AN OVERVIEW OF IRRITABLE BOWEL SYNDROME (IBS)

This content is for educational purposes only and is not intended to diagnose, treat, cure, or prevent any medical condition. It aims to help you better understand gut-related issues, but the causes and diagnoses of these conditions are often complex and overlapping, with potential for misdiagnosis. This is why it’s essential to consult a qualified healthcare provider, such as a gastroenterologist or your doctor, for proper evaluation and advice tailored to your needs.

KEY OUTTAKES

IBS affects approximately 20% of the global population, with women being more frequently diagnosed, and it significantly reduces both quality of life and work productivity.
IBS involves complex mechanisms including gut-brain axis dysregulation, altered gut motility, immune activation, and changes in gut microbiota.
IBS is diagnosed using the Rome IV criteria, stool analysis, colonoscopy, and other laboratory tests to rule out similar conditions.
IBS is classified into IBS-D (diarrhoea), IBS-C (constipation), and IBS-M (mixed), with patients often shifting between subtypes over time.
While there is no cure, managing IBS involves dietary changes, medications, probiotic supplementation and psychological support, focusing on symptom relief and improving quality of life.
The gut microbiome plays a crucial role in nutrient synthesis, immune function, and maintaining gut health.
Environmental factors such as diet and medication have a stronger influence on the gut microbiome than genetics.
Dysbiosis, or microbial imbalance, is linked to inflammation and IBS symptoms.
IBS patients show altered microbiome composition, with decreased beneficial bacteria like Bifidobacterium and increased harmful strains.
The gut-brain axis and stress significantly impact IBS, influencing motility, pain, and symptom severity.
Understanding the connection between gut microbiota and IBS can help develop more targeted treatment strategies.
Probiotics can effectively reduce IBS symptoms, with certain species like Lactobacillus and Bifidobacterium showing the most promise.
A daily dose of 10 Billion CFU or higher typically delivers the best results, with improvements often seen within 4 weeks.
Specific probiotic strains, such as L. acidophilus NCFM and B. lactis HN019, have been linked to improved gut function and reduced symptom severity.
Probiotics can support intestinal barrier integrity, modulate immune responses, and reduce gut inflammation, but effectiveness varies by strain.
Safety profiles of probiotics are generally favourable, though minor side effects like bloating may occur.
Dietary changes, such as the low-FODMAP diet (limiting fermentable carbohydrates) are critical in managing IBS symptoms like bloating and abdominal pain.
Exercise and fibre supplementation, particularly with soluble fibre, have shown positive effects on symptom relief and gut health.
Probiotics and prebiotics can play an important role in improving gut microbiota and IBS symptoms, with species like Bifidobacterium and Lactobacillus proving particularly effective.
Combining treatments, including diet, exercise, and probiotics, offers the best outcomes for reducing IBS severity and improving overall quality of life.

Introduction

This guide offers an in-depth look at Irritable Bowel Syndrome (IBS), a common and often debilitating gastrointestinal disorder affecting millions worldwide. While the exact causes of IBS are not fully understood, it has a profound impact on a person’s quality of life.

AN OVERVIEW OF IRRITABLE BOWEL SYNDROME (IBS)

Irritable Bowel Syndrome (IBS) is a common and often debilitating gastrointestinal disorder that affects a significant portion of between 9 – 23% of the global population. In South Africa specifically, 15-20% of the population suffers from IBS.

IBS is more frequently observed in women, with approximately 1.5 to 3 times more females affected than males. The onset of IBS symptoms often occurs during adolescence.

About 10% of IBS cases follow infectious gastroenteritis, with aggravating risk factors including female sex, younger age, stress, and the severity of the infection. Despite its high prevalence, the underlying causes of IBS are complex and not fully understood.

IMPACT ON QUALITY OF LIFE AND CAREER

IBS significantly affects both quality of life and socio-economic factors. A study in 2017 found that IBS patients miss an average of two workdays per month and have reduced productivity for an additional nine days per year. Their quality of life is often as impacted, or even more, than those with diabetes or renal disease.

