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Query: UMLS:C0022104 (irritable bowel syndrome)
 8,033 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Irritable Bowel Syndrome (IBS) is a common functional gastrointestinal disorder, defined as a variable combination of chronic or recurrent gastrointestinal symptoms not explained by structural or biochemical abnormalities. It is attributable to the intestine with symptoms of abdominal pain, altered bowel habits and bloating. The diagnosis is primarily based on typical symptoms and prudent use of investigations to exclude organic disorders. The initial positive diagnosis is accurate and on a longterm follow-up its revision rarely required. A change in its clinical manifestation may imply the superimposition of another disorder. Treatment primarily rely on the confidence in the diagnosis and a strong physician-patient relationship. High fiber diets and bulking agents may be effective in alleviating symptoms. Though antispasmodic, antidiarrheal and psychotropic drugs are repeatedly used in patients with moderate to severe symptoms their effects remain uncertain. Psychotherapy, hypnosis and biofeedback may relief symptoms and may be considered for motivated patients with moderate to severe symptoms.
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PMID:[Irritable colon]. 945 69

The differential diagnosis of chronic diarrhea varies markedly with age. In infants, it is usually a problem with formula intolerance. Because there is up to a 50% crossover intolerance between milk and soy, the infant should be given an extensively hydrolyzed formula. If such intervention is delayed, he or she may develop intractable diarrhea of infancy. Most affected toddlers have either irritable colon of infancy or protracted viral enteritis with low-grade mucosal injury and are consuming hypertonic feedings. In either case, institution of a high-fat, low-carbohydrate diet that includes whole milk often results in significant improvement. Dietary lactose rarely is a problem. A likely cause of diarrhea among children and adolescents is inflammatory bowel disease. With the exception of toddlers, chronic diarrhea suggests the presence of significant organic disease.
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PMID:Chronic diarrhea. 984 71

Constipation, diarrhea, and irritable bowel syndrome are commonly encountered in the primary care practice. Most episodes of constipation and diarrhea are benign and self-limited. Patients with chronic constipation should undergo a screening evaluation to exclude organic disease, after which most can be managed successfully with dietary modification and fiber supplementation. The cause of chronic diarrhea usually can be discerned clinically, with irritable bowel syndrome, inflammatory bowel disease, and lactose intolerance being diagnosed most frequently. Irritable bowel syndrome is a functional gastrointestinal disorder characterized by abdominal pain and disordered defecation, which is successfully managed with a strong physician-patient relationship and periodic pharmacologic intervention.
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PMID:Constipation, diarrhea, and irritable bowel syndrome. 992 98

In recent years, there has been increasing interest in how gastrointestinal symptoms relate to and impact on patients' health-related quality of life. This is particularly the case for functional gastrointestinal disorders that are characterized by a lack of biological markers for disease activity. There is only a slight variation in the type of gastrointestinal symptoms reported with different gastrointestinal disorders, and patients with dyspepsia or irritable bowel syndrome, for example, often describe a variety of gastrointestinal symptoms with considerable overlap between them. The same pattern has been observed in patients with gastroesophageal reflux disease, even though heartburn and acid regurgitation are easier to distinguish from other gastrointestinal symptoms, particularly in patients in whom objective reflux is verified. Most aspects of health-related quality of life in patients with gastrointestinal disorders are compromised, irrespective of diagnosis. Patients with functional disorders seem, if anything, to display more emotional distress than those with organic disorders. Given the considerable overlap between different gastrointestinal symptom clusters, it is not surprising that these conditions have a similar impact in terms of perceived health status and quality of life. The key factors associated with the degree of perceived distress and dysfunction relate to disease severity and the presence of abdominal pain symptoms.
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PMID:Quality of life in different gastrointestinal conditions. 1002 66

Motility disorders are very common in childhood, causing a number of gastrointestinal symptoms: recurrent vomiting, abdominal pain and distension, constipation and obstipation, and loose stools. The disorders result from disturbances of gut motor control mechanisms caused by either intrinsic disease of nerve and muscle, central nervous system dysfunction or perturbation of the humoral environment in which they operate. Intrinsic gut motor disease and central nervous system disorder are most usually congenital in origin, and alterations of the humoral environment acquired. Irritable bowel syndrome occurs in children as well as adults and is multifactorial in origin, with an interplay of psychogenic and organic disorders.
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PMID:Motility disorders in childhood. 1007 6

Acquired motility disorders in childhood cause a number of gastrointestinal symptoms - principally, recurrent vomiting, abdominal pain and distension, constipation and loose stools. Gastrointestinal motility disorders result from disturbances of the control mechanisms of gut motor activity, which may be produced by organic disease involving enteric nerves and muscle, perturbation of the humoral environment of the nerves and muscle, and altered central nervous system input. In children, both congenital and acquired disease processes may produce these pathogenetic mechanisms, resulting in syndromes that vary in severity from chronic intestinal pseudo-obstruction to the irritable bowel syndrome.
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PMID:Acquired motility disorders in childhood. 1020 13

