Irritable bowel syndrome

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A functional bowel disorder. Regarded as a diagnosis of exclusion. Different patterns exists sometimes with seemingly contrasting symptoms.

Criteria

Rome criteria requires that the patient must have recurrent abdominal pain or discomfort at least 3 days per month during the previous 3 months that is associated with 2 or more of the following:

  • Relieved by defecation
  • Onset associated with a change in stool frequency
  • Onset associated with a change in stool form or appearance

Symptoms supporting the diagnosis include:

  • Altered stool frequency
  • Altered stool form
  • Altered stool passage (straining and/or urgency)
  • Mucorrhoea
  • Abdominal bloating or subjective distension

Treatment

There are major difficulties with the literature in this condition[1] including publication bias and the possiblity of overlap syndromes or other classification issues. It even responds to placebos administered without deception[2]. The core treatments are:

Unproven include:

References

  1. Ford AC, Guyatt GH, Talley NJ, Moayyedi P. Errors in the conduct of systematic reviews of pharmacological interventions for irritable bowel syndrome. The American journal of gastroenterology. 2010 Feb; 105(2):280-8.(Link to article – subscription may be required.)
  2. Kaptchuk TJ, Friedlander E, Kelley JM, Sanchez MN, Kokkotou E, Singer JP, Kowalczykowski M, Miller FG, Kirsch I, Lembo AJ. Placebos without Deception: A Randomized Controlled Trial in Irritable Bowel Syndrome. PloS one. 2010; 5(12):e15591.(Epub) (Link to article – subscription may be required.)
  3. Huertas-Ceballos AA, Logan S, Bennett C, Macarthur C. Dietary interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Cochrane database of systematic reviews (Online). 2009; (1):CD003019.(Epub) (Link to article – subscription may be required.)
  4. Johannesson E, Simrén M, Strid H, Bajor A, Sadik R. Physical Activity Improves Symptoms in Irritable Bowel Syndrome: A Randomized Controlled Trial. The American journal of gastroenterology. 2011 Jan 4.(Epub ahead of print) (Link to article – subscription may be required.)
  5. Zijdenbos IL, de Wit NJ, van der Heijden GJ, Rubin G, Quartero AO. Psychological treatments for the management of irritable bowel syndrome. Cochrane database of systematic reviews (Online). 2009; (1):CD006442.(Epub) (Link to article – subscription may be required.)
  6. Quartero AO, Meineche-Schmidt V, Muris J, Rubin G, de Wit N. Bulking agents, antispasmodic and antidepressant medication for the treatment of irritable bowel syndrome. Cochrane database of systematic reviews (Online). 2005; (2):CD003460.(Epub) (Link to article – subscription may be required.)
  7. Ford AC, Talley NJ, Spiegel BM, Foxx-Orenstein AE, Schiller L, Quigley EM, Moayyedi P. Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ (Clinical research ed.). 2008; 337:a2313.(Epub)
  8. Evans BW, Clark WK, Moore DJ, Whorwell PJ. Tegaserod for the treatment of irritable bowel syndrome and chronic constipation. Cochrane database of systematic reviews (Online). 2007; (4):CD003960.(Epub) (Link to article – subscription may be required.)
  9. Moayyedi P, Ford AC, Talley NJ, Cremonini F, Foxx-Orenstein AE, Brandt LJ, Quigley EM. The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut. 2010 Mar; 59(3):325-32.(Link to article – subscription may be required.)
  10. Pimentel M, Lembo A, Chey WD, Zakko S, Ringel Y, Yu J, Mareya SM, Shaw AL, Bortey E, Forbes WP. Rifaximin therapy for patients with irritable bowel syndrome without constipation. The New England journal of medicine. 2011 Jan 6; 364(1):22-32.(Link to article – subscription may be required.)
  11. Webb AN, Kukuruzovic RH, Catto-Smith AG, Sawyer SM. Hypnotherapy for treatment of irritable bowel syndrome. Cochrane database of systematic reviews (Online). 2007; (4):CD005110.(Epub) (Link to article – subscription may be required.)
  12. Lim B, Manheimer E, Lao L, Ziea E, Wisniewski J, Liu J, Berman B. Acupuncture for treatment of irritable bowel syndrome. Cochrane database of systematic reviews (Online). 2006; (4):CD005111.(Epub) (Link to article – subscription may be required.)
  13. Liu JP, Yang M, Liu YX, Wei ML, Grimsgaard S. Herbal medicines for treatment of irritable bowel syndrome. Cochrane database of systematic reviews (Online). 2006; (1):CD004116.(Epub) (Link to article – subscription may be required.)

This article is a work in progress. Please feel free to contribute to it.

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