What are techniques to cure digestive problems
Irritable Bowel Syndrome: Not a cure, but a remedy for symptoms
GEO KNOWLEDGE: Dr. Goebel-Stengel, is the impression that more and more people are suffering from irritable bowel syndrome correct?
Dr. Miriam Goebel-Stengel: It's hard to say - I suspect it's often a matter of perception as well. Nowadays people pay more attention to their bodily functions and perceive things as unpleasant that were perhaps considered normal a few decades ago. To put it bluntly: If someone used to have flatulence a lot, they just had flatulence. Today, however, this is increasingly perceived as a nuisance and a social restriction. It is currently the case that around 50 percent of all patients who visit a gastroenterological practice suffer from symptoms typical of irritable bowel syndrome. Worldwide it is around ten percent of the population.
In many cases, would you say: don't act like that?
No, not at all. There is no objective criterion for whether a body perception is stressful for the person concerned or not. In many cases, untreated irritable bowel syndrome affects the quality of life even more than diabetes or chronic kidney failure, for example.
What do you mean specifically?
If someone has to go to the bathroom all the time, or if they keep getting gas, they may eventually stop going to parties because they are embarrassed. And then people only eat at home, because many people affected are sensitive to certain foods or suffer from complaints if they do not cook something themselves or do not know exactly what is in their food.
And then there are those patients who have severe diarrhea for long periods of time and now concentrate constantly on thinking: where is the nearest free toilet? They don't dare to take the train, go to a theater performance or a football stadium. This can be downright dramatic, especially for adolescents or young adults who are actually in a very active phase of life.
Are there many people who develop irritable bowel syndrome at this young age?
We actually have a lot of younger patients now. Often it is people who are currently in a very stressful phase of life, with studies or the entry into working life, with partnership, starting a family and building up their own existence. And stress just makes all the symptoms of irritable bowel syndrome worse.
Nor can you give the patient much hope of a cure.
In fact, we cannot promise a cure, but we can promise a symptom relief. There are currently no major breakthroughs in the diagnosis and treatment of irritable bowel syndrome. And far too few doctors deal clinically with the clinical picture - which is partly due to the fact that detailed patient discussions are very poorly remunerated. There are good reasons why those affected have a great need to talk to.
Can you also eat irritable bowel syndrome - namely by choosing the wrong food?
Indeed it is. I spend a lot of time trying to find out what foods my patients eat and how. As it turns out, many people do without breakfast, they don't eat until eleven or twelve o'clock, and often only fruit, nothing else. Then the complaints appear promptly.
What exactly are the problems with this?
This is mainly caused by the fructose: In a large study with 2390 patients who suffered from unclear abdominal complaints, we were able to show that almost two thirds of these people cannot tolerate much fructose. If the first meal of the day consists entirely of fruit, this can manifest itself in pain and gas.
Similar problems are experienced by people who drink a lot of carbonated soft drinks. These often contain an enormous amount of fructose, and this quickly causes problems for the intestine. And then there are those who eat raw vegetables all day - which leads to a lot of gas being produced during digestion.
Do the symptoms go away if people change their diet?
A lot of things get a lot better, but often this alone does not completely solve the problem. However, nutritional advice is an important part of therapy. There are some very simple rules of conduct that can help your digestion work better. I call this the “grandma rules” because it is advice that you may still know from your childhood: for example, don't eat too hot, not too spicy, not too cold, not too irregular - and above all, balanced. These and other behaviors are practiced at a nutritional counseling service and are referred to as the “traditional irritable bowel diet” in the professional world. The problem is that they are often not followed consistently and those affected seek nutritional advice too late.
Many IBS patients report receiving an incorrect diagnosis to begin with.
Indeed, it happens a lot. And it is due to the fact that many doctors often come across a finding during the first examinations that could be responsible for the symptoms, but it does not have to be. For example, many of the patients we examine in our clinic by gastroscopy have a slightly reddened mucous membrane. Now I could say to them: “You have an inflammation of the stomach lining, that's why you are feeling so bad.” Some patients find this very relieving, because there are effective preparations for this. And maybe it will actually make them feel better in the short term.
But is that in reality often not the real cause?
Probably not. It would be better to say: "You have a reddening of the stomach lining, but that probably does not explain why you have such severe abdominal pain and diarrhea and have to go to the toilet ten times a day - I assume that you have irritable bowel syndrome." As a doctor, however, I don't make things easier for myself, because instead of prescribing a drug, it entails many follow-up discussions about the patient's eating habits and life situation.
There are now tests on the Internet that can be used to examine your microbiome. Does that help?
You pay a lot of money for this and get an evaluation of how many and which bacteria colonize the intestine and whether that is good or bad. At the moment, this is just money tailoring. Because we still know far too little about what is normal in intestinal bacteria and what is not. The patients then often come to me and ask: “I have had my microbiome examined, what should I do with it now?” But no one can give a serious answer to this question at the moment.
The tests are often offered by doctors because of a “we have to do something” feeling
and gladly accepted by patients. However, you are left alone with the result. This is one of the reasons why it makes a lot of sense that research is currently working intensively on the connection between the state of the microbiome and the development and treatment of irritable bowel syndrome. Hopefully there will be helpful insights at some point.
Will it ever be possible to cure irritable bowel syndrome?
I'm sure. A multi-dimensional approach, including nutritional counseling and psychosomatic care, is likely to be necessary. I don't think there will be a single drug that will make the symptoms go away. While this is something most people want, neither is it with other systemic diseases such as diabetes. So it annoys me that many doctors are reluctant to treat IBS patients because they think it is difficult and tedious. It is no different with diabetes or high blood pressure patients.
What is the best treatment for irritable bowel syndrome right now?
The most important thing is to alleviate the symptoms. Cramps, flatulence, diarrhea, constipation: there are effective remedies for all of these. In addition, you have to encourage the patient to change their diet if necessary - and how they deal with stress. Psychotherapeutic approaches in particular are very effective. However, long-term lifestyle changes are often difficult to implement. But when some colleagues say to patients: “You only have irritable bowel syndrome, I can't do anything about that”, then it makes me sad.#Subjects
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