Irritable Bowel Syndrome, also known as IBS, is one of the commonest debilitating gastrointestinal disorders that significantly affects the digestive system. It is a group of symptoms which consistently occur together. The most common of these are the stomach cramps, bloating, discomfort, diarrhoea and constipation which usually alternates with each other. The symptoms vary among people and to determine the right treatment, one must know about the type of IBS.
Irritable Bowel Syndrome and Its Types
Irritable Bowel Syndrome, also known as IBS, is one of the commonest debilitating gastrointestinal disorders that significantly affects the digestive system. It is a group of symptoms which consistently occur together. The most common of these are the stomach cramps, bloating, discomfort, diarrhoea and constipation which usually alternates with each other. The symptoms vary among people and to determine the right treatment, one must know about the type of IBS.
As a functional GI disorder it comes in multiple forms:
● IBS-C refers to IBS with constipation predominantly and it is one of the more common types.
● IBS-D is also called IBS with diarrhoea mainly.
● IBS-M includes the mixed bowel habits i.e alternating diarrhoea and constipation.
● Post-Infectious IBS occurs after you have had a GI infection. Diarrhoea, vomiting are important signs.
● Post-diverticulitis IBS. People are at risk of developing IBS after they have had diverticulitis.
The Relationship between IBS and SIBO:
To understand the relationship between SIBO and IBS, the ground need is to first look at what SIBO means. SIBO stands for Small Intestinal Bacterial Overgrowth. It refers to the condition where there is an abnormal increase in the bacterial population of the small intestine. Briefly explaining, after an abdominal surgery such as a peptic ulcer repair or a gut infection, the movement of food particles in the digestive tract slows down which provides optimal conditions for bacteria to overgrow, resulting in a range of symptoms, for example, diarrhoea, abdominal bloating, and even may lead to malnutrition. So, the patients with SIBO suffer almost the same symptoms as the patients with IBS do. This overlap of symptoms makes it confusing for a doctor to reach a perfect diagnosis. However, it is worth mentioning that the diagnosis and the management of SIBO is quite straightforward, whereas IBS can only be diagnosed when all other possible diagnoses have been ruled out, meaning that IBS is a diagnosis of exclusion. The reason behind this difference is the availability of a test that can easily find out if the person is suffering from SIBO, hence, can be promptly treated.
There has been a ton of promising research around to find the relationship between the two. The association between SIBO and IBS, however, appears to be dubious. Many of the SIBO researchers are of the view that SIBO may be the underlying cause of IBS symptoms appearing in a subset of patients. While others oppose this view, point out that SIBO is often the root cause of IBS. Undoubtedly, there are many other potential reasons for the development of Irritable bowel Syndrome, but further ongoing studies state that approximately 80% of the people clinically diagnosed as IBS have SIBO too.
As this controversy prevails, some of the evidence comes in the favour of SIBO being the cause of IBS. The first evidence in favour of this theory is that the researchers have founded HBT (Hydrogen Breath Test) to be positive in affected patients of IBS than do unaffected persons, possibly pointing out SIBO as the underlying problem.
The second evidence is the effect of specific antibiotics given to IBS patients which led to a significant decrease in severity of symptoms. As these specific antibiotics are not absorbed in the stomach and only work in the small intestine, thus, adding more to prove that SIBO is the key problem.
Though the exact mechanism of SIBO causing IBS is not clearly known. One proposed mechanism explains that the disturbed gut microbiome and overgrowth of particular bacteria in the small intestine leads to diarrhoea, bloating, abdominal cramps etc which marks the symptoms of IBS.
Diagnosis and Treatment:
When we come to talk about the diagnosis of a syndrome, it becomes really difficult for a medical doctor to make a straightforward diagnosis. The reason for this lies in the overlapping of symptoms of various syndromes. So, if a patient is having abdominal pain, diarrhoea, bloating, constipation, a physician will then go through the medical history and detailed analysis of tests and symptoms and will exclude the probable diseases overlapping each other. This occurs in a stepwise fashion and is called a method of exclusion. We don’t have any specific test to declare IBS except the exclusion criteria of ruling out all other possible diseases through tests and medical history of patients, but we do have a specific test for SIBO. Let’s say if a doctor suspects SIBO in his patient, he will recommend a breath test to rule it out.
So if a patient has been experiencing the above mentioned symptoms and the diagnosis is still uncertain, it is worth going for breath testing. Since the symptoms tend to overlap in nearly 80 percent of the patients and the fact that SIBO treatment incredibly improves IBS symptoms simultaneously, hydrogen breath testing to look for SIBO first holds its own importance.
