"The Heart of the Matter"

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Transcripts: 510-1 to 510-3

Week: 510.1 Guest: Robert Mathieson, M.D. Topic: Irritable Bowel Syndrome - Part One Host: Richard Roeder Producer: Ed Graham

NEMA: This is a three part series on irritable bowel syndrome. My guest is Dr. Robert Mathieson, Chief of Gastroenterology at Union Memorial Hospital in Baltimore, Maryland.

NEMA: Dr. Mathieson, a term that was around a long time ago and I don't hear used much anymore and it seems to be replaced by a new term, is there such a thing anymore as something called a spastic colon or has it been replaced by the term irritable bowel syndrome or are they two different conditions?

Mathieson: You're using very similar terminology for both. They both mean basically the same thing. The problem is that people used to refer to spastic colon as spastic colitis which would imply that there's some sort of inflammation in the bowel, some irritation that might be causing diarrhea and bloating and gassiness in patients and that really sends the wrong message because there is no inflammation in the bowel in irritable bowel syndrome. It's just a condition where there's excessive motility and sensitivity in the bowel so that patient's complaint of diarrhea and constipation and excessive mucous and gassiness and so for that reason we tend to stay with irritable bowel and sort of shy away from spastic colon and spastic colitis and all the old terminology that used to be used to describe this condition.

NEMA: Well, how much of the gastrointestinal tract is considered to be involved with something like irritable bowel syndrome?

Mathieson: For the most part, we tend to view the irritable bowel as a colon type problem but that's not totally true. I mean, irritable bowel can also affect the small bowel as well as the stomach in terms of their motility. Irritable bowel can sometimes affect organs which are not even part of the GI system. People will complain more of urinary tract problems or pelvic problems in relation to irritable bowel. We don't know what the connection is there but there is a greater incidence of complaints in those areas that have nothing to do with bowel functions.

NEMA: Is there a most likely sufferer in terms of race, age, gender?

Mathieson: No. Irritable bowel affects all people, all sexes, races, ages. It affects everybody equally. One of the important things you need to remember about irritable bowel is that it tends to be more of a lifelong process. It's something that oftentimes people have had symptoms of when they were a teenager or in their 20s and it goes on throughout their lives. It's not just something that comes up out of the blue such as an infection or if someone has something bad in them like a cancer or something of this nature. It's a chronic condition.

NEMA: And how much of a role do you believe heredity is likely to play in this? Do the parents of sufferers seem to have also had this problem or brothers and sisters?

Mathieson: I don't think the genetics of this have been worked out but there are some family situations where you will see increased incidence of irritable bowel syndrome in a given family group.

NEMA: Join me for part two on irritable bowel syndrome with Dr. Robert Mathieson.

Transcripts:

Week: 510.2 Guest: Robert Mathieson, M.D. Topic: Irritable Bowel Syndrome - Part Two Host: Richard Roeder Producer: Ed Graham

NEMA: This is part two in a three part series on irritable bowel syndrome. My guest is Dr. Robert Mathieson, Chief of Gastroenterology at Union Memorial Hospital in Baltimore, Maryland. I asked Dr. Mathieson about the influence of heredity on irritable bowel syndrome.

Mathieson: That's not a common situation in terms of the hereditary disposition. It's more unusual but you do see it in families and again sometimes you don't really know if this is genetic influence or is this something in the environment or the diet that that particular family has been exposed to over the years.

NEMA: How much of a role, and I know this is an area of great controversy, different people really have strong feelings on this, different physicians and researchers, how much of a role does anxiety play in IBS?

Mathieson: I think that everyone is pretty much in agreement on the fact that there's no question that anxiety and depression, common psychiatric type of symptoms, psychological symptoms I should say that relate to stress are very commonly seen in patients with irritable bowel syndrome and probably have a factor in terms of its cause and effect. Now that's true for irritable bowel. It's not true though for inflammatory bowel which is the condition that oftentimes gets confused with irritable bowel. Inflammatory bowel disease or ulcerative colitis or Crohn's disease - there is no clear-cut relationship between stress and the cause of that illness so with inflammatory bowel disease, there is no relationship. With irritable bowel, there is a close relationship to stress and various anxiety disorders.

