The Connection Between IBS and GERD

Dietary changes and lifestyle modifications are essential for reducing the frequency of IBS while your are getting the treatment of GERD as IBS and acid reflux are often triggered by the same kinds of foods.

August 7, 2018

Irritable bowel syndrome (IBS) is a common condition that affects the large intestine, or colon. Although it may make you uncomfortable, IBS neither cause inflammation, nor will it permanently damage the colon.
Where as Gastroesophageal reflux (GERD) is the chronic form of acid reflux that may cause significant damage to the tissues and cells of the esophagus over time.
GERD occurs when stomach acids back up into the esophagus due to a poor functioning of lower esophageal sphincter (LES). The LES is a band of muscle that acts as a valve between the esophagus and the stomach. 
In case of patients with IBS, the bowel muscles that are responsible for moving food through the intestinal tract may contract more forcefully or more irregularly. This pushes food through the system abnormally. If waste material moves too fast it can cause diarrhea and if it moves too slow it can cause constipation.
The main symptom of both acid reflux and GERD is frequent heartburn. Other symptoms may include burning in the throat or a sour liquid taste in back of the mouth. Other symptoms of GERD such as symptoms such as coughing, sore throat, and difficulty swallowing are persistent and typically require treatment.
Symptoms of IBS include abdominal pain, cramps, bloating, constipation, diarrhea, and gas. Other symptoms of IBS may include urgent bowel movements or the feeling of incomplete evacuation. 

The IBS/GERD connection:

IBS is classified as a functional disorder in which symptoms are real, but physiological causes aren't easily identifiable. Although the causes of IBS are unknown, it is frequently exacerbated by stress. IBS also often accompanies GERD. Both of these conditions may share common disease mechanisms. This may be due to poor muscle function of the intestinal tract. There may be an incoordination of the muscles that line the esophagus, stomach, and intestines, contributing to symptoms of both IBS and acid reflux.
The food we eat moves ahead through the gastrointestinal tract during digestion process. Usually the rhythmic contractions of the muscles that line the walls of the intestines makes the movement smooth and easy. It can impact the movement of food during digestion and impair the digestion process itself if there is a problem with the muscles. If the contractions are strong, food moves quicker than normal and may lead to diarrhea. If the muscles are weak, the movement is slower or sluggish and can lead to constipation. Improper muscle movement also causes pain and abdominal discomfort.
The nervous system also plays an important role in digestion as it does in all processes of the body. The digestion process is impaired if there is a problem with the signaling between the nervous system and the digestive system.
Problems in signaling can occur due to many triggers like foods against which the body shows intolerance or enhanced sensitivity such as lactose and gluten, psychological stress and hormonal changes.
Individuals with both IBS and GERD report more sleep difficulties and more episodes of abdominal pain than people who just have IBS or GERD alone. There are a variety of individual, intestinal, and environmental factors that contribute to IBS making it a complicated condition than GERD. GERD and IBS are two conditions that overlap in a significant number of patients. if you have GERD, you are at a greater relative risk of developing IBS. Women are more likely than men to suffer from IBS. Often, women will find that IBS symptoms are worse during menstruation as hormones play a role in the development of IBS.

When GERD and IBS Symptoms Overlap:

There are several theories about why there could be an overlap between the two conditions. These explanations include:

Pain sensitivity:

There is a shared reason for both conditions which may be related to the same underlying mechanisms such as visceral hypersensitivity. Patients with either condition may have an altered perception of internal pain making them more sensitive to distress in their gut, whether it is reflux or an irritable bowel causing the trouble.

Symptom confusion:

Some patients with IBS may complain of GERD symptoms but may actually have IBS of the upper gut, which is known as functional dyspepsia. Appropriate testing is required to distinguish between having occasional symptoms and meeting the criteria for having GERD or IBS conditions.
Ambulatory esophageal pH monitoring is usually done to determine if GERD is present. The amount of acid in the reflux material is measured in this technique.
It involves having a small tube inserted via the nose into the esophagus, where it is left for 24 hours while the patient goes about his usual activities.

Condition overlap:

There is also possibility that you may have both conditions, making it hard to know where one set of symptoms ends and the other begins.

GERD, broadly defined:

GERD symptoms vary in severity for most patients. It is possible that IBS like symptoms exist as part of that spectrum for some patients. So you might just have a wider range of GERD symptoms and not have both conditions. However it can be difficult to sort this out. But in this case, treatment with anti-reflux medications may relieve both sets of symptoms.

