FlyRI and The Curse of the Irritable Bowel – Drs. Ed Iannuccilli & Tom DeNucci, gastroenterologists

by Drs. Ed Iannuccilli and Tom DeNucci, Gastroenterologists

We have seen many wonderful and clever ads celebrating our airport’s success in Rhode Island. Appropriately so. Like those who have traveled through T. F. Green, we are happy and proud to call it ours.

We were surprised by a recent ad that highlighted the connection between irritable bowel syndrome (IBS) and how travel, especially delays, can trigger it. The ad pointed out that choosing Logan Airport instead of T.F. Green International Airport in RI could be one of the triggers for IBS. Showing travelers clutching their midsections, it is titled “Irritable Boston Syndrome” or I. B. o. S.

As physicians specializing in gastroenterology and having treated many patients with this troublesome disorder, we can assure you that it’s not a problem to be taken lightly. We wouldn’t be who we are if we did not take this opportunity for a little education, as so much is misunderstood by IBS. So…

In our years of practice, we can attest to the frustration, exasperation, and sometimes helplessness caused by its consequences. It ain’t fun.

Irritable Bowel Syndrome (IBS) is a common disorder that affects up to 15% of people. Symptoms include cramping, abdominal pain, bloating, gas, diarrhea, urgency, constipation, or a combination of these. As a chronic condition, IBS requires ongoing, long-term management.

Many people experience severe symptoms that require medical treatment and counseling. Some can manage their symptoms through diet, lifestyle changes, and stress reduction. Rest assured, IBS does not, however, increase the risk of colorectal cancer.

Medical treatment of IBS has not changed much over the years. Unlike other gastrointestinal illnesses, where there are multiple new medications, such as ‘biologics,’ which may alter inflammation in the gut, the medications for IBS are mostly old school, like psyllium fiber, or probiotics. Mild gut “anti-spasm” meds have been around for years and are sometimes used, but they are not a cure-all. Yes, there are some newer and expensive prescriptions for the diarrhea or constipation, but counseling and lifestyle changes are the mainstay.

The exact cause of IBS isn’t known, but certain factors may play a role. They include disrupted intestinal muscle contractions, nerve dysfunction, poorly coordinated signals between the brain and the intestines, and bacterial overgrowth in the gut.

Symptoms of IBS can be triggered by:

Food. Many people have worse IBS symptoms when they eat or drink certain foods or beverages. These may include wheat, dairy products, citrus fruits, beans, nuts, cabbage, milk, and carbonated drinks.

Stress. Most people with IBS experience worse or more frequent symptoms during periods of increased stress. But while stress may make symptoms worse, it doesn’t cause them. Keep in mind that we never saw a patient who did not have stress, whatever the origin.

Risk factors. You’re more likely to have the syndrome if you:

Are young. IBS occurs more often in people under age 50.

Are female. In the United States, IBS is more common among women.

Are a Gastroenterologist, or

Have a family history of IBS. Though not proven, genetic factors may play a role.

And here is what concerns us about the ad.

Many of those with IBS have disrupted lives because of the symptoms.

Those with moderate to severe IBS report an inferior quality of life. Research indicates that those with IBS miss three times as many days from work as those without bowel symptoms. We have observed several things patients do because of their symptoms, such as being sure to know where the bathrooms are on their way to work – and if they are open. Or buying a camper so that you can stop anywhere you need if symptoms worsen.

Here is a scenario we heard often.

“Doctor, I was about to give a major presentation at work. After my morning decaf coffee (I dare not eat), I heard a gentle rumble, then it grew into a gas-fed cement mixer filled with rocks and rabid raccoons. I took my IBS pills and rushed to work.

On my way, even though the distance was not far, urgency hit, and I hit the gas (no pun intended). With no police officers around, I had to be a bear behind the wheel. I squeezed and pulled into a coffee shop.”

We knew what was coming as we had heard comparable stories often.

“There was a line. I asked the barista if I could move to the front.”

__ “Ya gotta buy something, Lady.”

“This is an emergency!”

“Sorry.”

“Out I ran, squeezing, looking at my phone for the closest Dunkin’ or McDonald’s, establishments known to the IBS world as having clean and available bathrooms, no purchase necessary. I heard a volcano. It was my gut. It was awful.” Her story continued.

It was a false alarm, so back in the car she went, only to stop again at a gas station. False alarm. Then a stop at the hotel with a sprint and the clinch. Uh, OK. False alarm again.

She finally reached her job, late, now more stressed, and sweating. She burst into the conference room. “Sorry I’m late!” She announced to the room full of suits. “Traffic was, ah, ah, intestinal. I mean, internal. I mean, intense. I mean extreme, extremely intestinal.”

The clients were confused. Her boss looked mortified. And her stomach chose that exact moment to let out a sound that resembled the groan of a dying whale.

“Technical difficulties,” she said weakly, clutching her presentation materials across the belt line. “Shall we begin?”

She nailed the presentation, got the contract, and celebrated that evening at home with a cup of tea and the comfort of her hot water bottle squeezed softly around her distended abdomen.

So! Witty, clever – or not – the irritable bowel metaphor in the T. F. Green ad may not be the best example for travel at an airport other than Green. Those suffering might ask you to reconsider.

We much prefer “FlyRI”!

Drs. Ed Iannuccilli and Tom DeNucci, Gastroenterologists

___

Publisher’s Note: We contact the public relations department at T. F. Green for a comment about our concerns about the ad – to no response.