Irritable bowel syndrome, food intolerances, and other causes of bloating

IBS was once called a functional gastrointestinal disorder, but do you know why the term is associated with some stigma, Rhiannon?

No.

Can you tell me more about it? So the word functional has

been used historically to describe chronic or recurrent symptoms that cannot be readily explained by structural disease.

The word functional is both nonspecific and stigmatising for being viewed as all in the head or psychiatric.

Right, so are we moving away from using that term now?

Yes, we are.

And what used to be called functional gastrointestinal disorders has been renamed to disorders of gut-brain interactions now.

Okay, so that seems to acknowledge the complexity of the conditions and indicates that it's a real physiological process.

So

what are some of the symptoms of IBS? Symptoms include recurrent abdominal pain or discomfort that's associated with a change in stool frequency or form.

Symptoms are nonspecific and often overlap with those of organic GI conditions like celiac, IBD, microscopic colitis, or bile acid diarrhea.

gynaecological conditions like ovarian cancer or endometriosis, or sometimes conditions such as thyroid disorders.

So

that's quite a broad list.

How do clinicians diagnose IBS then when the symptoms are so nonspecific?

So according to NICE, IBS can be diagnosed if a person has abdominal pain, relieved by defecation or associated with altered bowel frequency or stool form for at least six months.

And at least two of the following additional symptoms need to be present for diagnosis.

Urgency, bloating, symptoms made worse after eating or passing mucus.

The Rome 4 criteria requires there to be pain at least one day a week for the past three months and the pain should fulfill two of three criteria.

It should be related to the defecation, associated with a change of stool frequency or a change in

appearance of stool.

So IBS also has several subtypes and clinicians will need to determine which type of IBS it is because that's an important next step to determining management.

So there are four subtypes.

The predominant subtype is mixed IBS or IBS-M followed by diarrhoea predominant IBS or IBS-D, constipation predominant IBS or IBS-C and unclassified IBS or IBS-U.