In the Office with
Dr. Lin Chang

1. Childhood experiences, early life history of trauma or adversity, and stressors in adulthood are all potential risk factors for developing IBS. While stress can trigger IBS symptoms, IBS itself can also be a significant stressor.
2. Small Intestinal Bacterial Overgrowth (SIBO) presents similarly to IBS, but diagnostic breath tests can be unreliable, as even healthy individuals without symptoms may test positive for SIBO.
3. If treatment for SIBO (e.g., rifaximin antibiotics) does not alleviate symptoms, it is likely not the primary cause of the patient's symptoms. Even when rifaximin is effective, symptoms often return after several months because it is a short-term intervention that does not address underlying causes, such as motility issues.
4. Working with a dietitian to identify consistent food triggers can help avoid an overly restrictive diet in patients with IBS. Restrictive diets often negatively impact microbiome diversity.
5. There is new research on a food intolerance panel for IBS that shows promise, specifically the InFoods IBS panel. In general, however, there is little evidence to suggest most food intolerance or food sensitivity panels are effective tools for patients with IBS.
6. "Leaky gut" refers to increased intestinal permeability which is observed in a subset of IBS patients, particularly those with diarrhea-predominant symptoms or post-infectious IBS. There is some limited evidence to suggest glutamine may help normalize the mucosal barrier in patients with post-infectious IBS.
7. IBS is a real condition with many effective, available treatments. Responses to treatments are highly personalized and education from reputable sources can empower patients to manage their symptoms with the guidance of a healthcare professional.

Lin Chang, MD, is Professor of Medicine and Vice-Chief of the Vatche and Tamar Manoukian Division of Digestive Diseases at the David Geffen School of Medicine at UCLA. She is the Walter and Shirley Wang Endowed Chair in Integrative Digestive Health. She serves as Director of the Walter and Shirley Wang Center for Integrative Digestive Health, Co-Director of the G. Oppenheimer Center for Neurobiology of Stress and Resilience, and Director of the Clinical Studies and Database Core for the Goodman-Luskin Microbiome Center at UCLA. She is also Program Director of the UCLA Gastroenterology Fellowship Program. Dr. Chang's clinical and research expertise focuses on disorders of gut-brain interaction (DGBI), including irritable bowel syndrome (IBS), with particular emphasis on stress, early life adversity, sex differences, and epigenetic mechanisms underlying symptom pathophysiology and treatment response. She serves on the Rome Foundation Board of Directors and previously served as President of the American Neurogastroenterology and Motility Society and Clinical Councilor of the American Gastroenterology Association Governing Board. She is currently an Associate Editor of Gastroenterology.