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    How can chronic IBS be treated?

Posted on Tue, 18 Jul 2017 in Digestion and Bowels
Question: anticholinergics/antispasmodics for IBS w/urgency & cramping painful spasms. Also,just had open heart surgery for bypass as well as valve replacement. This IBS has been going on for years, comes & goes sometimes 2x per week / Some times a week or two without problems. A colonoscopy was incomplete as I've had 3 abdominal surgeries (Female stuff) & a lot of scar tissue. They couldn't get past the first bend / very stiff & hardened & were fearful of a perforation. I did go for a virtual colonoscopy after that which revealed diverticulitis which I knew from past sigmoidoscopy. This is a very painful life altering condition. Can't make plans because of uncertainty as to what the day may bring.
Answered by Dr. Ramesh Kumar 15 hours later
Brief Answer:
Detailed investigation with proper antibiotic therapy should be taken.

Detailed Answer:
Thanks for choosing HealthcareMagic for your query dear patient,
I am a Gastroenterologist and would be answering your query.
Have gone through your details and i appreciate your concerns.

Firstly i am very sorry for delayed response there was some techincal problem i guess.
As per your query answers are-
Before coming to solutions i would like to give you some briefing about the problems you are having.This would help you understand things better.
Diverticula occur throughout the gut, but by far the most common and most important are those that occur in the colon.In easy language we can say that diverticula means pouches(small pouches ) in intestines.
When these pouches are infected with bacteria they get swelled up inflamed and tender.This inflammation and tenderness cause severe spasms in the respective part of intestine leading to pain.
If diverticulitis has been diagnosed then proper antibiotic therapy should be taken for at least 14 days.
See inflammation can either be bacterial or protozoal therefore initially a stool microscopic test should be done to see if infection is mixed, bacterial or protozoal in nature.
After that a culture of stool should be done to see if bacteria are sensitive to a particular antibiotic.
Tab Cefixime 400mg(broad spectrum cephalosprin antibiotic) should be taken twice daily.
Tab Tramadol 50mg once daily(anti inflammatory and pain reliever safe in cardiac patients).
Tab Dicyclomine 10 mg thrice daily( to prevent spasm in effected area).
Tab Metronidazole 400mg thrice daily.
Capsule Pantoprazole 40 mg once daily(antacid).
Add metamucil fibres 2 tsf to your diet

However whether you should be initially on injectable therapy or oral would be decided by the load of bacteria in your stool report.
If colonoscopy was not successful then you can go for noninvasive tests like MRI of abdomen.Its an excellent test and would take hardly 20 minutes and would make picture clear.
Fecal calprotectin test should also be done-Its a protein which is elevated in stools as a result of inflammation.
Proper investigation with treatment can cure you fully in 14 days.

Hope i was helpful.
Sorry for late reply again.
In case you need any other professional advice feel free to follow up.
Above answer was peer-reviewed by : Dr. Remy Koshy
Follow up: Dr. Ramesh Kumar 9 hours later
*I'd forgotten to add that I was diagnosed w/celiac disease about 3 years ago & am diligent in eating gluten free (as well asno dairy). Around the same time was diagnosed w/Hashimoto's disease. Had Epstein Barre virus several years back & now have Fibromyalgia (Have seen a pain management specialist who prescribed Lyrica which seems to have helped considerally) *As I originally stated, these IBS flareups sometime happen 2x per week so my question is that the protocol which you have subscribed have to be followed for one time to get relief or will this be ongoing indefintely?
Answered by Dr. Ramesh Kumar 8 hours later
Brief Answer:
long term therapy has to be taken for IBS proper control.First aim of therapy would be to seperate intervals between to flares up.

Detailed Answer:
Hello again,

Tab Cefixime 400mg(broad spectrum cephalosprin antibiotic) should be taken twice daily.
Tab Tramadol 50mg once daily(anti inflammatory and pain reliever safe in cardiac patients).
Tab Dicyclomine 10 mg thrice daily( to prevent spasm in effected area).
Tab Metronidazole 400mg thrice daily.
Capsule Pantoprazole 40 mg once daily(antacid).
Add metamucil fibres 2 tsf to your diet
This protocol is just for 14 days dear patient and this treatment is basically for your Diverticular problem.Once this problem settles down we could start proper therapy for IBS. Though IBS is not curable yet symptoms could be controlled easily with proper therapy.
I would like to give you a briefing about IBS its treatment and problems encountered in treating patients with IBS.

