GERD Awareness Week: November 24-30, 2013

November 24, 2013

This week is the 15th annual GERD Awareness Week. Gastroesophageal reflux disease, like IBS, falls under the broad category of functional gastrointestinal and motility disorders, and many people with IBS also have GERD. According to IBS Guide Barbara Bradley Bolen, PhD, some studies show that over 70% of people with IBS report some symptoms of GERD and vice versa, but that among those with actual diagnoses, the overlap rate ranges from about one-quarter to one-third. GERD occurs when the lower esophageal sphincter, the valve connecting the esophagus to the stomach, fails to close completely and consistently when needed, and stomach acids and digested food inappropriately back up into the esophagus on a recurring basis. GERD is estimated to affect at least 20% of American adults, both men and women. GERD also commonly affects children of all ages, including infants. A wide variety of lifestyle factors, medical conditions and medication side effects are thought to be possible factors in causing or exacerbating GERD.

Symptoms vary from person to person and are not restricted to heartburn. Some people may not have noticeable symptoms at all until they experience complications. Some other possible symptoms of GERD are: belching, coughing, hoarseness, difficulty or pain in swallowing, excessive saliva, the sensation of food sticking in the esophagus,  chronically sore or irritated throat, laryngitis, inflammation of the gums, erosion of tooth enamel, bitter taste in the mouth, and bad breath. Chest pain may also be a symptom of GERD, but should receive immediate medical attention to rule out the possibility of cardiac problems or other serious conditions. Other possible symptoms of GERD occurring more than once a week or the need to use non-prescription heartburn/reflux medications for more than two weeks without resolution should be discussed with a doctor.

Relative to other functional gastrointestinal and motility disorders, GERD is generally considered by physicians and many affected people to be quite treatable by a variety of lifestyle and diet modifications, prescription medications and/or surgery. Many people have mild GERD and, with appropriate medical care, are at low risk of serious complications, but untreated GERD can lead to inflammation, erosion or narrowing of the esophagus or in a small percentage of cases, Barrett’s esophagus, cell changes that heighten the risk of esophageal cancer. According to a brief extract of a longer IFFGD publication by Carlo DiLorenzo, M.D. of Children’s Hospital of Columbus and Ohio State University, Dr. Mark Glassman, MD of Sound Shore Medical Center in New Rochelle, New York, and Paul Hyman, M.D. of Children’s Hospital in New Orleans, Louisiana, some children with GERD and other conditions such as asthma, cystic fibrosis, abnormal lung development due to premature birth, muscle or nerve disorders affecting swallowing, or esophageal dysplasia, are at risk of GERD complicating those conditions.

Please see the following links for further information and resources and the original source for Drs. DiLorenzo, Glassman and Hyman’s work mentioned above.  IFFGD also offers downloadable GERD, IBS and functional GI disorder awareness brochures and posters for anyone to hang or distribute in his or her own community, that are accessible from the IFFGD links posted here. As GERD Awareness Week is traditionally scheduled to be the week of American Thanksgiving, and this year, it coincides with the beginning of the Jewish holiday of Hanukkah (both Thursday, November 28, this year), readers may find IFFGD’s holiday GERD-reducing tips to be particularly useful.

 GERD Awareness Week section from the IFFGD About GERD website

Pediatric GERD section from the IFFGD About Kids  GI website

Medline Plus page on GERD  (subunit of the U.S. National Institutes of Health)

In addition to encouraging accurate awareness of irritable bowel syndrome, IBS Impact encourages awareness of related conditions that are known to often overlap with IBS, as improvement in symptom management, treatment options, public awareness and social resources may have overlapping positive effects that improve quality of life for some people with IBS. With the high prevalence of GERD in the general public, many people who are not otherwise aware of or who do not take particular interest in functional gastrointestinal and motility disorders may actually have GERD or be close to someone who does. This is another opportunity to educate them about GERD and about FGIMDs in general as issues that do indeed involve them.

