But according to gastrointestinal motility specialist Henry C. Lin, associate professor of medicine in the Keck School of Medicine of USC, the idea of a bacterial origin of IBS represents a major change in thinking.
Writing in the Aug. 18 issue of JAMA
proposed that ordinary bacteria normally confined to the large intestine may expand into the small intestine, prompting uncomfortable bloating and gas after meals, a change in bowel movements as well as an immune response that may account for the flu-like illness so common in the IBS patient, including such debilitating symptoms as headaches, muscle and joint pains and chronic fatigue.
For more than a dozen years, Lin
has searched for a common thread to account for the symptoms in IBS
Studies indicate 92 percent of IBS patients report bloating after they eat, a symptom he
saw again and again in his
While many physicians believe that IBS-related bloating is perceived and not real, Lin
noted that recent studies of IBS patients show that their abdomens do become measurably more distended than those of healthy patients.
With the symptom of post-meal bloating in mind, Lin began the quest for the cause of IBS by considering the problem of increased intestinal gas.
Gas comes about when gut bacteria ferment food in the intestinal tract.
There are plenty of organisms in the gut, where bacteria may number 100 trillion.
Bacteria perform a variety of valuable services in the large intestine, according to Lin
"But we believe problems may start when bacteria set up shop in the small intestine where they are normally scarce.
Usual medical tests such as endoscopy cannot detect this problem in most patients," he
However, a breath test can be used to indirectly tell if too many bacteria are in the small intestine.
In this test, the patient ingests a syrup containing the sugar lactulose.
Over the next three hours, the gaseous products of bacterial fermentation of this sugar may be measured in the exhaled breath.
In a 2003 paper authored by Lin and his research partner Mark Pimentel of Cedars-Sinai Medical Center, 84 percent of IBS patients were found to have abnormal breath test results suggesting small intestinal bacterial overgrowth.