Determining whether you have a stomachache or a more severe digestive condition may be difficult. For such occasions, doctors who specialize in gut health are crucial.
Dr. William Salt of IBS & Gut Microbiome Solutions in Columbus offers his expertise on stomach problems big and small.
HealthScene Ohio: Among the conditions your patients deal with are irritable bowel syndrome (IBS) and small intestinal bacterial growth (SIBO). What are these conditions, and how are they related?
Dr. William Salt: The symptoms of both IBS and SIBO are those of enteropathy, which is a triad of abdominal pain and discomfort, gas (abdominal bloating, distention, flatulence and noisy belly sounds), and bowel dysfunction (constipation, diarrhea or both). IBS is defined as the presence of recurrent abdominal pain, on average, at least one day per week in the last three months. Symptom onset must be six or more months prior to diagnosis, and associated with at least two of the following:
- Related to defecation
- Associated with a change in stool frequency
- Associated with a change in stool form (appearance)
IBS has traditionally been classified as IBS-D (diarrhea), IBS-C (constipation) and IBS-M (mixed). However, emerging research suggests that IBS-D and IBS-M can be grouped together, as long as bowel dysfunction is not predominantly constipation.
SIBO, now known to be commonly associated with IBS, is the presence of abnormal amounts of colon bacteria in the small intestine, where they are not supposed to be. Research shows that many to most with IBS-C have colonic growth of a microbe called Methanobrevibacter smithii, which produces methane gas that causes or contributes to constipation. Since this growth occurs predominantly in the colon, it is called a bloom, which is a small intestinal condition.
HSO: People sometimes get the impression that physical or emotional stress may cause IBS. Is this accurate?
WS: Psychological stress and emotional distress can aggravate symptoms of IBS and SIBO, but do not cause the conditions. Research confirms that bacterial food poisoning is the cause of many to most cases of IBS-D and IBS-M (but not of IBS-C). Infection with campylobacter, salmonella, shigella, E. coli or even Clostridium difficile often results in autoimmune nerve damage to the small intestine, with impairment of peristalsis (contractions), followed by SIBO.
HSO: Are there particular foods or drinks that should be avoided or emphasized in order to maintain a healthy gut?
WS: FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) are found in certain foods that are commonly poorly absorbed and fermented in people with IBS and SIBO, so restricting them can be very helpful.
HSO: Are there certain exercises or stretches that might help relieve IBS and/or SIBO?
WS: Research shows that physically active people move their bowels more frequently and have more rapid movement of stool through the colon than do individuals who are sedentary. A recent study showed that a structured exercise intervention led to greater improvements in overall IBS symptoms than did usual care. Physically inactive IBS patients should work to increase their physical activity. A simple recommendation is to begin walking for at least 30 minutes on most days of the week. Distance and pace can be gradually increased.
HSO: Is there any way to completely eliminate IBS and/or SIBO from a patient’s daily life?
WS: Healthy lifestyle – including stress management, dieting, and exercise – is important. If SIBO is associated with IBS, which is common, it is important to identify the cause of SIBO, which is a condition rather than a diagnosis. SIBO is always caused by something. Bacterial food poisoning and abdominal adhesions are examples. If the cause can be treated or eliminated, then the symptoms of enteropathy can be relieved.
HSO: At what point should someone see a specialist for gut discomfort?
WS: Consult with a health care professional if these red flags are present:
- Symptoms begin at age 50 or older
- Change in symptoms
- Progression of symptoms
- Unexplained weight loss
- Blood in the stool
- Diarrhea that interferes with sleep
- Abnormal physical examination (such as a mass) or lab result (such as iron deficiency anemia
HSO: Are there more serious conditions that may arise due to IBS and or SIBO?
WS: For IBS, unless misdiagnosed, no. For SIBO, malabsorption of nutrients such as vitamin B12 and iron can occur and may be serious.
HSO: Can IBS and or SIBO be misdiagnosed? If so, what typically causes such mix-ups?
WS: The symptoms of both are those of enteropathy, and there are many causes that must be considered, such as celiac disease, Crohn’s disease, and digestive tract cancer.
HSO: What are some uncommon gut-related problems and their symptoms? How can they be avoided and treated?
WS: Both celiac disease and Crohn’s disease include symptoms of enteropathy. Celiac disease requires eating a gluten-free diet. Crohn’s disease is a chronic inflammatory disorder of the intestine with many available treatments. However, many with Crohn’s disease also have IBS/SIBO, and effective treatment can result in avoidance of stronger drugs with potential side effects.
Lydia Freudenberg is a contributing editor. Feedback welcome at feedback@cityscenemediagroup.com.
About the Expert
William B. Salt II, MD graduated from medical school at The Ohio State University and trained at Vanderbilt University Hospitals, where he also served as a Chief Resident in Medicine. He is board certified in both internal medicine and gastroenterology. Dr. Salt is dedicated to both patient care and education of those suffering with IBS (irritable bowel syndrome) and the commonly associated condition SIBO (small intestinal bacterial overgrowth).
