When Dr. Yezaz Ghouri sees patients with the cramping, abdominal pain and diarrhea that are hallmark symptoms of irritable bowel syndrome (IBS), he'll typically ask how life's going.
More often than not, his patients say they are experiencing stress in their lives.
Now, Ghouri's team has established a link between IBS and anxiety, depression and suicidal ideation in patients who have been admitted to the hospital for their IBS. IBS is a chronic disorder of the gastrointestinal (GI) system that strikes up to 15 percent of the population.
Ghouri, an assistant professor of clinical medicine and gastroenterology at the University of Missouri School of Medicine, thinks that stress may be expressed through both the mind and body.
“I think it expresses in the form of mood disorders like depression, anxiety,” Ghouri said. “I think it expresses in a form of IBS, which is basically a manifestation of your autonomic nervous system [which controls involuntary actions like your heartbeat].”
The study used data from more than 1.2 million IBS patients in 4,000 U.S. hospitals over three years.
More than 38% of these patients had anxiety. More than 27% had depression. These numbers were double the levels of anxiety and depression found in patients who did not have IBS.
Lead researcher Dr. Zahid Ijaz Tarar, an assistant professor of clinical medicine, pointed to what's called the brain-gut axis. Tarar suggested in a university news release that IBS symptoms influence anxiety and depression, while those psychiatric issues may also cause IBS symptoms.
Ghouri said, “A lot of people with anxiety, they tend to have a higher heart rate. They can tend to be anxious. They tend to sweat a lot sometimes. These are all symptoms of autonomic nervous system. And I believe IBS is also a manifestation of that autonomic nervous system through the gut-brain axis."
Ghouri explained that patients experiencing these symptoms may first need to learn how to recognize their feelings of stress.
“That recognition is the most important part,” he said. “Number two, what are you going to do about it?”
Patients may need counseling, Ghouri noted.
Meditation, relaxation, eating healthy and sleeping well are all factors that can contribute to having a healthy life, he said.
In terms of improving gut health specifically, Ghouri suggests giving up or cutting back on processed or greasy foods, red meat, alcohol and smoking, in favor of fruits, vegetables and foods like yogurt.
“I think that helps you stabilize your gut microbiome, make it a little bit more healthy,” Ghouri said.
The team's findings were published recently in the Irish Journal of Medical Science.
Dr. Brooks Cash, chief of the division of gastroenterology, hepatology and nutrition at the University of Texas Health Science Center at Houston, said the study reiterates some key information about IBS.
“I think it's very important for us not to lose sight of the mental health component of GI health. And I think this study helps to highlight that,” said Cash, who was not involved with the study.
Cash's view is that mental health issues may augment gastrointestinal symptoms and GI symptoms may augment mental health issues, “but we don't know if there's a true causative or causal relationship between the two.”
He noted what the study authors said about the importance of addressing both physical and mental health symptoms in patients.
“It's a very complementary and kind of holistic approach that we need to take with these patients. We need to treat the GI symptoms as best we can, but we also need to not lose sight of the mental health symptoms and address them,” Cash said.
Cash said the majority of people with IBS symptoms don't seek out medical care, instead treating the symptoms themselves.
“There is nothing wrong with doing that as long as they're not ignoring alarm features,” he said.
A variety of over-the-counter treatments may help, including laxatives and anti-diarrheal medications. There are also a handful of U.S. Food and Drug Administration-approved prescription medications for irritable bowel syndrome, Cash said. Diet therapies may also make a difference.
Among popular therapies are the low-FODMAP diet, which restricts poorly digested carbohydrates, fibers and complex sugars. This is used in patients with bloating and diarrhea. There is also increasing evidence that prunes and kiwi can be effective for constipation.
“There's a number of different dietary and lifestyle modifications that patients can make, and every patient's different,” Cash said. “We have to take an individualized approach to every patient based on their symptoms."
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more on irritable bowel syndrome.
SOURCES: Yezaz Ghouri, MD, assistant professor, clinical medicine and gastroenterology, University of Missouri, School of Medicine, Columbia, Mo.; Brooks Cash, MD, chief, division of gastroenterology, hepatology, and nutrition, University of Texas Health Science Center, Houston; Irish Journal of Medical Science, Jan. 3, 2023