For sometime I've been frustrated at the responses of primary health care professionals in relation to IBS and now I can see the source of the advice which has been parroted to me here: publications.nice.org.uk/ir...
I think the NICE advice fails to capture the complexity of IBS and related gut problems.
Clearly the biggest problem is that there is no easily administered test (assuming the celiac test has proved negative) and no 'silver bullet' fix either and from there the mechanistic NHS falls down- no test based evidence, no 'real' problem as far as the docs are concerned.
If there isn't a quick diagnosis and or a quick/mechanical solution then I suspect the NHS isn't resourced to help with more intensive 'therapies' and the patient is subsequently left out in the cold. This is a great shame as there is a lot of useful information (lots of misinformation too) out there to help manage IBS and there are hints of proactive strategies to prevent it as well. Examples which would have been pertinent to me include:
* IBS Vs Small Intestinal Bacterial Overgrowth (SIBO) Are they distinct? Is SIBO a subset of IBS? In my experience primary care staff seem to confuse the two however they are quite different (SIBO relates to bacteria overgrowth in area of the gut where bacteria should be very scarce). This is an important area since many approaches recommend taking probiotics – is a bacterial overgrowth best treated with more bacteria?
* That the plethora of information relating to candida yeast is a misappropriation of cause but the phenomenon it refers to is real (in most cases probably SIBO)
* Should doctors recommend probiotics or prebiotics when administering antibiotics or even before going away to foreign areas?
* There seems to be outright denial that food intolerances exist (in my local surgery at least)- you have either celiac or an allergy (intolerances present over a 12-48 hr period whereas allergies present quite rapidly).
* No advice or help with exclusion diets
* What is a prebiotic/probiotic?
* What properties of prebiotics/probiotics should one look for ?
* Do probiotics contain lactose (many do and have caused me no end of trouble) ?
* How a blocked nose can cause gastric problems (due to air swallowing)
* What are possible consequences of taking proton pump inhibitors (SIBO??)
* The value of hypnotherapy
I might have been unlucky, I might be a one off (I don't think I am) but if some of the above information had been available to me 3 years ago, I might not have had such a difficult and disrupted life which has put great stress on me and those around me. At the worst time, early on, I was barely cogent and didn't have the faculty to research my condition. This was particularly difficult since there is such a plethora of pseudo-science/exploitative quackery which has flourished in the absence of answers in the mainstream medical community.
The next NICE review of IBS is not due until 2014.
•Irritable Bowel Syndrome Article by Professor Jonathan Brostoff allerguard.co.uk/Irritable%...
•Irritable Bowel Solutions: The Essential Guide to IBS, Its Causes and Treatments (Dr John Hunter)
•Non-Celiac Wheat Sensitivity Diagnosed by Double-Blind Placebo-Controlled Challenge: Exploring a New Clinical Entity ( nature.com/ajg/journal/vaop... )