Irritable Bowel Syndrome
Authors: Jennifer F. Wilson
Journal: Annals of Internal Medicine (2007)

In the Clinic3 July 2007Irritable Bowel SyndromeChristine Laine, MD, MPH, David R. Goldman, MD, and Jennifer F. WilsonChristine Laine, MD, MPHSearch for more papers by this author, David R. Goldman, MDSearch for more papers by this author, and Jennifer F. WilsonSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-147-1-200707030-01007 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Editor's Note: This issue of In the Clinic has been updated.DiagnosisIrritable bowel syndrome (IBS) is a common but poorly understood disorder that interferes with normal colon function, resulting in abdominal pain, bloating, constipation, and diarrhea. No specific biological biomarker, physiologic abnormality, or anatomical defect has been discovered. Psychosocial stress may exacerbate symptoms.IBS is 1 of 28 adult and 17 pediatric functional gastrointestinal disorders. These disorders are symptom-based and not explained by other pathologically defined diseases. IBS appears to be linked to motor and sensory physiology and brain-gut interaction (1). Emerging theories suggest that alteration of intestinal bacteria ...References1. Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology. 2006;130:1377-90. [PMID: 16678553] Google Scholar2. Longstreth GF. Irritable bowel syndrome. Diagnosis in the managed care era. Dig Dis Sci. 1997;42:1105-11. [PMID: 9201069] Google Scholar3. Manning AP, Thompson WG, Heaton KW, Morris AF. Towards positive diagnosis of the irritable bowel. Br Med J. 1978;2:653-4. [PMID: 698649] Google Scholar4. Thompson WG, Dotewall G, Drossman DA, et al. Irritable bowel syndrome: guidelines for the diagnosis. Gastroenterol Int. 1989;2:92-95. Google Scholar5. Thompson WG, Longstreth GF, Drossman DA, et al. Functional bowel disorders and functional abdominal pain. Gut. 1999;45 Suppl 2:II43-7. [PMID: 10457044] Google Scholar6. Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders. Gastroenterology. 2006;130:1480-91. [PMID: 16678561] Google Scholar7. Talley NJ, Phillips SF, Melton LJ, et al. Diagnostic value of the Manning criteria in irritable bowel syndrome. Gut. 1990;31:77-81. [PMID: 2318433] Google Scholar8. Tolliver BA, Herrera JL, DiPalma JA. Evaluation of patients who meet clinical criteria for irritable bowel syndrome. Am J Gastroenterol. 1994;89:176-8. [PMID: 8304298] Google Scholar9. Vanner SJ, Depew WT, Paterson WG, et al. Predictive value of the Rome criteria for diagnosing the irritable bowel syndrome. Am J Gastroenterol. 1999;94:2912-7. [PMID: 10520844] Google Scholar10. Chey WD, Olden K, Carter E, et al. Utility of the Rome I and Rome II criteria for irritable bowel syndrome in U.S. women. Am J Gastroenterol. 2002;97:2803-11. [PMID: 12425552] Google Scholar11. Mertz H, Naliboff B, Munakata J, Niazi N, Mayer EA. Altered rectal perception is a biological marker of patients with irritable bowel syndrome. Gastroenterology. 1995;109:40-52. [PMID: 7797041] Google Scholar12. Tibble JA, Sigthorsson G, Foster R, Forgacs I, Bjarnason I. Use of surrogate markers of inflammation and Rome criteria to distinguish organic from nonorganic intestinal disease. Gastroenterology. 2002;123:450-60. [PMID: 12145798] Google Scholar13. Bürgin-Wolff A, Gaze H, Hadziselimovic F, et al. Antigliadin and antiendomysium antibody determination for coeliac disease. Arch Dis Child. 1991;66:941-7. [PMID: 1819255] Google Scholar14. Prior A, Whorwell PJ. Double blind study of ispaghula in irritable bowel syndrome. Gut. 1987;28:1510-3. [PMID: 3322956] Google Scholar15. Müller-Lissner SA. Effect of wheat bran on weight of stool and gastrointestinal transit time: a meta analysis. Br Med J (Clin Res Ed). 1988;296:615-7. [PMID: 2832033] Google Scholar16. Brandt LJ, Bjorkman D, Fennerty MB, et al. Systematic review on the management of irritable bowel syndrome in North America. Am J Gastroenterol. 2002;97:S7-26. [PMID: 12425586] Google Scholar17. Colwell LJ, Prather CM, Phillips SF, Zinsmeister AR. Effects of an irritable bowel syndrome educational class on health-promoting behaviors and symptoms. Am J Gastroenterol. 