April 19 is World IBS Day, intended to raise awareness about IBS, which affects the stomach and intestines, also called the gastrointestinal tract.

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"Irritable bowel syndrome is a common disorder in the United States, affecting approximately 10% of U.S. adults," says Dr. Brian Lacy, a Mayo Clinic gastroenterologist.

The symptoms of IBS are sometimes embarrassing and can affect a person's physical and emotional well-being.

"Patients have symptoms of disordered defecation. And that, in some patients, means constipation, skipping days without a bowel movement, straining of a bowel movement, or diarrhea, loose, watery urgent bowel movements," says Dr. Lacy.

The exact cause of IBS is still unclear, but it's believed to be a combination of factors, including changes in the gut microbiome and food intolerances.

IBS is now categorized as a disorder of gut-brain interaction, which means there is a problem with how the gut and the brain communicate with each other.

"That stress, which can affect the brain, then sends signals to the gut, changing gut function and worsening your IBS symptoms," says Dr. Lacy.

There is no cure for IBS, but symptoms can be managed. Try eating smaller, more frequent meals, and exercising regularly. Deep breathing and yoga are also helpful to reduce stress.

When to see a doctor for irritable bowel syndrome

See your healthcare professional if you have significant changes in bowel habits. Some severe symptoms include:

• Bloody stools.
• Unintended weight loss.
• Unexplained vomiting.

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DEAR MAYO CLINIC: I was diagnosed with irritable bowel syndrome and my primary care doctor recommended that I manage the condition without medication. Is that typical or will I also need medication to control my symptoms?

ANSWER: As with many things, managing a health condition is often personal.Not everyone with irritable bowel syndrome (IBS) needs medication. Particularly if you are someone who has mild symptoms, lifestyle adjustments like diet modification, stress management, and regular exercise can sufficiently improve symptoms. However, for those with moderate to severe symptoms, medications may be needed when lifestyle changes fail to provide adequate improvement of symptoms.

The walls of the intestines are lined with layers of muscle that contract and relax in a coordinated rhythm as they move food through the digestive tract.  In addition, there is a vast network of nerves that control movement of the digestive tract, but also send sensory signals to the brain, which can be interpreted as pain or discomfort. It is believed that when the communication between the brain and the digestive tract becomes altered, irritable bowel syndrome develops. This can lead to sensations of abdominal cramping and pain, due to heightened nerve sensitivity, as food, gas or stool passes through the intestines. Irritable bowel syndrome also is associated with bowel irregularity, such as diarrhea or constipation, due to alterations in motility (movement of the digestive tract).

For those suspected of having irritable bowel syndrome, it is important to be aware that some abdominal symptoms are not associated with this disorder and could signal another underlying problem. In particular, symptoms that require prompt medical attention include: blood in the stool, unexplained or rapid weight loss, unrelenting or severe abdominal pain, unexplained vomiting, significant pain with or difficulty swallowing, or an abdominal mass or lump.

Irritable bowel syndrome is a chronic condition, and symptoms can wax and wane over time. There’s no cure, but symptoms often can be eased with diet, lifestyle and stress management.

More than 60% of people who have irritable bowel syndrome say their symptoms are connected to food in some way. However, because symptoms vary significantly from one person to another, it’s difficult to give specific dietary advice that works for everyone with this disorder.

In general, however, eating high-fiber foods (particularly soluble fiber, such as psyllium husk) and drinking plenty of fluids are beneficial for many people with irritable bowel syndrome. It is best to avoid foods and beverages that contribute to gas and bloating. Carbonated and alcoholic beverages; caffeine; raw fruit; and vegetables such as cabbage, broccoli and cauliflower, should be avoided. Reducing or eliminating gluten may also ease diarrhea in some patients with irritable bowel syndrome..

Research has shown that certain carbohydrates known as fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) can lead to abdominal pain, bloating and gas in people with irritable bowel syndrome. These are found in certain fruits and vegetables; wheat; rye; legumes; foods that contain lactose, such as milk, cheese and yogurt; and artificial sweeteners.

