Need surgery? Maybe it’s IBS

To some patients with IBS and the doctors who treat them, the disease is like what Winston Churchill said about Russia: "It is a riddle wrapped in a mystery inside an enigma." Sometimes the more you learn about it, the more questions you have to ask. And while this may be frustrating if you’re looking for fast relief, the questions all lead to better studies being conducted, which in turn lead to heightened understanding and more effective treatments. That said, one new study may spur more questions than it answers. Researchers at Kaiser Permanente in southern California studied the questionnaire responses of more than 89,000 examinees and discovered that people with IBS have unusually high surgical rates compared to healthy controls, to the tune of three times as many gall-bladder surgeries, twice as many appendectomies and hysterectomies and 50 percent more back surgeries.

Higher rates for cardiac or peptic ulcer surgery were not found, however. What these findings reveal is unclear, but the study’s principal investigator, AGA member, chief of gastroenterology at Kaiser Permanente Medical Center in San Diego, California has some theories. Gallbladder disease, for example, has some upper GI symptoms common with IBS, so some doctors are attributing these symptoms to gallstones. But many patients return later with no alleviation of their symptoms, and they and their doctors must return to the drawing board to search for the culprit. The pain from IBS can be very severe, so it sometimes is mistaken for pain from gallstones, appendicitis and even gynecological problems. IBS is probably under-recognized and under-diagnosed in primary care and by surgeons.

Doctor believes that part of the problem could be that many primary care physicians and surgeons are not completely familiar with the Rome criteria, a standard diagnostic tool used to determine the presence of IBS. Doctor agrees, we have a job to do to educate doctors about this. He suggests that IBS patients expecting to undergo such surgeries first ensure that their physicians or surgeons are familiar with the symptoms of IBS. Get a second opinion if you feel uncomfortable, or see a gastroenterologist. He further suggests that women facing hysterectomies for abdominal pain might want to make sure that their OB/GYNs collaborate with a gastroenterologist to ensure a comprehensive approach to the problem. Some evidence suggests that gynecologic surgery may actually prediscope patients to develop IBS symptoms later, although the reasons why are obscure.

Perhaps, doctor proposes, it’s because the stress of surgery might stimulate anxiety or depression, or even physiological changes that can bring on IBS in individuals with a pre-disposition toward the syndrome. More studies are needed, agree, to determine why people who suffer form IBS have such a comparatively high rate of surgery. But knowing that they do gives patients and doctors some clues that may some day crack the code of IBS.