1998;93:901-5. [PMID: 9647015] Google Scholar18. Owens DM, Nelson DK, Talley NJ. The irritable bowel syndrome: long-term prognosis and the physician-patient interaction. Ann Intern Med. 1995;122:107-12. [PMID: 7992984] Google Scholar19. Creed F, Craig T, Farmer R. Functional abdominal pain, psychiatric illness, and life events. Gut. 1988;29:235-42. [PMID: 3345935] Google Scholar20. Bennett EJ, Tennant CC, Piesse C, Badcock CA, Kellow JE. Level of chronic life stress predicts clinical outcome in irritable bowel syndrome. Gut. 1998;43:256-61. [PMID: 10189854] Google Scholar21. Drossman DA, Sandler RS, McKee DC, Lovitz AJ. Bowel patterns among subjects not seeking health care. Use of a questionnaire to identify a population with bowel dysfunction. Gastroenterology. 1982;83:529-34. [PMID: 7095360] Google Scholar22. Drossman DA, Leserman J, Nachman G, et al. Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann Intern Med. 1990;113:828-33. [PMID: 2240898] Google Scholar23. Hazlett-Stevens H, Craske MG, Mayer EA, Chang L, Naliboff BD. Prevalence of irritable bowel syndrome among university students: the roles of worry, neuroticism, anxiety sensitivity and visceral anxiety. J Psychosom Res. 2003;55:501-5. [PMID: 14642979] Google Scholar24. Gwee KA, Leong YL, Graham C, et al. The role of psychological and biological factors in postinfective gut dysfunction. Gut. 1999;44:400-6. [PMID: 10026328] Google Scholar25. Guthrie E, Creed F, Dawson D, Tomenson B. A controlled trial of psychological treatment for the irritable bowel syndrome. Gastroenterology. 1991;100:450-7. [PMID: 1985041] Google Scholar26. North of England IBS Research Group. The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome. Gastroenterology. 2003;124:303-17. [PMID: 12557136] Google Scholar27. Talley NJ, Owen BK, Boyce P, Paterson K. Psychological treatments for irritable bowel syndrome: a critique of controlled treatment trials. Am J Gastroenterol. 1996;91:277-83. [PMID: 8607493] Google Scholar28. Jailwala J, Imperiale TF, Kroenke K. Pharmacologic treatment of the irritable bowel syndrome: a systematic review of randomized, controlled trials. Ann Intern Med. 2000;133:136-47. [PMID: 10896640] Google Scholar29. International Foundation for Functional Gastrointestinal Disorders. IBS in the real world survey. Milwaukee, WI: International Foundation for Functional Gastrointestinal Disorders; 2002:1-19. Google Scholar30. Poynard T, Naveau S, Mory B, Chaput JC. Meta-analysis of smooth muscle relaxants in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 1994;8:499-510. [PMID: 7865642] Google Scholar31. Drossman DA, Whitehead WE, Camilleri M. Irritable bowel syndrome: a technical review for practice guideline development. Gastroenterology. 1997;112:2120-37. [PMID: 9178709] Google Scholar32. Andorsky RI, Goldner F. Colonic lavage solution (polyethylene glycol electrolyte lavage solution) as a treatment for chronic constipation: a double-blind, placebo-controlled study. Am J Gastroenterol. 1990;85:261-5. [PMID: 2178398] Google Scholar33. Cann PA, Read NW, Holdsworth CD, Barends D. Role of loperamide and placebo in management of irritable bowel syndrome (IBS). Dig Dis Sci. 1984;29:239-47. [PMID: 6365490] Google Scholar34. Efskind PS, Bernklev T, Vatn MH. A double-blind placebo-controlled trial with loperamide in irritable bowel syndrome. Scand J Gastroenterol. 1996;31:463-8. [PMID: 8734343] Google Scholar35. Talley NJ. Serotoninergic neuroenteric modulators. Lancet. 2001;358:2061-8. [PMID: 11755632] Google Scholar36. Watson ME, Lacey L, Kong S, et al. Alosetron improves quality of life in women with diarrhea-predominant irritable bowel syndrome. Am J Gastroenterol. 2001;96:455-9. [PMID: 11232690] Google Scholar37. Camilleri M, Northcutt AR, Kong S, et al. Efficacy and safety of alosetron in women with irritable bowel syndrome: a randomised, placebo-controlled trial. Lancet. 