Abstract
Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder with a wide variety of presentations that may include abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits. Symptom-based criteria and a limited medical evaluation are used for diagnosis. The heterogeneity of IBS presenting symptoms, together with the pathophysiology of the disorder, is unclear, making treatment challenging. Treatment strategies are focused on specific symptoms, potential underlying disorders in stress responsiveness, and predisposing psychological features. Although only two medications, tegaserod for constipation-predominant IBS and alosetron for diarrhea-predominant IBS, are specifically indicated, a wide variety of treatment options are available and are discussed in this review.
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References and Recommended Reading
American Gastroenterology Association: American Gastroenterological Association medical position statement: Irritable bowel syndrome. Gastroenterology 2002, 123:2105–2107. This position statement provides a comprehensive overview of the pathophysiology, diagnosis, and treatment of IBS.
Inadomi JM, Fennerty MB, Bjorkman D: Systematic review: The economic impact of irritable bowel syndrome. Aliment Pharmacol Ther 2003, 18:671–682.
Gralnek IM, Hays RD, Kilbourne A, et al.: The impact of irritable bowel syndrome on health-related quality of life. Gastroenterology 2000, 119:654–660.
Longstreth GF, Wilson A, Knight K, et al.: Irritable bowel syndrome, health care use, and costs: A U.S. managed care perspective. Am J Gastroenterol 2003, 98:600–607.
Delvaux M: Role of visceral sensitivity in the pathophysiology of irritable bowel syndrome. Gut 2002, 51:i67-i71.
Silverman DH, Munakata JA, Ennes H, et al.: Regional cerebral activity in normal and pathological perception of visceral pain. Gastroenterology 1997, 112:64–72.
Ringel Y, Drossman DA, Turkington TG, et al.: Regional brain activation in response to rectal distension in patients with irritable bowel syndrome and the effect of a history of abuse. Dig Dis Sci 2003, 48:1774–1781.
Naliboff BD, Derbyshire SW, Munakata J, et al.: Cerebral activation in patients with irritable bowel syndrome and control subjects during rectosigmoid stimulation. Psychosom Med 2001, 63:365–375.
Neal KR, Barker L, Spiller RC: Prognosis in post-infective irritable bowel syndrome: a six year follow up study. Gut 2002, 51:410–413.
Dunlop SP, Jenkins D, Neal KR, Spiller RC: Relative importance of enterochromaffin cell hyperplasia, anxiety, and depression in postinfectious IBS. Gastroenterology 2003, 125:1651–1659.
Thompson WG, Longstreth GF, Drossman DA, et al.: Functional bowel disorders and functional abdominal pain. Gut 1999, 45:II43-II47.
Manning AP, Thompson WG, Heaton KW, Morris AF: Towards positive diagnosis of the irritable bowel. BMJ 1978, 2:653–654.
Thompson WG, Dotevall G, Drossman DA, et al.: Irritable bowel syndrome: guidelines for the diagnosis. Gastroenterol Int 1989, 2:92–95.
Spiegel BM, DeRosa VP, Gralnek IM, et al.: Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: A cost-effectiveness analysis. Gastroenterology 2004, 126:1721–1732.
Vanner SJ, Depew WT, Paterson WG, et al.: Predictive value of the Rome criteria for diagnosing the irritable bowel syndrome. Am J Gastroenterol 1999, 94:2912–2917.
Tillisch K, Labus J, Naliboff B, et al.: Characterization of the alternating bowel habit subtype in patients with irritable bowel syndrome. Am J Gastroenterol 2005, 100:896–904.
Drossman DA, Morris CB, Hu Y, et al.: A prospective assessment of bowel habit in irritable bowel syndrome in women: Defining an alternator. Gastroenterology 2005, 128:580–589.
Whitehead WE, Palsson O, Jones KR: Systematic review of the comorbidity of irritable bowel syndrome with other disorders: What are the causes and implications? Gastroenterology 2002, 122:1140–1156.
