The treatment of irritable bowel syndrome

Abstract

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.

Pilot study: a randomised, double blind, placebo controlled trial of pancrealipase for the treatment of postprandial irritable bowel syndrome-diarrhoea

“…All patients entered into the study met the Rome II criteria for IBS: 12 consecutive or non-consecutive weeks or more in the past 12 months of abdominal discomfort or pain with two of the three features of (1) relief with defecation, (2) onset associated with a change in stool frequency and/or (3) onset associated with a change in the form (appearance) of the stool 24 36 37…”

“…Other possible therapies have included clonidine,19 cholestyramine,18 Chinese herbal therapy,20 21 cromolyn22 23 and psychotherapy 24 25. Antispasmodic agents such as hyoscyamine and dicyclomine are often prescribed but have not been established to be beneficial and may lose any possible benefit over time 7.…”

Sleep-Related Autonomic Disturbances in Symptom Subgroups of Women with Irritable Bowel Syndrome

“…A comprehensive gastrointestinal symptom profile was obtained when patients completed the Rome II integrative questionnaire at the time of the screening interview. Women were eligible to participate if they met Rome II criteria for IBS and had been diagnosed by a gastroenterologist within a year prior to the study [16,17]. In the event that a potential participant had not been diagnosed within the past year, a gastroenterologist at the Thomas N. Lynn Institute for Healthcare Research confirmed the diagnosis of IBS.…”

Prikkelbaredarmsyndroom in de huisartsenpraktijk

“…22 PDS is een chronische aandoening, waarbij 88% van de patiënten na 8 jaar followup nog steeds symptomen vertoont. 23 Bij slechts een klein aantal van de in de huisartsenpraktijk gediagnosticeerde patiënten wordt een organische verklaring gevonden. Tot nu toe zijn routineonderzoeken naar colorectaal carcinoom, coeliakie of andere mogelijke organische diagnoses niet kosteneffectief gebleken.…”