Prognosis in irritable bowel syndrome

[Pratibha]

Hi, my friend is a 32-year-old woman, talked to a pharmacist. She has recently received a prescription for Colpermin from her doctor. She says that they gave her terrible indigestion and so she has been taking Alu-Cap capsules, which have not worked terribly well. She has also decreased the number of Colpermin capsules she was taking. She wants to know if there is anything stronger for the indigestion. She feels her problems are just getting worse and worse: first she had constipation, stomach cramps and bloating. Now she has indigestion as well, and her original symptoms are worse than ever. She didn’t used to take any medicines and already she is on two, and she is seeing the hospital doctor in clinic this afternoon and fears she will be taking even more before long. Doctor diagnosed that she has irritable bowel syndrome. What is her prognosis likely to be? What lifestyle advice should she have been given?

[Ashma]

@Pratibha The prognosis can be very variable. IBS does not tend to develop into anything more sinister. However studies suggest that large numbers of patients will still have abdominal symptoms 5 years after diagnosis. Psychological symptoms, a long history of illness and previous abdominal surgery are all associated with a worse prognosis. If the IBS is linked to a stressful event, e.g. ongoing work related stress, which is unremitting, the patient is highly likely to be resistant to treatment.
A common first step in managing patients with IBS is to discuss lifestyle factors. Dietary changes and dietary fiber are likely to have been discussed, especially in patients presenting with constipation and bloating. Exclusion diets may have been tried, but these need to be under the guidance of a dietician.