irritable bowel syndrome (IBS)

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Introduction

A functional intestinal disorder associated with pain, alterations in pattern of defecation &/or bloat & distension.

Classification

  • IBS with constipation (IBS-C)
  • IBS with diarrhea (IBS-D)
  • mixed IBS (IBS-M)
  • unsubtyped IBS (IBS-U)
    • stool consistency does not meet criteria for IBS-C, IBS-D or IBS-M[2]

Etiology

Epidemiology

  • prevalence is 15-20% in Western countries
  • most individuals do not seek medical help
  • 75% of patients in Western nations who seek medical help are female
  • 25-50% of all outpatient referrals to gastroenterology
  • commonly affects women age 20-40 years[2]

Pathology

Clinical manifestations

Diagnostic criteria

* rule out celiac disease prior to diagnosis of irritable bowel syndrome[8]

Laboratory

* rule out celiac disease prior to diagnosis of irritable bowel syndrome[36]

Diagnostic procedures

Radiology

Complications

  • unnecessary surgery[6]

Differential diagnosis

* watch for celiac disease

Management

Notes

  • may be a genetic predisposition to respond to placebo[17]

More general terms

Additional terms

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 347-49
  2. Jump up to: 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015, 2018, 2021.
    Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  3. Jump up to: 3.0 3.1 Prescriber's Letter 8(8):43-44, 2001
  4. Jump up to: 4.0 4.1 4.2 Journal Watch 22(4):29, 2002 Maxwell PR et al, Antibiotics increase functional abdominal symptoms. Gastroenterol 97:104, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11808932
    Nobaek S et al Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. Am J Gastroenterol 95:1231, 2000 PMID: https://www.ncbi.nlm.nih.gov/pubmed/10811333
  5. Jump up to: 5.0 5.1 Prescriber's Letter 9(12):71 2002
  6. Jump up to: 6.0 6.1 Journal Watch 24(15):123, 2004 a) Longstreth GF, Yao JF. Irritable bowel syndrome and surgery: a multivariable analysis. Gastroenterology. 2004 Jun;126(7):1665-73. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15188159
    Talley NJ. Unnecessary abdominal and back surgery in irritable bowel syndrome: time to stem the flood now? Gastroenterology. 2004 Jun;126(7):1899-903. Review. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15188187
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  9. Jump up to: 9.0 9.1 Lu WZ, Gwee KA, Moochhalla S, Ho KY. Melatonin improves bowel symptoms in female patients with irritable bowel syndrome: a double-blind placebo-controlled study. Aliment Pharmacol Ther. 2005 Nov 15;22(10):927-34. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16268966
    Song GH, Leng PH, Gwee KA, Moochhala SM, Ho KY. Melatonin improves abdominal pain in irritable bowel syndrome patients who have sleep disturbances: a randomised, double blind, placebo controlled study. Gut. 2005 Oct;54(10):1402-7. Epub 2005 May 24. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15914575
    Elsenbruch S. Melatonin: a novel treatment for IBS? Gut. 2005 Oct;54(10):1353-4. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16162946
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  12. Jump up to: 12.00 12.01 12.02 12.03 12.04 12.05 12.06 12.07 12.08 12.09 12.10 University of Michigan Health System, News Release New recommendations released for treatment of IBS Dec 19, 2008 http://www2.med.umich.edu/prmc/media/newsroom/details.cfm?ID=945
    Full list of 2008 IBS guidelines http://www.nature.com/ajg/journal/v104/n1s/index.html/.
  13. Prescriber's Letter 16(5) 2009 Treatments for Irritable Bowel Syndrome (IBS) PATIENT HANDOUT: Managing Irritable Bowel Syndrome (IBS) COMMENTARY: Treatments for Irritable Bowel Syndrome (IBS) GUIDELINES: Evidence-Based Position Statement on the Management of Irritable Bowel Syndrome by the American College of Gastroenterology Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=250504&pb=PRL (subscription needed) http://www.prescribersletter.com
    An Evidence-Based Systematic Review on the Management of Irritable Bowel Syndrome American College of Gastroenterology Task Force on IBS http://www.nature.com/ajg/journal/v104/n1s/pdf/ajg2008122a.pdf
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Patient information

irritable bowel syndrome patient information