The irritable bowel syndrome. A clinical review and ethical considerations

Jb, Kirsner

doi:10.1001/archinte.141.5.635

Cited by 19 publications

(4 citation statements)

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“…The theory that the gut is hypersensitive is old, 3 but it has become the dominant hypothesis 53 . It can embrace other theories that irritable bowel syndrome is due to diet, 54 primary motility disturbance, 55 , 56 psychosocial distress 57 or infection 58 ,.…”

Section: Education and Reassurancementioning

confidence: 99%

“…Ignorance breeds contempt. In the past, some inexperienced hospital doctors have labelled patients complaining of irritable bowel syndrome symptoms as ‘crocks’ and ‘neurotics’ 3 . We have since learned much about the prevalence, prognosis and clinical presentation of irritable bowel syndrome and these data provide clues that help us to manage the disorder.…”

Section: Introductionmentioning

confidence: 99%

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The treatment of irritable bowel syndrome

Thompson¹

2002

Aliment Pharmacol Ther

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SUMMARY The efforts of clinical researchers, lay organizations and pharmaceutical companies have increased the public profile of irritable bowel syndrome and made it a respectable diagnosis. Diagnostic symptom criteria encourage a firm clinical diagnosis, which is the foundation of a logical management strategy. This begins with education. Reassurance that no structural disease threatens should be tempered with the reality that symptoms are likely to recur over many years. Patients expect diet and lifestyle advice, even if this is not specific to irritable bowel syndrome. Only a few of those with irritable bowel syndrome see doctors, and even fewer see specialists. Therefore, the treating physician should ascertain the reason for the visit, the patient's fears and the presence of any comorbid illness, such as depression, that might require treatment in its own right. No drug treatment is useful for all of the symptoms of irritable bowel syndrome, and many patients require no drug at all. If used, drugs should target the predominant symptom. Alosetron, a 5‐HT3 antagonist, is effective in treating women with irritable bowel syndrome who also have diarrhoea. Tegaserod, a 5‐HT4 agonist, is useful for women with irritable bowel syndrome who are constipated. Most patients with irritable bowel syndrome need psychological support. Reassurance, discussion and relaxation techniques can be provided by the family doctor. Difficult psychopathology may require referral to a mental health professional, and the gastroenterologist can settle diagnostic uncertainties. In all cases, successful treatment depends on a confident diagnosis and the strength of the doctor–patient relationship.

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Section: Education and Reassurancementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The treatment of irritable bowel syndrome

Thompson¹

2002

Aliment Pharmacol Ther

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“…More than 70 years ago, Bockus and others (1928) suggested that functional gastrointestinal symptoms were related to an imbalance or dysfunction within the ANS. Twenty years ago, Kirsner (1981) theorized that IBS symptoms were due to several patterns of ANS alteration, including "ANS overreactivity." A series of laboratory investigations led by various researchers has indicated that, at least for a subset of patients with functional bowel disorders (e.g., functional dyspepsia, IBS), ANS dysfunction may be present (Hausken and others 1993;Lindgren and others 1991;Camilleri and Fealey 1990;McAllister and others 1990).…”

mentioning

confidence: 99%

Comparison of Autonomic Nervous System Indices Based on Abdominal Pain Reports in Women with Irritable Bowel Syndrome

Burr

Heitkemper²,

Jarrett³

et al. 2000

Biological Research For Nursing

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Abdominal pain is an important symptom in irritable bowel syndrome (IBS), but patients report typical pain intensities ranging from mild to very severe. In a sample of women, the authors sought to determine whether measures of systemic autonomic activity are related to self-reported pain intensity and the occurrence of pain in the postprandial period. One hundred and six women with IBS and 41 controls completed bowel symptom and psychological distress questionnaires and wore 24-h Holter electrocardiogram monitors to estimate global heart rate variability measures of parasympathetic activity and sympathetic nervous system/parasympathetic nervous system balance. About one-third of the IBS sample reported severe or very severe abdominal pain (n = 34/106), and about one-half of the IBS sample reported postprandial pain (n = 52/106). Even after statistically controlling for age, body mass index, and psychological distress, vagal heart rate variability measures were markedly lower in women reporting high pain (P < 0.01) and markedly higher in women reporting postprandial pain (P < 0.02). The vagal component of heart rate variability appears to be reduced in women with severe abdominal pain, especially in those whose pain is not postprandial.

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“…Irritable bowel syndrome (IBS) is characterized clinically by abdominal pain and altered bowel habits (Maxwell et al, 1997) and may include symptoms such as dyspepsia, flatulence, nausea, cramping, constipation and/or diarrhoea (Kirsner, 1981). Although there is considerable symptom overlap with organic abdominal disease and other functional gastrointestinal disorders (Talley, 1998), reliable diagnostic criteria for IBS are available (Manning et al, 1978;Thompson et al, 1992).…”

Section: Introductionmentioning

confidence: 99%