Irritable Bowel Syndrome (IBS) and Public Toilet Access in the United Kingdom

November 18, 2013

Quick and plentiful access to public toilet facilities when needed is a common concern of many people with IBS, as well as other chronic medical conditions that may affect the bowel and/or bladder. IBS has addressed various aspects of this topic several times in the past, from the merits of “can’t wait cards” to “Ally’s Law” laws in several U. S. states, spearheaded by the inflammatory bowel disease (IBD) community to allow people with medical conditions emergency access to employee-only restrooms in retail stores.  (Click on the Ally’s Law tag below the post to see all relevant posts.) This is not just a concern in a single country, however, but cuts across national borders.

Because this blog has many readers from the United Kingdom, we’d like to draw attention to a blog post by Julie Thompson, registered dietician and advisor to The IBS Network in Sheffield, the U.K. national organization for irritable bowel syndrome. She regularly writes as Jules_GastroRD at Clinical Alimentary. Most recently, she discusses some concerns specific to the U.K. such as fees for use of public facilities and the closure of many of them in recent times. Pay toilets are common in Europe and other regions across the globe, while in the U.S., for the past few decades, the practice has been rare and, in fact, illegal in some localities.

Ms.Thompson cites a study surveying people with IBD and the negative impact of these barriers on their quality of life. Although IBD is a different condition from IBS, it shares a major symptom with IBS of often urgent, unpredictable need to use a toilet. She also discusses “can’t wait cards” as well as RADAR keys issued to people with disabilities in the U.K. for a modest charge in order to unlock “disabled” accessible public toilets, a resource also available to people with urgent medical needs, and offers links to other interesting articles and blog posts.  Please read the entire post at the link below.

IBS Impact is interested in encouraging U.K. readers and followers to discuss their opinions and experiences on the points raised by the post linked above. Are these common concerns in the IBS community as well, as might be surmised? How can advocacy and awareness specific to the U.K. possibly help the overall cause? Please comment, either here on the IBS Impact blog or directly on Clinical Alimentary.

Veterans With IBS and Functional Gastrointestinal Disorders 2013

November 11, 2013

Today, November 11, is Veterans Day in the U.S., and a good time to highlight veterans’ issues. U.S. veterans  and current military service members who have been deployed in the Persian Gulf/Southwest Asia region at any time since 1990 have been shown by multiple studies to be at even higher risk of IBS and other functional GI disorders than the general population. Conservative estimates put the incidence of functional GI disorders in the general population as 25%, most commonly irritable bowel syndrome. For veterans and military service members of the Persian Gulf era, the estimate may reach as high as 40%. This appears to be in part because of the high incidence of known functional GI risk factors during active duty, such as severe stress or trauma and/or food or water contamination that results in post-infectious IBS  (IBS-PI) or other post-infectious functional GI and motility disorders.

Here is IBS Impact’s August 12, 2011 post on the recognition two years ago by the U.S. Department of Veterans Affairs of irritable bowel syndrome and functional gastrointestinal disorders as presumptive service connected disabilities for Gulf War veterans.

IFFGD and its grassroots arm, the Digestive Health Alliance, have done considerable work in the past few years in advocating for federal funding and other legislative needs specific to veterans, conducting outreach to service members and veterans and encouraging those affected by functional GI and motility disorders to participate in veteran-specific self-advocacy efforts. Since fiscal year 2012, functional GI disorders have been included in the Department of Defense Gulf War Illness Research Program,which is part of the Congressionally Directed Medical Research Program. However, advocacy from the veteran community must occur on an ongoing basis for funding to be continued each fiscal year. Efforts for fiscal year 2014 are now underway.

The Digestive Health Alliance also provides a private, invitation-only online community for veterans with functional GI disorders to seek support and information from DHA and their peers. Further information on all of these activities and resources can be found on the Digestive Health Alliance page for veterans.

IBS Impact encourages veterans, service members and families in the IBS and functional GI community to inform themselves on these resources and to consider participating in self-advocacy activities, and we look forward to feedback from readers as to how IBS Impact may be able to support such efforts further.

15 Common Misconceptions That Shouldn’t Exist About Irritable Bowel Syndrome (IBS)

November 8, 2013

1. Misconception: I have never heard of IBS. It must be rare.

Reality: IBS is the most common functional gastrointestinal disorder. It affects anywhere from 9-23% of the population depending on the country and estimates of anywhere from 25 million to 58 million people in the United States alone. These estimates are higher than those for many other common and well-known chronic medical conditions. See the July 9, 2011 post for some relevant statistics and links.

