You’ve Been Diagnosed with Irritable Bowel Syndrome (IBS). Now What?

You have Been Diagnosed with Irritable Bowel Syndrome (IBS). Now What?

You’ve Been Diagnosed with Irritable Bowel Syndrome (IBS). Now What?

While IBS was discussed in Article 3, as a gastroenterologist, I’m going to emphasize several important issues relative to the diagnosis you’ve been given.

We begin with several assumptions:

  • You have the enteropathy triad of symptoms: abdominal pain and/or discomfort, gas (abdominal bloating, distention, flatulence, and/or gurgling and rumbling), and bowel dysfunction (constipation, diarrhea, or both).
  • Your predominant bowel dysfunction is recognized as either IBS-D (predominant symptom is diarrhea), IBS-C (predominant symptom is constipation), or IBS-D/M (mix of both diarrhea and constipation).
  • It’s likely that eating triggers symptoms.
  • It’s likely you have one or more non-gut symptoms and/or diagnoses, such as fatigue, brain fog, headaches, anxiety, sleep problems, fibromyalgia, chronic pelvic pain, and/or interstitial cystitis.
  • You have no “red flag” concerning features, such as blood in the stool or unexplained weight loss.
  • You and your healthcare professionals have considered your differential diagnosis and the likelihood that more than one condition is present (Figure 9.1). One example is IBS (Article 3) and Sucrose Intolerance (Article 6).
  • You’ve had an appropriate diagnostic evaluation (Article 4). In most cases, a colonoscopy and scans aren’t necessary.

Differential DiagnosisFigure 9.1

It’s Complicated — But You’ll Be Empowered Through Our Series

IBS and enteropathies are indeed complex, but we created this series to empower you with the knowledge to work collaboratively with your selected healthcare professionals to get properly diagnosed and effectively treated. Then you can commit to a healthy self-care plan.

Consider reviewing the following information, if you haven’t already done so:

Key IBS Concepts

I emphasize the following about your diagnosis of IBS:

  • IBS is usually associated with gut microbiome dysbiosis.
  • There are three main subtypes of IBS, defined by the predominant symptoms:
    • IBS-D: According to gastroenterologist Mark Pimentel, MD, IBS-D is the most common subtype of IBS, affecting about 40% of all IBS patients. There is an approximately equal prevalence (each 30%) of the other two subtypes.
    • IBS-C: Dr. Pimentel has also shown that most patients have associated colonic growth or BLOOM of a microbe that makes methane gas (CH4), which causes or contributes to symptoms, particularly constipation. The bug is called Methanobrevibacter smithii, or M. smithii. Methane can be detected by breath testing (Article 4), which can guide and inform treatment.
    • IBS-D/M: Gastroenterologist Mark Pimentel, MD has confirmed the most common cause of IBS-D/M is an autoimmune enteropathy resulting in SIBO (small intestinal bacterial overgrowth), triggered either by bacterial food poisoning (Campylobacter, Salmonella, Shigella, or E. coli) or colitis caused by Clostridium difficile infection. Dr. Pimentel has developed a diagnostic blood test called IBSSmart, and you can learn more about this test on the website, SIBO can be detected with breath testing (Article 4).
  • IBS and enteropathies are disorders of Mind/Body-BrainS/Gut dysfunction, which is why it’s likely you have other non-gut symptoms and diagnoses, such as fatigue, headaches, and fibromyalgia (Article 3).
  • Note BrainS is plural with a capital “S.” Remember, you have a second little brain in the gut.
  • IBS may be associated with chronic inflammation/immune dysfunction (Article 5).
  • We must drill down to a cellular level to understand IBS, enteropathies, and non-gut symptoms, which is why you took anatomy and physiology lessons.
  • IBS is NOT caused by stress!
  • The idea that IBS is caused by stress is a myth that must stop here. Stress can aggravate the symptoms of IBS, but it’s not the fundamental cause. Reciprocally, IBS and gut symptoms are stressful and can contribute to stress sensitivity, along with the generation of anxiety and depression. It’s a vicious cycle.
  • You’re going to need to become your own expert!
  • Sadly, the patient-doctor relationship is compromised in many ways, the most important of which is the RUSH of crammed schedules imposed on doctors. This enteropathy and IBS series is our way of empowering you.

Treatment: A Renaissance

While detailed discussion of treatment is beyond the scope of this article, you have many management options, including:

  • Self-care (diet, exercise, sleep, stress management, dietary supplements, and medical foods [specialty foods formulated for specific dietary needs])
  • Prescription-requiring medical foods and drugs

In the next article, you’ll gain a better understanding of celiac disease and non-celiac gluten sensitivity.

The views, opinions, and positions expressed by the authors and those providing comments on these blogs are theirs alone and do not necessarily reflect the views, opinions, or positions of

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