Dr. Udit Mittal

🧠 IBS is real — but many patients still feel they have to prove it.

🧠 IBS is real — but many patients still feel they have to prove it. In clinic, I often meet patients who have spent months or years feeling dismissed because their scans, blood tests or endoscopy have not shown a clear structural disease. But “normal tests” do not mean “nothing is wrong”. The updated Rome V framework describes IBS and related bowel disorders as part of a group called disorders of gut–brain interaction. These conditions can involve abdominal pain or discomfort, bloating, distension, constipation, diarrhoea, or a mixture of bowel symptoms. Rome V classifies bowel disorders into IBS, chronic constipation, functional diarrhoea, functional abdominal bloating, unclassified bowel disorder, and opioid-induced constipation. One of the most important messages is that IBS should be diagnosed positively and confidently — not as a vague “we could not find anything else” label. That does not mean ignoring red flags. Symptoms such as rectal bleeding, anaemia, unexplained weight loss, nocturnal diarrhoea, new symptoms after the age of 50, or a strong family history of bowel cancer, inflammatory bowel disease or coeliac disease should prompt appropriate assessment. But when the history fits, red flags are absent, and targeted tests are reassuring, patients deserve a clear explanation: IBS can involve altered gut sensitivity, bowel motility, immune activation, microbiome changes, diet-related triggers, stress physiology, and gut–brain signalling. That explanation matters. Because saying “nothing is wrong” can feel dismissive. Saying “your gut is more sensitive and reactive, and we have ways to help” can be validating, reassuring, and therapeutic. Treatment is not one-size-fits-all. It may include dietary strategies, soluble fibre, laxatives, anti-diarrhoeal treatment, antispasmodics, bile acid binders, neuromodulators, gut-directed psychological therapies, or a combination — depending on the symptom pattern and patient preference. IBS is common. IBS is real. IBS is treatable. And patients deserve to be believed. Nuffield Health The Manor Hospital The New Foscote Hospital The Royal Buckinghamshire Hospital Akessa Healthcare Group Linbury Doctors Concierge Medical Practice #Gastroenterology #IBS #GutHealth #DGBI #FunctionalBowelDisorders #PatientEducation #MedEd

High Quality Endoscopy at Royal Buckinghamshire Hospital

If you’re experiencing digestive symptoms, Dr. Udit Mittal, Consultant Gastroenterologist and Endoscopist at The Royal Buckinghamshire Hospital, provides thorough evaluation and tailored management for a wide range of gastrointestinal conditions. Book your consultation with Dr. Udit Mittal today. 📞 Want to learn more or make an enquiry? ➡️ Visit www.royalbucks.co.uk 📧 Email enquiries@royalbucks.co.uk 📱 Or call 01296 678800 to speak with our team #RoyalBuckinghamshireHospital #Gastroenterology #Endoscopy #GutHealth #DigestiveHealth #PrivateHealthcare #Colonoscopy #Gastroscopy #AbdominalPain #PatientCare #Aylesbury #Buckinghamshire #BucksHealthcare".

Fermentation is not the enemy — but in the wrong gut, at the wrong time, it can feel like one.

Fermentation is not the enemy — but in the wrong gut, at the wrong time, it can feel like one. Many patients tell me: “I eat healthy food — lentils, onions, garlic, fruit, yoghurt, wholegrains — but I feel bloated, windy, distended or uncomfortable.” This is where understandinggut fermentationhelps. Fermentation is a normal process. Bacteria in the gut break down certain carbohydrates and fibres, producing gases and short-chain fatty acids. These short-chain fatty acids, including butyrate, are important for gut health, the gut barrier and immune signalling. So fermentation itself is not “bad”. The problem is that in some people — especially those with disorder of gut–brain interaction — normal fermentation can become symptomatic because of: • increased gas production • water being drawn into the bowel • altered motility • visceral hypersensitivity • a gut that is more sensitive to stretch and distension This is why foods such as onions, garlic, wheat, beans, lentils, some fruits, milk, polyols and certain “healthy” high-fibre foods can trigger bloating, cramps, urgency or loose stools in some people. This is also the basis of thelow-FODMAP diet. But an important point: A low-FODMAP diet is not meant to be a permanent “healthy gut diet”. It is best used as a structured, time-limited diagnostic and therapeutic tool — ideally with dietetic guidance — followed by careful reintroduction and personalisation. The goal is not to remove fermentation forever. The goal is to identify which fermentable carbohydrates your gut struggles with, at what dose, and in what combination — while preserving dietary variety and microbiome health. In clinic, I often explain it like this: The same food can be nourishing for one gut and symptom-provoking for another. That does not mean the food is bad — it means the gut’s handling and sensitivity matter. For persistent bloating, distension, abdominal pain, diarrhoea, constipation or food intolerance symptoms, it is important not to self-diagnose everything as “just fermentation”. Coeliac disease, inflammatory bowel disease, bile acid diarrhoea, pancreatic insufficiency, microscopic colitis, SIBO/IMO and other conditions may need consideration depending on the clinical context. Fermentation is biology. Symptoms are biology plus sensitivity, motility, microbiome, diet pattern and the gut–brain axis. That is why personalised, evidence-based care matters. #Gastroenterology #GutHealth #IBS #Bloating #FODMAP #Microbiome #GutBrainAxis #DigestiveHealth