After Diagnosis

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Table of Contents
IBS Treatments
IBS Treatment Limitations
Heartburn and GERD Treatments
Heartburn and GERD Treatment Limitations
Food Intolerance Treatments
Food Intolerance Treatment Limitations
Further Reading And References

IBS Treatments

After diagnosis standard IBS treatments include symptoms management, which might include:

dietary & lifestyle advice and, if not successful, FODMAP exclusion diet
antispasmodics, laxatives, Imodium & anti-depressant medications depending on symptoms
psychological interventions (cognitive behavioural therapy [CBT], hypnotherapy and/or psychological therapy)

(1)

IBS Treatment Limitations

Symptoms management rather than treating underlying causes meaning relapses possible
The FODMAP diet relieves symptoms in the short term but since the diet reduces food for the microbiome it can alter microflora in a negative way. Studies have found a reduction in Bifidobacterium (2), which play an important part in preventing growth of harmful bacteria, helping digest fibre and producing compounds that are good for health (3)
The FODMAP diet can be highly restrictive if few FODMAPs are tolerated which could result in nutritional inadequacy, hyper vigilance around food, eating being not as enjoyable, less social interaction by reducing the ability to eat out and associated negative mental health consequences

Heartburn and GERD Treatments

IBS may come with other symptoms such as Heartburn/Acid Reflux/Gastro-oesophageal reflux disease (GERD). If suspected there may be a test for H pylori infection and treatment with antibiotics if this is present (4).

Treatment includes symptoms control which may involve:

Proton Pump Inhibitors (PPIs), which reduce stomach acid (4)
Self-management advice including eating smaller more frequent meals (5) and decreasing fat in the diet (6)
Endoscopy to diagnose Barrett’s oesophagus depending on risk factors for example, long duration of symptoms, increased frequency of symptoms, previous oesophagitis, previous hiatus hernia, oesophageal stricture or oesophageal ulcers, or male gender (4)
Surgery (14)

Heartburn and GERD Treatment Limitations

There has been a lack of robust studies regarding the safety of long term PPI use and benefits of PPI use have to be weighed against potential risks (7)
PPIs only treat the symptoms of Heartburn/GERD and not the underlying cause meaning relapse is possible
Eating small, more frequent meals to control symptoms may not allow enough time for the migratory motor complex to run which sweeps out the small intestine and could encourage small intestine bacterial overgrowth (one of the symptoms of which is GERD) (8) (9)
A low fat diet shifts the microbiome towards a greater number of pathogenic bacteria and fewer good microbes (10)

Note that persistent heartburn/GERD can lead to Barrett’s oesophagus which is a pre-cancerous condition, so it is important for it to be controlled. This may be by relieving constipation which may be a factor, improving IBS symptoms and reducing gas and bloating which can put pressure on the valve that sits between the stomach and the throat allowing stomach contents including acid to flow back. Some causes of heartburn/GERD include physiological issues such as hiatus hernia – these patients, those already with Barrett’s oesophagus or those unable to control symptoms by other means may require long term PPI treatment.

Food Intolerance Treatments

Food intolerances and IBS can go hand in hand. Although not all people with specific food intolerances will necessarily have IBS.

Treatments include:

Food elimination and reintroduction diet to identify foods that cause symptoms
Stop eating offending foods
Try to reintroduce small quantities later that may be tolerated

(11)

Food Intolerance Treatment Limitations

Avoiding certain foods or food groups does not treat the underlying cause, may cause nutritional deficiencies and causes hyper vigilance around food
Diets becoming skewed resulting in unintended consequences such as constipation, diarrhoea and bloating (12)
May adversely impact the microbiome; for example a gluten free diet decreases microbiome diversity and increased pathogens in the gut (13) ; this means that food elimination diets may be counterproductive in the long term