Recently the American College of Gastroenterology shared on social media an infographic highlighting the results of a study,”Episodic Nature of Irritable Bowel Syndrome” The study, which appeared in the September 2014 American Journal of Gastroenterology was authored by Olafur Palsson, PsyD, Professor of Medicine at the University of North Carolina Center for Functional GI and Motility Disorders, the late Jeffrey Baggish, MD of CSL Behring, and William Whitehead, PhD, the Director of the UNC Center.
According to Drs. Palsson, Baggish and Whitehead’s article abstract, they asked study volunteers with IBS to keep a diary of pain and bowel movement consistency based on the standard Bristol Stool Scale. They then analyzed the data for 124 of those people who were able to record at least 21 consecutive days up to 3 months. During this time, volunteers did not take any anti-diarrheal, laxative or other medication for IBS. The number of days logged averaged 72 days. Drs. Palsson, Baggish and Whitehead’s aims were to determine if the symptoms of diarrhea, constipation, abdominal pain and/or bloating occurred in clearly time-defined episodes or were random, to develop rules for when individual symptom flares begin and end, and to observe any overlap between the occurrence of pain and the occurrence of the other gastrointestinal symptoms.
According to the ACG’s comments in the infographic, prior to this study, it has been observed that about 79% of people with IBS have experienced both loose and/or watery stools and hard and/or lumpy stools at different times. Also, the Rome III criteria used for diagnosis of IBS (See page 889.) have assumed that the onset of pain and the onset of bowel symptoms are closely related. In addition, people with IBS often take medications for IBS symptoms as needed, without any clear guidelines for when to start and stop. The new study in question provides some additional insights into all three issues.
The study concluded that for the people in the study group, symptom episodes averaged 2-4 days in length. From those patterns, the researchers were able to develop rules defining onset and completion of episodes that applied to 75% of loose and/or watery stools and 80% of hard and/or lumpy stools. Significantly, they discovered that bloating and pain often occurred together in episodes, and while constipation and pain or diarrhea and pain also coexisted often, more than half the time, pain was independent of changes in stool consistency. As such, the ACG infographic suggests that the Rome criteria (Rome IV is currently in development.) may need to be revised to reflect that finding.
Given that these key findings seem to have clear potential implications for future diagnosis and treatment, they seem worthy of being further highlighted on this blog for our readers. It is hoped that these results can be replicated in ways that lead to more effective medical care and self-management for all with IBS.