Table Of ContentMaking Sense of IBS
A Johns Hopkins Press Health Book
Making Sense of IBS
A Physician Answers
Your Questions about
Irritable Bowel Syndrome
Brian E. Lacy, Ph.D., M.D.
The Johns Hopkins University Press
Baltimore
Note to the reader: This book is not meant to substitute for medical care, and treatment
should not be based solely on its contents. Instead, treatment must be developed in a
dialogue between you and your doctor. It is especially important to discuss the use of
any medications with your doctor.
© 2006 The Johns Hopkins University Press
All rights reserved. Published 2006
Printed in the United States of America on acid-free paper
9 8 7 6 5 4 3 2 1
The Johns Hopkins University Press
2715 North Charles Street
Baltimore, Maryland 21218-4363
www.press.jhu.edu
Library of Congress Cataloging-in-Publication Data
Lacy, Brian E.
Making sense of IBS: A physician answers your questions about irritable bowel
syndrome / Brian E. Lacy.
p. cm. — (A Johns Hopkins Press health book)
Includes bibliographical references (p. ) and index.
ISBN 0-8018-8455-1 (hardcover : alk. paper) — ISBN 0-8018-8456-X
(pbk. : alk. paper)
1. Irritable colon. I. Title. II. Series.
RC862.I77L33 2006
616.3(cid:118)42—dc22 2006008097
A catalog record for this book is available from the British Library.
Illustrations are by Jacqueline Schaffer.
Contents
Preface vii
Acknowledgments ix
List of Abbreviations xi
PART I
Irritable Bowel Syndrome: Who, What, and Why?
1. Why Me? Why Now? 3
2. What Is IBS? 10
3. How Common Is IBS? 31
4. What Causes IBS? 42
PART II
Diagnosing Irritable Bowel Syndrome
5. How Is IBS Diagnosed? 59
6. IBS and Other Medical Disorders 76
7. The Anatomy of Normal Digestion 90
8. Diagnostic Tests and What They Mean 106
9. What Is My Prognosis? 125
vi Contents
PART III
Treating Irritable Bowel Syndrome
10. Treatment Basics 135
11. Diet 146
12. Treatments for Constipation 161
13. Treatments for Diarrhea 181
14. Medications for Pain, Bloating, and Overall Symptoms 196
15. Psychological, Hypnotherapeutic, and Psychiatric
Therapies 219
16. Complementary and Alternative Medicine 229
PART IV
Other Issues
17. IBS and Children 239
18. What Does the Future Hold? 251
Appendix: About Clinical Trials and Scientific Research 261
Patient Resources 269
Glossary 273
References 285
Index 295
Preface
If you’ve picked up this book, then it is quite likely that you or a friend, a
co-worker, or someone in your family has irritable bowel syndrome (IBS).
I can safely make that statement because 1 in 5 to 1 in 6 adult Americans
suffers from this problem. Although the condition is quite common, peo-
ple with IBS have often found it difficult to get help for their symptoms or
answers to their questions. Fortunately, over the past 10 years, significant
advances have been made in our understanding of IBS. We now have a
much clearer picture of why IBS develops, and we also better understand
the very complex interactions that occur between the brain and the gut
in patients with IBS. In addition, researchers, scientists, and physicians
have made significant contributions to our ability to manage the multiple
symptoms of this often frustrating disorder.
Because the education of patients and health care providers about IBS
has been limited, I wanted to write this book to share this wealth of new
information with more people. The book has several goals:
• to convey what we currently understand about IBS
• to clear up the many misconceptions and misperceptions that sur-
round IBS
• to help you recognize the symptoms of IBS
• to describe tests that may be used during the evaluation of IBS symptoms
• to discuss the many treatment options available for the diverse symp-
toms of IBS
• to provide information that will allow people with IBS to better un-
viii Preface
derstand their symptoms, institute changes, and hopefully improve
their quality of life.
To accomplish these goals, I have divided this book into four parts.
Part 1 provides a general introduction to the disorder. Chapter 1 provides
an overview of IBS using the case history of a recent patient of mine.
Chapter 2 discusses typical symptoms of IBS, reviews how it is defined,
and discusses underlying problems in gut function that produce the mul-
tiple symptoms. Chapters 3 and 4 discuss how common IBS is and why
it develops.
Part 2 focuses on the evaluation and diagnosis of a patient with IBS
symptoms. Chapter 6 discusses the relationship between IBS and other
common disorders, while Chapters 5 and 8 focus on how IBS is diag-
nosed, describing and explaining typical screening and diagnostic tests.
To help you better understand why patients with IBS often have multiple
symptoms (abdominal pain, bloating, constipation or diarrhea or both),
the anatomy and physiology of the gastrointestinal tract is reviewed in
Chapter 7. Part 2 is completed with a discussion on the natural history of
IBS and the prognosis for patients with IBS.
Part 3 focuses on the treatment of IBS. Separate chapters address the
basics of good treatment and the role of exercise and lifestyle modifica-
tions (Chapter 10), the controversial topic of diet as it affects IBS (Chapter
11), and treatments for constipation, diarrhea, bloating, and abdominal
pain (Chapters 12–14). Chapter 15 focuses on treatments aimed at the
brain-gut connection (hypnotherapy and psychological therapies). This
section concludes with a discussion of the usefulness of complementary
and alternative therapies in the treatment of IBS.
Finally, in Part 4, the special population of children with IBS is ad-
dressed (Chapter 17) and the future of IBS is discussed (Chapter 18). At
the back of the book are lists of readily accessible patient resources and
titles of the original medical studies described in the book, for those who
might want to read further about them. Special terms used in the book
are defined in a glossary at the back, and at the front of the book there
is a list of abbreviations. There is also a short appendix about the design
and importance of clinical studies.
I hope that this book will answer your many questions about IBS and
allow you to make sense of this common and frustrating disorder.
Acknowledgments
The process of writing, editing, and publishing a book is a signifi-
cant undertaking that represents the collective efforts of many people.
Unfortunately, and unfairly, the cover of a book lists only the author’s
name and does not credit the many others so intimately involved in this
lengthy process. Although it is not possible to properly thank everyone who
contributed to this project, I would like to acknowledge some of them.
First, I want to thank all of the patients with IBS whom I have seen
over the past decade. I appreciate their willingness to describe their symp-
toms and share how IBS affects their lives. I hope that this book will pro-
vide them with new ideas and information that will enable them to better
understand this complex disorder and ameliorate their symptoms.
Thanks also go to Jacqueline Wehmueller and Anne Whitmore, both
of the Johns Hopkins University Press, for their cogent thoughts, contin-
ued encouragement, and tireless efforts in editing and revising the manu-
script. In addition, I owe great thanks to all of my friends and colleagues
at Dartmouth for their wonderful suggestions, advice, and support.
Finally, I dedicate this book to the memory of my father, who taught
me to be patient and understanding, and to Elaine, for her unwavering
patience, support, and selflessness.
Description:People with irritable bowel syndrome have chronic abdominal pain and discomfort, bloating, and disordered bowel habits. Understandably, they worry about their symptoms and how their lives are disrupted by IBS. And they are often frustrated because they cannot control their symptoms with dietary chan
