British Society of Gastroenterology guidelines for the management of the irritable bowel syndrome

Jones, Judy; Boorman, J; Cann, P A; Forbes, Anna; Gomborone, J. E.; Heaton, K W; Hungin, Pali; Kumar, Devinder; Libby, G. W.; Spiller, Robin C.; Read, N W; Silk, D. B. A.; Whorwell, Peter J.

doi:10.1136/gut.47.suppl_2.ii1

Cited by 148 publications

(138 citation statements)

References 157 publications

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“…IBS is a disorder presumed to be caused by adverse reactions to food; perceived food intolerance is common in these subjects, and dietary advice is part of the treatment recommendations (Ortolani et al, 1999;Jones et al, 2000). Figure 2 The correlation between food intolerance and musculoskeletal pain score (at the top) and mood disorders (at the bottom).…”

Section: Discussionmentioning

confidence: 99%

Perceived food intolerance in subjects with irritable bowel syndrome – etiology, prevalence and consequences

2005

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Objectives: This study estimates the prevalence of perceived food intolerance and its consequences in subjects with irritable bowel syndrome (IBS), evaluates the utility of common tests for food intolerance, studies the relation between perceived food intolerance and other disorders, and discusses the etiology. Design: Cross-sectional study. Setting: National health survey. Subjects: A selection of the population (n ¼ 11078) in Oppland county, Norway, was invited to a health screening, and a sample of subjects with IBS were included in the study. Interventions: A medical history of food intolerance, musculoskeletal pain, mood disorders and abdominal complaints was taken, and tests were performed for food allergy and malabsorption. A dietician evaluated the dietary habits of the subjects. Results: Out of 4622 subjects with adequately filled-in questionnaires, 84 were included in the study, 59 (70%) had symptoms related to intake of food, 62% limited or excluded food items from the diet and 12% had an inadequate diet. The mean numbers of food items related to symptoms and the number of foods limited or excluded from the diet were 4.8 and 2.5, respectively. There were no associations between the tests for food allergy and malabsorption and perceived food intolerance. Perceived food intolerance was unrelated to musculoskeletal pain and mood disorders. Conclusions: Perceived food intolerance is a common problem with significant nutritional consequences in a population with IBS. The uselessness of current antibody tests and tests for malabsorption and the lack of correlation to psychiatric co-morbidity make the etiology obscure.

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Section: Discussionmentioning

confidence: 99%

Perceived food intolerance in subjects with irritable bowel syndrome – etiology, prevalence and consequences

2005

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“…17,22 However, although guidelines for IBS recommend a general therapeutic approach, they place little emphasis on comorbid somatic symptoms. 15,23 We postulate that approaching only symptoms of IBS, whether it be by a well performed consultation or by novel drug therapies, will not ameliorate overall suffering or use of health resources in all patients with IBS. 24 The clinically significant differences in characteristics between patients with low and high SC suggest that subgroups of patients with different aetiologies and treatment needs do exist, and that they are possible to identify.…”

Section: Discussionmentioning

confidence: 99%

Comorbidity of irritable bowel syndrome in general practice: a striking feature with clinical implications

Vandvik

Wilhelmsen

Ihlebæk

et al. 2004

Aliment Pharmacol Ther

142

101

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Summary Background : Somatic comorbid symptoms might identify irritable bowel syndrome patients with different aetiologies and needs of treatment. Aims : To measure comorbid symptoms in patients with irritable bowel syndrome in general practice, and to explore characteristics of patients with low, intermediate and high somatic comorbidity. Methods : Prospective study of 208 of 278 consecutive patients with irritable bowel syndrome (Rome II) in nine general practices. Questionnaires assessed 22 comorbid symptoms (subjective health complaint inventory), psychosocial factors including psychological distress (Symptom Check list‐10) and quality of life (Short form‐12). Subjective health complaint data from 1240 adults (controls) constituted a reference material. Patients with low, intermediate and high somatic comorbidity were identified by a somatic comorbidity score (17 subjective health complaint items). Health care seeking was assessed after 6–9 months. Results : Patients with irritable bowel syndrome (67% females, mean age 50, s.d. 16) reported 20 of 22 comorbid symptoms significantly more frequent than controls (odds ratios = 2–7, P < 0.001). The somatic comorbidity score correlated with psychological distress (R = 0.46, P < 0.001). Patients with high somatic comorbidity reported higher levels of mood disorder, health anxiety, neuroticism, adverse life events and reduced quality of life and increased health care seeking when compared to those with low and intermediate somatic comorbidity (P‐values < 0.05). Conclusions : Our findings support the hypothesis that structured assessment of comorbid somatic symptoms might identify subgroups with different aetiology and needs of treatment.

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“…Classic symptoms of IBS are abdominal pain that is relieved by defecation, abdominal pain that is associated with a change in the frequency and/or consistency of the stools, and abdominal bloating. 3 Typical symptoms of PID are lower abdominal pain and tenderness, deep dyspareunia, abnormal vaginal or cervical discharge, cervical excitation and adnexal tenderness motion, and pyrexia. 4 These overlapping symptoms create potential diagnostic difficulties, not least of all because there are no simple noninvasive diagnostic tests that can be carried out.…”

Section: Introductionmentioning

confidence: 99%

Endometriosis and its coexistence with irritable bowel syndrome and pelvic inflammatory disease: findings from a national case–control study—Part 2

Seaman

Ballard

Wright

et al. 2008

BJOG

105

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Objective To investigate whether the increased chances of having a diagnosis of irritable bowel syndrome (IBS) and pelvic inflammatory disease (PID) in women with endometriosis is due to misdiagnosis or co‐morbidity.Design A case–control study of women aged 15–55 years with endometriosis and matched controls.Setting Data from the UK’s General Practice Research Database for the years 1992–2001.Sample A total of 5540 women aged 15–55 years, diagnosed with endometriosis, each matched to four controls without endometriosis. The index date was defined as the date of diagnosis.Methods Data were analysed to determine whether women with endometriosis were more likely to receive a diagnosis of PIDor IBS than women without endometriosis. Odds ratios were calculated for endometriosis associated with IBS and PID before and after the index date.Main outcome measures Diagnosis of IBS or PID before and after the index date.Results Compared with the controls, women with endometriosis were 3.5 times more likely to have received a diagnosis of IBS (OR 3.5 [95% CI: 3.1–3.9]). Even after women had been diagnosed with endometriosis, they were still two and a half times more likely to receive a new diagnosis of IBS when compared with the controls (OR 2.5 [95% CI: 2.2–2.8]). Similarly, women with endometriosis were more likely than those without endometriosis to have been treated for PID both before (OR 5.9 [95% CI: 5.1–6.9]) and after (OR 3.8 [95% CI: 3.1–4.6]) being diagnosed with endometriosis.Conclusions Women with endometriosis are more likely to be diagnosed with IBS and PID than controls, even after a definitive diagnosis of endometriosis has been reached.

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British Society of Gastroenterology guidelines for the management of the irritable bowel syndrome

Cited by 148 publications

References 157 publications

Perceived food intolerance in subjects with irritable bowel syndrome – etiology, prevalence and consequences

Perceived food intolerance in subjects with irritable bowel syndrome – etiology, prevalence and consequences

Comorbidity of irritable bowel syndrome in general practice: a striking feature with clinical implications

Endometriosis and its coexistence with irritable bowel syndrome and pelvic inflammatory disease: findings from a national case–control study—Part 2

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