Maggie McKay (Host): Although IBS or irritable bowel syndrome is more common than you might think. It is uncomfortable and reeks havoc on your intestinal tract, but there are ways to control it and treat it. So let's get some insight about irritable bowel syndrome with Dr. SIta Chokhavatia, who is a gastroenterologist and associate director of medicine at Valley Hospital.

Welcome to Conversations Like No Other presented by Valley Health System in Ridgewood, New Jersey. Our podcast goes beyond broad, everyday health topics to discuss very real and very specific subjects impacting men, women, and children. We think you'll enjoy our fresh take. Thanks for listening. I'm Maggie McKay. Thank you so much for being here today. Dr. Chohavatia.

Dr Sita Chokhavatia: Thank you Maggie. And hello to all our listeners.

Maggie McKay (Host): It's great to have you here. Thanks for making the time. Let's just get right to it. aren't many of the symptoms of irritable bowel syndrome normal.

Dr Sita Chokhavatia: Irritable bowel syndrome symptoms usually are abdominal discomfort or pain, so kind of stuff that happens that causes you discomfort, pain in the abdomen or the belly as they say. And also changing in your bowel habits such as constipation or diarrhea. The [inaudible] criteria for diagnosis of eligible bowel syndrome. But the symptoms are so common. Patients may have, excessive bloating, gas. It is seventh most common diagnosis that's made by primary care physicians. So all the symptoms of eligible bowel syndrome tend to occur pretty commonly, at least one in 10. If you look at a prevalence of about four to 11%.

Maggie McKay (Host): And so when should someone question that their symptoms are not normal, and when do they need to see a doctor? How do you know?

Dr Sita Chokhavatia: When one feels very uncomfortable and the symptoms keep reoccurring, it's time to see your doctor. You could go to your primary care physician who may or may not initially take care of the symptoms and then refer you to your gastroenterologist. The specialists are usually called in when you have alarm symptoms. So what do I mean by alarm symptoms? You have constipation, which is lack of bowel movement for many days. If you look at the normal bowel movements, you could have a bowel movement anywhere from three times a day to three times a week. And it all depends upon the individual.

So if you have more than three bowel movements a day, that then means it's diarrhea. If normally you were going once a day or twice a day, and if you don't have a bowel movement for more than a week, when you were going every day, or at least about every other, or third day, it's about time to see the doctor.

Maggie McKay (Host): And what age do symptoms of IBS start Generally?

Dr Sita Chokhavatia: So it's very interesting, symptoms can occur as early as teenage years or even earlier, and it occurs both in men and women. Interesting kind of trivia. It's, known that, you know, women have more symptoms of irritable bowel syndrome than men, especially in say, the United States. However, in certain parts of the world, it was considered. The men might report more symptoms of irritable bowel syndrome, and one of those countries was India. A hypothesis was that maybe the women were not as frequently, visiting their physicians and seeking medical care as the men were, but overall, it's common in both women and men. And as I said, worldwide prevalence is almost 10%.

Maggie McKay (Host): Wow. Dr. Chokhavatia is IBS genetic?

Dr Sita Chokhavatia: There are several patients that may have a family history for irritable bowel syndrome. So oftentimes I'll have somebody coming in and saying, my father or my mother has similar symptoms. There are no specific genes that have been localized for irritable bowel syndrome, unlike other, diseases. We do know that there are certain, associations with loci on genes, but we do not have a single gene that we know to be responsible for having irritable bowel syndrome. What we think is that the environmental factors, so it's more about nurture over nature that guides, the irritable bowel syndrome symptoms.

Maggie McKay (Host): Are there any triggers that can cause IBS to develop?

Dr Sita Chokhavatia: Interestingly, a lot of patients have stressors and they have anxiety. Depression. I usually find that if I talk about anxiety in 2023 after having gone through 2020, 2021, 2022, it'd be like somebody from Mars or Venus that could tell me that they have no anxieties, healthcare related anxieties because we are all so much on edge. So we all have our own anxieties outside of healthcare as well, and stressors, work related stressors, stressors related to family. So I guess there are stressors that can be causing the increase in symptoms, so presbitating exacerbation of symptoms. We do know that IBS irritable bowel syndrome is a mind gut interaction, which means the gut can send, impulses across to the brain, and then the brain can send impulses down to the gut.

And these can then increase or sometimes decrease the symptoms. So some of the treatments that we have are geared towards the central nervous system. There's also celiac disease, which we'll get to I guess later on, but that can be a trigger. So diet can be a trigger. And what we know for sure is there's something known as a post-infectious irritable bowel syndrome. And post-infectious, as somebody going off and traveling, having a prolonged diarrhea illness, subsequently, we know that they can have increased diarrhea, constipation, abdominal discomfort that can last for months, if not years.

