Part 3:

1- Comorbidities.
2- Management.
3-Alternative medicine.
4-Probiotics.
5-Herbal remedies.

Comorbidities.
1-Several medical conditions, or comorbidities, appear with greater frequency in people with IBS.
• 2-Neurological/psychiatric: A study of 97,593 individuals with IBS identified comorbidities such as headache, fibromyalgia, and depression.
3- IBS occurs in 51% of people with chronic fatigue syndrome and 49% of people with fibromyalgia, and psychiatric disorders occur in 94% of people with IBS.
4-Inflammatory bowel disease: IBS may be a type of low-grade inflammatory bowel disease. Researchers have suggested IBS and IBD are interrelated disease, noting that people with IBD experience IBS-like symptoms when their IBD is in remission
• Serum markers associated with inflammation have also been found in patients with IBS.
• Abdominal surgery: People with IBS were at increased risk of having unnecessary
• gall bladder removal surgery not due to an increased risk of gallstones,
• but rather to abdominal pain, awareness of having gallstones, and inappropriate surgical indications.
• These people also are 87% more likely to undergo abdominal and pelvic surgery and three times more likely to undergo gallbladder surgery. Also, people with IBS were twice as likely to undergo hysterectomy.
• Endometriosis: One study reported a statistically significant link between migraine headaches, IBS, and endometriosis.
Other chronic disorders: Interstitial cystitis may be associated with other chronic pain syndromes, such as irritable bowel syndrome and fibromyalgia.
Management.
A number of treatments have been found to be effective, including :
fiber, talk therapy, antispasmodic and antidepressant medication, and peppermint oil.
1-Diet.
FODMAP.
1- improved IBS symptoms with a low FODMAP diet;
2- . Symptoms most likely to improve include urgency,
flatulence, bloating,
abdominal pain, and altered stool output.
. Reduction of fructose and fructan has been shown to reduce IBS symptoms in a dose-dependent manner in people with fructose malabsorption and IBS.
=FODMAPs are fermentable oligo-, di-, monosaccharides and polyols, which are poorly
absorbed in the small intestine and subsequently fermented by the bacteria in the distal small and proximal large intestine. This is a normal phenomenon, common to everyone. The resultant production of gas potentially results in bloating and flatulence.
=Although FODMAPs can produce certain digestive discomfort in some people, not only do they not cause intestinal inflammation, but they help avoid it, because they produce beneficial alterations in the intestinal flora that contribute to maintaining the good health of the colon.
=FODMAPs are not the cause of irritable bowel syndrome nor other functional gastrointestinal disorders, but rather a person develops symptoms when the underlying bowel response is exaggerated or abnormal.
A low-FODMAP diet consists in restricting them from the diet. They are globally trimmed, rather than individually, which is more successful than for example restricting only fructose and fructans, which are also FODMAPs, as is recommended for those with fructose malabsorption. A low-FODMAP diet might help to improve short-term digestive symptoms in adults with irritable bowel syndrome, but its long-term follow-up can have negative effects because it causes a detrimental impact on the gut microbiota and metabolome.
It should only be used for short periods of time and under the advice of a specialist.
A low-FODMAP diet is highly restrictive in various groups of nutrients and can be impractical to follow in the long-term. .
In addition, the use of a low-FODMAP diet without verifying the diagnosis of IBS may results in misdiagnosis of other conditions such as celiac disease. Since the consumption of gluten is suppressed or reduced with a low-FODMAP diet, the improvement of the digestive symptoms with this diet may not be related to the withdrawal of the FODMAPs, but of gluten, indicating the presence of an unrecognized celiac disease, avoiding its diagnosis and correct treatment, with the consequent risk of several serious health complications, including various types of cancer.
3-Fiber.
=Some evidence suggests soluble fiber supplementation (e.g., psyllium/ispagula husk) is effective.
It acts as a bulking agent, and for many people with IBS-D, allows for a more consistent stool. For people with IBS-C, it seems to allow for a softer, moister, more easily passable stool.
=However, insoluble fiber (e.g., bran) has not been found to be effective for IBS. In some people, insoluble fiber supplementation may aggravate symptoms.
=Fiber might be beneficial in those who have a predominance of constipation. In people who have IBS-C, soluble fiber can reduce overall symptoms, but will not reduce pain.