“It affects 20% of people after meals”


It is one of the most common causes for a visit to the gastroenterologist. In Italy and in the world about 2 out of 10 people suffer from it, mostly women. It is Irritable Bowel Syndrome (IBS), a benign condition often triggered by stress and anxiety, about which little is known but which – according to a recent study published in Nature – affects 20 percent of the world’s population after a meal. “The reasons why this happens are not clear – admits Giovanni Sarnelli, Professor of Gastroenterology at the University of Naples Federico II and member of the Sige, Italian Society of Gastroenterology and Digestive Endoscopy – but they concern the entire Western population and the most advanced countries . This data suggests that factors related to lifestyle and globalized dietary regimes may have a preponderant role, compared to factors related to ethnicity. Furthermore, in recent decades we have witnessed a radical change in the agro-food production processes, with the use of food preservation and refining techniques, which put our digestive system under stress ”.

What is the mechanism behind food-induced abdominal pain? “The study in question – emphasizes Sarnelli – confirms previously reported evidence that indicates that at the base of abdominal pain there is an anomaly in the exchanges that normally occur between immune cells and nerves of the intestinal mucosa. Specifically, some foods stimulate mast cells (immune cells normally involved in allergic reactions) which release excessive quantities of some mediators, such as histamine, which is capable of acting directly on the intestinal nerves causing them to be excessively excited. As a further confirmation of this phenomenon it should also be said that in the mucosa of the intestine of these subjects the mast cells are anatomically located in closer contact with the nerves, further facilitating their stimulation and activating the nerve reflexes that lead to pain. Also, let’s not forget that the gut is our “second brain”. The old adage that goes “think with your stomach” is absolutely true. In fact, throughout the digestive system, from the mouth to the intestine, there is a real nervous system called enteric, which is made up of about 100 million nerve cells (many more than in the spinal cord) organized in a dense and complex matrix on whose functioning the main digestive functions depend. The enteric nervous system is independent of the so-called brain, but at the same time it is an integral part of it because it transmits the sensations and stimuli coming from the intestine, making us appreciate the joy of a delicious meal, or as the study on nature shows, causing sensations unpleasant in some subjects “.

Those suffering from irritable bowel syndrome manifest multiple symptoms: in addition to abdominal pain, a common feature, some subjects complain of “irregularity of the hive with diarrhea – again Sarnelli – constipation or alternation of both”. In other subjects, disturbances such as “abdominal swelling, bloating, nausea and digestive difficulties” may be present.

Although it has a higher incidence in the female gender, Irritable Bowel Syndrome increasingly affects young adults. “In recent years – says Sarnelli – we have witnessed a very fast and radical change in eating habits and food quality. Although a clear causal link remains to be established, it is evident that the increase in symptoms induced by the meal is correlated to the evolution of the processing techniques of agri-food products. To this parallelism it should also be added that in the intestine there is an immune system that has been perfected over the course of evolution to defend us from gastrointestinal infections, which today have dramatically reduced, leaving the system in a state of perennial alert. In simple terms, refined foods and products are introduced which, once they reach the intestinal mucosa, activate some cells of the immune system which release substances capable of stimulating the nerves present in the intestine with the appearance of symptoms “.

This benign condition, which at the origin often has a psychological component, can also suffer from those who have never had intestinal disorders, says the Sige expert who adds: “Various hypotheses have been considered to explain the appearance of symptoms, but more recent studies indicate that gastrointestinal infections are the trigger in about 20% of subjects. The circumstance reported by some patients appears emblematic who, after an episode of acute gastroenteritis (with diarrhea and vomiting lasting a few days), complain of chronic persistence of abdominal pain and alterations of the hive. The Nature study confirms this hypothesis and identifies inflammation of the intestinal mucosa as the triggering factor capable of triggering the onset of symptoms “.

Is it possible to intervene? “A multifactorial pathology such as Irritable Bowel Syndrome must be treated with a holistic approach – again Sarnelli -. The guidelines and common sense indicate that the greatest therapeutic gain is obtained by establishing an empathic relationship between patient and doctor, who has the task of explaining in a simple way the complex mechanisms underlying the symptoms. Thereafter, the therapy may be directed to treat the prevailing symptoms, such as diarrhea, constipation and / or bloating, recommending pharmacological, probiotic and / or targeted nutritional interventions. In the most severe cases, in which the psychosomatic component is predominant, the use of psychotherapy or the use of low doses of serotonergic drugs (antidepressants) can be an additional resource to improve symptoms that dramatically impact the quality of life of millions of patients. On the prevention front, however, it is necessary to know the precise cause of a pathology. Since this is a multifactorial disease that involves alterations in intestinal motility, dietary and immune factors, intestinal microbiota and a strong psychosomatic component, it is evident that prevention measures must necessarily include each of the listed causes “.

To improve intestinal function it is recommended to drink a lot, practice regular physical activity and follow an ad hoc diet. “As a general rule, the habit of consuming small and frequent meals, varying the diet and possibly moderating, rather than completely eliminating those foods that are most annoying, I believe is the wisest choice to recommend. Exclusion diets, on the other hand, do not have long-lasting effects. Indeed, but they expose the subjects to enormous sacrifices induced by deprivation, causing, in some cases, the reduction of some essential elements and nutrients for the organism. Furthermore, some dietary regimens that are followed, and unfortunately also prescribed, have a limited efficacy over time and although patients may report a certain improvement this is due more to a placebo effect than to a real therapeutic effect “.

What does a gluten-free diet entail if you don’t have celiac disease? “According to Google, the gluten-free diet is among the trendiest in the world – remembers Sarnelli – and is followed even when not indicated. The scientific literature has clearly shown that this diet is not effective in subjects suffering from irritable bowel syndrome; it should also be added that gluten-free foods are more caloric and this can lead to an increase in body weight “.


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