Stomach ache, bloating, diarrhea, constipation... for many people, these are just occasional troubles. But for those suffering from irritable bowel syndrome, it's a part of daily life.
What is it, what are the causes, and most importantly, how can it be relieved?
Irritable Bowel Syndrome, a chronic and functional disorder
Irritable bowel syndrome (also known as irritable bowel syndrome or functional colopathy) affects between 10 and 20% of the world's population and accounts for 30 to 40% of gastroenterology consultations. It is, after the common cold, one of the most frequent causes of absenteeism from work.
Symptoms
- Irritable bowel syndrome is characterized by the combination of:
- Chronic abdominal pain,
- Bloating,
- Changes in bowel habits (diarrhea and/or constipation).
For at least 1 day per week over the past three months and for at least six months (1). It's this spread over time that qualifies it as a "chronic disorder".
The pain meets the Rome III criteria, meaning that it:
- Is relieved by bowel movements.
- Is associated with a change in bowel movement frequency (defined as going to the bathroom 3 times (or more) a day, or less than 3 times a week).
- Is associated with an abnormal change in stool consistency (too hard or too soft). (2)
Diagnosis
The diagnosis of IBS is made by exclusion (3), meaning that all benign organic causes (pancreatitis, Crohn's disease, celiac disease...) or malignant causes (cancerous) have been ruled out. Blood tests, samples, and results from medical imaging (CT scans, MRIs, colonoscopies) are normal. In essence, there are no alarm signs (4).
However, despite the absence of anatomical lesions, there is a problem: the functioning of the organism. That's why IBS is called a functional problem, which sometimes leaves patients feeling confused and misunderstood.
What are the causes of irritable bowel syndrome?
While it was long believed that irritable bowel syndrome was psychogenic, purely psychological in origin (the famous "It's in your head"), it's now considered to be multifactorial, with several possible primary and secondary factors:
- Repeated use of antibiotics,
- A diet rich in carbohydrates (6),
- Emotional stress and anxiety (7),
- Intestinal inflammation (8), especially after an infectious episode like gastroenteritis,
- Disruption of intestinal motility linked to a decrease in the expression of specific serotonin reuptake transporters (9), meaning that the muscles in the intestinal wall don't contract as they should (referred to as "lazy intestine"),
- Visceral hypersensitivity (10).
It has been shown that IBS always accompanies an imbalance in the intestinal microbiota (or intestinal flora, which naturally contains billions of bacteria essential for digestion) (11).
Relieving irritable bowel syndrome
The role of probiotics
In the absence of lesions, medical treatments can only be palliative (they alleviate symptoms without resolving the cause): antispasmodics, antidiarrheals, laxatives, antidepressants... and there is currently no standard treatment for IBS (12).
However, given that the balance of intestinal microbiota is involved in irritable bowel syndrome, there is a growing consensus on the benefits of probiotics (13), particularly in reducing abdominal pain.
Defined by the WHO as "live microorganisms that, when administered in adequate amounts, exert a beneficial effect on health, beyond traditional nutritional effects". It is recognized that probiotics help induce beneficial changes in the unbalanced intestinal microbiota (14).
However, it seems that not all probiotics available on the market produce the same favorable effects. Thus, revivable probiotics are favored. Furthermore, some strains appear more effective than others in relieving IBS. For example, the combination of Lactobacillus rhamnosus R0011 and Lactobacillus helveticus Rosell-52 (15) seems particularly valuable for reducing abdominal pain, colic, bloating, and abdominal pressure.
Lactobacillus helveticus Lafti L10 (16), on the other hand, improves the barrier function of the mucosa and inflammation by acting at a microscopic level.
For optimal effect, it is recommended to consume probiotics with meals because the gastric acidity, to which they are sensitive, is buffered by the food bolus.
Dietary supplements
Dietary supplements can also help relieve symptoms of IBS:
L-glutamine, an amino acid, which restores the integrity of the intestinal mucosa (17),
Curcumin (18), a molecule found in turmeric that tends to reduce inflammation, stimulates bile secretion, and improves digestion,
Cinnamon with its antispasmodic properties,
Bromelain (19), an enzyme found in pineapple that promotes digestion, protects, and repairs the gastric mucosa.
The importance of diet and lifestyle
Respecting a number of hygienic and dietary measures also plays an important role in managing IBS.
The "Low FODMAP" diet
People with IBS often notice a link between consuming certain foods and the onset or worsening of their symptoms (20).
While many diets and dietary restrictions have been recommended in the past, it is now believed that a low FODMAP diet is the most recommended to reduce symptoms associated with IBS (21) (22).
The term FODMAP is an acronym that stands for:
F = Fermentable (rapidly fermented by colonic bacteria)
O = Oligosaccharides (fructans and galacto-oligosaccharides or GOS)
D = Disaccharides (lactose)
M = Monosaccharides (fructose in excess of glucose)
A = And (and)
P = Polyols (sorbitol, mannitol, xylitol, and maltitol)
In concrete terms, it involves limiting foods containing so-called "fermentable" sugars. These carbohydrates are fermented by colonic bacteria and cause symptoms of bloating, gas, and abdominal pain. Dairy products (especially milk and yogurt), certain fruits (such as apples, pears, prunes), vegetables (especially cabbage and derivatives, leeks, garlic, onions), wheat, as well as sugar-free sweeteners and confectionery are particularly implicated. Most industrial preparations are also approached with great caution due to the various additives they contain.
The low FODMAP diet will be accompanied by simple rules:
Eat at fixed times.
Eat in small quantities.
Eat slowly and calmly.
Wait at least two hours between the evening meal and bedtime.
Physical activity and relaxation
It has been observed that regular moderate physical activity has a beneficial effect on IBS symptoms (23) and tends to regulate intestinal motility. Walking, swimming, cardiovascular work, or yoga are thus to be favored.
Relaxation methods (conscious breathing, heart coherence, meditation, sophrology, etc.) also tend to bring improvement, notably because they contribute to reducing the stress that exacerbates symptoms (24).
Finally, in the realm of so-called alternative methods, only hypnosis has truly shown its effectiveness (25).
While irritable bowel syndrome cannot be cured, well-chosen dietary supplements (probiotics, L-glutamine, turmeric...) along with a reasoned diet and lifestyle focusing on stress management and physical activity can significantly relieve symptoms.
Sources :
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(12) Source : APSSI
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