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

Constipation and disordered defaecation are symptoms, not disease entities. Usually these symptoms are not caused by organic abnormalities, but by disordered motility of the colon and pelvic floor. Both decreased colonic motility (inertia coli) and increased frequency and amplitude of haustrating colonic contractions in the context of an irritable bowel syndrome may lead to constipation. A third important functional cause of constipation is by paradoxical straining of the pelvic floor muscles during (attempts to) defaecate: anismus. In the diagnosis of constipation the primary aim usually is the exclusion of organic disorders. A plain abdominal X-ray and measurement of colonic transit with radiopaque particles will provide information about the severity of the constipation. Defaecography is indicated primarily if disordered faecal expulsion exists. Anorectal manometry is relevant when Hirschsprung's disease is suspected.
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PMID:[Gastrointestinal surgery and gastroenterology. IX. Obstipation: etiology and diagnosis]. 1082 Oct 35

Irritable bowel syndrome (IBS) is the most common disorder diagnosed by gastroenterologists and one of the more common ones encountered in general practice. The overall prevalence rate is similar (approximately 10%) in most industrialized countries; the illness has a large economic impact on health care use and indirect costs, chiefly through absenteeism. IBS is a biopsychosocial disorder in which 3 major mechanisms interact: psychosocial factors, altered motility, and/or heightened sensory function of the intestine. Subtle inflammatory changes suggest a role for inflammation, especially after infectious enteritis, but this has not yet resulted in changes in the approach to patient treatment. Treatment of patients is based on positive diagnosis of the symptom complex, limited exclusion of underlying organic disease, and institution of a therapeutic trial. If patient symptoms are intractable, further investigations are needed to exclude specific motility or other disorders. Symptoms fluctuate over time; treatment is often restricted to times when patients experience symptoms. Symptomatic treatment includes supplementing fiber to achieve a total intake of up to 30 g in those with constipation, those taking loperamide or other opioids for diarrhea, and those taking low-dose antidepressants or infrequently using antispasmodics for pain. Older conventional therapies do not address pain in IBS. Behavioral psychotherapy and hypnotherapy are also being evaluated. Novel approaches include alosetron; a 5-HT(3) antagonist, tegaserod, a partial 5-HT(4) agonist, kappa-opioid agonists, and neurokinin antagonists to address the remaining challenging symptoms of pain, constipation, and bloating. Understanding the brain-gut axis is key to the eventual development of effective therapies for IBS.
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PMID:Management of the irritable bowel syndrome. 1175 47

Irritable bowel syndrome is a common gastrointestinal disorder characterized by abdominal pain and a change in bowel habits. It is estimated to occur in 9% to 22% of the US population, and is more often diagnosed in women than in men. There are no diagnostic markers for irritable bowel syndrome and no evidence of organic disease. Moreover, the pathophysiology is not completely understood; however, abnormal gastrointestinal motility, altered sensory activity, central neural dysfunction, psychological disturbances, and luminal factors have been proposed. Treatment requires a multifaceted approach. Education, dietary measures, fiber supplementation, and pharmacological and psychological interventions have been used in the management of this disorder.
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PMID:Irritable bowel syndrome. 1148 42

Irritable bowel syndrome is a chronic, relapsing functional bowel disorder of unknown aetiology. Methods of studying intestinal motor function, nociception, and interactions of the central nervous system and enteric nervous system are not applicable for clinical use. The diagnosis is therefore made on the symptoms, but it is necessary to exclude relevant organic disease. Establishment of the diagnosis, information about the disorder, elimination of foods and other factors that provoke the symptoms, and a change in life-style are sufficient in most cases. Treatment is hampered by the lack of effective treatment and the psychological aspects. The therapeutic gain of drug administration is modest and the rate of response to placebo is high. Fibre supplementation, magnesium oxide or cisapride may be tried for constipation, diphenoxylate or loperamide for diarrhoea, and low dose tricyclic antidepressants or serotonin reuptake blockers for severe pain. The introduction of 5-hydroxytryptamine-3 (5-HT3) receptor antagonists seems promising.
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PMID:[Irritable colon]. 1153 May 62

Irritable bowel syndrome is characterised by constant or recurrent abdominal complaints over more than three months, in the absence of any pathological changes in the routinely employed examination procedures. The diagnosis is established on the basis of typical symptoms and specific exclusion of relevant differential diagnoses. The heart of the diagnostic evaluation comprises a limited routine laboratory investigation, and endoscopic exploration to exclude organic disease of the gastrointestinal tract. Diagnostic re-evaluation is necessary only when there is a change in the patient's symptoms. A psychosomatic diagnostic evaluation and, where necessary, psychotherapy is indicated in about 5% of the patients. For IBS, causal treatment is not available. Apart from symptomatic drug treatment, intensive counseling and regular interviews are of particular importance.
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PMID:[Is it irritable bowel syndrome? Validating the diagnosis]. 1168 Sep 23

