Bowel Diseases Affect Millions in US – featuring Dr. Cecilia Arango


Bowel diseases affect millions in U.S.

Cecila Arango, MD Internal Medicine

Cecila Arango, MD
Internal Medicine

10 percent to 15 percent of adults have irritable bowel syndrome symptoms.

By Robin Williams Adams, Ledger correspondent
Published: Thursday, May 5, 2016


WINTER HAVEN – Life-altering gastrointestinal conditions force millions of people to be wary about what they eat and create symptoms like abdominal pain and frequent diarrhea.

Children, as well as adults, struggle with these conditions, with indications some are on the rise among children.

The acronyms depicting them – IBS for irritable bowel syndrome and IBD for inflammatory bowel disease – sound alike but there are distinct differences in where and how they strike, which tie directly to the best ways of treating each.

Treatments aren’t interchangeable. If symptoms become more than patients can manage on their own, they need to see a doctor to determine which condition is causing them and what’s available for relief.

Answers may include changes in diet, stress-relieving techniques, medications that merely relieve symptoms, medications to reduce flare ups of the disease and surgery for some with inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis.

“There’s a lot of overlap among these different bowel conditions, so it can be difficult to tell by symptoms alone,” said Dr. David B. Simmons, a gastroenterologist with an independent practice in Winter Haven.

Learning about the diseases and their impact can be a useful starting point for people whose lives regularly are affected by them, which is why the American College of Gastroenterology and the Crohn’s & Colitis Foundation of America have extensive information for patients on their websites.

Those are and

IBS is More Common

Between 10 percent to 15 percent of adults in the United States have symptoms of irritable bowel syndrome, when the gut isn’t working right and intestines are more sensitive than normal. Some estimates say as many as 1 in 5 people may have IBS, with some patients impacted more severely than others.

Abdominal discomfort, bloating, gas, diarrhea or constipation that occur regularly are some of its symptoms.

With irritable bowel syndrome, changes in diet are a standard recommendation.

Patients increasingly demand holistic treatment, including dietary and behavioral counseling, said Dr. William Chey of the University of Michigan Health System’s gastroenterology division

Between half and three-fourths of patients associate eating with either triggering or intensifying their symptoms of IBS, he said in an article published online Feb. 9 in the American Journal of Gastroenterology.

Patients often lack access to a nutritionist specializing in gastroenterology, Chey said in a follow-up interview, but helpful books and online information are available.

He suggested “The Complete Low-FODMAP Diet” by Peter Gibson and Sue Shepherd and cookbooks by Patsy Catsos, a New England dietitian.

FOPMAP is an acronym for some specific types of carbohydrates. The dietary plan, often suggested for IBS, involves severely limiting sources of those carbohydrates, such as fructose in fruits and honey, lactose (dairy) products, various types of sweeteners, garlic, onion and wheat, to name a few.

FODMAPs are poorly or nondigested by the small intestine, Chey said. The goal is determining which trigger individual patients’ symptoms.

While irritable bowel syndrome often is miserable to live with, Simmons said, it doesn’t cause visible damage to the body.

IBD Is More Dangerous

That’s not the case with IBD, inflammatory bowel disease, predominantly Crohn’s disease and ulcerative colitis. With Crohn’s disease and ulcerative colitis, the body’s own immune system is attacking parts of its digestive system.

Between 1.4 million and 1.6 million people in the U.S. have IBD, divided fairly evenly between the two diseases and between men and women.

“It’s a very life limiting, life altering and debilitating illness,” said Erin Silber, certified child life specialist with BayCare , who works with children in the pediatric gastrointestinal unit of St. Joseph’s Children’s Hospital in Tampa.

“There are a lot of different oral medication.  It’s a lot of trial and error and it’s a lot of experiments to see what’s best for their bodies.” Silber is the contact for a free group for children who have irritable bowel disease and for their parents.

Its next meeting with be 6:30pm May 17 at St. Joseph’s Hospital Medical Arts Building, 3003 W Dr. Martin Luther King Jr. Blvd.  She can be reached at 813-357-0594 or [email protected].  Children with inflammatory bowel disease deal with issues such as embarrassment, limits on their activities and hospitalizations.

Parents deal with those and feelings of misplaced guilt, Silber said.  Information on causes of IBD is spotty, generally believed to relate to hereditary, genetic and possibly environmental factors that remain to be pinpointed, leaving a lot of room for parental angst.

The most common symptoms of ulcerative colitis include persistent diarrhea with crampy abdominal pain and stool that’s generally bloody. Other symptoms are urgent need to have a bowel movement, not getting pain relief after having one, being tired, having nausea, not being hungry, weight loss., fever and anemia.

“There are a lot of patients who say ‘I can live with it’ but, when you talk with them they’re suffering a lot,” Simmons said.  Symptoms of Crohn’s disease include persistent diarrhea, rectal bleeding and urgency about having a bowel movement, similar to ulcerative colitis.

People often feel they haven’t had a full movement and may have constipation.  Discomfort typically is worse with inflammatory bowel disease than with irritable bowel syndrome, said Cecila Arango, a family practice specialist at Bond Clinic in Winter Haven.

“You have severe pain,’ she said of IBD.  “You can go can go to the bathroom but you don’t get any relief.  You may have blood in the stool.”

What about a more holistic approach to treatment for IBD patients?  The Crohn’s & Colitis Foundation is preparing to embark on a major trial that would test the relative benefits of the Specific Carbohydrate Diet against the well-known Mediterranean diet with its emphasis on fruits, vegetables, olive oil and whole grains.

The Specific Carbohydrate Diet involves easily absorbed carbohydrates and properly fermented yogurt, but avoids starches in grains, corns and potatoes, according to information at http://www.breaking/

Doctors try a mixture of treatments for IBS and IBD, including probiotics containing live bacteria.  They can be useful, Chey said, but he and a host of others warn that products claiming to contain them very often don’t.

The best evidence for probiotics with IBS supports Align, a probiotic supplement containing bifidobacter infantis 3564, Chey said, and some studies show the probiotic in Activia helped with constipation.  Irritable bowel syndrome is the most common disease gastroenterologists diagnose.

IBS is 1.5 times to 2 times more common in women than men and most commonly is diagnosed before age 50.  Yet Arango is optimistic about the outcome for IMS patients.  “With a lot of diet and lifestyle modification, you are going to be perfectly fine.” she said 

IBS often is the diagnosis made after more inflammatory conditions like Crohn’s or colitis are ruled out.  Most who have one of those inflammatory diseases are diagnosed by the time they turn 40.

Some studies find 30 percent of Crohn’s and 20 percent of ulcerative colitis appear before age 20, making Silber’s job increasingly busy.  As many as two-thirds of people with Crohn’s end up requiring surgery at some point, the foundation said, and surgery may be considered for a smaller percentage with severe ulcerative colitis.

“Some people can get remarkable improvement with the medication available, but not everyone does,” Simmons said.