HOW IBS AFFECTS THE BODY

IBS is characterised by diverse causes and varied symptoms, historically thought to arise from abnormal brain–gut interactions, unhealthy gut microbiome, intestinal permeability (leaky GUT) and immune cell over-reactivity.

Dysregulation of the brain–gut axis plays a central role, leading to symptoms such as abdominal pain, bloating, and irregular bowel movements. Additionally, recent research suggests that IBS may also involve alterations in gut immune activation, increased intestinal permeability, and changes in gut microbiota composition.

Patients with IBS frequently experience disturbances in bowel movement (gut motility), which are often exacerbated by stress via the gut-brain axis (Drossman, 2016). These changes manifest as diarrhoea, constipation, or a combination of both. Research indicates that serotonin plays a crucial role in regulating gastrointestinal motility. Elevated serotonin levels are typically associated with diarrhoea-predominant IBS, while reduced serotonin levels are linked to constipation-predominant IBS (Crowell, 2004; Camilleri, 2009).

Gut microbiota imbalances, increased mucosal permeability, and low-grade inflammation are key factors in IBS. These issues may heighten gut-to-brain signalling, contributing to IBS symptoms.

A review of 22 studies found that IBS patients have altered gut microbiota. Additionally, IBS is associated with increased intestinal permeability and inflammation of the gut lining.

DIAGNOSIS OF IRRITABLE BOWEL SYNDROME (IBS)

Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder (FGID) characterised by abdominal pain and changes in bowel habits without any obvious causes.

Doctors diagnose IBS using clinical guidelines like the Rome IV criteria and tests like colonoscopy and lab work to rule out other conditions.

DIAGNOSTIC CRITERIA FOR IBS

ROME IV CRITERIA:

IBS is diagnosed using the Rome IV criteria, which define it as recurring abdominal pain at least once a week for the past three months. The pain must also be linked to two or more changes in the following; defecation frequency (how often you poop), stool appearance (how your poop looks), or its consistency.
IBS is further categorised into subtypes based on the Bristol Stool Form Scale (BSFS), which classifies stool consistency from hard to soft on a scale of 1–7. The subtypes are:
- Stool types 1–2: IBS with Predominant Constipation (IBS-C)
- Stool types 6–7: IBS with Predominant Diarrhoea (IBS-D)
- A combination of constipation and diarrhoea: IBS with Mixed Bowel Habits (IBS-M)
- Unclassified IBS (IBS-U): Meets IBS criteria but cannot be classified into the other subtypes

UNDERSTANDING THE DIFFERENT SUBTYPES OF IBS

IBS is not a single condition, but a general term for different subtypes that share some similarities but have distinct symptoms. It’s important for healthcare providers to recognise the different subtypes and use the standard terminology, like the one created by the Rome Committees.

Irritable Bowel Syndrome (IBS) is characterised by different subtypes, primarily IBS-D (diarrhoea predominant), IBS-C (constipation predominant), and IBS-M (mixed). Studies have investigated the microbiota composition in these subtypes, revealing distinct patterns.

In Irritable Bowel Syndrome (IBS), patients often experience changes in subtype over time with only about 25% maintaining their subtype for over a year, while 75% shift to different subtypes. Studies also show varied colonic transit times among IBS subtypes, with only a small percentage of IBS-C and IBS-D patients showing typical delayed or rapid transit times.

MRI scans reveal different patterns of water content and colon volume across subtypes.

Gut microbiota analyses also show subtype-specific differences, with IBS-D and IBS-M having fewer butyrate- and methane-producing bacteria.

Regardless of subtype, IBS patients generally have increased colonic motility and visceral hypersensitivity (pain in internal abdominal organs) compared to healthy individuals. This shows that IBS has both unique and shared features in how it affects the body.

The IBS-QoL questionnaire is an important scale for evaluating the quality of life in patients with IBS, with higher scores indicating better IBS-specific quality of life. The IBS-QoL score is related to the patient’s abdominal pain, extraintestinal symptoms, symptom flare-ups, and disease-related issues, and is correlated with disease severity.