Following a diet low in FODMAPs can ease symptoms of irritable bowel syndrome. But because so many foods contain these compounds, it can be difficult for patients to create such a diet on their own, as the initial phase of the diet can be quite restrictive, and it is important to re-introduce foods in a systematic manner. Finding a dietitian familiar with irritable bowel syndrome can help. A dietitian can review a patient’s symptoms and dietary needs, discuss recommended changes and develop an individualized food plan to ease symptoms.

Stress also affects irritable bowel syndrome, with episodes of higher stress associated with an increase in symptoms. Using stress reduction techniques and participating in activities that relieve stress, such as yoga and meditation, may decrease stress-related flare-ups. Working with a therapist or counselor experienced in stress management, mindfulness and behavior modification also may help those with irritable bowel syndrome better control stress and thereby ease symptoms.

Regular exercise is recommended for people who have irritable bowel syndrome. Daily physical activity relieves stress, stimulates normal contractions of the intestines and promotes overall wellness.

If lifestyle changes alone aren’t enough to keep irritable bowel syndrome from disrupting daily life, talk to your health care provider about medication options. A wide variety of prescription and nonprescription medications are available to treat irritable bowel syndrome. — Dr. David J. Cangemi, Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida

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Arthur Beyder, M.D., Ph.D., runs a research laboratory at Mayo Clinic focused on examining the molecular mechanisms of gastrointestinal function and dysfunction in diseases such as irritable bowel syndrome. His goal is to discover better ways to diagnose and treat these conditions, including individualized treatment options.

"These conditions affect 10-15 percent of Americans, and it's amazing how much we still have to learn about the molecular mechanisms of these diseases," says Dr. Beyder. 

Dr. Beyder believes that the "high risk, high reward" approach may be the best way to go when it comes to tackling this problem. He recently received a 2019 NIH Director’s New Innovator Award,  honoring his work as an "exceptionally creative early career investigator," an award given to support the researchers who pursue high risk, high reward research.

What is high-risk, high-reward research?

High-risk, high-reward research is innovative research that pushes the boundaries of science and has the potential for broad impact.

"Incremental questions lead to incremental progress," says Dr. Beyder. "High-risk questions allow us to break away to view the problems in a completely different light or from a different perspective. These approaches allow us to make big leaps forward and often bring true transformation in science and medicine."

"At Mayo Clinic, we're focused on turning scientific discoveries into treatments quickly, so patients can benefit as soon as possible," says Gianrico Farrugia, M.D., president and CEO of Mayo Clinic, and one of Dr. Beyder's mentors. "To achieve that, we need to think big, move fast, and take well-calculated risks. Researchers like Dr. Beyder are helping advance a new mindset that will accelerate innovation."

Read the rest of the article on Advancing the Science.
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Other Mayo Clinic medical research websites:

• Research at Mayo Clinic
• Discovery’s Edge
• Advancing the Science
• Forefront
• Mayo Clinic Center for Individualized Medicine
• Center for Regenerative Medicine
• Center for the Science of Health Care Delivery

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Marissa Russo has been battling symptoms of inflammatory bowel disease for half her life. When a flare-up that lasted several months had her confined to bed and barely able to function, she turned to the expertise of Mayo Clinic for a new approach to treatment.

Fitness, nutrition and health are incredibly important to Marissa Russo. She's been doing CrossFit for the past six years and is used to exercising five times a week. And Marissa has maintained that pace despite dealing with the symptoms of inflammatory bowel disease for nearly 20 years.

For a time, however, as her medical condition spiraled downward, Marissa's ability to continue her active ways appeared to be in jeopardy. Then she turned to Mayo Clinic, where she found help from Michael Picco, M.D., Ph.D., chair of Gastroenterology and Hepatology and a specialist in inflammatory bowel disease at Mayo Clinic in Florida.

