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Irritable bowel syndrome (IBS) is a gastrointestinal disorder that is highly prevalent, affecting about 20 percent of the population. On this episode of Patient Power, host Andrew Schorr is joined by Dr. Carol Burke, a gastroenterologist from the Cleveland Clinic to discuss the symptoms of irritable bowel syndrome, possible causes and different treatment options. Dr. Burke is also director of the Center for Colon Polyps and Cancer Prevention at the Cleveland Clinic.

The program begins with a brief overview of the two different kinds of irritable bowel syndrome, which affects women almost twice as much as men. Dr. Burke explains why some minority populations are affected more frequently, as well as how the symptoms of IBS are often triggered by the stress of social situations or certain foods. The interview then moves to a more in-depth biological explanation about the causes of IBS, including the role of motility and serotonin. Dr. Burke discusses the interaction between the brain and the neurotransmitters in the intestinal tract. She contends that an insult into the intestinal tract can actually change the neurophysiology and lead to symptoms of IBS. It is a complex interaction that is differs from patient to patient.

Dr. Burke offers numerous suggestions for how to address symptoms common with IBS—which can include diarrhea, pain, gas, bloating and constipation. Learn about the warning signs that require immediate attention and further testing before being attributed to IBS. Dr. Burke mentions three different types of treatment for IBS that can affect the bowel symptoms, whether it is the brain or the enteric nervous system, the motility side or muscular movements, spasms, or secretions. It could be something as simple as adding more fiber into your diet, or you could require a prescription medicine treatment. The point is--there is help for people with IBS.

As Dr. Burke says, “There are so many new therapies available for irritable bowel syndrome that are not available over-the-counter. No one should be suffering with irritable bowel symptoms at home.”

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Produced in association with Cleveland Clinic Foundation

Transcript

Andrew Schorr:

Good morning across America. I’m Andrew Schorr broadcasting from right by the Space Needle in Seattle under cloudy skies, and yes it is Daylight Savings Time, and so it’s probably an hour later than you may have thought it is. Here in Seattle it’s a little after 9:00 a.m. We drink a lot of coffee here, so this was a triple latte day morning for me to get going.

Today we are going to talk about irritable bowel syndrome. Now what’s irritable bowel syndrome? Well we are going to have an expert join me in a second, and she is going to tell much more, but here’s something that maybe you may have felt, or somebody you know; cramping, diarrhea, or bloating, constipation and times when you just have to go to the bathroom a lot.

It certainly affects your quality of life, and I know Dr. Carol Burke who is joining us from the Cleveland Clinic, she’s a gastroenterologist. Carol you were telling me the other day that you did a video I think with one of your patients, and the patient was saying when asked about the quality of life that this gentleman found it difficult to go to a ball game with his daughter because he was afraid that he would need to go to the bathroom, and he couldn’t leave her by herself, she’s young, and so in a sense they just couldn’t go. So I’m sure that you hear all the time people with irritable bowel syndrome where it is a real lifestyle problem. Is that right?

Dr. Burke:

There are two different forms of irritable bowel quite frankly. One is the diarrhea predominant that you talked about; patients going to the bathroom quite frequently, which can affect social situations, work situations, but the other type of irritable bowel is constipation predominant, and I have patients who not only miss social events which troubles their family, but those are the folks who can’t leave the house in the morning to get to work because they can’t get their bowels moving, and they are spending hours or getting up at 4:30 in the morning. So it can affect both the individuals that have diarrhea-predominant as well as constipation-predominant irritable bowel.

Andrew Schorr:

Now Dr. Carol Burke who is with us is a gastroenterologist at the Cleveland Clinic, which of course is one of our outstanding medical centers in the country. Carol also is the Director of the Center for Colon Polyps and Cancer Prevention, and I want to point out to our audience if you take a look at our website www.patientpower.info, last week I did two hours of programs on colon cancer prevention, and it is so important.

There too there has been the embarrassment of if you have blood in your stool or something like that do you get it checked, and unfortunately a lot of people don’t, or they don’t follow the guidelines now of getting a colonoscopy starting at age 50 or younger for African Americans, or certainly if there is a problem that needs to be investigated. So take a look at that on the web, but today we are going to talk about irritable bowel syndrome. It’s not a disease. Carol Burke what is irritable bowel syndrome?

Dr. Burke:

Irritable bowel is a gastrointestinal disorder that is diagnosed based on symptoms so different than many other diseases where we can have some type of testing in a lab or in the doctor’s office to tell a physician what’s going on. With irritable bowel syndrome the diagnosis is based on abdominal discomfort that’s associated with two of three things. Either when the pain comes on; when you move your bowels the pain is relieved, or when you get abdominal pain you have a change in the frequency or consistency of stool. So it is really a painful gastrointestinal disorder that is associated with a change in bowel habits.

