State-of-the-art of irritable bowel syndrome and inflammatory bowel disease research in 2008

Abstract

Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are two of the leading causes of chronic intestinal conditions in the world. This issue of World Journal of Gastroenterology (WJG ) presents a series of papers from world experts who discuss the current knowledge and opinions on these important conditions. Although great strides have been made in the diagnosis, treatment and pathology of IBS and IBD; much has yet to be explained. The etiologies and risk factors of these multifactorial conditions remain elusive. Specific diagnostic biomarkers need to be developed and safer treatments developed. The burden of IBS and IBD on the healthcare system is felt with repeated medical care visits and high costs. IBS and IBD patients can account for 30%-50% of office visits at gastroenterology services/clinics. Over one million people have IBD in the United States, with 30 000 new cases being diagnosed every year. One-quarter million people in the UK are afflicted with IBD. The cost of medical care in the United States for IBD is estimated to be $1.8 billion/year. IRRITABLE BOWEL SYNDROME (IBS)Incidence of IBS IBS is a global problem and is more common in women than men. In developed countries, the prevalence of IBS ranges from 3%-25% of adults [1][2][3][4] and in the United States, IBS affects 15 million adults [5] . In the United Kingdom, IBS affects 10%-15% of the adult population [6] . The cost of direct and indirect medical care for IBS reached over $200 billion dollars in the United States [5,7] . Diagnosis of IBSAs there are no biologic markers for IBS, the diagnosis is usually based on symptoms and exclusion of other known causes of intestinal distress [6] . Unlike IBD, IBS does not cause severe inflammation, ulcers or other structural damage that aids the diagnosis of IBD. IBS is a functional disorder characterized by abdominal bloating, flatulence, abdominal pain and bowel dysfunction. The varying nature of symptoms and lack of structural abnormalities presents a diagnostic challenge. There are three main types of disease phenotypes: diarrhea-predominant (IBS-D), constipation-predominant (IBD-C) or alternating diarrhea-constipation (IBS-A). The diarrhea-predominant type is more common (48%) in males, whereas constipation-predominant (39%) or alternating types (48%) are more common in women [1] . Several tools (for example, Rome Ⅲ, Manning criteria) have been developed to standardize the diagnosis of IBS. Most of the historic research has been focused on the pathophysiology of diarrhea, but constipation has not been as well described. The review by McCrea and colleagues in this issue summarizes our current knowledge about the physiology and pathology of constipation [8] . The prevalence of constipation ranges from 15%-25% in the general population and is more common in women than men and in ages over 70 years old [9] . The typical definition of constipation (less than three stools/week) may not be a sensitive measure for this condition, as individuals vary widely in their own bowel habits. ...

Impact of Shiftwork on Irritable Bowel Syndrome and Functional Dyspepsia

“…The altered motility, visceral hypersensitivity, dysfunctional brain-gut interaction, low-grade mucosal inflammation, genetic factors, food allergies, and altered bowel microflora can give rise to the characteristic clinical symptoms of IBS (25). Some studies incited the psychosocial aspects of IBS and FD, revealed altered GI symptoms of rotating shift workers, as a part of a various symptoms (26). Furthermore, several studies have reported a higher prevalence of GI symptoms such as diarrhea, bloating, and heartburn among the rotating shift workers compared to daytime worker (27, 28).…”

The role of primary care physicians in early diagnosis and treatment of chronic gastrointestinal diseases

“…The prevalence of IBS ranges from 3%–25% of adults and causes much morbidity and cost in terms of lost time at work and drain on health resources 86. Because the symptoms of IBS are common to a number of other GI conditions, IBS was long considered a “diagnosis of exclusion”, leading to excessive testing of patients with characteristic symptoms.…”

Moxibustion for Diarrhea‐Predominant Irritable Bowel Syndrome: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

“…The direct and indirect healthcare costs related to IBS in the United States have been steadily increasing and amounted to 1.35 billion dollars in 2003 [ 6 ]. The worldwide health costs associated with IBS are estimated to exceed 200 billion dollars [ 7 ].…”