NEMA: What are the treatments or what is the treatment for IBS and how successful is it?

Mathieson: The treatment mainly is to first of all put the patient at ease because most of the time patients come in with these complaints thinking that they have got something terrible going on, that they have cancer or they worry about chronic conditions like colitis and Crohn's disease so you want to reassure them that they don't have these conditions and their condition is not something that's in their head. It is a true physical condition that is related to dietary matters as well as ones stress and anxiety level so the treatment is really directed at diet and relieving stress.

NEMA: And how do you change the diet?

Mathieson: You basically would need to do several things. One is to try to put more whole grain, more fiber in your diet and to eat less in the way of fats. It's been shown that diets that are very high in fat - you distort the motility of the intestine and make it very sluggish so you want to be on a low fat diet and a high fiber diet which is kind of what people are hearing from everybody from cardiologists to whatever - to be on a healthy diet is to be on a high fiber, low fat diet but that also works well with irritable bowel.

NEMA: Join me for part three on irritable bowel syndrome with Dr. Robert Mathieson.

Transcripts:

Week: 510.3 Guest: Robert Mathieson, M.D. Topic: Irritable Bowel Syndrome - Part Three Host: Richard Roeder Producer: Ed Graham

NEMA: This is part three in a three part series on irritable bowel syndrome. My guest is Dr. Robert Mathieson, Chief of Gastroenterology at Union Memorial Hospital in Baltimore, Maryland. I asked Dr. Mathieson about the effect of diet on irritable bowel syndrome.

Mathieson: To be on a healthy diet it to be on a high fiber, low fat diet but that also works well with irritable bowel. You also want to watch out for what we call secretagogues. These are just ingredients that are in foods that may overstimulate your bowel so drinking too much caffeine which comes from coffee and tea and soda might cause increased symptomatology in irritable bowel. Sometimes people note that eating certain spicy foods and things of this nature may cause them to have more symptomatology. Milk may be an important factor. Now milk, of course, is - what we're talking about here is lactose intolerance or milk intolerance. That's a very common problem and can be confused and give you all the symptoms of irritable bowel syndrome so it is important that that is ruled out.

NEMA: You made the point very clearly that people who come to you thinking they might have a much more serious condition, first thing you want to do when you determine they have IBS is to reassure them that they don't have one of those conditions. Can irritable bowel syndrome however be associated with a higher frequency of certain more serious diseases at some time down the line? For example, colon cancer? Is there any increased risk of colon cancer if you have IBS?

Mathieson: There's no increased risk of colon cancer related to IBS but the situation is this - and that is irritable bowel is exceedingly common whereas colon cancer, Crohn's disease, ulcerative colitis and things of this nature are common but they're not that common. So it's quite feasible that you're going to have patients who have symptoms of irritable bowel that may also have these underlying conditions and that is why it's very important to reassure the patient that they don't have these conditions by doing appropriate testing which might include blood tests or various tests that look at your bowel either from an x-ray point of view or from an endoscopic point of view to make sure that things really are okay and that they don't have these more serious conditions.

NEMA: There was a time that the treatment for what was called spastic colon was to remove all the fiber from the diet because it was believed that that was what was causing the problem. Now apparently the opposite is true. When did that change take place and who brought that change about? Why were they so convinced before that an absence of fiber was the helpful treatment?

Mathieson: That's a good question. Actually there's a lot of mythology in medicine. I would have to say that doctors think about maybe things that their parents told them that they should or should not eat and it's the type of thing like with diverticulitis or diverticulosis that you shouldn't eat seeds and nuts and things of this nature. That's often propagated by the medical community towards their patients and there really isn't much evidence to prove that that's true at all. With the fiber business, again studies are conflicting on that in terms of the actual therapeutic effect it might have on irritable bowel but fiber acts sort of as a stabilizing effect on bowel content.

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