Q: My father was suffering from severe acidity, gastritis, constipation, fullness in stomach, dysentery since the last one and a half years. I had consulted a number of surgeons. Had undergone a lot of tests like endoscopy, ultrasound, cholonoscopy etc apart from the regular blood, stool, urine tests. All the reports are said to have shown normal results. And the last contacted doctor said that it is only a functional problem and need to take acre of food. He prescribed the following tablets: Pantocid-40 mg (1 month), Tagon-6 mg (45 days), Tryptomer-10 mg-(2 months). Luckily, during all the above medications he does not have any of the above problems and was comfortable with taking any food including milk etc. Presently all the medications have completed. But he often is facing such similar problems. The doctor says to continue the medications. I request you to please advise whether he should take all the above medicines as earlier or should change over to any other prescription? Again I came to know that Tryptomer should not be prescribed a long more as he is not suffering from any depression.

A:Your father is likely suffering from irritable bowel syndrome. It is a is a functional GI disorder characterized by abdominal pain and altered bowel habits in the absence of demonstrable organic pathology. To diagnose IBS, one has to exclude underlying organic pathology and IBS remains a clinically defined illness. The Criteria for the diagnosis of IBS require that patients must have the following continuous or recurrent symptoms for at least 3 months: a) Abdominal pain or discomfort characterized by the following: -Relieved by defecation -Associated with a change in stool frequency -Associated with a change in stool consistency b) Two or more of the following characteristics at least 25% of the time: -Altered stool frequency -Altered stool form -Altered stool passage -Mucorrhea -Abdominal bloating or subjective distention Successful management relies on a strong patient-physician relationship. The patient should be reassured that the absence of an organic pathology indicates a normal life expectancy. There will be expected chronicity of symptoms with periodic exacerbations and the patients have should know that stressors increase symptoms and they have to use avoidance techniques. Diet: -Fiber supplementation may improve symptoms of constipation and diarrhoea. Treatment has to be individualised because few patients experience exacerbated bloating and distention with high-fiber diets. Polycarbophil compounds may produce less flatulence than psyllium compounds. -Judicious water intake in patients who predominantly experience constipation is recommended. -Caffeine avoidance may limit anxiety and symptom exacerbation. -Legume avoidance may decrease abdominal bloating. Drugs: A variety of new drugs like Peripheral opiate narcotic antagonists that modulate visceral nociception without a central effect (Fedotozine, Trimebutine), Serotonin (5-HT4) agonists which stimulate colonic transit (Tegaserod, Prucalopride); Somatostatin analogues (Octreotide) increase rectal compliance and may accelerate intestinal transit; Muscarinic receptor antagoniststhat inhibit intestinal motility and possibly secretion etc. are available. You need to consult a gastroenterologist in whom you have faith and follow his advice.