People who suffer from stomach ache, especially women, turn to the doctor, looking for explanations of why the abdomen is bad, swollen, or why it goes badly, too much, too little. To find out, are willing to do everything, and sometimes even unnecessary invasive tests, to undergo extremely restrictive diets or to test each type of allergen. For this reason, our expert in Gastroenterology in Rome , Professor Eleonora Gaetani, makes light on this wide, multidisciplinary clinical framework, which requires a careful specialist analysis
Irritable Bowel Syndrome (IBS), which most people know as " irritable colon " and / or "spastic colitis", is undoubtedly one of the most common functional disorders of the digestive tract. For "functional", simplistically, we can say that it refers to the fact that you are unable to identify a cause of the specific nature of the "organic". It is therefore not a question of inflammatory pathology properly said, or of polyps or anything that is "objectivable".
How is Irritable Bowel Syndrome diagnosed?
According to what has been developed and updated by the Rome Foundation in 2016, the diagnosis of IBS is placed according to the presence of positive symptoms: abdominal pain or discomfort, abdominal bloating, and changes in constipated alvus sense, diarrheal and with an alternation of the two. The symptoms are not accompanied by demonstrations considered alarm such as fever onset of symptoms, a significant weight loss or the presence of blood in the stool. If clinical criteria are met, it is generally not necessary to resort to challenging diagnostic tests. Experts in the syndrome, not all even between gastroenterologists, making only first-level tests such as complete blood count to rule out anemia or an increased typical cells of bacterial and / or viral infections, inflammatory markers such as CRP (protein C- reactive) and the dosage of faecal calprotectin expression of intestinal inflammation.
The intestine: the second brain
Many patients come to our attention with extensive documentation, but without a clear diagnosis or that satisfies them. This dissatisfaction stems from the fact that we are often unable to explain clearly to our patients that there is an extremely complex bidirectional communication between the intestines and the brain, the so-called "intense Gut Brain Axix", which is based on connections that They are born inside the womb. The central nervous system and the enteric system talk to each other, and exchange continuous messages, mutually affecting. Sometimes the intestine becomes a " second brain " that influences us until it prevails on the first. If we do not explain this concept that is first of all "biological" and not psychological, patients will continue to think of being taken for "psychosomatic patients", somehow of "B series". We need to give the right role in this connection, and treat the person on either side. In most cases this strategy produces better results and prevents patients from wandering in search of satisfactory responses.
What are the treatments to combat irritable bowel?
The terpeutico approach is multimodal, it acts by correcting the coarser food conduct errors, resorting to integration with pre and probiotics, muscle relaxants and in the most difficult cases even to drugs that act on the central nervous system, which is in fact fundamental to modulate an intestine very challenging and conditioning. From my point of view, working on a single level is unsuccessful for the patient and frustrating for the doctor.
What kind of psychological course is recommended to treat the irritable colon?
Since patients with irritable bowel syndrome are more anxious middle of the control population and sometimes frankly depressed, literature data show that a psychological support approach can be very useful. The most convincing data are the cognitive behavioral approach, although sometimes the only counseling may be enough. In addition, it is important not to forget that, often, especially in young people, an "aspecific" picture such as IBS can conceal initial disorders of eating behavior or similarly subtle gynecological disorders such as endometriosis or interstitial cystitis. Promptly diagnosed, have potentially dangerous health risks for patients.
Editor: Valerio Bellio