“Consuming excess fibre is one of the main reasons for excess gas and bloating”, said Dr Kok-Ann Gwee, a senior consultant gastroenterologist from Singapore and President of the Asian Neurogastroenterolgy and Motility Asssociation, who was here in India recently. He shared his observations of how 86% of rice-eating Singaporeans were troubled by these symptoms when prescibed 2 spoonfulls of bran, considered a healthy dietary supplement in the West. Indeed many who decide to turn health freaks, and start binging on sprouts often land up consulting gastroenterologists for symptoms of bloating and belching. Milk, in those with lactose intolerance, often cause the same symptoms as undigested food in the intestines encourage breakdown by the colonizing bacteria, releasing large quantities of CO2, Hydrogen and methane gases, which stretch the intestines.
Stating that “What suits the western gut may not apply to Asian intestines at all”, Dr Gwee went on to show evidence how the large intestine of Asians moved 2 times more quickly than French or Italian ones, and how Asians with Irritable Bowel Syndrome did not quite fit the western description of the disease according to the “Rome Criteria”, by being more distressed with incomplete evacuation of their bowels than with pain.
Indeed researchers from Asian countries have formed a separate group to study and identify unique features of functional bowel disorders that occur here. Led by Dr Uday C Ghoshal of SGPGI, the Indian workers recently published their observation of 3000 patients from across the country. Males in India seem to suffer, or at least complain, more than females who predominate in other parts of the world, and describe a mixed set of symptoms more commony than the “constipating” and pain predominant forms seen in western counterparts.
The role of diet could be important but not exclusively related to the bowel disorder. Dr Mahmud Hasan, an eminent researcher from Bangladesh, highlighted the overlap with dyspeptic symptoms in patients with IBS in their predominantly rice-eating population. He also drew attention to the possible role of spices, especially chillies, in both aggravating stomach symptoms, as well as increasing rectal sensitivity that give the familiar feeling of incomplete evacuation.
Treating Irritable Bowel Syndrome could be as complex as understanding its myriad causes and patterns. In a sudy described by Dr Gwee, good dieatary advice provided relief in only one-third of patients, most distressed patients requiring medications in addition. A combination of laxatives and antspasmodics provided relief in half. The best results of upto 80% was achieved when all the components of the “syndrome” were tackled, often with the addition of acid-suppressors and stress alleviators to the cocktail.
Functional bowel disorders affect around 10% of the population and constitute an ill-understood poorly managed group of disorders that make many suffer for years. Improved understanding and mangement strategies are finally helping to bring back the smile on the faces of these long sufferers.
As published in HT City( Hindustan Times) dated 7 August, 2011.
well said sir. you have translated the gist of Dr Gwee's talk in understandable form to the public .
ReplyDelete