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Let's talk about irritable bowel syndrome (IBS)
Professor David S. Sanders
Professor Sanders highlights that many patients presenting with irritable bowel syndrome (IBS) have underlying diseases.
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Hello, my name is David Sanders. I’m the Professor of Gastroenterology here at the Royal Hallamshire Hospital and with the University of Sheffield, United Kingdom. What I’d like to talk to you today is irritable bowel syndrome, and the question I would like to ask is, Is this a disorder where an extensive workup is necessary?
If you are a cinema lover as I am, then you will know that in ‘The Matrix’, Morpheus offers a choice to Keanu Reeves: Would he like the ‘blue pill’ or the ‘red pill’? and I ask the same question of you. The blue pill allows you to continue in your current practice in the management of patients with IBS-type symptoms, but the red pill may change how you see things and change your practice forever.
Now, we all know that the Rome Criteria are supposed to be used to make a positive diagnosis for IBS patients without extensive investigations, but let me ask you this question: Is there anything else in your practice, as a gut doctor that makes you come to a diagnosis without further tests? I know that’s surprising but it’s something I’d really like you to think about. Of course, IBS is a diagnosis and there are many patients who benefit from having that diagnosis and there is an extensive pathophysiological mechanism as I’ve shown on this slide. But what’s always troubled me is, Could there be patients lurking within there who have IBS-type symptoms - and I’m very specific in how I differentiate this – who, in fact, have another diagnosis, disease or disorder?
Why would I think that? Well, can I ask you: Why is it that your patients do not always benefit from having treatments that are well recognised for IBS? Why is there such a high placebo response? Is it because they are a very mixed group of patients, a heterogeneous group of patients, and that there are other diseases lurking within this group? Now, I appreciate that I am a heretic and I’m giving you a different view but in the next few slides I will summarise my perspective.
When you really look at the data and look at the publication stream out there, there are a number of studies looking at different conditions: Coeliac disease, exocrine pancreatic insufficiency, bile acid diarrhoea, microscopic colitis and small bowel bacterial overgrowth, and if you investigate your patients (and I strongly urge you to do so) who present to your outpatient clinic with unselected symptoms of an IBS-type nature, then you will discover all of these diagnosis within, and it will leave you with a group of patients who truly do have IBS and I firmly believe that those are the ones who will benefit from the right therapeutic approach.
So I ask you again: Would you like the blue pill, or the red pill?
Job number: JB57410GBb(1) Date of Preparation: June 2020
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Professor Sanders argues that many patients presenting with irritable bowel syndrome (IBS) have underlying diseases. He explores a series of studies that suggest approximately 25% of patients presenting with IBS symptoms have BAD as the underlying cause.
Professor Walters explores the classification of different causes of bile acid diarrhoea (BAD). Professor Walters describes the normal entrohepatic circulation of bile salts and what occurs when the system does not function correctly.
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