2. Misconception: IBS is not a real disorder but a catchall label for any gastrointestinal problem doctors can’t or won’t otherwise diagnose or IBS is a diagnosis of exclusion after doctors have tested and ruled out everything else it might be.

Reality: It has been well established in IBS research that IBS involves visceral hypersensitivity (abnormal pain thresholds), dysfunction in the brain-gut axis (communication between the brain and the digestive system), and abnormalities in the signaling and transport of serotonin, a neurotransmitter. Many other possible factors are still being studied. For over two decades, international experts in functional gastrointestinal disorders have widely recommended and used the Rome criteria to diagnose IBS based on symptoms and limited tests based on an individual person’s situation. They state that a Rome criteria diagnosis is 98% accurate. The current version is Rome III. Rome IV is currently under development. See the October 9, 2011 post for further details.

3. Misconception: IBS is caused by poor diet and lifestyle. Follow [specific diet] [exercise] [don’t smoke/drink] [sleep more/less] and you will be fine.

Reality: While many people with IBS are helped to varying extents by changes in diet and/or exercise or lifestyle routines, many others do not experience significant differences. Food and lifestyle do not “cause” IBS and some people who have healthful diets and lifestyles may develop IBS or continue to have symptoms anyway. Certain identifiable triggers may worsen symptoms for some people, but these can vary from person to person. There is no single foolproof list of “safe” or “unsafe” foods or lifestyle interventions. Consider viewing the following video on diet and IBS from the University of North Carolina Center for Functional GI and Motility Disorders. The presenter is Erin Slater, RD, LDN, a registered dietitian and person with IBS.

4. Misconception: IBS is “all in your head” or IBS is caused by stress.

Reality: IBS is a real physical disorder, just not one that can be obviously seen on existing tests currently available to health care providers outside a research lab. See Misconception #2.  Because of the brain-gut connection and because the brain and the digestive system have serotonin and other neurotransmitters in common, in combination with other factors, ongoing physical and psychological stress can possibly contribute to the development of IBS or worsen symptoms to varying extents depending on the person. This is why some psychological treatment options are helpful to many people with IBS, even some who do not have coexisting mental health diagnoses. Researchers know that many people with IBS have coexisting depression or anxiety, either separately from IBS, or perhaps as a result of the stresses of living with severe IBS. These correlations are still being studied, but IBS, in itself, is not a mental health disorder and it is not “caused” by stress alone. See this overview of stress and its role in IBS from the IFFGD website.

5. Misconception: My (my family member’s) (my friend’s) IBS was cured by [name an intervention] so yours can be too.

Reality: IBS is a complex, unpredictable chronic disorder. Although there is much that researchers know about it, there is still much to learn. Each person’s IBS is different in symptom patterns, severity and other factors.While there are various treatment and management strategies, at this time, there is no way for anyone to predict which ones will help any given individual, and there is no cure. Some people are fortunate to have mild symptoms and/or symptoms that come and go intermittently. Many people’s symptoms improve somewhat over time and researchers estimate that every year about 10% become symptom-free. (Scroll down to see “Is IBS forever?” on the IFFGD  site.) Some studies suggest that over the course of several years, a higher percentage will no longer have IBS, especially in the post-infectious subset. But the vast majority of people with IBS will need to manage it by some means over the long term and we cannot be quickly and simply restored to the way we were before we had IBS.

6. Misconception: IBS is the same thing as inflammatory bowel disease (IBD).

Reality: Although there is some research evidence of non-overt inflammation in some people with IBS, especially those with post-infectious IBS, (See the August 5, 2011 and September 10, 2013 posts.) and a small number of people have both conditions, IBS and IBD are very different disorders. See the August 31, 2011 post and a September 2013 post by IBD Guide Amber Tresca comparing and contrasting IBS and IBD.

7.  Misconception: IBS increases the risk of colon cancer.

Reality: There’s no reputable scientific evidence to support this idea. See a 2010 news release from the University of Michigan about a relevant study led by William Chey, MD.

