Irritable bowel syndrome: A clinical review

Abstract

Irritable bowel syndrome (IBS) remains a clinical challenge in the 21(st) century. It's the most commonly diagnosed gastrointestinal condition and also the most common reason for referral to gastroenterology clinics. Its can affect up to one in five people at some point in their lives, and has a significantly impact of life quality and health care utilization. The prevalence varies according to country and criteria used to define IBS. Various mechanisms and theories have been proposed about its etiology, but the biopsychosocial model is the most currently accepted for IBS. The complex of symptoms would be the result of the interaction between psychological, behavioral, psychosocial and environmental factors. The diagnosis of IBS is not confirmed by a specific test or structural abnormality. It is made using criteria based on clinical symptoms such as Rome criteria, unless the symptoms are thought to be atypical. Today the Rome Criteria III is the current gold-standard for the diagnoses of IBS. Secure positive evidence of IBS by means of specific disease marker is currently not possible and cannot be currently recommended for routine diagnosis. There is still no clinical evidence to recommend the use of biomarkers in blood to diagnose IBS. However, a number of different changes in IBS patients were demonstrated in recent years, some of which can be used in the future as a diagnostic support. IBS has no definitive treatment but could be controlled by non-pharmacologic management eliminating of some exacerbating factors such certain drugs, stressor conditions and changes in dietary habits.The traditional pharmacologic management of IBS has been symptom based and several drugs have been used. However, the cornerstone of its therapy is a solid patient physician relationship. This review will provide a summary of pathophysiology, diagnostic criteria and current and emerging therapies for IBS.

Irritable bowel syndrome - from etiopathogenesis to therapy

“…Fibromyalgia, chronic fatigue syndrome, temporomandibular joint disorder and chronic pelvic pain are nongastrointestinal disorders with a well-documented association with IBS(ref. 4 ). Also frequently associated are psychiatric disorders including major depression, anxiety and somatoform disorders 43 .…”

“…Comorbidity with other functional gastrointestinal disorders (FGIDs) is high and can be caused by shared visceral hypersensitivity pathophysiological mechanisms 4,5 . Fibromyalgia, chronic fatigue syndrome, temporomandibular joint disorder and chronic pelvic pain are nongastrointestinal disorders with a well-documented association with IBS(ref.…”

“…Despite its high prevalence, the pathophysiology of IBS is not yet completely understood and seems to be multifactorial [4][5][6]13,14 . Many pathogenetic factors (Table 1), in various combinations, and not all necessarily present in each patient, can play an important role 15 .…”

“…This disease is characterized by abdominal pain, bloating, and changes in bowel habits that lack a known structural or anatomic explanation [1][2][3] . Over the years, the unexplained gastrointestinal symptoms of IBS have been described in various terms, including mucous colitis, spastic colitis, nervous colon, and irritable colon 4 . The symptoms of IBS appear and dissapear over time, and are often associated with other functional gastrointestinal dieases and non-gastrointestinal somatic pain disorders 5 .…”

Tünetek, laboratóriumi paraméterek és a betegségpercepció eltérései irritábilis bél szindróma és gyulladásos bélbetegség esetén. Segíthetnek-e a kérdőívek a két betegség elkülönítésében?

“…Az IBS és az IBD differenciáldiag-nosztikájában gyakran alkalmaznak invazív diagnosztikai eljárásokat, amelyek költségesek, és nem megfelelő indikáció esetén feleslegesen teszik ki a beteget a megterhelésnek és a beavatkozás kockázatainak. Emiatt ezek elkerülésére és elsősorban noninvazív, tünetorientált diagnózis felállítására kellene törekedni [4,5].…”