IRRITABLE BOWEL SYNDROME MANAGEMENT: BUMPY ROAD FOR PHYSICIANS

Abstract

Irritable bowel syndrome is a complex gastrointestinal disorder related to over activity of nerves supplying the gut. 1It has been matter of enormous concern for both the patients and treating physicians’ .The clinical course is diverse and takes different twist and turns. Sometimes it does present with typical symptoms like bloating, flatulence and altered bowel habits. At times there is mental illness like severe depression that comes in the way which is real challenge for the physicians to treat as mere reassurance doesn’t suffice. The longer the history of symptoms, more complicated it gets. There are multiple obstacles before making in rows in treatment.2

The most frustrating point is when the patient fails to show any improvement after months of treatment. They have symptoms in relapsing and remitting manner. Post infectious IBS is more agonizing as the patient need antibiotics in an era of increasing resistance .3Failure of one antibiotic to resolve symptoms leads to usage of multiple ones at the same time .The cramping abdominal pain and the sleepless nights leading to daytime fatigue do have an enormous and disastrous impact on the activities of daily living. After the decades of research, optimization of treatment for irritable bowel syndrome is still a daunting task even for experienced gastroenterologists.4

The emergence of alarm symptoms like bleeding per rectum,uninetentional weight loss and feeling of abdominal mass in individuals who have altered bowel for years do ring the bell for physicians to act vigilantly who were otherwise complacent. 4They were relying on traditional treatment regimens like giving laxatives,anti spasmodic and medications for depression. Some of them do consider expeditious referral to psychiatrist without getting to the bottom of the situation. Colonoscopy is advised at the end when much damaged have been caused already .It will be excellent practice to advised stool routine examination ,culture.ESR,CRP and calprotectin levels.5 They will give an idea of level of inflammation in the gut as invasive investigations are always dangerous in setting of acute flare of disease such as inflammatory bowel disease