And that's IBS post-infectious and it's classified as such. You can also have outbreaks of infections. we know that food related, gastroenteritis occurs, you know, with certain fruits, certain vegetables, with chicken. So you do wanna make sure that when you have your fruits and vegetables, just clean them properly and then if you have, meats, you wanna cook them. So you try and avoid those triggers for, irritable bowel syndrome symptoms.

Maggie McKay (Host): And do you have any suggestions for people who are embarrassed about their symptoms on how to approach the topic with their doctors? Because you know, some people might be hesitant.

Dr Sita Chokhavatia: The GI doctors are, known to be very empathetic. I hope all my colleagues are, some of us are known for being poop doctors, flatologists, like flatus doctors, we deal with gas and belch. So, my niece used to call me a gas doctor. Gastro doctor. So by and large, your physicians, you shouldn't be embarrassed to state your case. You want to make sure that your visit is successful. having all your symptoms related to your food or, specific bowel habits itemized. So when you speak to your doctor, they can actually make some kind of, logical correlations and then they will educate you on this, irritible bowel syndrome.

Because a lot of times we know it's, Long haul. And although there is no increased mortality, we want to make sure that our patients are reassured that this is not pre-cancerous. And we do want to establish a relationship of trust with our patients, so they should not be embarrassed. The most common, symptom that patients are embarrassed by is fecal incontinence. A lot of times they'll come and report diarrhea, whereas actually it's the loss of, control over their stools. So there is no reason to be embarrassed about telling your doctor what symptoms you have.

Maggie McKay (Host): And you mentioned the long haul. Is IBS something you'll always have to live with?

Dr Sita Chokhavatia: There were several studies that are looking at, longitudinal, relationship of, symptoms. And, a study for Mayo Clinic shows that there is no increased mortality, but patients with irritable bowel syndrome can eventually 10, 20 years later, convert from having a constipation to diarrhea with abdominal discomfort. So they do last, they will come back when you're very stressed. So if you have life, you know, stressor event, they may be exacerbated. However, there may be times that you have no symptoms. So again, it's there, in the background. Just because you have IBS does not mean that when you hit 45 years of age, you shall not be exempt from doing a colon cancer screening or that you cannot have other diseases, so you can have coexisting other GI diseases. But the IBS can wax and wain.

Maggie McKay (Host): And how is IBS treated?

Dr Sita Chokhavatia: Interesting. There are several modes of treating the specific symptoms of irritable bowel syndrome. So if you have diarrhea predominant versus constipation predominant. And as I mentioned, if you Google it, you know Dr. Google knows all, and you will be able to find Jerome criteria for irritable bowel syndrome with constipation, irritable bowel syndrome with diarrhea, or a mix where patients have alternating constipation and diarrhea, or sometimes No one bowel, habit is predominant. And in that case, less than 25% of the time, they have neither constipation or diarrhea. So, If you have constipation, then we address that. And, usually there are laxatives over the counter medications.

There was a study from the American College of Gastroenterology that showed that if you ate four prunes or two kiwi fruit, you might ease your, bowel habits. You can also take soluble fiber, which is Metamucil or Bena fiber. Or you could also, take over the counter MiraLax, which is, pegylated laxative. There's also Senna. There are other [inaudibl, but I would stay away from, Unknown, herbs and such because they can cause problems with the liver. If there's diarrhea, then the most important thing is to look at what foods are triggering this diarrhea and stay away from sugar-free, foods.

Because sugar substitutes are kind of like laxative. you can use Imodium, but if you have diarrhea, the best thing to do is first figure out why you're having the diarrhea. So it's better to seek medical attention and then, Have your doctor prescribed medication. We do have a lot of, prescription medicines, but a lot of these medications may not be covered by the insurance and they're kind of expensive. So again, there are other medicines for avoiding, or at least helping ease the spasms that people have with the abdominal pain that are over the counter peppermint preparations that you could use. IB G that you can have. Relief from your. Abdominal discomfort. So, different ways.

If there are other stressors, if there's anxiety or depression, then there are methods to, relieve those by seeing a therapist or following up with a psychologist or psychiatrist. And, the other one piece I wanted to mention was diet. Because a lot of people go online and find a low FOD MOP maps diet, which is fermentable oligo dye, monosaccharides and polyols. So these are foods that when you eat, reach your colon and then they are fermented by the bacteria that are normally occurring in your colon. So when you decrease the amount of substrate that the bacteria can get, you may get decreased amount of gas. There are also, certain other probiotics that patients use, but there are no data that suggest that these might be of help. There are also antibiotics that patients can be given for small intestinal bacterial overgrowth, which can coexist with irritable bowel syndrome or cause some of the symptoms of eligible bowel syndrome.