In IBS there is some problem in the functional ability of the gut that leads to the symptoms of irritable bowel syndrome. The structure of the intestines is normal, only functional abnormality occurs in this condition.So frankly speaking (IBS) represents a functional disorder of gastrointestinal tract without the presence of an anatomic defect.

Recent studies by French scientists have indicated that the most important mechanisms include visceral sensitivity, abnormal gut motility and autonomous nervous system dysfunction. The interactions between these three mechanisms make bowel's function susceptible to many exogenous and endogenous factors like gastrointestinal flora, feeding and psychosocial factors.

Further data indicate that according to the above mechanisms, the influence of genetic factors and polymorphisms of human DNA in the development of IBS is equally important.

So in lay mans language till date we are not sure whats the exact cause of this problem.So the million dollar question is how to repair a system when you don't know which part of it is faulty(Some says it can be brain other says it can be hormone anxiety age etc etc).

Some patients have symptoms of unformed stools some have bloating and some may have severe constipation. Some patients have occasional symptoms whereas others may have symptoms for a long period of time.So as seen above every patient is different.Intensity of symptoms in every patient is different as so is the response to medicines and life style change.A patient may respond good to one medication while other patient is totally unresponsive to the same.

Our goal-
Every drug is not effective in every patient so we have to try different therapies till we find the drug which suits best our patient.

Dicyclomine is an anticholinergic drug.An anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system. Anticholinergics inhibit parasympathetic nerve impulses by selectively blocking the binding of the neurotransmitter acetylcholine to its receptor in nerve cells.

Mebeverine is an antispasmodic medicine and is very useful in IBS and is well tolerated by patient with minimal side effects. Mebeverine works on certain muscles in the wall of your intestines, causing them to relax.

Clidinium bromide is an anticholinergic (specifically a muscarinic antagonist) drug. It may help symptoms of frequent stools.

Chlordiazepoxide works by increasing the action of GABA, a chemical messenger which suppresses the abnormal and excessive activity of the nerve cells in the brain.Can be used in combination with above mentioned medicines.

However as of now initially lets treat diverticulitis once its gone we would start therapy for IBS.
Hope i answered your query well.
Feel free to follow up.

Above answer was peer-reviewed by : Dr. Nagamani Ng
Follow up: Dr. Ramesh Kumar 1 hour later
Thank you so much for your detailed information. Just as an aside, my family has a history of high cholesterol (as do I). I've been taking crestor & zetia prior to my heart surgery & my most recent labs were HDL 312 / LDL 232 ... Needless to say far from optimal so now in addition I've begun 75mg Praluent injections every 2 weeks in the hope of finally being within a healthy range that would protect my heart. I guess my last question for you would be with all of the protocols / medications that you've set forth for IBS/diverticulitis,are they safe for me to take with regard to my heart?
PS ~ Also must take 75mg Plavix for 1 year & 81mg aspirin therapy.
*Thank you in advance for all of your time & effort expended on my behalf.
Answered by Dr. Ramesh Kumar 4 hours later
Brief Answer:
Follow up!

Detailed Answer:
Hi again XXXX,
Don't worry after a year they are going to shift you on baby aspirin and plavix would be stopped.
Yes all potocols and treatments are suggested after considering that you are post CABG patient.You had mentioned in second line of your initial question that you had a by pass surgery so don't worry all suggestion were made considering that you are a heart patient.

Hope i was helpful XXXX!
Wish you a happy recovery.

Above answer was peer-reviewed by : Dr. Remy Koshy
Follow up: Dr. Ramesh Kumar 11 hours later
Again, thank you for your expertise in answering and addressing all of my concerns.
I am most satisfied.
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Thank you so much dear

Detailed Answer:
Hello again,
Thank you so much.

Wish you a fast recovery dear.

Please do write a review.
Warm regards!

Above answer was peer-reviewed by : Dr. Arnab Banerjee
Answered by
Dr. Ramesh Kumar


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