This consensus document reviews the current status of the epidemiology, social impact, patient quality of life, pathophysiology, diagnosis and treatment of irritable bowel syndrome. Current evidence suggests that two major mechanisms may interact in irritable bowel syndrome: altered gastrointestinal motility and increased sensitivity of the intestine. However, other factors, such as psychosocial factors, intake of food and prior infection, may contribute to its development. Management of patients is based on a positive diagnosis of the symptom complex, careful history and physical examination to exclude 'red flags' as risk factors for organic disease, and, if indicated, investigations to exclude other disorders. Therapeutic choices include dietary fibre for constipation, opioid agents for diarrhoea and low-dose antidepressants or infrequent use of antispasmodics for pain, although the evidence basis for efficacy is limited or in some cases absent. Psychotherapy and hypnotherapy are the subject of ongoing study. Treatment should be tailored to patient needs and fears. Novel therapies are emerging, and drugs acting on serotonin receptors have proven efficacy and a scientific rationale and, if approved, should be useful in the overall management of patients with irritable bowel syndrome. Patient and physician education, early identification of psychosocial issues and better therapies are important strategies to reduce the suffering and societal cost of irritable bowel syndrome.
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PMID:Clinical perspectives, mechanisms, diagnosis and management of irritable bowel syndrome. 1218 41

Because irritable bowel syndrome (IBS) is a prevalent cause of visits to the gastroenterologist, it is extremely important to have accurate guidelines for the diagnosis. During the clinical assessment of IBS, the physician must look for the gastrointestinal symptoms, extraintestinal symptoms, and psychological history that are commonly associated with IBS. There are three diagnostic criteria that may be used in the IBS diagnosis: Manning, Rome I, and Rome II. Although there is discrepancy about which is most effective, we recommend that the Rome II be used in clinical practice. To confidently diagnose IBS, the physician must rule out organic disease as a cause of symptoms. This can be done by evaluating the patient's symptoms and screening for "red flags." The diagnostic strategy for IBS involves a thorough evaluation of the patient: taking a patient history, performing a physical exam, and performing the appropriate diagnostic tests when necessary.
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PMID:Clinical assessment of irritable bowel syndrome. 1218 37

Irritable bowel syndrome (IBS) is a multi-factorial gastrointestinal condition affecting 8-22 % of the population with a higher prevalence in women and accounting for 20-50 % of referrals to gastroenterology clinics. It is characterised by abdominal pain, excessive flatus, variable bowel habit and abdominal bloating for which there is no evidence of detectable organic disease. Suggested aetiologies include gut motility and psychological disorders, psychophysiological phenomena and colonic malfermentation. The faecal microflora in IBS has been shown to be abnormal with higher numbers of facultative organisms and low numbers of lactobacilli and bifidobacteria. Although there is no evidence of food allergy in IBS, food intolerance has been identified and exclusion diets are beneficial to many IBS patients. Food intolerance may be due to abnormal fermentation of food residues in the colon, as a result of disruption of the normal flora. The role of probiotics in IBS has not been clearly defined. Some studies have shown improvements in pain and flatulence in response to probiotic administration, whilst others have shown no symptomatic improvement. It is possible that the future role of probiotics in IBS will lie in prevention, rather than cure.
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PMID:A review of the role of the gut microflora in irritable bowel syndrome and the effects of probiotics. 1221 82

Irritable bowel syndrome is the most common functional disorder of the gastrointestinal tract and is frequently treated by family physicians. Despite patients' worries about the symptoms of irritable bowel syndrome, it is a benign condition. The diagnosis should be made using standard criteria after red flags that may signify organic disease have been ruled out. An effective physician-patient relationship is vital to successful management. Episodes of diarrhea are best managed with loperamide, while constipation often will respond to fiber supplements. Antispasmodics or anticholinergic agents may help relieve the abdominal pain of irritable bowel syndrome. Refractory cases are often treated with tricyclic antidepressants. Newer agents such as tegaserod and ondansetron target neurotransmitter receptors in the gastrointestinal tract Some forms of psychologic treatment may be helpful, and gastroenterology consultation is occasionally needed to reassure the patient. Comorbid conditions such as depression or anxiety should be investigated and treated.
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PMID:Management of irritable bowel syndrome. 1246 60

Symptoms of IBS are very prevalent. One quarter of symptomatic individuals present for medical care because of symptom severity and psychologic factors. The pathogenesis of IBS is multifactorial, involving abnormalities in the gut, immune system, enteric sensory and motor nerves, and the CNS. IBS is diagnosed by symptomatology according to the Rome criteria and the absence of alarm findings suggestive of organic disease. Minimal testing is advocated to confirm the diagnosis in patients presenting with typical symptoms. Therapy is based on the dominant symptom (IBS subtype). Therapeutic options include dietary modifications, counseling, medications, and psychologic treatments. Novel therapies are being investigated to correct potentially pathogenetic peripheral and CNS abnormalities in IBS.
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PMID:The irritable bowel syndrome. 1251 Apr 63


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