Complications of IBS:

Alternating diarrhea and constipation can cause hemorrhoids or piles. This can worsen existing hemorrhoids if you already have it. The piles can bleed and cause severe localized pain which makes passing stools an uncomfortable and painful process. Rectal fissures that is cuts in the anal opening may open up due to straining while passing stools.
The constant pain causes stress and anxiety, which only aggravate the existing condition. This has a serious impact on daily life as well as quality of life of an individual. Constant pain and discomfort may lead to a feeling of discouragement and depression. If you are eliminating too many types of foods due to the anxiety that can lead to deficiency of nutrition as you are not getting the essential nutrients from those foods by denying it.

Treatment of IBS linked to GERD:

Treatment of IBS linked to GERD is usually done by eliminating the root cause of the problem. Most chronic diseases develop due to an imbalance in the normal bodily functions. Therefore, bringing back the lost balance is a way to cure a chronic condition.
Different factors may trigger IBS symptoms in different people. For example, things like intestinal infection or medication may cause symptoms in one person, while other people may react to certain foods or stress.
Eliminating H. pylori infections, which is the cause in the majority of the cases, small intestinal bacterial overgrowth (SIBO) and regulating acid production is the key for treating GERD . All of these can be done using a combination of dietary and lifestyle modifications, along with dietary supplements.
Dietary changes and lifestyle modifications are essential for reducing the frequency of IBS while your are getting the treatment of GERD. IBS and acid reflux are often triggered by the same kinds of foods. You need to limit the consumption of foods and beverages that stimulate the intestines and cause diarrhea. These include:

  • Alcohol
  • Caffeine
  • Fatty foods
  • Dairy products as lactose sensitivity is associated with IBS
  • Sugary foods
  • Garlic and onions
  • Spicy foods
  • Tomato-based foods, such as pizza and spaghetti sauces
  • Certain sugars like high fructose corn syrup and lactose
  • Alternative sweeteners such as xylitol and sorbitol
  • Some vegetables like cauliflower, broccoli, cabbage and beans may cause gas and bloating.
  • Carbonated drinks

A diet that is low in FODMAPs (Fermentable Oligo-saccharides, Disaccharides, Monosaccharides And Polyols) may help relieve IBS. FODMAPs are short chain carbohydrates.
Probiotics help in correcting the imbalance in the gut microflora. An imbalanced gut microflora makes it easy for bacteria like H. pylori and SIBO to colonize the gut and cause GERD. Probiotics can also reduce symptoms of GERD related IBS. Probiotic rich foods or a high quality probiotic supplement can be consumed to balance the gut microflora which can works as wonders to the health of the digestive system.
Make mindful eating as a practice which include eating slowly, chewing every mouthful a sufficient number of times and without thinking about anything else. You should enjoy eating your food, enjoying every flavor and aroma of the food. You should also consume smaller meals as well as adequate amounts of water between meals to reduce the likelihood of cramping, constipation and diarrhea.
Add fibers such as flax seeds or psyllium supplementation to your diet to regulate bowel movement and avoid constipation. But, too much fiber should be avoided as it is bad and can itself cause gas and bloating.
Supplementation with vitamin B1 and fish oil can be immensely helpful in GERD related IBS. B1 is necessary to eliminate fatigue that is caused by chronic IBS. Fish oil helps lubricate the gut and reduces inflammation. A well lubricated gut makes it easy for the food to move along easily which can reduce the chances of fermentation of food and resultant gas formation. This eases GERD as well as IBS symptoms.
In addition to avoiding certain foods, people with IBS or GERD may find relief by losing weight, quitting smoking, and learning stress reduction techniques such as deep breathing, exercise, or yoga. Alternative methods like acupuncture and hypnosis have also been found to be effective in treating IBS.
Lifestyle and dietary changes can benefit many people with IBS. But, if you have GERD symptoms as well, certain medications may help that include:

  • Proton pump inhibitors, such as omeprazole, are helpful for GERD sufferers.
  • Antacids may be enough to relieve symptoms for people with occasional mild acid reflux.
  • Anti-gas medications like simethicone (Gas-X) can work for occasional gas, bloating, and indigestion.

Medications that focus on the management of IBS vary greatly depending on whether the main symptoms are constipation, diarrhea, or both. Your doctor can help guide your treatment.
See your doctor for a thorough examination if you have symptoms of GERD, IBS, or other intestinal problems. As most accurate diagnosis is required if you want the right treatment. Depending on your symptoms, evaluation and testing is required to determine your diagnosis and which treatment options are best for you.
The problem may be lactose intolerance, not IBS if trigger foods include dairy products such as milk, cheese, or ice cream.
If cramping or bloating occurs after eating dairy products only, then you should stop eating these foods for a period of two weeks to see if symptoms subside. If symptoms subside after avoiding dairy, speak with your doctor about the possibility of lactose intolerance. If, in addition to dairy other non-lactose foods aggravate your symptoms, you are more likely to have IBS.