Secrets the NHS does not tell you about IBS
by Michael Franklin
Of all the chronic illnesses with unpleasant symptoms, Irritable Bowel Syndrome, or IBS as it is called for short, almost certainly gets treated less effectively by the NHS than any other.
There is even disagreement and confusion about what symptoms constitute IBS but, after fifteen years of running the IBS and Gut Disorder Centre and seeing a huge number of patients with the syndrome, there is no doubt in my mind that the best way to define it is to say that someone has IBS when they have had at least two of the following symptoms for a minimum of three months:
One major reason the NHS does not treat it effectively is because it is regarded by most doctors as a “dustbin diagnosis”, which means that they do not see it as a real illness but simply a collection of symptoms that can be given the label of IBS only when more serious illnesses have been ruled out.
Palmed off with a prescription
When a patient goes to their GP with any of the above symptoms, they are usually palmed off with a prescription for a medicine that can easily be bought over the counter and which the patient herself has probably already bought and found it has made no improvement. By the time they have seen their GP two or three times, they will probably get a referral to a gastroenterologist who will order a test to rule out either advanced stages of cancer, Ulcerative colitis or Crohn’s disease. If these tests are negative, then the patient will be sent back to their GP and told they probably have IBS and that they will just have to learn to live with it - a situation which is exemplified by a story I was told by a recent patient who said his GP had said to him, “Oh my God, it’s you with your IBS again. One of these days you’ll have a real illness to complain about.”
Drawbacks of NHS tests
What doctors cannot comprehend is that IBS has more than one cause. They have spent six years in medical school but most of it has been spent studying anatomy, physiology, pharmacology, pathology, etc. They have spent very little time being taught how to help people with chronic symptoms like fatigue, migraine or IBS.
The tests used by the NHS are all camera tests which look for inflammation in the gut wall by means of a camera being sent down your throat in the case of an endoscopy or up the backside in the case of a colonoscopy or sigmoidoscopy. They are all invasive and often very unpleasant to experience.
What doctors just don’t seem to realise is that they are looking solely at the gut wall and are not looking at the contents of the bowel. The fact that they are not looking at what is swimming around in the gut means that those tests just do not enquire at all about three of the major causes of IBS:
The tests we use to look for these three possible causes of IBS and to quantify on a scale of 0-4 the amount of beneficial bacteria in the gut involves the examination of stools and is done by an American lab whose techniques are considerably more sophisticated than any that are at the moment available in the UK. David Hopkinson was an example of this. He had had quite bad diarrhoea for the last three years accompanied by a certain amount of flatulence, bloating and abdominal pain, so life was no fun for him at all - particularly because the diarrhoea was always so bad in the mornings that he was frightened to leave the house before 11.00am. He had been to no less than three gastroenterologists because he was determined to get to the bottom of his symptoms. I saw a copy of the letters written by the consultants to his GP and there is no doubt that all of them had tried hard. But they all tried hard only with the tests which they used. They had never, as one long-term patient of mine often observes, “looked outside the box”.
David’s test had found no sign of cancer, Crohn’s or Ulcerative colitis and so, in spite of having five different NHS tests, no answer had been found. He had been referred back to his GP and guess what his GP had suggested? An anti-depressant.
When David came to us we sent him three long questionnaires and these ask so many questions that almost always lurking somewhere is an answer that gives a very strong clue as to the cause of the patient’s symptoms. In David’s case it was the fact that his symptoms had originated soon after a trip to the Dominican Republic where he had had a fairly severe short-term upset stomach with diarrhoea and vomiting. When I told him this immediately suggested parasites as a cause, he said, “Yes, I know that, that’s why I went to a hospital and they found Giardia. I took a drug for it and three months later a re-test showed I was clear. So it can’t be that and surely that means parasites are not the cause.”
I told him that was not the case and that parasites could indeed still be the cause because we have often found that when a previous test has found only Giardia, a subsequent test using the very sophisticated techniques of the American lab we use will find that the Giardia has indeed gone, but that the patient still has one or even two other parasites that have never been fully eradicated. This is what happened in David’s case. The test found both Blastocystis hominis and Dientamoeba fragilis, two parasites which are surprisingly common in British patients who have IBS-type symptoms. With the appropriate treatment David got a lot better and his diarrhoea went away.
What causes IBS in one person is different to what causes it in another. The symptoms may be very similar, but the causes can be very different and this is what GPs, with a consultation time of only seven minutes, cannot get to grips with and cannot really understand. Treatment by the IBS and Gut Disorder Centre is very different. It has a very high chance of success because consultations last at least an hour and are so thorough that each and every one of the possible causes can be looked at.
The IBS & Gut Disorder Centre
9 Weymouth Street
London W1W 6DB
0345 129 7996
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