Grumpy Tummy?

Grumpy Tummy?
Grumpy Tummy?

Are you suffering from lower gastrointestinal distress? Do you often feel abdominal discomfort with symptoms of bloating, constipation, diarrhea, or maybe even bloody stools? Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are two diagnoses that may fit your symptoms. These diagnoses are certainly not equal but may show some cross-over of symptoms.

IBS is generally less severe than Inflammatory Bowel Disease and usually consists of diarrhea, constipation or an alternation of both. However, bleeding and inflammation are not major symptoms in IBS, but are in Inflammatory Bowel Disease. IBD is a more serious condition leading to weight loss or other life threatening complications like severe lesions inside the GI tract. IBD can be subdivided into ulcerative colitis and Crohn’s Disease. Ulcerative colitis is an inflammatory condition of the intestines that affects only the colon and the rectum. Crohn’s disease is an inflammatory intestinal condition that can affect any portion of the gastrointestinal tract – mouth to bottom. A susceptibility to develop Crohn’s disease is thought to be genetically inherited and is a condition which must be treated in patients for the rest of their lives, so if you have a family member already diagnosed with Crohn’s, tell your doctor as soon as any prolonged or recurrent GI symptoms develop.

IBS is diagnosed when all other causes are ruled out, because this syndrome is not very specific to procedures or tests your doctor can perform. IBD is diagnosed after a colonoscopy, CT scans and blood tests used to detect inflammation and/or ulceration in the gastrointestinal tract.

IBS, IBD and their subdivisions are treated in different fashions because the processes of the diseases are different. IBS patients may start out by changing their diets or lifestyles. Identifying triggers is an important way to tackle this syndrome and common ones include refined foods (cookies, bread, cereal, chips, soda, coffee), dairy, or alcohol. IBS patients sometimes need prescription medications to reduce symptoms, but often these patients can be managed with OTC therapies. IBD patients, on the other hand, can change their diet and try OTCs, but the disease is usually so severe that prescription medication is considered early on.

If medications are needed, IBS patients are treated with those that reduce symptoms. These medications include antidiarrheal agents or laxatives for constipation. If symptoms do not subside, prescription medications are considered which include antispasmodics (such as dicyclomine or hyoscyamine) and medications that control serotonin, a neurotransmitter that can affect the GI tract (such as Paxil, Zoloft, or Prozac).

If dieting changes and OTC (Over the Counter) treatments do not relieve symptoms in patients with IBD, prescription therapies are started right away. Mesalamine (Asacol HD) is the initial drug treatment option and will help reduce inflammation in the digestive tract, which will help to relieve pain and allow absorption of nutrients. For most people, mesalamine is enough for effective control of symptoms, but if you need additional aid for uncontrolled inflammation, corticosteroids such as prednisone may be added to the mesalamine therapy. Prednisone mimics a natural steroid found in the adrenal gland of the body and works quickly to reduce the inflammation and other symptoms of IBD including diarrhea and bleeding. Other medications include azathioprine, methotrexate, or 6-MP. For extreme cases, injectable variations of these drugs or new biological therapies can be used as if oral medications are not efficient. Infliximab (Remicade), is a biologic drug offers distinct advantages (such as acting selectively on enzymes and proteins that have been proven defective) versus corticosteroids, which suppress the entire immune system. Other newer treatments include natalizumab (Tysarbri), adalimumab (Humira), and certolizumab (Cimzia).

Every patient is different so your physician or specialist should examine and diagnose you according to your specific symptoms. Then treatment with diet or medications can be tailored to you and your needs. Finally, and as always, check with your pharmacist before starting any new therapies (OTC, Rx, or non-medication treatment) to be sure there won’t be any adverse interactions, and so you know what effects and side-effects to expect.
For more information, be sure to check out these links:

http://www.ccfa.org/resources/ibs-and-ibd-two-very.html
http://www.cdc.gov/ibd/
http://www.nlm.nih.gov/medlineplus/irritablebowelsyndrome.html

This article was written by Cassandra Camp and Bruce Tran,
LECOM School of Pharmacy Class of 2014 PharmD Candidates
Students of Dr. Rebecca Wise

Be Well, Be Wise
–Dr.Becky

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