OTHER DIAGNOSTIC OPTIONS

1. ROLE OF COLONOSCOPY IN IBS DIAGNOSIS:

Diagnostic Utility

A colonoscopy helps rule out other diseases and check for signs of IBS, like gut sensitivity and abnormal colon movement. It’s also useful when warning signs of other conditions are present.

A study of 4,178 patients showed no major difference in organic colonic diseases between those who met Rome III criteria and those who didn’t, meaning the criteria can’t rule out organic issues. Colonoscopy is advised for IBS patients with warning signs or persistent symptoms to check for conditions like microscopic colitis and eosinophilic enteritis.

2. LABORATORY TESTS FOR DIFFERENTIAL DIAGNOSIS:

Upper Gastrointestinal Endoscopy and Radiography:

Upper gastrointestinal endoscopy and imaging studies can aid in differentiating IBS from other diseases. Blood, urine, and faecal tests are also useful.

Inflammatory Markers:

Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels are used to detect inflammatory bowel disease (IBD). Studies suggest that a CRP level of ≤6 mg/L and an ESR level of ≤10 mm/h can effectively rule out IBD.

Celiac Disease (CD):

Celiac disease can present with symptoms similar to IBS. Screening with serum IgA tissue transglutaminase and confirming with duodenal biopsy are recommended.

Bile Acid Malabsorption (BAM):

IBS-D may overlap with BAM. Studies indicate that a significant proportion of IBS-D patients have BAM. Screening tests for BAM, such as serum biomarkers 7α-hydroxy-4-cholesten-3-one and fibroblast growth factor-19, are proposed but not widely available.

SUPPLEMENTATION RECOMMENDATION

REPOPULATING YOUR GUT MICROBIOME WITH THE RIGHT GOOD BACTERIA
Repopulating your gut microbiome with the right good bacteria to improve its function and role within your health will start resolving your symptoms.
Ensure you only take a probiotic that meets pharmaceutical grade standards to ensure efficacy and that dose delivery for symptom improvement, (uses gold-standard strains backed by clinical evidence for efficacy, with a minimum dose of 10 Billion CFU’s, protects it bacterial dose by ensuring shelf stability and full stomach acid protection with targeted delivery of the bacteria to your intestine, and meets all other quality metrics).The bacteria in your microbiome improves digestion and nutrient absorption, acts at the guts pharmacy – making vitamins, producing SCFA’s and other important metabolites, like serotonin. It is both the boss of and manager of our immune system. They Influence our brain and hormones, improve our mood + how our brain work. The microbiome also influence our Metabolic and Hormonal system/health.
HEALING THE WHOLE GUT SYSTEM, IMPROVING THE STRUCTURE, ENVIRONMENT AND FUNCTION
This condition can affect the gut structure, environment and function, leading to an overall decline in the performance of the whole gut system. This results in gut inflammation, increased oxidative levels altered colonic PH levels. It impairs; immune capabilities, cell function, barrier function, digestion and metabolic health. Which makes it harder for good bacteria to survive in your gut, and easier for pathogens to take over – leading to a negative-cyclical feedback loop that keeps you unhealthy, compromised and struggling with severe symptoms.

Probitec Intrinsic Bowel Support (30 capsules) and Probitec Gastro (10 capsules), have 8-strains and 20 Billion CFU’s, housed in the worlds most advanced probiotics capsule.

Probitec Fibre+ is a 3-in-1 formula of prebiotic fibre, glutamine and digestive enzymes, designed to enhance the composition and integrity of the whole gut system

The strains have over 120 studies confirming significant relief and improvement of the symptoms associated with the following:

Abdominal pain and discomfort
Diarrhoea, constipation
Bowel regularity and motility
Gas and bloating
Enhancing the gut-brain axis, reducing stress and improving mood
Improving Immunity and combatting pathogenic infections and overgrowth
Enhancing Intestinal Integrity
Reducing gut inflammation
Relieving GI distress or dysbiosis
Improving Quality of Life issues such as fatigue, brain fog and skin conditions.