Consensus report: clinical perspectives, mechanisms, diagnosis and management of irritable bowel syndrome

Abstract

Summary 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.

Evaluation of the Antidiarrhoeal and Antidiabetic Activities of the Leaf Aqueous Extract of Syzygium cordatum Hoscht. ex C.Krauss (Mytraceae) in Rodents

“…This leads to the segmental contractions in the colon increasing, the propulsive movement of the small intestine and colon being inhibited and the transit time of the intestinal content being prolonged (Altman, 2001). Loperamide 1s also known to have an antimuscarinic activity contributing to the inhibition of peristalsis by inhibiting contractions in both the longitudinal and circular muscles (Waller et al, 2005a;Camillen et al, 2002;Altman, 2001 ). In this study, therefore, loperamide may be antagonizing castor oil-induced diarrhoea by decreasing the intestinal motility.…”

Probiotic Fermented Milk Containing Dietary Fiber Has Additive Effects in IBS with Constipation Compared to Plain Probiotic Fer-mented Milk

“…Although dietary fiber does not appear to be useful as the sole treatment for IBS, fiber appears to play a role in the management of some patients with IBS, especially if constipation is the dominant concern. [16][17][18] The two types of fiber, soluble and insoluble, have different effects on global IBS related symptoms. Insoluble fiber in probably no better than placebo.…”

“…The proposed mechanism of action of fiber, in the treatment of IBS and constipation, is the acceleration of oroanal transit and a decrease in the intra-colon pressures. 16,17 Despite a large number of trials, each with design limitations, the benefits remain unproven and patient tolerance can be a problem. However, there may be a limited role for the careful use of dietary fiber or bulking agents, in the management of some patients with IBS, especially in those with the constipation dominant form.…”

Applying Case Definition Criteria to Irritable Bowel Syndrome

“…However, in a clinical setting, the Rome II criteria identify a smaller number of patients compared to the Rome I criteria. 2,9,18 The fact that no patients in this study fulfilled Rome I and II criteria alone may relate to their original design as epidemiological screening tools for identifying patients meeting clinical trial eligibility requirements. 4 Hence, their applicability as clinical practice-based tools for evaluating IBS may be limited.…”