"Dr. Picco and his team are the Cadillac of GI services. They do what it takes to get you whatever tests you need," Marissa says. "They are very quick to respond, and they're advocates for you. They make you feel like you're their number one priority from start to finish."

Disturbing decline

Inflammatory bowel disease is an umbrella term that describes incurable disorders that involve chronic inflammation of the digestive tract. Ulcerative colitis and Crohn's disease are the two main types. Marissa began experiencing symptoms of inflammatory bowel disease when she was in her early 20s.

"It all started when I was about 22 years old," Marissa says. "I couldn't keep any weight on. Every time I would eat something, I felt like I had to use the restroom immediately."

When she started noticing blood in her stool, Marissa went to a gastroenterologist who diagnosed her with Crohn's disease and began treatment by prescribing Marissa anti-inflammatory drugs, including corticosteroids and sulfasalazine. The medications, which she took for 10 years, improved her symptoms. But when she was approaching her 38th birthday, Marissa's condition took a turn for the worse.

"My symptoms were becoming more frequent and harder to put into remission," Marissa says. "I went from taking the drugs for two weeks to having to be on them for four to six weeks. I would go six months without being able to get my flare-ups under control."

"(The bowel spasms) felt like birthing contractions, and I would literally see stars because I was in so much pain."

Marissa Russo

Her local doctor prescribed different medications. But none of them put Marissa's condition into remission, and they had significant side effects, including severe nausea that made it hard for her to do her day-to-day activities.

Then when she turned 39, Marissa began to experience the worst flare-up she'd ever had. It started in November 2017 and lasted through February 2018. During that time, Marissa was having 16 bowel movements a day.

"I was passing blood coupled with tissue during my bowel movements. I also had severe cramping from bowel spasms every 20 minutes," Marissa says. "They felt like birthing contractions, and I would literally see stars because I was in so much pain."

Too weak to drive her two kids to school, Marissa had to enlist help from neighbors, family and friends. Frustrated and in hopes of finding a solution, Marissa did some research and tried home remedies. They helped somewhat, but she remained in considerable pain. Marissa and her husband decided it was time to get another medical opinion.

"My doctor at the time wasn't listening to me," Marissa says. "So my husband said, 'We're getting you to Mayo Clinic.'"

Promising treatment

Marissa had a consult with Dr. Picco at Mayo Clinic in Florida on Feb. 15, 2018. That appointment followed two weeks of excruciating pain during which she lost 20 pounds.

"By the end of 14 days, I went from looking healthy to looking emaciated," Marissa says. "The first thing that went through my mind was, 'Am I going to live through this?' I thought there was a chance that I wasn't going to make it, and I was losing hope."

To get a better understanding of Marissa's condition, Dr. Picco ordered a colonoscopy. "There's no one test to distinguish between ulcerative colitis, which involves only the colon, and Crohn's, which can involve either the colon or both the colon and small intestine," Dr. Picco says. "The colonoscopy showed that Mrs. Russo had a pattern of inflammation in the large intestine which made it difficult to determine if she had ulcerative colitis or Crohn's disease. If it's not absolutely clear, we treat the patient with medications that are effective for both."

"It seemed like once (Dr. Picco) found out what was really going on, he immediately had a solution."

Marissa Russo

Dr. Picco recommended Marissa undergo treatment with the medication infliximab, which is used to treat ulcerative colitis and Crohn's. It involves three IV infusions over six weeks. Then if that is effective, the medication is given every eight weeks.

"I felt so relieved to have an answer and feel like there was going to be a solution to my problem," Marissa says.

Dr. Picco explained that Marissa would need to continue the medication as long as it was well-tolerated and effective, and that at some point, it could stop working because some people eventually develop antibodies to the drug. If that happens, a higher dose, a shorter time between treatment or both can help maintain the medication's effectiveness.

Marissa's interactions with Dr. Picco kindled new optimism in her. "He listened. He allowed my husband to share his concerns, and he explained things in a way that we could understand," Marissa says. "It seemed like once he found out what was really going on, he immediately had a solution. He told me, 'You will get better.' That's all I needed to hear."

