Tuesday 25 October 2016

Irritable Bowel Syndrome: Millions could be misdiagnosed

Irritable Bowel Syndrome: Millions could be misdiagnosed a
Irritable Bowel Syndrome

Irritable bowel syndrome is a medical condition which affects millions of people in the UK, is a commonly misdiagnosed condition and could actually be an indicator of something else.

Experts believe gut symptoms account for at least 12 per cent of GP workload - though the true prevalence of gut disorders is thought to be much higher.

Around 41 per cent of people have never visited their doctors about their complaints, according to a survey by the Digestive Diseases charity CORE.

Millions of people are self-medicating with over-the-counter remedies and or experimenting with changes in their diets.

A new book called What's Up With Your Gut written by health writer Jo Waters and co-authored by gastroenterologist, Professor Julian Walters, suggests that people are often told they have IBS (irritable bowel syndrome) which currently has no specific treatment.

But the experts warn people could be suffering from a range of other conditions.

Professor Walters said: "I see an endless stream of patients told they had IBS or chronic constipation, for instance, often suffering years of misery with their symptoms but simple tests could pinpoint the real cause."

Non-coeliac gluten sensitivity (NCGS): Millions of people could have NCGS in the UK. But the condition is controversial — some doctors are skeptical about it and suggest that it is, in fact, IBS.

Those with NCGS have symptoms similar to coeliac disease including 'foggy' brain, eczema, headaches, fatigue, joint and muscle pain, depression and anaemia plus diarrhoea and weight loss and do well on a gluten free diet - blood tests and biopsies are negative for coeliac disease. If the patient is wrongly diagnosed with irritable bowel and told to eat more fibre, this could make their symptoms worse.

Is there a test? Not currently

Treatment: It's as simple as avoiding gluten. But there are differing degrees of severity, explained Professor Walters. "Some people can tolerate small amounts — it's not like coeliac disease where no gluten at all can be tolerated."

IBO - small intestinal bacterial overgrowth: SIBO is another common cause of watery diarrhoea. It's caused by too much bacteria growing in the small intestine and results in fatty stools, weight loss, bloating, fatigue and often anaemia.

It is estimated to affect between 12 to 80 percent of IBS sufferers.

It's caused by too many bacteria growing in the small intestine, the part of the digestive tract that connects the stomach and large intestine or colon. This can interfere with normal digestion.

Is there a test? Diagnosis can be made by collecting small intestinal juices usually through an upper endoscopy and culturing the bacteria. But it can be hard to get a clear count.

Treatment: Rather than undergo tests some patients are just offered a treatment of antibiotics including one called Rifaximin which is not currently licensed in the UK for this condition. Professor Walters said other antibiotics, such a ciproflocacin and doxycycline, can be helpful to people with SIBO.

Microscopic colitis: This can be a cause of severe, watery, persistent diarrhoea, bloating and pain and is caused by inflammation of the colon and is estimated to affect one in 1,000 people.

The inflammation is only visible under a microscope and so can be missed.

Is there test? Yes, GPs are good at sending patients for a colonoscopy but the vital question here is to ask is did they take biopsies.

Unless the colonoscopist takes biopsies which are looked at under the microscope, you will not be certain whether microscopic colitis has been ruled out.

Treatment: Yes, Microscopic colitis is usually now treated with a medicine called budesonide, in a controlled release form. Budesonide is a type of steroid that is safer than prednisolone as it is broken down in the liver as soon as it has been absorbed into the bloodstream.

Globus sensation: This is the medical name for feeling that you have a lump in your throat - when no physical lump exists - and accounts for four per cent of referrals to ears, nose and throat specialists.

The most common cause is acid reflux from the stomach, which can lead to excessive throat clearing and a tickly cough, as well as the 'lump in the throat' sensation. Some people report their symptoms get worse and become more frequent when they are under stress.

Is there a test? Yes, patients can have an endoscopy.

Treatment: Avoiding throat clearing and drinking between 1.5 and 2 litres of water a day.

Pelvic Radiation Disease PRD: PRD around 17,000 new patients a year and cause multiple bowel symptoms including bloating and diarrhoea with loose and fatty stools and follows radiation treatment for cancer in the pelvic area. Symptoms can develop long after treatment so patients may not realise they are connected to their radiotherapy.

Is there a test? The Pelvic Radiation Disease Association can offer help and advice about referrals to specialists in PRD.

Treatments: Many treatments are available including drugs, dietary advice, biofeedback, pelvic foor exercises, toileting exercises and perhaps antibiotic treatment and more specialized treatments also.



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