"Irritable Bowel Syndrome": Missed Diagnostic Opportunities? Irritable Bowel Syndrome (IBS) is a common digestive illness marked by many different symptoms including bloating, indigestion, a change in bowel habit of constipation, diarrhea or change in size or quality of stool, abdominal pain, nausea, rectal pain and urgency and other symptoms for which a specific diagnosis (such as ulcer, reflux, bacterial infection, parasites, cancer, etc.) cannot be found. Often, symptoms are worse after eating (suggesting food intolerances and allergies which are rarely addressed by conventional physicians). It is therefore considered a "diagnosis of exclusion" in the sense that the doctor will first do appropriate conventional tests to determine if a specific disease process is causing the symptoms noted. Having failed to find a specific disease entity, the diagnosis of IBS may be considered. It is my belief, based on my clinical experience in practice, that in fact people with IBS actually will be found to have specific causes in as many as two thirds of cases that can be readily treated if a more careful diagnostic evaluation is undertaken. Unfortunately, this is not pursued in the majority of cases. In this article, I will explore the bases for this assertion, the reasons why other treatable causes are missed and discuss how missing causes for IBS are found. Medical doctors, including gastroenterologists (digestive disease specialists), currently classify IBS as a "disorder of motility"-- that is, an abnormality in the way the intestines move their digestive contents along during the digestive (breakdown and absorption) process. There is truth in this definition of IBS. However, as noted, the cause(s) of this motility disturbance is not known, but sometimes its symptoms may be successfully controlled by a variety of medications that affect the muscular layers and their nerves that are responsible for that complex but well-organized movement (known in medicine as "peristalsis") as well using such medicines as the sedative-tranquilizers and antidepressants. All such medicines have variable success: some may achieve only a partial response to conventional treatment or, worse, none at all. In addition, often when the medication is stopped, the symptoms may return. Such frustrating outcomes stimulate patient and physician alike to rethink the potential causes of IBS. In response to this situation, more physicians and other health practitioners are evaluating IBS in different ways. First, careful analysis of a person's diet, lifestyles factors and choices, states of stress and response to them, exposures to environmental chemicals and other factors are made in an attempt to see if they bear upon digestive health. The intestinal lining is very sensitive to stress and emotional factors. There is as much nervous tissue surrounding this lining as there is in the brain. This system is actually referred to as the "second brain". Hormones and neurotransmitters of the brain are found around our intestines, and, amazingly, gastrointestinal signal molecules can also be isolated within the brain itself. Secondly, we often forget the intestine is an "interface" with the outside environment just like the skin which covers and protects us is. Indeed, these two linings are actually very closely related in many ways. Likewise, it is forgotten that the intestinal lining is part of our immune (defense) system in that it monitors all ingested foods-- the chemicals they naturally contain plus all other ingested materials including chemical toxins (food preservatives and additives, pesticides and hormones), microbes, dust particles, etc. As such, the intestine is a hard working organ exposed to our outside environment. It is any wonder that IBS may be so difficult to diagnose properly and treat when it may be brought on by environmental chemicals and food components not usually considered by physicians. Treatment of IBS then often may include stress reduction, relaxation techniques, changes in diet, body detoxification, immune support and/or environmental "cleanup", methods seldom usually suggested. Parasites and other microbes are checked for by doctors in patients thought to have IBS. Unfortunately, the diagnostic method commonly used, microscopic examination of random stool samples, has been reported by the Centers For Disease Control (CDC) to be only accurate about 15-25% of the time. Clearly, parasites are frequently missed as much as 85% of the time. Newer methods of detection, including blood and saliva tests for presence of immune reaction to such "bugs", add much added accuracy to diagnosis, but are not frequently used by doctors for several reasons including slowness to accept these newer techniques, an unfortunately common behavior among doctors. Also, I believe there is a low awareness, if not denial, in this country about parasites leading both doctors and patients to ignore their presence. The same lack of awareness and belief exists for yeast, or Candida, infection of the bowel, a very common and overlooked cause of suspected IBS. Unless a person has AIDS or cancer (when Candida can commonly occur), the doctor again will disbelieve this to be a true cause of the digestive symptoms. With the extensive use of antibiotics, hormone replacement, birth control pills and food additives in our country, I find Candida commonly on stool analysis and its treatment (with antifungal medications, herbs, lower carbohydrate diets and probiotics) frequently improves or cures the patient. Once again, unfortunate lack of awareness and belief in food allergy as the basis for IBS is common. I find this to be one of the most common of all causes of IBS. It is interesting to note, both in the medical literature and in lay sources such as Internet sites, avoidance of foods commonly causing digestive disturbances (such as wheat, corn, milk/cheese, soy and other grains) is strongly recommended for IBS. For reasons unclear even to me, doctors are very reluctant to consider food allergies as sources of digestive disease. This may in part due again to denial and the prejudicial belief that food allergies only occur if the patient gets a rash or has respiratory emergency from common allergic foods such as nuts or seafood. These symptoms are not the only manifestations of food allergy in my experience and may manifest as IBS symptoms. Patients commonly report success with food avoidance. By using more intensive and broader based testing, particularly a comprehensive stool analysis (a panel of many tests designed to look for various other causes of digestive symptoms, including microbial (parasitic, bacterial, molds), food allergies and abnormal or deficient populations of healthy bacteria sometimes referred to as "dysbiosis"), many cases of IBS can be resolved to a more specific diagnosis and treated properly. Such testing by competent and more enlightened laboratories add much diagnostic accuracy to our attempts. In my opinion, it is imperative that physicians maintain flexibility and openness to possibilities in diagnosing IBS or any other condition for which an obvious or commonly accepted cause is not found or known. This is the moment, when no clear answer is apparent, that our creative powers should be engaged. Patients especially and concerned individuals such as health store and supplement companies personnel and other health care practitioners play a great role in raising consciousness and curiosity about novel or missed causes of such illnesses. Much confusion and frustration for both doctor and patient can be avoided in doing so, not to mention the avoidance of the discomfort and misery of undiagnosed problems.