In November I wrote about an important study in the Annals of Internal Medicine that demonstrated the effectiveness of an antibiotic for the symptoms of irritable bowel syndrome (IBS).  Dr. Mark Pimentel, the author of the study, is the director of the Cedars-Sinai Medical Center Gastrointestinal Motility Program.  Last year he published a book outlining his theories about the cause and treatment of IBS:  A New IBS Solution.  After reading my post about the Annals article, he kindly asked me to review his book.

The cause of IBS remains mysterious.  Dr. Pimentel makes the astute point that when the cause of a disease is unknown, it is very frequently initially presumed to be psychological.  A generation ago, stomach ulcers were thought to be due to emotional stress.  (They are not.  They are almost always due to a specific bacterium or to anti-inflammatory pain medicine.)  Heart attacks were thought to be more common in patients with the type A-personality.  (They are not.)  The assumption that IBS has primarily psychological causes has stigmatized IBS patients, and has misdirected researchers away from potentially useful diagnostic tests and treatments.

Dr. Pimentel’s central theme is that bacterial overgrowth is a major cause of IBS.  Bacterial overgrowth is a condition that occurs when bacteria that normally live in the colon (large intestine) move into and colonize the small intestine which is normally free of bacteria.  Small intestine bacterial overgrowth can be diagnosed by testing for specific gasses in exhaled breath, and can be treated with antibiotics.  In language aimed for the general public, Dr. Pimentel summarizes the evidence supporting this theory, and details the protocol used at Cedars-Sinai to manage IBS.  The book is also peppered with patient testimonials which help put a human face on a medical problem that is frequently very miserable.

The ideas in A New IBS Solution are an important breakthrough in a very common disease for which treatments up until now have been only marginally effective.  I will certainly recommend the book to all of my patients with IBS.