Teresa,Below is a reprint of my own list of treatment options for the various forms of IBS. The only change I might wish to make isto include the information about Caffeine in all four of the
sections:IBS-D: Irritable Bowel Syndrome with diarrhea and pain as the primary symptoms. (This form of IBS is more likely to occur with patients who have had gallbladder disease, particularly those who have undergone gallbladder removal.)Treatment Options for
IBS-D:1. Calcium Carbonate. It is not understood why calcium carbonate supplements work well for this IBS subgroup. It may be that a steady dribble of bile through the GI tract is irritating, and that the calcium carbonate neutralizes the bile acidity. However, it isvery clear by the voluminous and enthusiastic response received on the Bulletin Board that this treatment is very effective for a good percentage of IBS-D patients. Most patients report best results with Caltrate 600mg Plus, from one half tablet up to three tablets per day.2. Lotronex: Lotronex is a prescription drug which was approved by the FDA, then withdrawn by it�s manufacturer approximately one year later. A number of IBS-D patients found this drug to be extremely effective, one of the few treatments that has ever been found effective for their particular case. Unfortunately, it appears that it may have been prescribed inappropriately for patients suffering from constipation, rather than diarrhea, and this led to a number of patients developing severe, life threatening complications. There is currently a campaign to have the manufacturer re-release this medication, the outcome of which is uncertain.3. Colestid, Questran: These drugs were developed for other purposes, but have proven to be extremely effective against IBS-D for certain patients. Questran comes in powder form, and often � package per day is satisfactory.4. Immodium A/D: This over-the-counter antidiarrheal medication is effective, but dosage must be carefully controlled to avoid excursion into constipation and other side effects.IBS-C/D: Irritable Bowel Syndrome with alternating bouts of constipation and diarrhea plus abdominal pain as the primary symptoms. This is the classic IBS symptom set, with pain often but not always concentrated in the lower left abdomen.Treatment Options for IBS-C/D:1. Food Allergy/Intolerance: Some would argue that if a food allergy or intolerance is found to be the cause of IBS symptoms, then it is not "real" IBS, but this argument is somewhat pointless from a clinical standpoint, because the symptoms are the same. If a patient has known allergies, then this should be suspected. Removal of specific foods from the diet will completely eliminate IBS symptoms in some patients. Please note that at low concentrations or when consuming low quantities in the diet, an allergen may have no effect. At higher concentrations, it may produce IBS symptoms. At still higher concentrations it may produce a more immediate allergic reaction. � Food Journal - Some patients have been successful in tracking down the particular food item(s) which they cannot tolerate by keeping a detailed hourly journal. Once a journal is built up of foods consumed and symptoms experienced, it may be possible to track down the offending foods. Please note that patients may experience a 12-18 hour delay between consumption and symptom onset, making the diagnosis more difficult. Other patients may have a very specific reaction a few hours post consumption. � Elimination diet - This is a draconian measure, where the patient is limited to a very restricted diet (typically chicken, rice & spinach), and new foods are progressively introduced, with a 3 day trial for each new food. [There are diagnostic labs which are in business specifically to conduct detailed food intolerance testing, which may be an alternative to the elimination diet.]Common allergens/intolerances are listed below:� Caffeine (See next paragraph.)� Alcohol� Gluten (This may represent a failure to diagnose Celiac disease.)� Dairy foods (May be either casein protein or lactose intolerance.)� Fructose (Especially pears and foods with "high fructose corn syrup".)� Sorbitol (sweetener) or other sugar alcohols.� Citrus fruits� Tomatoes� Lettuce2. Caffeine: Caffeine is a well known nervous system stimulant. It�s affect on the autonomous nervous system controlling the colon is not as well understood, but it makes sense that patients with a tendency towards colon spasm should try to avoid nervous system stimulants. Some patients on the BB have abrupt symptomatic relief after removing caffeine from the diet. This substance seems to work in opposition to amitriptyline (see next treatment item). [A few other patients, particularly those with primarily constipation (IBS-C), actually report that they can induce bowel movements with consumption of coffee. This could possibly be the result of heavy overconsumption of the stimulant.] Caffeine appears in coffee, tea, colas & other soft drinks, plus chocolate.3. Antidepressants: Treatment with amitriptyline (Elavil) or other tricyclic antidepressants has proven very effective in many patients. Reported effective dosage and side effect tolerance varies dramatically. Dosage of 10 mg/day or less is probably a good starting point. Alcohol must be avoided when taking amitriptyline, as this can produce severe drowsiness.4. Antispasmodics: Treatment with dicyclomine (Bentyl) or other anti-spasmodics has proven effective for many patients. Tolerance of antispasmodics is even more variable than anti-depressants. A low dosage of 10 mg/day or less is probably a good starting point. Some patients may tolerate (and require) much higher dosages. Side effects may include dry mouth, intoxication, drowsiness, and generalized abdominal pain. Alcohol must also be avoided when taking dicyclomine.IBS-C: Irritable Bowel Syndrome with constipation and pain as the primary symptoms. Patients often experience hard, pellet-like stools. Under no circumstances should these patients be treated with drug treatments listed under IBS-D above, since this is likely to lead to worsening of the condition. Treatment Options for
IBS-C:1. Fiber supplementation: Some patients may experience improvement with fiber supplements like fibercon, metamucil, etc. This varies quite a bit, with some patients reporting worsening of symptoms with fiber supplements. Some patients experience improvement by greatly increasing their intake of natural fiber-containing greens, especially spinach, collard greens, etc. A change in stool consistency and appearance may be expected with this strategy.2. Antidepressant or antispasmodic drugs as described above may also be helpful with IBS-C.IBS-B: Irritable Bowel Syndrome with bloating and pain as the primary symptoms. Some patients may experience substantial, measurable abdominal distention. This may be associated with abnormal levels of flatulence. It may exist on top of constipation or diarrhea symptoms. It is possible that some patients with this problem have undiagnosed celiac disease, fructose intolerance or raffinose intolerance.Treatment Options for
IBS-B:1. See above treatments for IBS-D, IBS-C/D, or IBS-C, depending on other symptoms.2. Adkins Diet: Some patients report a substantial improvement in symptoms when going on one of several different reduced carbohydrate diets. Why this is effective is not clear, but it may be that the patient has an abnormally high level of intestinal bacteria which produce gas on breaking down carbohydrates.3. Antibiotics: Some medical centers have reported abnormally high levels of intestinal bacteria in a percentage of IBS patients, which may respond to antibiotic treatment. Several patients on the BB report that antibiotic treatment can improve symptoms, but generally for a limited time period of several months.4. Probiotics: Plain yogurt with active cultures, or other so-called probiotics, are helpful for some patients. These may alter the intestinal flora in such a way as to reduce the generation of gas.I hope this information proves helpful to you.
