September 6, 2013
New Type Of Irritable Bowel Syndrome Identified
Rebekah Eliason for redOrbit.com – Your Universe Online
Researchers at UCLA have identified a new form of irritable bowel syndrome (IBS) that occurs after an acute bout of diverticulitis, when parts of the intestine become inflamed or infected, causing patients significant pain. These findings could help lead to better management of symptoms for some patients.
The discovery of this new condition, dubbed Post-Diverticulitis Irritable Bowel Syndrome (PDV-IBS), confirms the irritable bowel symptoms that some patients report long after suffering from a bout of diverticulitis, but that many doctors had attributed to the original condition, said Dr. Brennan Spiegel, associate professor of medicine at UCLA and lead author of the study.
"We've known for a long time that after some people develop diverticulitis, they're a different person. They experience recurrent abdominal pains, cramping and diarrhea that they didn't have before," Spiegel said.
"The prevailing wisdom has been that once diverticulitis is treated, it's gone. But we've shown that IBS symptoms occur after the diverticulitis, and it may result from an inflammatory process like a bomb going off in the body and leaving residual damage."
As they age, many people develop diverticulosis, a condition in which pouches form in lining of the colon. Although more than half of all people over the age 60 have the condition, the pouches usually don't cause any major problems. However, occasionally the pouches become inflamed, which causes pain and infection in the abdomen. Doctors typically treat these symptoms with antibiotics, or in more severe cases, surgery.
"A major surprise in our study was that diverticulitis patients not only developed IBS at a higher rate than the controls, but they also developed mood disorders like depression and anxiety at a higher rate," Spiegel said.
"Because IBS and mood disorders often go hand in hand, this suggests that acute diverticulitis might even set off a process leading to long-standing changes in the brain-gut axis."
Spiegel noted that many PDV-IBS patients often report ongoing IBS symptoms long after the diverticulitis has passed.
“This study supports their beliefs and introduces a new diagnosis," Spiegel said, adding that the discovery of PDV-IBS could help bring relief to patients complaining of symptoms after diverticulitis, which until now has been largely dismissed by doctors.
"If doctors recognize this, they may take the symptoms more seriously and manage them actively, just as they can manage IBS actively with various new drugs on the market and currently in development."
More than 1,000 patient records from the West Los Angeles Veteran's Affairs Medical Center were examined for the two-year study, including one group that had suffered acute diverticulitis and another group that had not. The groups were matched for age and sex and had similar comorbidities, or other existing health problems.
The groups were then followed for many years as researchers tracked the differences in IBS diagnoses and mood disorders.
"This study expands our understanding a little bit about what might cause IBS. It's such a common condition and there may be different flavors," Spiegel said. "We've now added a new flavor to the menu, a new risk factor for developing IBS. By learning more, we might be able to expand the therapies we can use on these patients."
"Our findings support the evolving paradigm of diverticular disease as a chronic illness - not merely an acute condition marked by abrupt complications," the researchers wrote in a report published September 5 in the journal Clinical Gastronenterology and Hepatology.
“Far from a self-limited episode, acute diverticulitis may become a chronic disorder in some patients,” wrote the researchers
"Diverticulitis is correlated with not only chronic IBS symptoms, but also long-term emotional distress beyond the event itself. Awareness of this possible risk is important because persistent, untreated gastrointestinal symptoms and comorbid depression may worsen outcome and increase the economic burden of an already prevalent disease."