanish population suffers from this disease, better known colloquially as 'irritable bowel'. It is more frequent in women than in men and a progressive decrease is observed as the age of the population studied increases. What must be clear is that it is a benign disorder of the digestive tract.
What are your main symptoms? Dr. José Walter Huaman, a specialist in the digestive system at the Hospital Universitari General de Catalunya (Barcelona), maintains that his main symptoms are three: abdominal pain or discomfort; abdominal swelling or distension and altered bowel habits (constipation and/or diarrhoea). According to him, this syndrome has a "great impact" on the personal and social activities of patients, since it fundamentally worsens their quality of life, while reducing work productivity, compared to the general population.
In fact, it stands out that, according to data from the Spanish Digestive System Society, it is the most frequently diagnosed gastrointestinal disorder, as well as the second cause of work absenteeism after the common cold. "Between 10-15% of the population experience irritable bowel symptoms throughout their lives, although only 15% of those affected consult a doctor for it," he points out.
Of course, what is not completely clear today are the causes that could cause it. This expert from the Hospital Universitari General de Catalunya indicates that this phenomenon or entity is considered an alteration in the bidirectional interactions between the intestine and the brain with visceral hypersensitivity. It could be caused by alterations in gastrointestinal motility, as well as by added psychological and social factors. "The epithelial barrier, gut microbiota, food antigens, and bile acids elicit abnormal responses in regulators of sensorimotor function, including the hypothalamic-pituitary-adrenal axis, the immune system, the gut-brain axis, and the enteric nervous system." ", highlights doctor José Walter Huaman.
In addition, he maintains that many factors play an "important role" in the generation of irritable bowel syndrome symptoms, but some may be more predominant in certain individuals than in others: "Evidence in recent years has shown the existence of alterations in the intestinal microbiota in patients with this entity. Patients with irritable bowel would also present a lower diversity of species, with a greater abundance of proinflammatory enterotypes compared to the general population".
The current diagnostic criteria are those of ROME IV, remarks this expert in the digestive system, and consist of the presence of recurrent abdominal pain at least one day a week, and in maintaining some of the following characteristics associated with defecation: changes in the frequency of stools and changes in their consistency. "In addition, they must have started a minimum of 6 months before diagnosis," he specifies. That is why it is advisable to establish the subtypes of this syndrome according to the consistency of the stools, evaluated according to the Bristol scale, and which classifies the consistency of these based on their shape between 1 (goat feces) and 7 ( liquid stools). "In this way we have: constipation-predominant irritable bowel syndrome, diarrhea-predominant irritable bowel syndrome, mixed predominance, or not classifiable."
Regarding treatment, he maintains that it is aimed at relieving symptoms and improving the patient's quality of life. If the signs and symptoms are mild, he says that they can be controlled by managing stress, as well as making changes in the patient's diet and lifestyle, by practicing regular exercise, drinking plenty of fluids, sleeping adequate hours, avoiding foods that generate a lot of gases (alcoholic and carbonated beverages), as well as the consumption of caffeine, raw fruits, or certain vegetables such as cabbage, broccoli, and cauliflower.
"Soluble fiber has been shown to be beneficial, but it can increase abdominal pain, bloating, and meteorism," maintains the gastroenterologist. That is why, as he continues, if the symptoms are more severe and constipation predominates, fiber supplements such as plantain or magnesium-based or polyethylene glycol-based osmotic laxatives may be useful.
"If, on the contrary, diarrhea predominates, loperamide or bile acid chelators can help. To control abdominal pain, anticholinergics and neuromodulators can be used. All these measures always under medical prescription," he says. Here, the following of a diet low in FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) stands out, "a novel treatment modality", which includes a series of short-chain carbohydrates that are poorly absorbed in the small intestine and can produce osmotic activity and fermentation of intestinal bacteria excess gas production and symptoms such as diarrhea, bloating, abdominal pain and bloating.
"Although there are several controlled studies that have shown its efficacy in the short term, since it is an excessively restrictive diet, it must be controlled by nutrition experts, and only in the short term because it has been shown that it can alter the microbiota" Huaman points out. He maintains that in some patients prebiotics (a substrate that is selectively used by host organisms, conferring a health benefit) and probiotics (live microorganisms that confer a health benefit when administered in adequate amounts) may be equally useful. since some have been found to produce a "significant improvement" on the global perception of symptoms in patients with irritable bowel syndrome and selectively on pain, bloating, meteorism and diarrhea.