2000;355:1035-40. [PMID: 10744088] Google Scholar38. Camilleri M, Chey WY, Mayer EA, et al. A randomized controlled clinical trial of the serotonin type 3 receptor antagonist alosetron in women with diarrhea-predominant irritable bowel syndrome. Arch Intern Med. 2001;161:1733-40. [PMID: 11485506] Google Scholar39. Camilleri M, Mayer EA, Drossman DA, et al. Improvement in pain and bowel function in female irritable bowel patients with alosetron, a 5-HT3 receptor antagonist. Aliment Pharmacol Ther. 1999;13:1149-59. [PMID: 10468696] Google Scholar40. Jackson JL, O'Malley PG, Tomkins G, et al. Treatment of functional gastrointestinal disorders with antidepressant medications: a meta-analysis. Am J Med. 2000;108:65-72. [PMID: 11059442] Google Scholar41. Myren J, Løvland B, Larssen SE, Larsen S. A double-blind study of the effect of trimipramine in patients with the irritable bowel syndrome. Scand J Gastroenterol. 1984;19:835-43. [PMID: 6151243] Google Scholar42. Greenbaum DS, Mayle JE, Vanegeren LE, et al. Effects of desipramine on irritable bowel syndrome compared with atropine and placebo. Dig Dis Sci. 1987;32:257-66. [PMID: 3545719] Google Scholar43. Drossman DA, Toner BB, Whitehead WE, et al. Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Gastroenterology. 2003;125:19-31. [PMID: 12851867] Google Scholar44. Pimentel M, Chow EJ, Lin HC. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol. 2000;95:3503-6. [PMID: 11151884] Google Scholar45. Pimentel M, Chow EJ, Lin HC. Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome. A double-blind, randomized, placebo-controlled study. Am J Gastro-enterol. 2003;98:412-9. [PMID: 12591062] Google Scholar46. Attar A, Flourié B, Rambaud JC, et al. Antibiotic efficacy in small intestinal bacterial overgrowth-related chronic diarrhea: a crossover, randomized trial. Gastroenterology. 1999;117:794-7. [PMID: 10500060] Google Scholar47. Pimentel M, Park S, Mirocha J, Kane SV, Kong Y. The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial. Ann Intern Med. 2006;145:557-63. [PMID: 17043337] Google Scholar48. Meyers NL, Tack J, Middleton S, et al. Efficacy and safety or renzapride in patients with constipation-predominant irritable bowel syndrome [Abstract]. Gut. 2002;51(suppl III): A10. Google Scholar49. George A, Meyers NL, Palmer RMJ. Efficacy and safety of renzapride in patients with constipation-predominant IBS: a phase IIB study in the UK primary healthcare setting [Abstract]. Gut. 2003;52:A91. Google Scholar50. Julia V, Morteau O, Buéno L. Involvement of neurokinin 1 and 2 receptors in viscerosensitive response to rectal distension in rats. Gastroenterology. 1994;107:94-102. [PMID: 7517374] Google Scholar51. Lördal M, Navalesi G, Theodorsson E, Maggi CA, Hellström PM. A novel tachykinin NK2 receptor antagonist prevents motility-stimulating effects of neurokinin A in small intestine. Br J Pharmacol. 2001;134:215-23. [PMID: 11522614] Google Scholar52. Coulie B, Szarka LA, Camilleri M, et al. Recombinant human neurotrophic factors accelerate colonic transit and relieve constipation in humans. Gastroenterology. 2000;119:41-50. [PMID: 10889153] Google Scholar53. Coulie B, Lee JS, Lyford G, et al. Recombinant human neurotrophin-3 increases noncholinergic smooth muscle contractility and decreases nonadrenergic (NANC) inhibition of myenteric neurons in guinea-pig colon [Abstract]. Gastroenterology. 2000;118:A710. Google Scholar54. Spanier JA, Howden CW, Jones MP. A systematic review of alternative therapies in the irritable bowel syndrome. Arch Intern Med. 2003;163:265-74. [PMID: 12578506] Google Scholar Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byBeneficial Effects of Ginkgo biloba in Neurological DisordersPhysical Activity Improves Symptoms in Irritable Bowel Syndrome: A Randomized Controlled TrialPalliative Care and CHF Chapter: Aaron Olden and Timothy Quill 3 July 2007Volume 147, Issue 1Page: ITC7-1KeywordsAbdominal painAntibioticsColonComplete blood countConstipationDiarrheaDiarrhea-predominant irritable bowel syndromeDietDrugsPatients ePublished: 3 July 2007 Issue Published: 3 July 2007 Copyright & PermissionsCopyright © 2007 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...