Irritable bowel syndrome (IBS), a common ailment of highly developed western nations, is characterized by chronic or recurrent abdominal pain, bloating, and diarrhea for which no clear medical abnormality can be identified. Remarkably, as many as 20–44% of the population report irritable bowel symptoms. For the vast majority, IBS is a nuisance but otherwise does not cause any harmful effects. Food allergy has been implicated, but in fact, few sufferers have true allergy.
Tests
Underlying causes of intestinal disease are ruled out by a careful history and physical examination, together with screening blood tests. Stool samples for ova, parasites, disease-causing bacteria, and blood — together with a sigmoidoscopy — are typically performed. In some instances, a barium enema, colonoscopy, or biopsies (removing tissue specimens) may also be done.
Food-Related Causes
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True Food Allergies
True food allergies are rare as a cause of IBS; however, in some instances testing is performed. Common food allergens include milk, eggs, wheat, fish, shellfish, and tree nuts.
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Immunologic Bowel Disease
Celiac sprue is a rare but potentially serious disease caused by ingesting wheat gluten (gliadin). Rye, oat, and barley — which contain prolamins, a substance similar to gliadin — can make celiac sprue worse.
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Carbohydrate Malabsorption
• Lactose intolerance is very common, increases with age, and is more prevalent among non-Scandinavian populations. Treatment includes avoidance and Lactaid with meals.
• Fructose intolerance is common and often goes undiagnosed. Fruits, soft drinks, and berries are common sources of fructose, and frequent ingestion may result in IBS symptoms.
• Sorbitol malabsorption is also common and underappreciated. Diet foods, sugarless gums, plums, peaches, pears, apples, and fruit juices are common sources of sorbitol. In a European study of patients with IBS, one-half had sorbitol/fructose malabsorption and nearly one-half had abdominal pain.
Treatment
- Avoid foods that may be irritating to the intestinal tract, including excessive alcohol or caffeine.
- Avoiding dairy products and milk (lactose) may be helpful.
- A high-fiber diet may also be helpful.
- Food allergies are a rare cause, but any identified offending food should be avoided.
- A trial avoiding fructose and sorbitol is warranted, given the European studies.
- Avoid overuse of antispasmodics such as Lomotil or Imodium.
Irritable bowel syndrome is common and generally not a serious medical condition. However, if symptoms are severe or worsen, you should see your family doctor. Occasionally, an evaluation by a gastroenterologist may be warranted.
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