Andrew Schorr:

And what percentage of the population do we think is affected by it? When does it develop? Is it more women than men?

Dr. Burke:

This is a highly prevalent disorder, and in fact colon cancer is very important because it is a preventable disease, but only about 150-thousand people in the United States would be affected with colon cancer. Irritable bowel syndrome affects 20 percent of our population. The onset is usually in later teens, early twenties, but there have been studies that show that it could have its onset anywhere up to about the age of 55 or so. It affects women more often than men, usually about two to one, but both genders are affected by irritable bowel syndrome.

Andrew Schorr:

Now is irritable bowel syndrome though separate from a lactose intolerance or things that just trigger your bowels acting crazy? How do you differentiate that?

Dr. Burke:

Well as I said, the diagnosis of irritable bowel is based on symptoms. It used to be a diagnosis of exclusion in that we would have to do every other test, and when we couldn’t find anything we assigned the diagnosis to someone, and that wasn’t very palatable to patients. They felt like they were just being cornered into a wastebasket diagnosis, but in fact the other things that can coexist with irritable bowel syndrome, or when present and it’s not irritable bowel syndrome, deserve a different type of evaluation.

So there are things that can affect irritable bowel syndrome such as dietary factors. Many people will state that when they go out to eat they have trouble. They have to pull off the road and find the nearest bathroom, or when they go to the mall they identify where all the bathrooms are before they start their walk. So irritable bowel can certainly be set off by meals, but it’s not a specific intolerance or allergy to any food like lactose intolerance is. But lactose intolerance is common in the population too; 20 percent of the population could have it. African Americans are more at risk; as we age we are more at risk, and lactose intolerance’s inability to absorb lactate or lactose, which is a sugar in milk. Irritable bowel syndrome can be affected by meals, but there is no particular food that seems to set off the symptoms.

Like you said before certain social situations, like some of my patients that know they are going to work, you know their autonomic nervous system revs up when they wake up in the morning. Either their bowels start churning or the anxiety starts and those types of social situations such as getting to a wedding can be a problem. I had one patient who called me on her wedding day saying, ‘I can’t get my wedding gown on because I’m having terrible diarrhea.’ So social situations can set it off; changes in sleep/wake cycle, travel, stressful situations. There was a young patient that I invited to be on the air with us today, and he said he might consider writing a book about irritable bowel but couldn’t appear on the show because he was too afraid that he would have to leave and go to the bathroom. So the stress of a social situation or presentation can affect people, and we don’t really know what the neurohormonal cause of this affect of the brain on our gut-brain is.

Andrew Schorr:

Okay, so basically though whatever is affecting this transmission of messages is the gut then sort of spasming? Is that what’s going on?

Dr. Burke:

Well the cause of irritable bowel is probably related to motility, and motility is the muscular movement of the intestine as well as secretions. There has been a lot of research over the last decade or so to find out what causes changes in motility, or muscle transmission and secretion of fluid and electrolytes within the bowel, and irritable bowel syndrome if we were to look in with an upper endoscope or a colonoscope or even take biopsies of the intestines or do laboratory studies on patients with irritable bowel syndrome we wouldn’t see anything that would be abnormal, but we know that these neurochemicals within the intestinal nervous system, it’s called the enteric nervous system, are a little bit off, and most of the research these days has looked at a neurotransmitter called serotonin that seems to be most important in affecting that secretion and motility in the gut, and medications these days are actually made to either inhibit serotonin or augment it.

Andrew Schorr:

Carol, we’ll continue to understand the science of it in just a minute when we come back. We’re visiting with Dr. Carol Burke, a gastroenterologist at the Cleveland Clinic in Cleveland, and we are talking about irritable bowel syndrome. We’ll be right back with much more of Patient Power.

Thank you for spending part of your Sunday. Check your clock. Remember we are on Daylight Savings Time now. Andrew Schorr here broadcasting live from Seattle where I usually am. Next week I’m going to be down in Houston. I’m hosting a breast cancer event, an important event. We’re partnered with the Sister's Network which is the largest African American breast cancer group, and they are having their national conference there, and I’m going to lead a discussion with a bunch of prominent breast cancer experts, and then that will be put on the web on what I do during the week, and that’s www.HealthTalk.com. So take a look at that. There is a breast cancer education network there, and it will be the latest in breast cancer information.

While I’m there I’m going to do a show next week on the HealthRadio Network, and we are going to talk about kidney and liver transplantation, and we have a problem of hepatitis C in this country and also diabetes, and both of those lead to the need for those transplantations, and unfortunately as you know there is a shortage of organs. Not enough of us are organ donors. Take a look at your license, and see if you can have that say “organ donor” in your state. So we’ll have an expert on from Columbia University and also the Baylor College of Medicine right there in Houston.

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