Irritable bowel syndrome, IBS


## Basic introduction

  • IBS constitutes a group of symptoms, such as abdominal pain and changes in the pattern of bowel movements that occur over a long period of time, without clear evidence of underlying damage.

## Classification of IBS

  • IBS-D: where diarrhea is common
  • IBS-C: where constipation is common
  • IBS-M: where both diarrhea and constipation is common
  • IBS-U: where neither diarrhea nor constipation are common

## Complications of IBS

  • Anxiety
  • Chronic fatigue syndrome
  • Major depression
  • Missed work /school hours

## Causes of IBS

  • The cause is not fully understood
  • Bacterial overgrowth in the small intestines
  • Food allergy
  • Genetic factors
  • Gut motility disorders
  • Gut–brain axis disorders

## Factors that are known to trigger IBS

  • Infection(s) in the intestines
  • Stress

## Statistics

  • Globally, reported prevalence of IBS varies from 1- 45%.
  • Prevalence of IBS in Kenya is 8% with male to female ratio of 1.4:1

Peak prevalence age is 20-30yrs

  • Abdominal pain
  • Diarrhea or constipation
  • Tenesmus
  • Backache
  • Bloating
  • Chronic fatigue syndrome
  • Anxiety
  • Depression
  • Fibromyalgia
  • Gastroesophageal reflux
  • Genitourinary system disorders
  • Headache
  • Reduced libido
  • Clinical review
  • Tests to exclude other conditions:

_Stool microscopy and culture

_Full Blood Count (FBC)

_Abdominal ultrasound

_Endoscopy and biopsies


_Hydrogen breath testing



  • Amebiasis
  • Colon cancer
  • Giardiasis
  • Diverticular disease.
  • Inflammatory bowel disease (IBD) mainly Crohn's disease and ulcerative colitis.
  • Thyroid disorders
  • Gallstones and other biliary tract diseases
  • Peptic ulcer disease
  • Fructose and lactose malabsorption
  • Pelvic inflammatory disease
  • Endometriosis
  • Ovarian tumors
  • Anxiety
  • Depression
  • Low FODMAPs diet
  • Relaxation
  • Some physical activities

1.Kenyan Ministry of Health. Clinical guidelines for management and referral of common conditions at levels 4-6. Hospitals. 2009; 3:259-261.

2. Barrett JS; Extending our knowledge of fermentable, short-chain carbohydrates for managing gastrointestinal symptoms. Nutr Clin Pract. 2013 Jun;28 (3):300-6.

3. Ministry of Health, Kenya. Kenya Essential Medicine List (2016).

4. Definition and Facts for Irritable Bowel Syndrome". NIDDKD. 23 February 2015. Retrieved 29 March 2016

5. Talley NJ (2006). "Irritable bowel syndrome". Intern Med J. 36 (11): 724–8.

6. Lule GN, Amayo EO. Irritable bowel syndrome in Kenyans. East Afr Med J. 2002 Jul;79(7):360-3.

  • There is no known cure for IBS
  • Relaxation and some physical activities
  • Take regular meals
  • Avoid alcohol and fizzy drinks
  • Take plenty of fluids (with minimum coffee and tea)
  • In a case of IBS-C adding high-fiber foods such as whole meal flour or bran may help
  • In a case of IBS-D limiting high-fiber foods such as whole meal flour or bran may help
  • Foods low in Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs)

## High FODMAPs diet (NOT recommended for IBS patient)

  • Vegetables: Asparagus, onions, garlic, legumes/pulses, beetroot, and Savoy cabbage
  • Fruits: Apples, pears, mango, watermelon, peaches and plums
  • Milk and dairy: Cow’s milk, yogurt, soft cheese, cream, custard, ice cream
  • Protein sources: Legumes/pulses
  • Breads and cereal: Wheat-containing breads, wheat-based cereals with dried fruit and wheat pasta.
  • Biscuits (cookies) and snacks: Rye crackers, wheat-based biscuits
  • Nuts and seeds: Cashews

## Low FODMAPs diet (Recommended for IBS patient)

  • Vegetables: Green beans, capsicum, carrot, cucumber, lettuce, and tomato
  • Fruits: Banana, orange, grapes and melon
  • Milk and dairy: Lactose-free milk, lactose-free yogurts, hard cheese
  • Protein sources: Meats, fish and chicken
  • Breads and cereal: Gluten-free bread, oats, gluten-free pasta, and rice
  • Biscuits (cookies) and snacks: Gluten-free biscuits, rice cakes, corn thins
  • Nuts and seeds: Almonds and pumpkin seeds
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