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Diagnosis: Discomfort

'Irritable bowel' has eluded cure, though study may offer hope


By Sherry Jacobsen / The Dallas Morning News

A medical condition is killing Jennifer Salos' social life.

More information

Irritable bowel syndrome is a catchall name for a variety of ailments also referred to as spastic colon, nervous colon, spastic bowel, mucous colitis and irritable colon. It is the most common intestinal disorder but is not life-threatening.

The syndrome affects millions of Americans, mostly women. While there is no cure, adding dietary fiber and decreasing fat intake can alleviate some symptoms, as can certain medications.

"It's one of the most embarrassing diseases out there," says the 29-year-old Dallas resident. "I can't even go to a party because I may need to go to the bathroom and I might have only two seconds to get there or I'll have an accident. It's too humiliating."

Her condition is called irritable bowel, also sometimes known as colitis, spastic colon or functional bowel disease. It falls under a syndrome of ailments believed to affect 22 million Americans, most of them women.

While no one is certain what causes it, the symptoms include persistent gas, bloating, diarrhea, abdominal pain and constipation. And every patient seems to suffer a different variation of the discomforts.

"I got really sick last summer, and they thought I had appendicitis or an infection," recalls 26-year-old Christine McKeever of Dallas, who was diagnosed with irritable bowel last August. "All the tests came back negative, so they knew it was this."

Some studies suggest that gastrointestinal ailments have become the No. 2 reason that people call in sick at work, after colds. Not surprisingly, a virtual health-care industry has grown up around irritable bowel – dispensing books, diets and various medications to millions of sufferers. But the treatments work for some people and not others.

"We don't cure it," says Dr. Lyman Bilhartz, a Dallas gastrointestinal specialist who has treated hundreds of patients with irritable bowel since 1983. "We try to get them educated and involved in the management of their own symptoms. It's best if you can do it with dietary measures and not tranquilizers and anti-depressants."

The syndrome was a collection of complaints that was not taken very seriously by medical researchers until the late 1980s, after specialists developed diagnostic guidelines and grouped a growing number of patient symptoms under the name irritable bowel syndrome. But the experts stopped short of calling it a disease.

Unlike more serious health conditions, people with irritable bowel do not have life-threatening problems and seldom require hospitalization or costly treatment. Irritable-bowel sufferers are more likely to experience disrupted lifestyles and social habits, as the symptoms push some of them into a more restricted life in order to avoid embarrassing accidents.

Since doctors have not pinpointed an organic cause of the condition, it has been suggested that the problem may be as much psychological as it is physical.

But just recently, researchers in California turned their attention to the possibility that an overgrowth of intestinal bacteria might be the source of all this grief. Their study, showing a possible connection between irritable bowel and bacterial overgrowth in the lower intestines, was published in the December issue of the American Journal of Gastroenterology.

Dr. Mark Pimentel, the lead researcher, says his group decided to focus on the most common symptom of irritable bowel: bloating due to excessive abdominal gas.

"There's only two ways to get excessive amounts of gas in the intestines," he says. "That's from swallowing too much air or from [having] too much gas production in the intestines due to bacteria."

To test the bacteria theory, the Los Angeles researchers took a group of 202 irritable-bowel patients and checked for the presence of excessive bacteria in their small intestines. The researchers used a breath test that detects higher-than-normal amounts of hydrogen, which is associated with an overgrowth of bacteria.

The test determined that 157 of the patients, or 78 percent, had excessive bacterial growth that could be causing irritable bowel symptoms. The patients who tested positive were treated with a 10-day regimen of antibiotics.

Subsequently, half of those who returned for a follow-up exam were shown to have no evidence of bacterial overgrowth and also said their irritable bowel symptoms were gone. The rest were shown to have smaller amounts of bacteria and weakened intestinal symptoms, according to the study.

While other researchers have questioned the validity of the study's conclusion, Dr. Pimentel, of Cedars-Sinai Medical Center, says he is moving forward with a second round of testing.

"I'm not saying that bacterial overgrowth is the cause of irritable bowel in 100 percent of the cases," he stresses. "But if you find something to account for more than 70 percent of a condition in a group of patients, that's the cause."

The second study is expected to be completed by late March and will undergo peer review for possible publication in a medical journal this year, he says. Normally, other researchers must reproduce the study's results before its conclusions are considered valid enough to be applied to patient care.

Still, the study has raised the hopes of many irritable-bowel sufferers. Several have even flown across the country – at their own expense – to be tested and treated by Dr. Pimentel and his colleagues in the past month.

"People with irritable bowel syndrome have been looking for a cure for years for something they can't even confirm they have," says Jeffrey Roberts of Toronto, who operates a popular Web site for syndrome sufferers ( "I've had this condition for 30 years, and I'm very optimistic about this research."

However, doctors who treat irritable-bowel patients are urging caution. To them, the study is not slam-dunk proof of bacteria as the cause of the bowel-related problems. Some researchers challenge key elements of the California study, including how the subjects were chosen and the fact that only 30 percent of those treated with antibiotics returned for a follow-up evaluation.

"The study has some weaknesses, and the conclusions are premature," says Dr. William Whitehead, a leading gastrointestinal researcher at the University of North Carolina at Chapel Hill. "The subjects were not a representative sample of people diagnosed with irritable bowel syndrome. And we don't know anything about the group that did not return for evaluation" after the antibiotic treatment. In addition, the study had no control group – patients who would receive a placebo for comparison's sake.

Dr. Pimentel acknowledges that the study has some problems. He too was concerned that only 47 of the 157 patients came back for a second visit, he says.

"I would love to know what happened to them as well," he says. "I think if there had been more people returning, we would have seen better results. I'm convinced that the majority of people who didn't return got better."

If the study holds up under further scrutiny, it will represent a major departure in irritable bowel research. In recent years, studies have tried to link the syndrome to possible problems in the part of the central nervous system that controls intestinal functions. Other studies have suggested that there may be a psychological component to explain why some people have heightened sensitivity to intestinal discomfort.

"This is headed in a whole new direction," Dr. Bilhartz, a professor of internal medicine at the University of Texas Southwestern Medical Center at Dallas, says of the bacterial study. "If these guys are right, none of us have been doing enough hydrogen breath tests."

Typically, antibiotics are not prescribed for irritable-bowel patients, he notes, although such patients probably would take antibiotics at some point for other health problems and might have seen improvement in their intestinal symptoms.

"If this works, you would expect patients and doctors to pick up on this connection before," he says. "I remain a little skeptical until a controlled study is done."

So the waiting continues for irritable-bowel sufferers. But most of them are accustomed to it, after countless doctor visits and treatment regimens in search of relief.

"You can spend a fortune going to all these doctors with all these different theories about what's causing it," says Karen Lukin, 43, who has suffered from irritable bowel for more than a decade. "Nobody has any real answers for us. But we keep searching. It's a price we're willing to pay to try to feel good every day."

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