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Possible Complications of IBS

By William Salt, M.D. ; Updated August 14, 2017

There are no serious complications of IBS, such as developing inflammatory bowel disease or gastrointestinal cancer. If an accurate diagnosis of IBS is made, the risk of a later alternative diagnosis is very small. However, there are several potential “risks” associated with IBS, including considerations of the burden of illness, delay in diagnosis, unnecessary testing, unnecessary surgery and contracting bacterial food poisoning.

There is no relationship between IBS and inflammatory bowel disease (Crohn’s disease and ulcerative colitis) and colorectal cancer or GI malignancy. A patient who is accurately diagnosed with IBS can be confident about the future because of the availability of many effective treatments and continuing research. Furthermore, studies confirm the risk of a patient receiving a future alternative diagnosis of a mimicking disease, such as celiac disease or inflammatory bowel disease, is less than 5 percent.

Burden of Illness

Research confirms that IBS significantly reduces your quality of life and work productivity. The 2015 American Gastroenterological Association (AGA) IBS in America survey shows that IBS symptoms are often so bothersome and unpredictable that they interfere with daily life at home, work and school. IBS is “expensive,” leading to 3.1 ambulatory care visits and 5.9 million prescriptions annually. IBS accounts for about one in 10 primary care visits, and 25 percent of what a gastroenterologist sees is IBS. Factoring in missed work, IBS costs about $20 billion every year. AGA suggests these three things patients can do to help their doctor manage their IBS: “Speak Up Early, Completely and Often." With open, honest conversations and feedback, doctors are more likely to be able to help their patients navigate their own IBS treatment path.

Delay in Diagnosis

Most people with IBS symptoms do not consult with a health care professional, and diagnosis of IBS is usually not made for several years after symptom onset. This results in prolongation of unnecessary suffering and can lead to unneeded testing and surgery.

Unnecessary Testing

A positive diagnosis of IBS can usually be made based upon recognition of the IBS symptom subtype and simple blood and stool tests. Uncomfortable, expensive and potentially risky X-rays and procedures can usually be avoided unless mimicking diseases like celiac disease, inflammatory bowel disease or colorectal cancer are suspected.

Unnecessary Surgery

Patients with IBS, particularly if undiagnosed, are more likely to endure unnecessary surgery than are those without IBS. The three most common surgeries are appendectomy, cholecystectomy and hysterectomy. Abdominal and pelvic surgery can result in adhesion formation, complicated by small intestinal obstruction and/or small intestinal bacterial overgrowth (SIBO). Cholecystectomy commonly results in diarrhea following meals caused by bile acid malabsorption. Abdominal and pelvic surgery can cause or contribute to chronic pain.

Bacterial Food Poisoning

Post infectious IBS (IBS-PI) can occur following acute bacterial food poisoning with Campylobacter, Salmonella, Shigella or E. Coli. These bacteria can make a common toxin that elicits an antibody response. This antibody cross-reacts with a protein in the intestinal lining resulting in an ongoing autoimmune dysfunction that interferes with normal peristalsis and motility. IBS-PI/SIBO then develops. Having IBS-PI increases the risk of developing food poisoning in the future. Many with IBS-PI will recover after several years, but if bacterial gastroenteritis recurs, it can reactivate IBS-PI. Furthermore, if an individual with chronic IBS-PI again contracts food poisoning, the IBS symptoms can worsen.

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