Irritable Bowel Syndrome (IBS), Pt 2: Root Causes
Intro
Irritable bowel syndrome (IBS) occurs in 10-15% of people in North America and 11% of people worldwide, and is a common gut health condition that people come to see me for in-office. IBS manifests as abdominal discomfort and changes to bowel habits, and is diagnosed via the Rome IV Criteria. In last week’s post, I spoke extensively about symptoms of IBS, diagnosis, and the other conditions that can look like IBS. In this blog post, you will learn about the different root causes of IBS and how testing can be used to identify root causes and help with treatment.
IBS Root Causes
Remember, IBS is considered a diagnosis of exclusion, which means that conditions that look like IBS need to be ruled out. Some that were mentioned last week were: Hypothyroidism, celiac disease, inflammatory bowel disease, colorectal cancer, & more. After those are ruled out and IBS is diagnosed, a provider will try to identify the cause of a person’s IBS.
Some root causes of IBS are:
Commensal intestinal bacteria/yeast overgrowth: Small intestinal bacterial overgrowth (SIBO) is when there is too much good (or commensal) bacteria in the small intestine, leading to symptoms of IBS. There are some risk factors for SIBO, such as frequent use of acid blockers to reduce heartburn; intestinal motility disorders and abnormalities in the migrating motor complex; gastric bypass surgery; and more. Small intestinal fungal/yeast overgrowth (SIFO) could also be a cause of IBS, and is described as the presence of excess numbers of fungal organisms in the small intestine. Common symptoms seen in those with SIFO are belching, bloating, indigestion, nausea, diarrhea, and gas. And, it has been seen that one of the possible root causes of SIFO is recurrent use of heartburn medications.
Psychiatric & mood disorders: There is a link between psychiatric disorders and IBS, with psychiatric disorders found in 94% of those seeking IBS treatment and psychiatric interventions improving IBS symptoms.
Stress & Hypothalamic-pituitary-adrenal (HPA) axis dysfunction: The HPA axis is involved in the stress response where the hypothalamus in the brain senses physical and emotional stressors, then sends signals to the pituitary gland to activate the adrenals to release cortisol and neurotransmitters called catecholamines. And, brain signals, cortisol, and catecholamines have been reported to be higher in those with IBS. Additionally, stress often worsens symptoms in those with IBS, indicating that there is a link between stress, gut health, and IBS.
Post-infectious IBS: Post-infectious IBS is a when someone experiences symptoms of IBS after acute gastroenteritis, and can happen in 5-32% of the general population. Disease-causing bacteria that have been identified to cause post-infectious IBS are: Campylobacter, Shigella, Salmonella and Escherichia coli (E. coli). Several factors can potentially take place after acute gastroenteritis that can lead to IBS symptoms, such as intestinal inflammation, intestinal permeability, gluten intolerance, and more.
Exocrine pancreatic insufficiency (EPI): EPI is when the pancreas cannot make enough natural digestive enzymes to help break down for for nutrient absorption. This can then lead to abdominal pain, weight loss, diarrhea, gas, and more.
Food intolerance: The mechanism as to how food intolerance plays a role in IBS is yet to be fully understood, but there is evidence that reveals that dietary elimination and food challenges can improve IBS symptoms in some.
& more
IBS testing options
Due to the various root causes of IBS, there are testing options that a licensed naturopathic doctor (ND) may recommend to get a better understanding of a person’s specific root causes. The reason why licensed NDs seek to identify root cause of symptoms is that
Some integrative work-up options that a licensed ND may recommend are:
Bloodwork
Stool analysis: To ascertain the levels of commensal microorganisms in the intestines
Lactulose breath test: The gold standard diagnostic procedure for the diagnosis of SIBO
4-point salivary cortisol testing: To ascertain adrenal output of cortisol throughout the day
Food sensitivity testing
& more
Takeaways & Summary
There are various potential root causes for IBS. Remember, IBS is a diagnosis of exclusion, and other conditions that look like IBS need to be ruled out first before IBS is officially diagnosed. After being diagnosed with IBS, a provider may order tests or identify possible root causes or IBS. Identifying the root cause will help with targeting treatment for the patient’s specific health picture, and this also means that testing may differ from person to person who have IBS.
I hope that this blog post was helpful and educational. And, if you think you have IBS or have been diagnosed with IBS, I hope that his blog makes you feel confident about speaking to your provider about testing for root causes to get targeted treatment for IBS.
If you haven’t read the first blog post on IBS that came out last week, click here. Next week, I will talk about root cause treatment options for IBS.
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