Page 13 - Boca Club News - November '24

Boca Club News, Page 13
Medical Matters: Irritable Bowel Syndrome (I.B.S.)

By Richard Nagler, M.D., a member a thorough evaluation to convince them that no serious pistachios, and sugar-free sweets. After several weeks or
of Broken Sound Club and retired diseases are present. more, if significant improvement with this diet is achieved
physician. After graduating from There is no specific diagnostic test for IBS. However, in it is recommended to reintroduce restricted items one at a
the University of Pennsylvania and addition to a careful evaluation of the patient’s symptoms time to see which ones might be responsible for symptoms.
New York University’s School of and a thorough physical examination, the following tests There are other effective treatment options available.
Medicine, Dr. Nagler served his should be done: A CBC and serum iron to detect anemia due However, many of them will not be effective unless the
internship and residency at Baltimore to blood loss; a stool examination for occult blood, parasites patient is absolutely convinced that there is no serious
City Hospital and Johns Hopkins. He and bacteria; a colonoscopy; an upper endoscopy of the disease present. Patients should be advised to avoid all
followed that with a Fellowship in stomach and small intestine to look for bacterial overgrowth the triggers enumerated above. They should eat high-fiber
Gastroenterology at Yale University School of Medicine, and biopsy for possible celiac disease, and a CT scan of the foods, carbohydrates, be well hydrated, get regular exercise
and was then Chief of Gastroenterology at Fitzsimons abdomen. These tests are essential to rule out colon cancer, and have good sleep patterns. Fiber supplements such as
General Army Hospital in Denver. He returned to the Yale Crohn’s and ulcerative colitis, and to convince patients with Metamucil and laxatives like Miralax and milk of magnesia
Medical School for one year as an Assistant Professor of IBS that they don’t have a serious disease. for constipation, Imodium and such bile acid binders as
Medicine before opening his own successful private practice There is no specific cause for IBS. A family history of Colestil for diarrhea, anticholinergics like Bentyl, tricyclic
in Internal Medicine and Gastroenterology. During that it is not involved. Estrogen may be a factor as the disease antidepressants such as Tofranil, Pamelor and Prozac, as
time, he also served for ten years as Chief of Medicine at is much more common in women and symptoms increase well as Lyrica for pain and bloating are beneficial, but all
Huntington Hospital in Huntington, N.Y. during menses. An adverse impact on the quality of life, of them have side effects of blurred vision, dry mouth,
IBS—also known as spastic colon, mucus colitis and emotional stress—including anxiety and depression— drowsiness and dizziness.
nervous colon—is one of the most common diseases in the are often involved, but more likely that is the result of If bacterial overgrowth is identified, the antibiotic
United States. It affects 15% of the adult population and distressing symptoms, especially uncontrolled fecal Rifoximin is effective. Enteric-coated peppermint may
is the most frequently diagnosed gastrointestinal disorder. incontinence. There are some recent clinical studies ease urgency, bloating, abdominal pain and facilitate
A chronic condition that mainly affects the large intestine suggesting that intestinal infections can alter the lining of the easier passage of stool. Probiotics can relieve abdominal
(colon), it is seen in adults, usually under 50, predominantly intestinal tract, disturbing the normal barrier and allowing pain, bloating and diarrhea by replenishing good bacteria
females. While it can cause significant symptoms and the absorption of allergy-inducing proteins, resulting in in the intestine. Acupuncture, yoga, meditation, hypnosis,
adversely affect the quality of life, there are rarely any these people becoming intolerant to foods that previously bio feedback, progressive relaxation exercises and CBT
serious complications. There is no specific cure for IBS. caused them no problems. (cognitive behavioral counseling) all may help.
The symptoms of IBS include abdominal pain and There are certain foods that act as triggers for symptoms For those people who have more severe symptoms,
swelling, cramping, bloating, excess gas and mucus in the to appear, such as wheat (with persistent diarrhea celiac especially diarrhea not responding to all other treatment,
stool. Constipation or diarrhea can be severe and may result disease should be considered). There are some people with there is a new effective drug, Alosetron (lotronex). Viberzi
in as many as 20% of patients having uncontrollable bouts IBS who claim that restricting gluten helps them even when is another similar drug effective in reducing diarrhea
of fecal incontinence. Persistent constipation or diarrhea there is no evidence of celiac disease. There is the FODMAT by easing muscle contractions in the colon, decreasing
can alternate but may be interrupted with periods of time diet which has been reported as successful in significantly fluid secretion and increasing muscle tone in the rectum.
where the symptoms abate spontaneously. There is often reducing bloating, abdominal pain and diarrhea in over Bowel training and exercises to strengthen the pelvic
the sensation that full evacuation of stool has not occurred. 60% of patients with IBS. It is based on the theory that floor muscles can improve control. Amitiza is a drug that
It is extremely important to recognize that these these foods, especially carbohydrates, are not digested or relieves constipation and abdominal pain in women by
same symptoms may be seen in serious diseases, such as absorbed in the small intestine and are fermented in the increasing fluid secretion in the small intestine, facilitating
ulcerative colitis, Crohn’s and colon cancer, and many of colon by normal bacteria, causing the typical symptoms. the passage of stool in the colon.
these patients are concerned that they may be afflicted. With this diet certain foods can all trigger symptoms and The successful treatment of IBS depends in large part
Attempts by a doctor to dismiss IBS as psychological should be eliminated. These include: such dairy products as upon the doctor’s capacity to understand and empathize
will fail since most patients with IBS will not accept that milk, yogurt and ice cream (Lactose intolerance) plus raw with the patient’s distress, and to communicate reassurance
diagnosis. When there is a firm trusting doctor-patient fruit, cauliflower, broccoli, cabbage, beans, onions, garlic, to the patient that there is no serious disease present.
relationship the doctor will be far more effective in helping raisins, apricots, prunes, brussels sprouts, carbonated drinks,
these patients by empathizing with their fears and starting alcohol, chewing gum, tea, coffee, nuts like cashews and

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