A twenty-eight year old man complains of daily bloating of his belly with abdominal cramps for ten years. He often has multiple diarrhea especially in the mornings, and his symptoms go away with bowel movement (going to the toilet). The patient never has symptoms at night while asleep, and there is no weight loss. In fact he is slightly obese and otherwise feels completely fine. He says the symptoms gets worse when he is under stress. He was planning to work in Dubai, but he is nervous that his condition may cause problems for him. His physical examination and basic blood tests were all normal.

Irritable bowel syndrome ( IBS) which this patient has is one of the commonest problem that a doctor ( especially a gastroenterologist, a bowel doctor) sees in his clinic in Nepal. This is a clinical diagnosis, that is the doctor makes the diagnosis by taking a careful history of the patient’s problems and doing a simple physical exam. There are no especial blood tests, scoping procedures of the bowel, or radiological tests to make the diagnosis. Additional evaluation is not only unnecessary and expensive but also potentially harmful when invasive procedures are ordered.Of course if the patient were older, had fever and chills and weight loss, other more sinister diagnosis may need to be considered.  

The most important part of the treatment is that the patient should be reassured that although this problem is annoying and inconvenient ,it is not life-threatening.

Sometimes patients who have IBS have concomitant difficulty in digesting milk and milk products, what is called lactase deficiency. Lactase is the enzyme in the small intestine necessary for digesting milk and milk products. Amazingly about 90 % of people from South Asia are deficient in this enzyme which leads to the classic gurgling noise( “paetgadyangudung”) from the belly followed by loose motion after drinking a glass or two of milk. Because this is such a common problem here, it is possible lactase deficiency may overlap with IBS.

So patients with IBS disease should see if not using milk and milk products helps their problem.There is also evidence that IBS is linked to mental problems like depression and anxiety and seeking help in this regard may also be a helpful approach in the treatment of IBS.

This patient in question did see a competent Nepali gastroenterologist who made the diagnosis and helped the patient without resorting to unnecessary, expensive laboratory or radiological testing. The patient is now working in Dubai.