Maggie McKay (Host): So it sounds like there are so many ways to treat it. You should probably get the information from your doctor depending on your symptoms, if somebody sees blood in their stool, how concerned should they be?

Dr Sita Chokhavatia: Especially if you see something that's out of the ordinary and you see blood in a place where it shouldn't be, which is in your stool, you should be concerned about it. There's several, reasons for having that. It could be something very benign as hemorrhoids and mostly women. So again, it's common in women irritable bowel Syndrome, but they can have constipation and when they strain, they may cause their hemorrhoids to bleed. However, if you see blood, then you definitely want to follow up with your physician and you do not want to ignore it. So seeing it once you can at least mention it to your doctor and they can then review your entire history and decide if there's needs to be other actions that need to be taken.

Maggie McKay (Host): Do you have any suggestions for curbing urgent diarrhea? I know you mentioned a few over the counter things, but when it's urgent, you know, other than staying home because someone might be at work experiencing it, what do you do?

Dr Sita Chokhavatia: In a irritable bowel syndrome with diarrhea. Again, if it's not from small intestinal bacterial overgrowth where we give people antibiotics or it's not related to the diet where they're taking sugar free, foods. I have a lot of patients that come in chewing gum and I ask them if this is sugar free, they'll be like, Hmm, I think it is. And I say, just spit it out right here and now because that may be causing some of your diarrhea. So again, if you have urgent diarrhea, You don't wanna stop it because if you block it and it's infectious in etiology, so it's the cause of the diarrhea is an infection, like a gastroenteritis. You can just make your disease longer.

Your symptoms go on for a longer time, and you might just want it to run its course. You can't start doing a brat diet, that's bananas, rice, applesauce, and toast, because those will bind and cause you not to have as much liquid coming out. In the old days, they used to have these diets where they would have, glucose because if you take that, the water then goes along passively and gets reabsorbed from your colon. So it's oral rehydration therapy. And what I tell most people, especially if they're elderly, anytime you have diarrhea, illness, every time you go and have a bowel movement, please replace that amount of fluid. So drink pedialyte, drink some Gatorade, not the sugar free kind, but do make sure that you do not get dehydrated, so you want to get more fluids in.

Maggie McKay (Host):

When it comes to lifestyle adjustments, you mentioned having less stress and of course diet. Are there other things people can do to control IBS symptoms?

Dr Sita Chokhavatia: So if you come up with a way to decrease the stress, then maybe we can put you up for the Nobel price or something. Otherwise it's, you know, dealing with it. And so a couple of things that you can do is mindfulness. And again, there's several programs you can download off the internet. So mindfulness is one, yoga is the other. Meditation is something that people have resorted to. So there are different ways that you can, you know, diet, anxiety comes with everything that you do, but it's the way you react to your stressors and that's what, you try and get people to realize that most of us have to deal with stress in life and you try to decrease as much of it as you can by having, family, friends, trying to stay happy.

Maggie McKay (Host): You mentioned, maybe three or four certain foods. What are the top ones that people should avoid if they have IBS?

Dr Sita Chokhavatia: I can start off with a four foods Maggie, but I think the most important thing to do is to avoid, getting into a cycle where you are not eating. I have patients that just avoid food and there's actually a disorder that's known as avoidant restrictive food intake disorder, or ARFID. So you can't start with the for diet, which is a fermentable foods, and those are really, good foods because they're fiber, they're broccoli.

If you like broccoli, If you're President Bush, you probably don't eat broccoli, but otherwise you wanna try and stay away from certain fruits and vegetables, fruits that can cause increased gas, and, they're fermentable. So those are things to avoid dairy, you wanna stay away from. Gluten is a big, number one. hot. Button topic. People try and say I'm gluten intolerant, but really very few people have celiac disease, proven with, blood tests or with, endoscopy and biopsies. If it does help to stay away from some of those foods, You stay away from it, but gradually try and bring back one food at a time so you're not getting into a very tight schedule.

You want to enjoy your life and you want to eat food. So again, it gets to be a catch 22 where you then don't have food and get more anxious and more stressed, and then you start losing more weight. So, It's good to avoid dairy. You can stick to almond milk, you can try lactate, for people that are dairy or lactose intolerant, try staying away from wheat or gluten if that's what's causing your symptoms. But then you should follow up with your physician and see if you truly have any kind of specific allergen. And then, like I said, stay away on a low FOD MAPs diet. But again, with the FOD MAPs, you try and introduce foods one at a time.

