Diplomate, American Board of Surgery
Diplomate, American Board of Colon and Rectal Surgery
Fellow, American College of Surgeons
Fellow, American Society of Colon and Rectal Surgeons
Honorary Fellow, Philippine Society of Colon and Rectal Surgeons
Honorary Member, Surgical Section Serbian Medical Association
Dr. Maher Abbas is an American Board Certified Colon and Rectal Surgeon who performs the latest and most advanced procedures to treat conditions affecting the small intestine, colon, rectum, and anus. He is a leader in minimally invasive and endoscopic surgery. With over 18,000 operations and procedures experience, he provides state of the art treatment to his patients.
Irritable bowel syndrome, known as IBS, is a common gastrointestinal disorder which predominantly affects the large bowel [Figure 1]. The spectrum of symptoms in patients with IBS can vary significantly in nature, severity, and frequency. It is important to note that IBS is a diagnosis of exclusion, which means other gastrointestinal conditions need to be excluded before assigning an individual patient the diagnosis of IBS. IBS affects approximately 15% of the population. Although it is more common in women, it occurs in men as well. All age groups from childhood to elderly age suffer from IBS but most patients are young under the age of 50 years. Although IBS negatively impacts the quality of life, it is not dangerous and there is no increased risk for colorectal cancer in patients with IBS. IBS can lead to depression and anxiety and can contribute to the development of proctologic disorders such as hemorrhoids.
Figure 1 – The large bowel
Despite extensive scientific research, we still have a limited understanding of the causes of IBS. Abnormal sensitivity of the large bowel with irregular contraction of the muscles and nerves in the bowel wall have been implicated as plausible mechanisms. Weak intestinal contractions lead to constipation and bloating pain while strong fast contractions lead to diarrhea and spasm. Factors which trigger symptoms include environmental elements, bacterial overgrowth in the gut, food intolerance or sensitivity, emotional or physical stress, or prior gut inflammation or infection. Women can experience worse symptoms around their menstrual periods.
The spectrum of IBS symptoms varies from patient to patient in nature, severity, and frequency. Patients have 1 or more of the following symptoms:
It is important to note that the symptoms of IBS are non-specific and many other types of gastrointestinal disorders can present with similar symptoms. Therefore, it is important to seek care to exclude other conditions such as:
Patients with a presumed history of IBS should seek immediate medical attention if any of the following symptoms is present:
The history and physical examination are the first step in evaluating patients with irritable syndrome. As other more serious gastrointestinal conditions can present with IBS like symptoms, several tests are conducted to exclude such conditions. Dr. Maher Abbas individualizes the care of his patients based on a variety of factors. Several of the following tests may be recommended after the initial evaluation:
Blood tests: CBC (complete blood count to assess for anemia or infection), liver function test, renal (kidney) function test, CRP (C reactive protein) and/or ESR (erythrocyte sedimentation rate) to check for inflammation, thyroid test, calcium level, celiac disease serology, helicobacter pylori bacteria serology, pregnancy test in women of reproductive age
Breath tests: urea breath test for helicobacter pylori bacteria, lactose intolerance test, fructose and lactose intolerance test (inability to digest some sugars including dairy products). In addition, a test for bacterial overgrowth can be helpful in some patients
Colonic transit study to check for colon function in patients with severe constipation (bowel movement frequency less than once a week). In this procedure, you swallow a capsule that contains small ring markers which travel through the intestine. XRAY films are obtained 3 and 5 days later to assess how fast these markers travel through the colon
Endoscopic procedures: Colonoscopy and Gastroscopy to check inside the colon and stomach
Radiologic examinations: CT scan (computed tomography), MRI (magnetic resonance imaging scan), or ultrasound of the abdomen
Stool tests: useful tests include ova and parasites, Calprotectin level (to check for inflammation), guaiac or the FIT test (fecal immunochemical test) to check for blood in the stool, helicobacter pylori bacteria toxin for bacterial infection, stool cultures, Gastrointestinal Multiplex panel (to test for various infection), clostridium difficile toxin
Other tests: in rare cases, other types of tests are available to evaluate your condition
No surgical intervention is indicated for patients with IBS. After the initial evaluation and documentation of IBS, Dr. Maher Abbas will provide you with some general recommendations and he will refer you to a gastroenterology colleague (medical doctor) who will assist in managing your condition long-term. Medical management of IBS include the following:
In addition to the above interventions, the gastroenterologist will determine which medication can be helpful for your specific condition. Depending on your symptoms, medications to relieve constipation or control the diarrhea are prescribed. Anti-spasmodic medications decrease intestinal spasm and pain. A course of one of the specific anti-depressant medications for several months can get the symptoms under control. Some patients can benefit from antibiotics or probiotics to alter the bacterial composition of the gut. Peppermint oil can provide relief in some patients.
