New Straits Times (Apr 29, 02:34 AM)  THE month of April is Irritable Bowel Syndrome Awareness Month, held in recognition of the millions of Malaysians who suffer from this debilitating problem.

"There's nothing wrong with you." Time and again this is the exasperating response Lisa receives from doctors she had visited. Lisa, a 32-year-old homemaker, has been troubled with recurrent bouts of abdominal pain and bloating ever since she can remember.

She has been through the works as far as medical examinations and investigations are concerned - blood tests, X-rays and more recently, endoscopy (an investigative procedure that involved the examination of the inside of her stomach and colon with a tube, at the end of which is a miniature video camera).

So far, all the tests have drawn a blank and yet the pain and bloating continue to haunt her. Some doctors have even suggested that it is all in her mind and have hinted that she should just get a hold of herself and become more stoical.

Rahman, a 41-year-old clerk, has been troubled with recurrent abdominal pain since leaving school. Not someone who is too keen to undergo medical tests, he has gone from one doctor to another, hoping that one of them can cure him without having to undertake any tests.

Rahman's illness has been diagnosed as ranging from stomach ulcer, gastritis and gastric flu to inflammation in his intestines. Somehow, none of the treatments prescribed ever produced sustained relief.

Lisa and Rahman both suffer from ailments that are collectively termed functional gastrointestinal disorders. Essentially, this means that despite the continuous suffering, there is no structural abnormality in their stomachs and intestines.

Conventional medical tests including X-rays and endoscopies will reveal no abnormality. Even if biopsies are taken of the gut and the specimens studied under the microscope, the appearance will be entirely normal.

How then do we reconcile this absence of structural abnormalities with Rahman and Lisa's obvious suffering?

Biopsychosocial disorder is the new medical buzz word to describe functional gastrointestinal disorders. This means that the condition arises as a result of the interaction of biological factors inherent to the patient as well as psychological, emotional and social environment factors.

While conventional medical tools fail to detect any abnormality, sophisticated research tools have demonstrated that patients with functional gastrointestinal disorders experience abnormalities in the peristaltic contractions of the gut.

The gut has also been shown to be increasingly sensitive to various stimuli. For instance, distension of a balloon in the rectum or stomach of someone with this disorder produces pain and discomfort while similar distension in a normal individual does not produce the same unpleasant symptoms.

These abnormalities have to do with complex nervous circuitry of the gut and its intimate connections with the brain. Despite these abnormalities, the digestive processes are not compromised and sufferers do not become malnourished nor do they develop serious complications.

The individual's personality and psychological make-up play a vital role in the condition. Sufferers are often somewhat more highly strung, although this is by no means invariable.

Undoubtedly, symptoms are aggravated during periods of stress. Sufferers will often report that the worst times are during exams, when chasing deadlines or dealing with a difficult boss at the office.

The term functional gastrointestinal disorder is an umbrella term that includes a number of different conditions distinguished by the pattern of the symptoms. These conditions include irritable bowel syndrome, functional dyspepsia, functional bloating, recurrent abdominal pain and so on.

These conditions do not kill or result in the sufferer requiring surgery. What is sometimes worrying is that the symptoms are often similar to those of other potentially more serious ailments of the gut such as stomach ulcer, stomach cancer and colon cancer just to name a few.

With this in mind, investigations are often done more to exclude these other more serious conditions rather than to make a positive diagnosis of functional gastrointestinal disorder for which there is really no confirmatory test.

One of the frequently encountered difficulties among sufferers and doctors alike is to come to terms with the fact that there is a problem despite all tests being normal. This often creates either an air of mystique about the condition or a cynical distrust of the diagnosis.

Some have suggested that condition may be a contrived entity. The overwhelming evidence, however, is that it is a very real condition.

Perhaps the strongest evidence comes from studies investigating the economic impact of this group of disorders.

The economic impact of the irritable bowel syndrome, which is one of the commonest types of functional gastrointestinal disorder, has been extensively studied. In the US, the annual direct costs of irritable bowel syndrome has been estimated to be US$41 billion (RM155.8 billion), a figure which can be considerably higher if indirect costs can also be calculated.

Irritable bowel syndrome is reported to be the second leading cause of absenteeism from school and work, surpassing many other serious conditions. Such is the economic impact that concerted efforts are being made to find effective therapies.

The pharmaceutical industry, recognising the need to provide better treatment options, have invested large sums into research and development with a measure of success. While medication undoubtedly plays a role in the management of functional gastrointestinal disorders, a holistic approach is required.

Lifestyle changes, stress management, relaxation therapy and perhaps a philosophical change in the whole outlook on life are as important in overcoming this debilitating malady.

For further information on irritable bowel syndrome, you can contact your doctor or visit www.ibsandhealth.com.

Enquiries should be e-mailed to epapr@ epapr.com.my or sent to: Gut Talk, c/o Eric Pringle Associates Public Relations Sdn Bhd, Box # 392, Lot 7.20, 7th Floor, Wisma Central, Jalan Ampang 50450 Kuala Lumpur.