Achieving remission

Marissa began the treatment with infliximab the following week, and she saw immediate results. "I went from having 20 to 30 spasms a day to having four to five the day after the first infusion. A week later, I had no more spasms or blood or tissue in my stool. It was a wonder drug," Marissa says. "For the first time in a long time, I felt like I was actually living."

Marissa continued to see Dr. Picco for follow-up appointments every two weeks for the first six weeks of her treatment and then every four weeks for the following two months. Results from a six-month follow-up colonoscopy in August 2018 showed there was little to no inflammation in Marissa's digestive tract.

"For the first time in a long time, I felt like I was actually living."

Marissa Russo

Around that time, her husband, a Navy pilot, received orders to go to Japan. But because of Marissa's illness, they were denied medical clearance to go overseas. "Dr. Picco wrote up additional information about my treatment, and how he was a proponent for my family to go to Japan if the treatment could be continued," Marissa says. "We appealed, and were approved to go to Japan in October."

Marissa and her family have been in Japan since January, and her medical condition has remained stable. "I've been on this treatment for a year and a half, and it's still working for me," Marissa says. "My hope is that it will keep me in remission through next summer when my husband's overseas tour ends."

Relishing family life

In addition to allowing her the freedom to travel, the treatment has made it possible for Marissa to go back to the gym and return to her CrossFit routine.

"In March 2018 I could no longer do a pullup. I couldn't jump more than three inches off the ground," Marissa says. "In about 60 days from the start of my infusions, I had 75% of my original strength. That was a pretty quick turnaround."

She's also now able to do many of the things for and with her children that she was too weak to do because of her illness. "I'm most grateful that I'm able to function for my kids — that I'm able to be a mom the way I was before the flare-up," Marissa says. "It's wonderful to be able to lead our normal life as a family, which involves fitness and travel."

For Dr. Picco, helping people like Marissa who have inflammatory bowel disease live the way they want to is the goal of the expert care he and his team provide. "We offer the ability to have one place for care," he says. "We do tests to determine if treatment or medications need to be modified. And we're well-versed in all the medications and how to maximize their effectiveness. This is a very complex disease that requires very specialized care, including appropriate management, monitoring and follow-up."

HELPFUL LINKS

• Learn more about inflammatory bowel disease.
• Read about inflammatory bowel disease care at Mayo Clinic.
• Visit the Department of Gastroenterology and Hepatology.
• Connect with others talking about digestive health on Mayo Clinic Connect.
• Explore Mayo Clinic in Florida.
• Request an appointment.

The post Sharing Mayo Clinic: Lifting the weight of debilitating inflammatory bowel disease appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Robert Kraichely, a Mayo Clinic gastroenterologist, will discuss treatment for IBS. Also on the program, Dr. Jennifer Vande Voort, a Mayo Clinic psychiatrist, will discuss esketamine nasal spray — a fast-acting treatment for depression that recently was approved by the Food and Drug Administration. And Dr. Nipunie Rajapakse, a Mayo Clinic infectious diseases specialist, will share what you need to know about childhood vaccines.

To hear the program, find an affiliate in your area.

Use the hashtag #MayoClinicRadio, and tweet your questions.

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Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

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In April 2018, Evan Beard received the shocking news that he had colon cancer. Evan's local doctor referred him to Mayo Clinic where a multidisciplinary team and the right combination of chemotherapy and surgery made it possible for the young father to beat his daunting diagnosis.

In March 2018, 23-year-old Evan Beard had just celebrated his oldest son Benjamin's second birthday, and his son Noah was about to turn 4 months old. Evan was enjoying managing the operations of a Brunswick, Georgia, coffee company, and life with his wife, Megan, who he'd married three years earlier.

But amid all the positive aspects of his life, there was a persistent problem. For a year, Evan had been noticing changes in his bowel habits, including long periods of constipation. And those changes were getting worse — finally warranting a visit to his primary care doctor and a gastroenterologist.

