Vim & Vigor - Spring 2020 - UVA - 27

You mentioned
cognitive behavior therapy.
What about prescribing
antidepressants for IBS?

Grover: Antidepressants and behavioral

therapies have been shown to be helpful in IBS,
especially in the moderate to severe spectrum
when pain is frequent or there is difficulty with
quality of life, or both. Tricyclic antidepressants
and selective serotonin reuptake inhibitors
(SSRIs) have been tested in IBS. Typically,
tricyclic antidepressants such as amitriptyline
and nortriptyline are helpful in patients with IBS
with diarrhea. SSRI drugs are more frequently
used for IBS with constipation. These are usually
prescribed in low doses, and we watch carefully
for side effects. Psychotherapies like cognitive
behavior therapy and hypnosis are also effective, especially if provided by therapists with an
expertise in IBS and gastrointestinal disorders.

What foods make IBS worse?

Grover: It depends. It's not always easy to

When You
Need to
See an Expert

PHOTO BY STOCKSY

Your primary care provider can
address most digestive health
concerns. For more complex
issues, you'll want to tap the
experts at UVA Health, ranked
among the top 50 digestive care
programs by U.S. News & World
Report. Find an expert at
uvahealth.com/digestive.

understand whether a food causes IBS or
whether the body has developed a hypersensitivity to the food over time. So we have to be
careful when looking at the diet.
I would say, typically, fatty, greasy foods and
carbonated beverages can have an impact. We
realize that things containing either high fructose corn syrup or artificial sweeteners can
make symptoms worse, so regular soda and
diet soda are equally bad when it comes to
IBS. And, of course, if somebody has bloating
or a lot of gas, carbonated beverages like beer
and soda will make things worse. Another
factor is the caffeine in cola and other drinks,
which people may not realize is a problem.

What's the difference
between IBS and IBD?

Grover: Inflammatory bowel disease (IBD)

comprises two main subsets-ulcerative colitis
and Crohn's disease. The mechanisms are quite
different, and in active IBD, there is inflammation that can be seen during endoscopy and
through biopsies, whereas in IBS, inflammation is not present. Symptoms like bloody
stool, weight loss and fever should raise alarm
for IBD and prompt additional work-up by a
doctor. That being said, IBD patients can have
overlapping IBS symptoms as well. *

How Is
Irritable
Bowel
Syndrome
Diagnosed?

Figuring out that someone
has IBS isn't always
straightforward. "We
don't have one blood test
or an imaging scan to
diagnose IBS, so we use
symptom-based criteria,"
says Madhusudan Grover,
MD, MBBS, a spokesman
for the American
Gastroenterological
Association.
A doctor might use a
variety of strategies,
including:
Asking questions
about symptoms and your
family members' history of
gastrointestinal issues
Performing a physical
exam and feeling the
abdominal area
Possibly ordering
bloodwork, stool sample
testing, a colonoscopy or
an endoscopy
Once the testing is
complete, if no cause is
found, a person might be
diagnosed with IBS if he
or she is having diarrhea,
abdominal pain and
constipation more than
three times a month for
three months and if the
symptoms are affecting
quality of life.

VIM & VIGOR SPRING 2020

http://www.uvahealth.com/digestive

Vim & Vigor - Spring 2020 - UVA

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