Doctors' Answers to "Frequently Asked Questions" - Irritable Bowel Syndrome

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

IBS and Prevacid/Prilosec [posted 1/14/99]
Question: I am currently being treated for IBS and GERD with 30 mg of Prevacid once a day. After taking the drug for a month I have noticed that the symptoms of my IBS and GERD are steadily getting worse. I had been taking over-the-counter medication for about 4 months, doubling the dose, which seemed to work better than the Prevacid. I talked to my Gastro about switching to Prilosec, but he said it was exactly the same as Prevacid. I would like to know your opinion on this. I do not like to take any medication as a rule but my IBS and the secondary problems that go with it will not seem to diminish know matter what I do. I had my gall bladder removed about 7 years ago and have had digestion problems ever since. I have a hard time accepting that this condition is just "something to live with". Any feedback would be greatly appreciated. I am only 30 and do not want to be battling with my stomach for the rest of my life.

Answer: Well, prevacid and prilosec do cause diarrhea in some patients. I'd try the usual H2 blockers like Zantac, Tagamet, etc. Carafate might be a good pick. Also, if some of the problem is post-gall bladder problems, questran is of occasional help. This may be limited by the sandy sensation following swallowing the mix, but it usually helps. Lastly, a trial of carafate may be helpful if you are having any bile reflux in addition to your acid problems.

IBS [posted 1/14/99]
Question: I have had every test there is, upper GI tests from the top to the bottom. Due to the all of the testing nothing came out of it. Just spent money. I have side effects with other high b/p medication so stopping the procardia is not a good idea. My b/p is 180/110 at times other times it is 140/80. Have you had any other individuals ask the same? I'm still wondering about a diet for IBS. This what I think I have.

Answer: You're probably right about the IBS. Irritable bowel is usually characterized by constipation alternating with diarrhea. Fiber is the basis of most treatment regiments with medications for either extremes of the diarrhea/constipation. Most people with IBS will tell you after a while which medications/foods cause problems. Sometimes, a lactose free diet might help, particularly if you have a partial lactose intolerance. So see if dairy foods cause gas. Lactose intolerance (even partial)is very common. Good luck.

Could Medications Have Caused Irritated Bowel Syndrome (IBS) [posted 11/11/98]
Question: I am taking clonazepam and before that ativan for about two years. I take .05mg. at bedtime. I consequently have been diagnosed with IBS. Pretty much right after I started the benzodiazipines. The IBS is bad to severe more and have been given bentyl for that, which really doesn't help much. Could the benzodiazipines have given me the IBS?

Answer: Probably not, but, SRI antidepressants are used extensively in IBS and may be helpful to lower your doses of benzodiazepams while helping your bowel.

Concerns about Taking Lomotil for Irritated Bowel Syndrome (IBS) [posted 10/28/98]
Question: I have been suffering with IBS for many years now and have been taking low-dosage (2.5MG) lomotil on a daily basis for over a year. Usually it is just one dose and on extreme days I may take two to three doses. My question is: Is this harmful? I haven't experienced any side effects that I am aware of, but don't feel I can live without it. Taking lomotil beats having to run to the nearest bathroom everywhere I go. It lets me leave the house.

Answer: Probably of no concern at this frequency.

Irritated Bowel [posted 10/21/98]
Question: I am 17 years old and I was told I have IBS three years ago and it still bothers me a lot today. I had many tests done, all of which showed that nothing was wrong. The only test that was not normal was for my SED rate which showed it was elevated. What does that mean and what does it indicate? My doctor, who I no longer see anymore, couldn't tell me anything about it. I'd appreciate any information you could give me on this. Thank you.

Answer: A sedimentation rate is a non-specific measure of inflammation. It will be elevated in all types of disease that causes inflammation from infections to lupus to cancers. It does not diagnose the problem;but, is used as a screen. For example, if you truly have IBS, you should have a normal sed rate. Something is causing the elevated sed rate and needs to be diagnosed. Possibly something with your bowel and you really don't have IBS. It also depends a lot on the magniture of the elevation;that is, a small elevation is usually of no concern-doubling of the ESR would be of concern. Repeat your sed rate with another doctor. If continued elevated, find the cause.

Irritated Bowel [posted 10/20/98]
Question: For the past 2 weeks I have been experiencing diarrhea-like symptoms when I have a bowel movement. My bowel "rhythm" is normal, but my stool is runny every time I go to the bathroom and at least once a day I feel sick to my stomach. My diet hasn't changed at all during this period. Also, once during this period (last Sunday) I had severe anal itching. Any advice?

Answer: If it persists or you see any blood to call a physician. I wouldn't be too concerned unless it stretches over a month.

Yeast Overgrowth
Question: A few years ago a doctor told me that I have irritable bowel syndrome but didn't explain how to control the symptoms. Because of this, I have tried to do some research and have come across some information that suggests that yeast overgrowth may be responsible for the illness. How is it treated?

Answer: There is a lot of lay press concerning fungal overgrowths causing several bowel problems. These include chronic fatigue, irritable bowel, etc. The common thread is the inability of current medical science to address the symptoms or cure the problem. I know of no reputable scientific studies which show fungal overgrowth having any effect on the GI tract. I also have patients who have tried treating themselves or talked me into treating them, and I have seen no change in a small group.

Irritable Bowel Syndrome
Question: Is a person more likely to get colon cancer if he has had IBS?

Answer: This Doesn't appear so. Indeed some studies have shown a lower incidence of death from colon cancer. This probably represents extra diagnostic studies done on patients with IBS rather than any link.

Irritable Bowel Syndrome
Question: Is there anything someone can do to alleviate some of the symptoms that accompany IBS? I know it's a chronic condition and would just like to know if there are any really good medications (or other therapies) out there to try?

Answer: Treatment of is mainly symptom based. That is, some patients experience constipation while others experience cramps and diarrhea. Treatment is based on treating whichever symptom is present at the time. Fiber and stool softeners are used for constipation and antispasmodics are used for the cramps. An old method that really works is liquid belladonna (for cramps). This drug can be titrated drop by drop and allows fine tuning so that you don't overshoot and become constipated. It can be hard to find, but really is helpful. Also, eliminate any dairy products and any wheat based products to ensure that you don't really have a mild lactose intolerance or gluten sensitivity.



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