"I thought I might have IBS or ulcerative colitis," Evan recalls.

Receiving devastating news

To investigate what might be going on, Evan had a colonoscopy at a local health care facility. Afterward, the results of the test shocked him. He had a tumor in his colon.

Although the diagnosis was almost unimaginable to Evan, his isn't an isolated case. Among adults in their 20s, 30s and 40s, colorectal cancer is on the rise. And because screening is not routinely recommended for people in those age groups, when they develop the disease, it often goes undetected until it has spread to other areas of the body.

That was the second part of the bad news for Evan and his family. His local doctors advised him to have a CT scan of his chest and abdomen to check for other tumors. The scan revealed Evan also had four spots on his liver that appeared to be cancer.

"That's when the bottom really fell out for us," Evan says. "That's when our lives fell apart."

One of his local physicians made a call to a colleague at Mayo Clinic's Florida campus about Evan's case. Arrangements were made for Evan and Megan to meet with a multidisciplinary team at Mayo Clinic the next day.

"One of the most epic moments was meeting all the doctors and nurses. I could tell they were on the cutting edge," Evan says. "They gave us a lot of hope and told my wife, 'You're going to be rocking next to your husband when you're old.' I felt beyond grateful to be able to be in their care."

Benefitting from a new approach

Evan met with Mayo Clinic hematologist-oncologist Pashtoon Kasi, M.B.B.S., M.D. He recommended a combination of chemotherapy and a targeted drug specific to Evan's type of colorectal cancer, along with a combined colon and liver surgery to remove the tumor and the spots on the liver.

This method is different from traditional treatment, according to Dr. Kasi. "Patients who historically would not be offered the chance of being cured of their cancer through surgery are now being considered surgical candidates," he says. "The approach now is to first do chemo paired with the right biologic to shrink the tumor and get rid of as much of the cancer as possible. Then we surgically remove what's left, and do chemo post-surgery to ensure all the cancer cells are completely gone."

"I felt beyond grateful to be able to be in their care."

Evan Beard

Evan was eager to move forward. "I hear people are sometimes hesitant to do chemo, but I had too much on the line, too much to fight for," he says.

Midway through his chemotherapy regimen, Evan's CT scans showed an excellent response. A few of the spots on his liver had all but disappeared, and his tumor had shrunk significantly. A circulating tumor DNA test, known as a liquid biopsy, also revealed a significant decline in the tumor shedding its DNA. That meant the tumor was responding to the treatment.

Buoyed by those encouraging results, it was time for Evan to have surgery. On Aug. 6, 2018, a team of Mayo Clinic surgeons, including Kristopher Croome, M.D., and Dorin Colibaseanu, M.D., removed part of Evan's colon and 30 percent of his liver.

The procedure required teamwork and exacting attention to detail, according to Dr. Colibaseanu. "Constant communication between the teams is necessary, as is precision of technique with minimal blood loss. The outcome of one surgery directly impacts the other," he says. "Mayo uses specialized teams to perform these types of surgeries, which we perform frequently."

Envisioning a bright future

Although he had been apprehensive about the procedure, afterward Evan was grateful to learn the surgery had achieved its goal. "I was scared going into surgery because there was so much riding on that," Evan says. "It was really successful, and the surgeons reported great margins."

Evan resumed his chemotherapy infusions in early September 2018 to complete a total of six months of treatment. On Nov. 13, Evan rang the bell on the third floor of Mayo Clinic's Mangurian Building to celebrate the end of his cancer treatment.

"The whole floor of nurses came out cheering for me," Evan says. "That was an unbelievable moment."

"After my surgery, I got to spend a lot of time with the nurses on the hospital floor. It made me realize that I'd really like to help people by becoming a nurse."

