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Irritable Bowel Syndrome and Parasites

Symptoms
Abdominal pain, flatulence, diarrhea or sudden urge to defecate are described in the Rome III criteria, and form the basis of the diagnosis Irritable Bowel Syndrome (IBS). This diagnosis is usually made without the use laboratory testing. For that reason, the underlying cause of the symptoms is often missed. It is often overlooked that an infection with intestinal parasites causes identical symptoms to IBS. If you suffer from IBS-complaints, it is advisable to rule out a parasitic infection as well as several other diseases.

The Irritable Bowel Syndrome or infection with parasites?
Approximately 20% of the population of the Western world suffers from intestinal problems. It is important that doctors rule out diseases that cause intestinal problems before issuing the diagnosis IBS. Testing for anemia, lactose intolerance, thyroid disease, celiac disease, pathogenic bacteria, food allergies and so on is of importance. The diagnosis IBS is often made while testing for parasitic infections never took place. In the Netherlands, medical doctors are advised to only test for Giardia lamblia when the symptoms developed after a visit to the (sub)tropics. Testing for D.fragilis and B.hominis are not (yet) standard diagnostic procedures for people with IBS.

Giardia lamblia
The Dutch College of General Practitioners advises to only order a test to rule out G.lamblia infection if complaints started during, or shortly after, a visit to a (sub)tropical region. G.lamblia is a parasite damaging the small intestine. In general practice in the Netherlands, about 6 percent of patients with  chronic intestinal problems are infected with Giardia lamblia. It is of importance to know that the majority of these people became infected within their own country. Children are often infected at school. It is of great importance to detect the infection as quickly as possible. Approximately 80% of patients who undergo a Giardia infection develop post-infectious IBS symptoms and 50% a food intolerance.

The parasites that cause chronic intestinal symptoms.
Dientamoeba fragilis and Blastocystis hominis infect the colon and cause flatulence, abdominal pain, abnormal stool and / or diarrhea. Dientamoeba fragilis dies quickly outside the body. People with IBS symptoms are infected with Dientamoeba fragilis 30% of the time.
Blastocystis hominis is present in 48% of patients with flatulence, diarrhea, nausea and other IBS symptoms. The parasite has 10 different subtypes, some of which cause symptoms. In many cases the symptoms disappear after a successful medical treatment.
Infection with Dientamoeba fragilis and Blastocystis hominis is much more common than Giardia lamblia.
Parasiet.com uses the most accurate DNA testing to identify these parasites.

Intestinal complaints and internal examination
A small portion of the patients with persistent irritable bowel symptoms undergo an internal exam by means of endoscopy. This is specifically indicated when the patient has alarm signals: blood in the stool, fever or weight loss. Endoscopy can only detect serious bowel diseases: ulcerative colitis, Cohn’s disease or colon cancer. However less than 0.1% of the population suffers from these diseases.
It is of great value that physicians focus on the detection of serious diseases. However, it is equally  urgent to detect the causes of  milder symptoms. Symptoms such as abdominal pain, flatulence, incontinence for stool, anal itching, nausea or fatigue decrease the joy of living, create shame and can inhibit social interactions. People with chronic bowel complaints are often incapacitated. Children with  bowel symptoms often perform less well in school.
It is important to realize that infections with parasites or bacteria are not visible during endoscopy exams and cause no visible abnormalities. Only a stool test demonstrates these infections. More than 30% of the patients with chronic intestinal problems are infected with parasites.

Appendix
Rome III criteria for Irritable Bowel Syndrome, IBS.
The diagnosis of Irritable Bowel Syndrome is based on a pattern of symptoms. The Rome III criteria were drawn up in 2007 as the successor of the Rome II criteria. An international team of specialists drew up the list of symptoms en criteria.
a. Symptoms lasting longer than 3 months.
b. A combination of abdominal pain and change in stool pattern and/ or stool structure.
c. Two forms are recognized: the IBS-diarrhea and the IBS-constipation type, which can alternate.

Typical symptoms are:
1. Flatulence.
2. Bloating or abdominal distention.
3. Abdominal pain or discomfort in the abdomen, which decreases after defecation.
4. An abnormal stool frequency: three or more three times per day or less than three times per week.
5. Irregularly shaped, very hard, soft or watery stools.
6. An abnormal passage: sudden urge, incomplete emptying of the bowl or straining while defecating.
7. Mucus in the stool.
 
 The Rome III criteria alarm signals
Alarms can indicate an underlying disease, necessitating pelvic examination.
1. Blood in the stool or anemia
2. Weight Loss
3. Fever

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Thank you for visiting this website. We hope that we have provided you with sufficient information and have answered your questions regarding intestinal parasites. It is our goal to contribute to the diagnosis of intestinal problems, since one in five people suffer from chronic bowel complaints. Stool exams provide a major contribution in identifying the cause of the symptoms. For many people the diagnosis of Irritable Bowel Syndrome, IBS, and testing is of great value since more than 30% of IBS patients are infected with parasites.

Many doctors do not order parasitic tests, the reason is often the unfamiliarity with the subject. Many doctors assume that most people are infected in (sub) tropical regions, and are not aware that infection with parasites is no longer the specialized field of tropical medicine. Through tourism and immigration we all come into contact with intestinal parasites on a daily basis. Children are often contract a infection in kindergarten or school. The laboratory uses advanced DNA testing techniques and offers the test at the lowest possible price.


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