Irritable Bowel Syndrome (IBS) is the 2nd most common cause of work absenteeism in India & negatively impacts quality of life reveals survey by HCFI

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  • Medical Practitioners surveyed feel that peppermint oil is a safe and better treatment option that can help alleviate symptoms
  • Over 3000 patients and 300 medical practitioners participated in the survey

Delhi, April 19, 2018: A study conducted by the HCFI, a leading National Health NGO has revealed that about 5-10% of the population surveyed experiences symptoms of Irritable Bowel Syndrome (IBS) such as abdominal pain, diarrhoea, constipation or incomplete evacuation. Yet, a majority of them do not seek medical help.

The study aimed at analyzing IBS from the physician and patient’s point of view – awareness about the disease, its impact on day-to-day life and treatment options. It is interesting to note that even though 84.6% of the respondents felt that abdominal pain or other symptoms of IBS cannot be ignored, an overwhelming 58% of them use over-the-counter medications for relief and did not see a doctor. Given the impact of IBS on a person’s day-to-day life, it is important to raise awareness about IBS amongst both the medical fraternity and patients about IBS.

Speaking about the need to raise awareness Dr KK Aggarwal – President HCFI said, “A simple mantra that everyone must remember is that if there is no pain, it can’t be IBS. Raising awareness about the disease incidence is key. ”

Dr. G S Lamba, Chief of Gastroenterology and Hepatology, Sri Balaji Action Medical institute, Delhi, opined, “Drinking lots of water and increasing your fiber intake may help regulate IBS symptoms, especially if relaxation methods and other ways to constipation is a problem. Fiber is found in bran, bread, cereal, beans, fruits, and vegetables. Apart from this, regular exercise is also beneficial and so are stress reduction methods or counselling. It is important to not use over-the-counter medications without consulting a specialist. Peppermint oil as an antispasmodic has been found beneficial in managing IBS symptoms.”

Speaking about this, Dr. Uday C Ghoshal, Professor, Gastro Dept, Sanjay Gandhi Post Graduation Institute of Medical Sciences, Lucknow said, “There is a lack of awareness about IBS in India and the fact that it is one of the leading causes of work absenteeism. Some symptoms of this condition include constipation, diarrhoea or both.Associated psychological disturbances & multiple somatic symptoms are also associated with in a proportion of patients.”

The most common symptom of IBS is abdominal pain with changes in bowel habits (diarrhoea and/or constipation). Abdominal pain is typically crampy and varies in intensity. Some people notice that emotional stress and eating worsen the pain and that having a bowel movement relieves the pain. Women may notice an association between pain episodes and their menstrual cycle.

The results of the survey conducted amongst the medical practitioners on the treatment methodologies for IBS revealed that almost 55.9% of the doctors use a symptom-directed, multidrug approach in the treatment of IBS; 54.5% doctors prescribe antispasmodics; and another 30.8% prescribe antibiotics, antispasmodics.

About 80% of the doctors surveyed believe that an ideal antispasmodic for the treatment of IBS should offer relief from symptoms of abdominal pain/discomfort, bloating/flatulence and complete evacuation and also possess minimum side effects. Peppermint oil has emerged as a good option since almost half of the participating doctors feel that it is effective in relieving abdominal pain, gas, bloating and fecal urgency through its selective effect on the smooth muscles of the intestine.

There is an unmet need in the treatment of IBS, as, despite the wide variety and effective treatments available, most patients do not get appropriate treatment. More widespread knowledge and proper use of available therapies (such as diet restriction and peppermint oil) will enable both the physicians as well as patients in achieving a better quality of life and relief from symptoms.

Some interesting insights from the patient survey include the following.

  • 84.6% said that pain in abdomen and altered bowel habits cannot be ignored
  • 58.3% people self-treat symptoms with over-the-counter drugs
  • 33.3% feel that the condition is not serious enough to contact a doctor
  • 8.3% would seek no treatment at all
  • 46% say IBS hampers their daily life
  • 50% of them said they would take multiple drugs including antibiotics, antispasmodics etc., each time they have an attack
  • 41.6% opted for diet change or probiotics for each attack

Every food-borne illness outbreak should be treated to its source

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Recently, the CDC investigated a multistate outbreak of E. coli in the US and sourced it to Romain lettuce grown from the Yuma, Arizona growing region, although no particular grower, supplier, distributor, or brand has been identified. Further to this, the CDC issued an advisory for the consumers as well as retailers and restaurants.

For consumers, the CDC has recommended that they should �ask retailers where their romaine lettuce was sourced from and not eat or buy chopped romaine lettuce from Yuma, Arizona. If you have already bought products containing chopped romaine lettuce, such as bagged salads, salad mixes or prepared salads, throw them away and do not eat them�. Similarly, the CDC has asked retailers, restaurants, and other food service operators to not sell or serve any chopped romaine lettuce from the winter growing areas in Yuma, Arizona. If the source of the chopped romaine lettuce cannot be determined, then it should neither be sold nor served.

Food adulteration is not uncommon in India. Stories of food adulteration, are often covered by media. Milk and milk products, food grains, pulses, flour, condiments, sugar, spices and condiments, vegetables, salt are amongst the most common adulterated foods. The last major food recall across the country perhaps was for Maggi Noodles in 2015 due to lead content beyond the permissible levels.

In India, most cases of food contamination are passed off as food poisoning. The patient is treated for his symptoms and the matter ends there.

The Food Safety and Standards Authority of India (FSSAI) has issued guidelines for food recall by food business operators (FBO). Released last year, these guidelines require all FBOs engaged in the manufacturing, or importing, or wholesale supply of packaged food products to have a recall plan. An FBO is a person who carries on any activity related to manufacture, process, packaging, storage, transportation, distribution or import of food or provides food services. However, FBOs in food retail service sector (such as restaurants, caterers, take-away joints, etc.) who are not engaged in the foregoing activities are not required to have a recall plan.

The onus is on the FBOs to have a recall plan and implement it. Is there a system in place to check if these guidelines are implemented, if at all in the first place and then how stringently are they being implemented? To ensure food safety and thereby public health, there should be no exemptions to these guidelines.

Food adulteration�is a punishable offence under the Indian Penal Code: Adulteration of food or drink intended for sale (IPC 272) and sale of noxious food or drink (IPC 273).

Every food-borne illness outbreak should be treated to its source like in the US and an advisory or health warning issued for the general public.

When will we reach such a level in India?

Dr KK Aggarwal

Padma Shri AwardeeVice President CMAAOGroup Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA