Vim & Vigor - Spring 2020 - UVA - 26

26

Are there different kinds of IBS?

Grover: Yes. When we look at patients with IBS,

we divide them into three categories. About
a third have diarrhea-predominant IBS, a
third have constipation-predominant IBS
and the rest have mixed IBS, meaning they
can have symptoms of both. We have learned
from long-term studies that these symptoms
can fluctuate. Somebody may have more
problems with bloating, but if you survey
them many years later, they might say that
nausea or diarrhea is their most bothersome
symptom. And people can sometimes switch
categories, so if somebody has IBS with diarrhea, we may see them many years later and
find they have IBS with constipation.

Why are women more
commonly diagnosed with IBS?

Grover: Studies have suggested that there are
clear differences in terms of physiology in
the gut bacteria in men and women and that
women are more vulnerable to injury from
infections or foodborne illnesses, which have
been associated with IBS. So it is possible that
due to differences in microbiota (the living
organisms inside the digestive tract), women
react differently to an infection than men do.
Another thing is hormonal differences, and
IBS could be triggered through a hormonal
mechanism. Some studies are looking at men's
and women's levels of serotonin (a chemical
that helps influence well-being and regulate
bowel function).
The other important paradigm is that a
history of abuse (and the resulting psychological effects of the trauma) has been associated
with IBS. Abuse can happen to both men and
women, but it's more common in women, so
that may be one of the factors that drives the
higher number of cases.

Grover: We use a multi-tier approach. Sixty
percent of patients have mild IBS. This
means that they would likely improve with
dietary changes, avoiding foods that trigger
symptoms or some simple treatments. If they
have diarrhea, they might take an over-thecounter medication like loperamide. If they
have constipation, they might take a fiber
SPRING 2020 VIM & VIGOR

Madhusudan
Grover, MD, MBBS,
gastroenterologist
and spokesman
for the American
Gastroenterological
Association

ILLUSTRATION BY MONICA HELLSTRÖM

How do you treat patients
with IBS?

OUR EXPERT

supplement, increase their water intake or
exercise more regularly.
Then we move up the ladder and deal with
people who have more moderate to severe
symptoms, which tend to be patients who are
seen in the gastroenterologist's office. What
is interesting with these patients is that stress
plays a heavier role. The brain has a stronger
influence. And many of these individuals have
had long-term symptoms that affect their
work productivity, their quality of life, things
they can't do with their kids and grandkids
and so forth. So that's the group that we may
offer prescription medications.
On the severe end of the spectrum, if someone is on disability leave and can't work, for
example, or is in a lot of pain, then we think
about partnering with a psychologist or a pain
rehabilitation center (where patients can learn
techniques, such as cognitive behavior therapy, to manage pain) to get them the treatment
they need.



Vim & Vigor - Spring 2020 - UVA

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Vim & Vigor - Spring 2020 - UVA - Cover1
Vim & Vigor - Spring 2020 - UVA - Cover2
Vim & Vigor - Spring 2020 - UVA - Contents
Vim & Vigor - Spring 2020 - UVA - 2
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Vim & Vigor - Spring 2020 - UVA - Cover3
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