DR MAX PEMBERTON: The major cause of IBS that’s nothing to do with diet. I see too many patients living in misery who are dismissed as ‘neurotic’. Here’s what you must discuss with your doctor

Think about how many people you know who suffer from their intestines. The bloating, the cramps, the running to the bathroom, the awful mornings spent in pain have doubled.

Irritable bowel syndrome (IBS) alone affects around one in five people in the UK, but for many the reason they suffer remains frustratingly elusive.

They were examined with binoculars, scanned, poked and prodded. They cut out gluten, dairy, and anything else a well-intentioned friend might find helpful once reading. And still no one thought to ask them about their childhood. But new research suggests this might be just the right place to start.

As a psychiatrist, I have seen this pattern more times than I can count. Patients with IBS are often referred to specialists like me because they develop depression, anxiety, or eating disorders as a result of their gut problems. They come with a long and inconclusive medical history, years of gut problems that no one can explain, and we go through this together.

And then, almost as an aside, a different kind of story begins to emerge: a difficult beginning; a struggling parent; a home that feels unsafe or unpredictable for a young child; parents who argue a lot; abuse; neglect

Most people with IBS know that stress makes their symptoms worse; But what medicine pays much less attention to is not the stress of today, but the stress of 30 or 40 years ago. It turns out there may be good scientific reasons why early history is so important.

A new study from New York University published in the journal Gastroenterology contains findings that will stop any gastroenterologist.

We know that early-life stress can increase the likelihood of anxiety and depression in adulthood.

But what this latest research shows is that the effects of childhood stress extend beyond the brain.

Researchers have found that stress early in life (from birth to the early years of school) can fundamentally change the way the gut and brain communicate with each other, increasing the risk of digestive problems that can last for decades. And we’re not talking about minor tummy troubles. We’re talking chronic abdominal pain, constipation and IBS.

To understand why, you need to know that the gut and brain are in constant, two-way communication known as the ‘gut-brain axis’.

The two talk to each other at all hours of every day (via a complex system of receptors and nerve signals, and even the vast community of bacteria, viruses, and fungi that is our gut microbiome).

If something disrupts this relationship early in life, the consequences can be severe.

Digestion slows down or speeds up irregularly. Pain signals are strengthened. Research also suggests that early stress alters the gut microbiome, another way a difficult childhood can leave its mark. The intestine actually becomes delicate and miserably tender.

To test this, the New York University team separated young mice from their mothers at intervals each day, mimicking the kind of disruption and insecurity that early adversity can create.

When these animals reached adulthood, they exhibited higher anxiety and were significantly more prone to intestinal pain and intestinal dysfunction than young mice not exposed to the same stress.

The way this impairment expressed itself also differed between genders; women were more likely to have looser stools and men were more prone to constipation; This will sound familiar to any clinician who cares for large numbers of patients with bowel problems.

Researchers also found that different symptoms arise from different biological pathways. Intestinal pain and motility problems, it seems, are not two sides of the same coin, as is often assumed.

This is extremely important; suggests that the same drug or intervention is unlikely to help everyone with a gut-brain disorder and that we will need more personalized approaches.

The findings in mice were later supported by two large studies in children conducted by the same research group. The first tracked more than 40,000 Danish children over the age of 15 and compared children born to mothers whose depression was untreated during or after pregnancy with those born to mothers who had no depression or whose depression was treated.

Children whose mothers had depression but did not receive treatment were much more likely to be diagnosed with digestive disorders such as constipation, colic and IBS. The worse the mother’s mental health, the greater the risk to the child’s gut.

A second study in the US, involving children aged nine and ten, examined the full spectrum of adverse childhood experiences, from neglect and abuse to having a parent with mental illness.

Any type of early stress was linked to a higher likelihood of gastrointestinal problems. It didn’t matter what kind of stress it was.

Lead researcher, pediatric gastroenterologist Professor Kara Margolis, put this clearly.

He said doctors should not just ask about current stress levels when a patient comes in with bowel problems, but what happened in childhood is just as important and is something medicine needs to take much more seriously.

Pediatric gastroenterologist Professor Kara Margolis says when a patient comes in with bowel problems, doctors should ask them what happened in childhood.

And yet IBS is still often dismissed as a neurotic complaint, as if its partly psychological nature somehow makes it less deserving of appropriate care. A brochure is distributed and sent to patients.

I have seen many spiral into severe depression or starve themselves to a dangerous weight after years of cutting out food groups in desperation because no one was taking their symptoms seriously enough to provide appropriate support.

Just because something has a psychological component doesn’t make it less bad. This is what mental health stigma looks like hiding in a gastroenterology clinic.

None of this means that gut problems are inevitable for anyone who’s had a difficult start in life, or that they can’t be addressed.

For example, psychological interventions such as CBT can have dramatic and lasting benefits for people with IBS.

But this new research suggests that for people whose gut problems stem from early adversity, more targeted approaches—approaches that directly address the original trauma—may be more effective.

What this means is; The next time a patient sits down before a doctor and describes years of unexplained intestinal problems, the most important question may not be what he ate, but what happened to him so long ago.