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Hanover Medical Specialists, P.A. is a multi-specialty practice in Wilmington, NC consisting of gastroenterology, cardiology, endocrinology and hematology / oncology.

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Irritable Bowel Syndrome
Frederick H. Opper, M.D., F.A.C.P., F.A.C.G., A.G.A.F. 

Irritable Bowel Syndrome (IBS) is the most commonly diagnosed gastrointestinal condition. It is characterized by abdominal pain and altered bowel habits in the absence of any identifiable cause. The prevalence of IBS is estimated to be about 15% of the U.S. population but only a minority of sufferers seek medical care. IBS is second only to the common cold as a cause of absence from work. There is no cure for IBS but recent scientific advances have yielded effective treatments with other promising remedies currently in research trials. IBS usually starts in young adulthood but has been reported in the young and elderly. Patients can present with a wide array of non-specific symptoms both digestive and non-digestive in nature. The pain is often located in the lower abdomen but can vary widely. The severity may range from mildly annoying to debilitating. Many patients notice increased pain with emotional distress or eating, and relief of pain with defecation.

The altered bowel habits may include diarrhea, constipation or alternating diarrhea and constipation. The diarrhea is often preceded by a sense of extreme urgency and followed by a feeling of incomplete evacuation. Many patients notice mucous discharge with diarrhea. When constipated, patients complain of hard and pellet-shaped stools. Some patients experience a sensation of incomplete evacuation even when their rectum is empty. The constipation can last from days to months. IBS patients commonly experience other gastrointestinal symptoms such as bloating, gas, belching, nausea, and feelings of early fullness when eating. Some common non-gastrointestinal symptoms include frequent and urgent urination and painful menstruation.

Many intestinal disorders present with symptoms that are similar to IBS. Some of these disorders are serious such as Celiac Disease and Crohn's Disease (inflammatory bowel disease) as well as very benign, non-serious problems like lactose intolerance. A medical history and physical exam are key to establishing the diagnosis of IBS. There are no lab tests (blood tests, x-rays, etc) that diagnose IBS. Doctors usually make use of a variety of tests when they feel they are necessary to exclude other possible diagnoses.

Treatment of IBS is usually a long-term process with good communication mandatory between patient and doctor. Because of wide variability in symptoms, treatments are tailored to the individual. Treatments include dietary fiber, (more useful in the constipation predominant variant), symptom diaries, dietary modification and psychosocial therapies such as counseling, exercise and hypnosis.

Many drugs are available to treat IBS symptoms. The choice of drugs depends on the patient's symptoms and effectiveness varies from one person to another. The discovery that serotonin (a hormone) is involved in both intestinal contraction and intestinal sensation has opened the door to many innovative drugs such as Tegaserod (Zelnorm) and Alosetron (Lotronex). These medications as well as newer agents under clinical investigation are in use by the gastroenterologists at Hanover Medical Specialists.