How is Irritable Bowel Syndrome treated?
Dr. Tan Chi Chiu discusses the various approaches to managing and treating this gastrointestinal condition
If the symptoms are very typical of irritable bowel and they occur in an otherwise healthy young patient we have less to worry about, says Dr. Tan.
Depending on how anxious the patient is we may do some tests or we may do more tests. If a patient can be reassured that our clinical impression is that it is a benign condition [that is irritable bowel] then perhaps we can avoid doing more than a simple blood test, just to make sure that there is no evidence of systemic illness.
If a patient is very anxious or the patient is slightly older, perhaps over the age of 45 when the possibility of serious illness is much higher, we may do more tests. For example, a blood test but also some scanning, perhaps an ultrasound scan or, depending on the symptoms, even a CT scan or an MRI scan. And we may offer endoscopy in order for us to be sure whether or not there is a problem in the digestive system that we can diagnose physically. Having done these tests if they are relative normal we try to reassure the patient of this. In many instances the sheer knowledge that there is no serious disease to be found is sufficient for the patient to feel very reassured and if the symptoms are not too intense the patient may not even ask for treatment and they will go away happy.
On the other hand, patients may have symptoms sufficient enough to disrupt life and work, in which case we should give some treatment. At this point we tell patients, "Well there is good news and bad news. The good news is that you have Irritable Bowel Syndrome and that it is a benign condition and it will never kill you. The bad news is that because it is a functional disease and not a serious organic illness it may be difficult to control even though we may have many tools in our armamentarium, many different drugs and many different palliations that we can suggest.”
Some patients find that their symptoms take time to resolve. Sometimes we find that having started the patient on a certain strategy of treatment the patient improves somewhat but not sufficiently nor satisfactorily enough and the patient is not yet happy with the status. At that point we have to be frank with patients and say that we need more patience and that we might take some more time to study what works and what doesn’t to adjust the treatment, to raise or lower dosages or change different types of medications or try other dietary manipulations in order to see whether we can get them better.
Setting expectations is very important. What we do not want is for patients to lose confidence in the process and run off to see other doctors and perhaps end up with multiple repeat tests of the same kind with exactly the same result. If they flip from doctor to doctor and not give enough time for the irritable bowel symptoms to be dealt with then they will be left unhappy at the end.
We do try in this sort of instance to develop a very strong patient-doctor relationship, one where the patient understands how we are approaching the problem and where we help the patient to manage their expectations and also to have a follow-up plan so that the patient has confidence that we are doing the right thing for them.