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Medical Edge Newspaper Column from Mayo Clinic

WHEN THE GUT MISBEHAVES

DEAR MAYO CLINIC: Is there a diagnostic test for irritable bowel syndrome? —
New Hampshire

ANSWER: No. Nevertheless, we can diagnose this disease through other means, and successfully treat it.

Irritable bowel syndrome is a functional disorder; there is no obvious physical cause. The bowel (consisting of the upper and lower intestines) appears to be normal, but it doesn’t function normally. Its muscle contractions, which move food from the stomach through the intestinal tract and ultimately to the rectum, are too strong or too weak. Food is either forced through the intestines more quickly, causing loose stools, or it is slowed down and stools become hard and dry.

These diarrhea or constipation symptoms can afflict the IBS patient in alternating bouts, and can be accompanied by other signs such as abdominal pain, bloating, flatulence and mucus in the stools.

Because there is no physical test for IBS, it has traditionally been diagnosed through the process of elimination — by ruling out more serious gastrointestinal problems such as ulcerative colitis or colon cancer. At the extreme, physicians have sometimes ordered invasive procedures such as sigmoidoscopy or colonoscopy (in which a small, flexible tube is used to examine a portion or the entire length of the large intestine), or elaborate imaging procedures such as CT scans of the abdomen.

But in the absence of additional, worrisome factors, such as weight loss, bloody stools, or cases of colon cancer in the patient’s family, this negative-diagnostic approach is a bit excessive and old-fashioned.

A more modern practice is to diagnose IBS if the patient’s symptoms and history correspond to a standardized set of criteria, called the Rome Criteria. Abdominal pain must have lasted for at least 12 weeks, not necessarily consecutive, of the preceding 12 months. And at least two of the following three features must also have been present: pain relief with a bowel movement; a change in the frequency of stools; a change in the appearance of stools.

Along with this diagnosis comes a set of initial and clear-cut treatments: 1) fiber supplements to relieve constipation; 2) loperamide (Imodium) to control diarrhea; and 3) anticholinergic medications (such as dicyclomine) that ease abdominal pain by blocking bowel spasms.

IBS is remarkably common — up to one in five American adults has it, and the disorder accounts for more than one out of every 10 doctor visits. For most people, however, the symptoms of irritable bowel syndrome are mild and can be controlled by managing diet, lifestyle and stress (which does not cause IBS but may aggravate its symptoms).

In addition, there is always the possibility that a patient may have lactose or wheat-protein intolerance. These conditions sometimes produce similar symptoms to those of IBS. Food intolerances can be controlled by eliminating the offending substances from one’s diet.

— Nicholas J. Talley, M.D., Ph.D. Gastroenterology, Mayo Clinic, Rochester, Minn.

Additional Resources:
Information on Irritable Bowel Syndrome
Appointment Information
More Information on Irritable Bowel Syndrome

READERS: The prolonged immobility of passengers during long-haul air travel increases the risk of developing blood clots, which could prove fatal, especially to people whose travel occurs just prior to major surgery, researchers report in Mayo Clinic Proceedings.

“At medical institutions where patients are traveling a great distance for surgery, physicians should consider it as an additional risk factor for postoperative blood clots in the veins,” says Juraj Sprung, M.D., Ph.D., a Mayo Clinic researcher in the Department of Anesthesiology.

Dr. Sprung and colleagues analyzed patient information at Mayo Clinic and found that of 181,765 patients who underwent operations between 1998 and 2002, a total of 3,736 lived outside the United States, Canada and Mexico and traveled on average more than 5,000 miles prior to surgery. For these long-haul travelers, the incidence of dangerous blood clots or pulmonary embolisms within 28 days of surgery was over 30 times higher, compared to the surgical patients who either did not travel or traveled within North America.

The researchers note that people who are traveling long distances prior to major surgery should be aware of the increased risk of complications with blood clots. During the flight, people can take preventive measures by staying well hydrated, exercising and wearing elastic compression stockings. High-risk patients also can benefit from prescribed medications to prevent the problem.
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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.