Evan Beard

The support Evan received from the nursing team not only helped him in his recovery, it inspired him to pursue a different career track. "After my surgery, I got to spend a lot of time with the nurses on the hospital floor," he says. "It made me realize that I'd really like to help people by becoming a nurse."

Like many patients who have undergone this type of cancer treatment, Evan requires close follow-up with his care team, including CT scans, blood work and colonoscopies. But overall, the future is filled with promise for Evan and his family. In addition to applying to a nursing program, he's eagerly anticipating the joy of being there for his children's milestones.

"When I was first diagnosed I didn't have confidence I'd live to see Benjamin's next birthday," Evan says. "Now I'm cancer-free."

HELPFUL LINKS

• Learn more about colon cancer.
• Read about Mayo Clinic Cancer Center.
• Explore Mayo Clinic's Florida campus.
• Request an appointment.

The post Sharing Mayo Clinic: New career path after beating colon cancer appeared first on Mayo Clinic News Network.

ANSWER: Irritable bowel syndrome, or IBS, can cause the symptoms you describe, but other medical conditions can trigger them, too. It would be a good idea to see your doctor and talk to him or her about your symptoms. Although no specific test to diagnose IBS exists at this time, your doctor can then decide whether additional tests are needed to rule out other disorders.

IBS is a disorder that affects the intestines. It’s not clear what causes IBS, but several factors seem to play a role in its development. The walls of the intestines are lined with layers of muscle that contract and relax in a coordinated rhythm as they move food — which later becomes waste — from your stomach through your intestinal tract to your rectum. If you have IBS, the contractions may be stronger and last longer than normal. That can lead to abdominal pain or discomfort as food, gas or stool passes through the GI tract. IBS is also associated with bowel irregularity — sometimes diarrhea, sometimes constipation, sometimes both. Common associated symptoms can include gas and bloating.

Both adults and children can get IBS. But the condition often begins in the early twenties, and it tends to affect women slightly more often than men. The exact symptoms of IBS and the severity of those symptoms can vary from one person to another. Although symptoms may come and go, for most people diagnosed with it, IBS is a chronic, lifelong condition. Estimates suggest that about 10 to 15 percent of the population in the United States has IBS.

An evaluation for IBS typically involves a comprehensive assessment of your symptoms and your medical history, along with a thorough physical exam. No other testing usually is necessary beyond that if your symptoms are typical of IBS. Depending on your situation, your doctor may recommend additional tests to rule out other causes for your symptoms, since there are other conditions that can cause pain, diarrhea and constipation. This may happen if your symptoms are severe, if there is a family history of a GI condition, or if you are experiencing other symptoms that are not typical of IBS (for example, bleeding).

If you do have IBS, treatment for the disorder typically focuses on controlling the symptoms. For people with mild to moderate IBS, diet changes can often make a big difference. The specific changes needed depend on whether you are dealing with diarrhea, constipation or both. Some people with IBS find it helpful to work with a dietitian to identify healthy food choices that won’t trigger their symptoms. For more severe forms of IBS, a number of over-the-counter and prescription medications are available to help reduce symptoms.

If you feel like your symptoms are interfering with your daily life, make an appointment with your doctor to review your condition and decide on next steps. If IBS is the diagnosis, it is likely that there are therapies that can relieve your discomfort and help you feel better. — Yuri Saito, M.D., M.P.H., Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn.

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Here's the podcast: MayoClinicRadio 07-04-15 PODCAST

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Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are two very different chronic digestive system conditions that are sometimes confused with one another. On this week's program, gastroenterologists Dr. Sunanda Kane and Dr. Yuri Saito discuss the differences between IBD and IBS, and explain how each is treated. Also on the program, Dr. Thomas Allison, director  of the Mayo Clinic Sports Cardiology Program, talks about a simple treadmill test that can help predict whether you'll live 10 years or more. And psychologist Dr. Karen Grothe has strategies for keeping the weight off after losing it.

Myth or Matter-of-Fact: Inflammatory bowel disease and irritable bowel syndrome are both conditions from which full recovery is possible.

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