8. Misconception: IBS is a women’s disease.

Reality: It is true that in most Western countries, about 2/3 of known people with IBS are female, however, in a few countries in Asia, the male-female discrepancy is not as pronounced. Researchers are still studying the possible differences in how IBS presents in women and men. It is thought that the difference involves both physiological factors such as hormones, and social and cultural factors such as greater access to or willingness to seek medical care. The following articles from the University of North Carolina Center for Functional GI and Motility Disorders explain more.  “IBS in Women” and “IBS in Men”

9. Misconception: Children don’t develop IBS.

Reality: Estimated prevalence increases in adolescence and adulthood, but people of all ages can have IBS, including young children. See the April 11, 2012 post for more information and links to resources for children and teens with IBS and their parents.

10. Misconception: The  high prevalence of IBS is the result of an affluent, modern,Western lifestyle.

Reality: IBS is found all over the world and in every socioeconomic group and ethnicity. Statistics for this blog indicate that it has reached over 100 countries on every continent in the two and a half years it has existed. In a 2012 post on his own blog FGID Update, “IBS:A Truly Global Phenomenon,” Olafur Palsson, PsyD. of the University of North Carolina Functional GI and Motility Disorders outlines some of analysis in many countries. Research by Val Harrington PhD of the University of Manchester in the United Kingdom reports records of symptoms consistent with what is now known as IBS at least as far back as the 19th century, perhaps even earlier.

11. Misconception: IBS is caused by lactose intolerance.

Reality: Lactose intolerance and IBS can cause some similar symptoms and many people have both conditions. But they are not the same thing. See the September 26, 2012 post.

12. Misconception: IBS is caused by gluten and/or fructose intolerance.

Reality: Again, food intolerances may coexist with IBS, but they are separate conditions. One popular intervention that is gaining attention and some scientific evidence for reducing symptoms in some people, is the low FODMAP diet, which includes restricting some fruits and wheat products for other scientific reasons, not intolerance per se. For more information, see the August 7, 2013 post.

13.  Misconception: The only possible symptoms of IBS are abdominal pain or discomfort, diarrhea, constipation, gas and bloating.

Reality: It is true that, by definition, the Rome criteria include abdominal pain or discomfort and alterations in the form and/or frequency of stools, such as constipation or diarrhea. Gas and bloating are not in the criteria but are also very common in IBS. Not all people with IBS have additional symptoms, however, many do experience various extraintestinal (non-GI) symptoms or commonly overlapping conditions.These add to the self-perceived and objective challenges of managing IBS. For more information, resources and links, see the September 6,2011 and March 11, 2013 posts.

14. Misconception: Only a very small number of people with IBS have severe, disabling symptoms, so IBS is not a serious problem worthy of attention.

Reality: In 2011, a Rome Foundation Working Team report acknowledged that the percentages of people with moderate or severe IBS appear to be higher than these same researchers originally believed.  (See the January 10, 2012 post.) There are many research studies and anecdotal reports directly from people with IBS that health related quality of life can suffer in many ways (See the June 25, 2013 post) with the reported burden sometimes greater than other chronic illnesses. This includes social stigma, which according to research by Tiffany Taft, PsyD of Oak Park Behavioral Medicine and Northwestern University, was perceived by significantly greater percentages of study participants with IBS versus participants with IBD. (See the April 15, 2013 post.)

15. Misconception: Well, if IBS is so common and such a struggle, there must be plenty of help available.

Reality: Truly knowledgeable and experienced health and mental health care professionals, research funding, local support groups and community education programs for people with IBS, families and professionals, and other resources are few and far between, out of proportion with the enormous numbers of people with IBS. A relatively small group of organizations, research entities, legislators and policy makers, websites, and individual professionals and people and families affected by IBS and related conditions all work long and hard in various ways on behalf of the IBS community. However, most of us come across erroneous information and opinions like those mentioned above and worse on a regular basis. These misconceptions come from the general public, the media, legislators, health care providers, and often people with IBS and families themselves. IBS Impact was created in the belief that this should not be the case.

Regular readers of this blog and supporters of IBS Impact’s philosophy, please share this post. If you are encountering this blog and this information for the first time, whether you are a person with IBS or a related condition, a family member, friend, health care professional or have some other role, we welcome you and encourage you to learn more from the reputable sources linked on this blog, our main website and social media. Knowledge is power and future progress for all of us with IBS.