This is the second of a two part series in which we're exploring the underlying differences between Gastroenterologists and IBS Experts. The differences are significant and a deeper understanding of the various approaches to your health will help you to make more informed decisions about your own.

IBS Specialty

IBS specialists are experts in irritable bowel syndrome (IBS). A gastroenterologist may diagnose IBS, but that will only tell you what you already know, that your bowel irritates you. To the IBS specialist the label of IBS only serves as a starting point for further investigation, nothing more.

The IBS specialist focuses on assessing and diagnosing the cause of your digestive problems, not on the gross structural integrity of the digestive tract. Rather than focusing on the patients symptoms, or simply treating the symptoms, the IBS specialist is devoted to identifying the condition or conditions in the patient that are causing the symptoms.

There are literally hundreds of different causes of IBS and the digestive problems associated with IBS. An IBS specialist does not have any idea about how they will treat an IBS patient when they first meet that patient. Patients with identical symptoms may have radically different causes for those symptoms. An IBS specialist focuses on the detective work required to develop the proper treatment plan for each unique patient.

This process involves a detailed evaluation of how the body is responding to the foods in the diet (food allergies, intolerances, and sensitivities), and a thorough assessment of the profound ecosystem (including probiotics, yeast, bad bacteria, and parasites) that is contained within the digestive tract. It may also involve evaluating enzyme production, acid production, and the overall functioning of the digestive tract.

IBS specialists do not do what gastroenterologist do, and gastroenterologists do not do what IBS specialists do. These are completely different specialties. There is only a very tiny amount of overlap with regard to stool testing. But even this is extremely minor as the IBS specialist utilizes much more advanced stool analyses.

If you have Irritable Bowel Syndrome and continue to see gastroenterologists, then you will continue to get the same kind of testing and treatment that you’ve always gotten even if you go to the Mayo Clinic, or the Cleveland Clinic, or any other big name medical facility or highly regarded expert – because they have a “standard of care” that recommends limiting testing. If that hasn’t helped, or you’d simply like to begin your journey with a different approach, then you need to see an IBS specialist. Your experience will be very different, which makes it far more likely that the outcome will be very different.

This is the first of a two part series in which we're discussing the underlying differences between Gastroenterologists and IBS Experts. The differences are significant and a deeper understanding of the various approaches to your health will help you to make more informed decisions about your own.

Part 1 - Gastroenterology

People often make assumptions about medical specialists and their areas of expertise. This is certainly true with gastroenterology, where many people assume that gastroenterologists are experts in all things related to the digestive tract.

Gastroenterologists are experts in diseases of the digestive tract, not syndromes or symptoms. While Gastroenterologists do primarily pay attention to the digestive tract, there are some surprising gaps in their training on the science of digestion. Gastroenterologists primarily focus on performing colonoscopies and upper endoscopies. They may also do other imaging work of the GI tract, such as an ultrasound, CT scan,MRI, x-rays, and even “pill cameras”. And they may perform studies that assess the motility of the digestive tract. Therefore, if you go to a gastroenterologist your diagnosis will be based on this testing.

Notice that all of the things mentioned so far are visual exams. Gastroenterology is primarily a specialty in assessing the structure of the digestive tract. Gastroenterologists are focused on diagnosing ulcers, polyps, cancers, and other physically apparent abnormalities of the digestive tract.

A gastroenterologist may run a stool test for pathogens such as giardia, salmonella, and hemorrhagic E. coli, although any doctor can test for these. However, H. pylori may be assessed via a biopsy done during an endoscopy.

Surprisingly, gastroenterologists do not have training in nutrition or most reactions to foods. And though the digestive tract is the single most concentrated area of immune activity, gastroenterologists have no special training in immunology.

The tools of the gastroenterologist are all very useful tools – they are really important to diagnose cancers, structural problems, certain kinds of infections, and other problems. But the standard of care for problems other than those is purely palliative (also known as care to make you feel better about having IBS). The American College of Gastorenterology recommends (in their 2009 position paper) fiber, lowering stress, and a few drugs. This is where the specialties of gastroenterology and IBS diverge.

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More one size fits most solutions - this time it is the FODMaps diet. The argument is that people have trouble digesting carbs.

But there is plenty of evidence that many people are allergic to some of the foods eliminated in this diet. That point, plus the evidence that many people have allergic reactions to gluten is likely a better explanation as to why.

The cited theory, (that people with IBS have difficulty absorbing certain carbohydrates) doesn't explain the dairy part of the diet at all.

Diet May Provide IBS Relief

Eating guidelines called the low-Fodmaps diet are gaining attention as a way to relieve irritable bowel syndrome. The diet calls for eliminating certain foods, including dairy products, wheat, rye, corn syrup, fruits, artificial sweeteners and vegetables, on the theory that people with IBS have difficulty absorbing certain carbohydrates.

A key quote from a recent Wall Street Journal article sums up the misconception:

"Eventually, many IBS sufferers find they can tolerate many foods on the list as long as they keep the total amount of Fodmaps under a certain level."

"It's not like having celiac disease, where people can't ever eat gluten," says Sue Shepherd, a dietician in Victoria, Australia, who developed the diet in 2001 mainly for patients with lactose or fructose intolerance, but found it worked well with IBS sufferers as well."

Our response: That's because celiacs "can't" eat gluten. Remember, the vast majority of people with celiac disease are asymptomatic.

The article continues...


"GI doctors can also rule out more serious causes of symptoms, such as celiac disease, inflammatory bowel disease or colon cancer."

"We've been missing the boat in not recognizing the role of foods in functional GI disorders," Dr. Chey says. "We'll see much more attention to this in the next few years."

Agreed!
In the same 'Digestive Health Brief', there was this about gluten free:

People who respond to gluten-free diet may not all be celiacs. People with gastrointestinal issues who feel better after going gluten-free do not necessarily have celiac disease, says Washington, D.C.-area gastroenterologist Dr. Robynne Chutkan, who adds the popularity of the diet is more of a trend than anything else.

A blood test and biopsy are used to diagnose celiac disease, and a food challenge can show gluten intolerance, but using a gluten-free diet to lose weight may not be a good idea.

Your thoughts?
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Image thanks to businessinsider.com