Maggie McKay (Host): And you mentioned celiac disease. Is that related to, IBS?

Dr Sita Chokhavatia: It's not related as much as, patients with IBS may have celiac disease, if diarrhea predominant, irritable bowel syndrome.. One thing I forgot to mention earlier, the foods to avoid, but then healthy living, which is, not smoking, staying away from, alcohol and then maintaining your idle body weight. And then taking a lot of the over-the-counter medications for pain such as aspirin, Motrin, Advil, oli, ibuprofen, because all of those can trigger some of your symptoms and cause you to get pain as well as sometimes can cause diarrhea. So you wanna try and stay away from those. you really wanna get to your doctor to get yourself tested. If you think, there's a family history for celiac disease, if you definitely notice a correlation with gluten ingestion.

Maggie McKay (Host): Why is colorectal cancer screening so important and who and when should people be screened?

Dr Sita Chokhavatia: So, Maggie, I'll go one better on you. Okay. . So I'll go with five Ws. Colorectal cancer screening is very important because of all the screening tests that are out there, colorectal cancer screening prevents cancer. You get a colonoscopy, your gastroenterologist or your colorectal surgeon finds a polyp and they remove it. You've removed a pre-cancerous lesion and you've prevented cancer. All the other tests that are out there, they actually find cancer, breast cancer screening, prostate cancer screening. So with colon cancer, it's important to get screened so that you prevent cancer, and there's several ways of doing it, but why do you do it?

Because it's the third most common cause of cancer related deaths in both men and women. Almost 50,000 people in the. Probably will die from colon cancer per year. We know that a lot of celebrities have had this, and that brings it to the focus and forefront of a lot of people. Right now when you have, very prominent celebrities diagnosed with colon cancer screening and then, succumbing to it, when do you start doing it? The second W. Average risk. That means no symptoms, no constipation, diarrhea, no blood in your stool, no abdominal pain, no weight loss, no change in your bowel, caliber, average risk, right? And no family history.

You start at age 45. Used to be age 50, but now it's 45 for both men and women. If there is a family history or if you have symptoms, then you might even get it earlier. Who do you. Men, women, over 45, family history patients with what's known as a Lynch syndrome and if they have certain genes. So again, you have to see your physician and they will recommend that for you. And what options do you have? That's the fourth W. It's stool tests, it's virtual colonoscopy or CAT scans. Blood tests mean, plus minus on, how important those are in, Specificity, sensitivity for diagnosis of colon cancer, and then of course colonoscopy.

There are studies that have shown that flexible sigmoidoscopy, which is, just a quarter of the colon that's reviewed also helps prevent colon cancer as do fecal OC blood tests. So whatever tests you get done, that is the best test because we have patients that come in for colonoscopy referrals, and they do not want it done, and they don't do anything about it. In which case, it's a failure for screening. So the best screening test is the one that gets done. And where should you get this? The final W, you go to your primary care and they can refer you to a gastroenterologist or a colorectal surgeon, or they can do the blood test or the stool test or the CAT scan.

But I would prefer either the stool test or the colonoscopy. And there are a lot of healthcare disparities, so when people don't have access to healthcare, you wanna try and bring it to them. And there's several underserved populations that do not have access to screening. So this is so. Very important and we need to address this as society.

Maggie McKay (Host): So how would you do that? I mean, it's not like you can take a mobile van like you can, do you know how dentists do that to underserved communities?

Dr Sita Chokhavatia: Well, They had mailouts that they send out to patients. Getting people to be out there and be an advocate and have, group meetings and, bring this up at several different levels. we are doing a church webinar. We are trying to have several, table set up at the mall at the library because Marsh is Colorectal Cancer Awareness Month. And Valley has a lot of outreach programs to try and address exactly this.

Maggie McKay (Host): That's great. Dr. Chokhavatia. This information has not only been informative, but possibly lifesaving for some people affected by IBS who maybe didn't know all the facts, because there's a lot to know. So thank you so much for sharing your knowledge with us today.

Dr Sita Chokhavatia: Thank you, Maggie. appreciate all your attention to this and, wishing everyone a wonderful day.

Maggie McKay (Host): Thank you again. That's Dr. SIta Chokhavatia. And if you'd like more information about digestive health at Valley or to make an appointment, please visit valleyhealth.com/digestive health or call 201-614-6130. If you found this podcast helpful, please share it on your social channels and check out the full podcast library For topics of interest to you. This is Conversations Like No Other, a podcast presented by Valley Health System. I'm Maggie McKay. Thanks for listening.