Though the basic science of the irritable bowel syndrome is far from certain, and the clinical science is often confusing, it is still possible to make some sense of the syndrome in a clinical context. These common complaints of altered bowel patterns, pain and bloating are extremely common and vary greatly in the impact they have on person's lives. From 'non-patients' who do not present for medical care to those who seek referral to multiple specialists, the spectrum is well known. If sense is to be made, the physician must understand the patient's major symptoms, how and to what degree they disturb their lifestyle, what is the patient's knowledge about and understanding of the syndrome, what has been done before, and why the patient is now presenting. What are the expectations and potential frustrations anticipated with this present consultation? A positive diagnostic approach can be taken but care is necessary to assuage lingering fears of organic disease, to correct misconceptions of the syndrome, to settle existing frustrations of the patient, and to educate. With these approaches, managing irritable bowel syndrome can be rewarding, though demanding.
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PMID:Irritable bowel syndrome: making sense of it all. 1058 Sep 24

Irritable bowel syndrome (IBS) is a common chronic functional bowel disorder characterized by abdominal pain or discomfort and alterations in bowel habits. In clinical practice, diagnosis is based on positive symptoms known as the Rome criteria and limited diagnostic screen, taking into account warning features suggestive of organic disease. Minimal diagnostic tests are warranted to rule out structural lesions in a cost-effective manner and to convince the patient of the diagnosis of IBS. An initial diagnosis of IBS is safe and rarely needs revision over time. Persistence of symptoms is to be expected and does not justify suspicion of other diagnoses. Only change in the clinical pattern over time justifies additional investigations. Other diagnostic evaluations depend on predominant symptoms, namely constipation, diarrhea, and pain or discomfort. It should be emphasized that although an initial "positive diagnosis" is safe to exclude other diseases with similar symptoms, a common disorder such as IBS may often coexist with other asymptomatic disorders.
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PMID:Diagnostic approach to the patient with irritable bowel syndrome. 1058 69

This review explores a broad range of patient characteristics that might be considered when selecting patients for inclusion into drug trials for irritable bowel syndrome (IBS). These characteristics have been chosen according to the author's perspective and a review of the literature based on a Medline search encompassing references to IBS (clinical, pharmacologic, and drug trials) from 1966 to 1998. The focus is to improve patient selection, which until now has concentrated predominantly on physical symptoms. Irritable bowel symptoms involve both physical and psychological domains in an inseparable way, the interaction profoundly affecting the physical manifestations of the condition, the patient's interpretation of these physical changes, the ability of the patient to cope with these symptoms, the extent to which the patient feels the need to seek treatment, and the response to different types of treatment. Selection criteria need to take both physical and psychological domains into account. When defining the disorder for purposes of patient selection, a simple definition of long-standing abdominal pain and bloating associated with alternating diarrhea and constipation (after the exclusion of organic disease) may still be the most practical. The Manning and Rome criteria have been reasonably well validated, especially when the constellation of symptoms is used as a unit; however, their applicability to men and the elderly is not as well validated and deserves further attention. Other patient characteristics that may be useful in the future in deciding suitability for a trial, or predicting response, include symptom pattern, length of symptom history, whether the condition was triggered by enteric infection, whether a patient is in primary, secondary, or tertiary care, psychological characteristics, a history of physical or sexual abuse, and possibly visceral sensitivity testing or autonomic dysfunction. Different studies may be required for primary care and tertiary care patients, who may differ in their psychological characteristics. Studies should also include patients across the demographic spectrum who are likely to require treatment for this condition, including adolescents and the elderly. The type of drug being tested will also influence patient selection, depending on whether it is fast or slow acting, and its predominant pharmacologic effects and side effects. This has particular relevance in relation to the presence of diarrhea or constipation, how prominent the symptom of pain is, and whether the drug has psychotropic or anxiolytic effects. Because of the recognition that IBS patients compose a heterogeneous population, precise characterization of patients, and targeted drug therapies are likely to lead to better therapeutic results. Further attention also needs to be paid to the type of drug under investigation, in relation to these different patient characteristics.
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PMID:Entry criteria for drug trials of irritable bowel syndrome. 1058 73

A diagnosis of IBS can often be established on the basis of the Manning and Rome criteria, which delineate specific features. A limited evaluation to exclude organic disease confirms this clinical impression. Patients should be reassured that no serious organic illness is causing the symptoms and should be educated about the natural history of the disorder. Treatment must be directed at both achieving control of the gastrointestinal complaints and searching for an underlying psychological or social factor that may contribute to the disorder.
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PMID:Irritable bowel syndrome. Definitive diagnostic criteria help focus symptomatic treatment. 1072 44


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