Maxton DG, Morris JA, Whorwell PJ: Ranking of symptoms by patients with the irritable bowel syndrome. BMJ 1989, 299:1138.
Levy RL, Von Korff M, Whitehead WE, et al.: Costs of care for irritable bowel syndrome patients in a health maintenance organization. Am J Gastroenterol 2001, 96:3122–3129.
Spiegel BM, Gralnek IM, Bolus R, et al.: Clinical determinants of health-related quality of life in patients with irritable bowel syndrome. Arch Intern Med 2004, 164:1773–1780.
Agreus L, Svardsudd K, Nyren O, Tibblin G: Irritable bowel syndrome and dyspepsia in the general population: Overlap and lack of stability over time. Gastroenterology 1995, 109:671–680.
Sperber AD, Atzmon Y, Neumann L, et al.: Fibromyalgia in the irritable bowel syndrome: studies of prevalence and clinical implications. Am J Gastroenterol 1999, 94:3541–3546.
Aaron LA, Buchwald D: A review of the evidence for overlap among unexplained clinical conditions. Ann Intern Med 2001, 134:868–881.
Whitehead WE, Bosmajian L, Zonderman AB, et al.: Symptoms of psychological distress associated with irritable bowel syndrome. Gastroenterology 1988, 95:709–714.
Drossman DA: Diagnosing and treating patients with refractory functional gastrointestinal disorders. Ann Intern Med 1995, 123:688–697.
Atkinson W, Sheldon TA, Shaath N, Whorwell PJ: Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial. Gut 2004, 53:1459–1464.
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-S26. This review provides an evidence-based evaluation of IBS symptom criteria and treatment options with an extensive reference list of original sources.
Poynard T, Regimbeau C, Benhamou Y: Meta-analysis of smooth muscle relaxants in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther 2001, 15:355–361.
Sun WM, Read NW, Verlinden M: Effects of loperamide oxide on gastrointestinal transit time and anorectal function in patients with chronic diarrhoea and faecal incontinence. Scand J Gastroenterol 1997, 32:34–38.
Bearcroft CP, Perrett D, Farthing MJG: Postprandial plasma 5-hydroxytryptamine in diarrhea predominant irritable bowel syndrome. Gut 1998, 42:42–44.
Houghton LA, Atkinson W, Whitaker RP, et al.: Increased platelet depleted plasma 5-hydroxytryptamine concentration following meal ingestion in symptomatic female subjects with diarrhoea predominant irritable bowel syndrome. Gut 2003, 52:663–667.
El-Salhy M, Norrgard O, Spinnell S: Abnormal colonic endocrine cells in patients with chronic idiopathic slow-transit constipation. Scand J Gastroenterol 1999, 34:1007–1011.
Coates MD, Mahoney CR, Linden DR, et al.: Molecular defects in mucosal serotonin content and decreased serotonin reuptake transporter in ulcerative colitis and irritable bowel syndrome. Gastroenterology 2004, 126:1657–1664.
Camilleri M, Northcutt AR, Kong S, et al.: The efficacy and safety of alosetron in female patients with irritable bowel syndrome: a randomised, placebo controlled study. Lancet 2000, 355:1035–1040.
Camilleri M, Mayer E, Drossman D, et al.: Improvement in pain and bowel function in female irritable bowel syndrome patients with alosetron, a 5-HT3-receptor antagonist. Aliment Pharmacol Ther 1999, 13:1149–1151.
Camilleri M, Chey W, Mayer E, et al.: A randomized controlled clinical trial of the serotonin type 3 receptor antagonist alosetron in women with diarrhea-predominant IBS. Arch Intern Med 2001, 161:1733–1740.
Bardhan K, Bodemar G, Geldof H, et al.: A double-blind placebo-controlled study to evaluate the efficacy of alosetron in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther 2000, 14:23–24.
Chang L, Ameen VZ, Dukes GE, et al.: A dose-ranging, phase II study of the efficacy and safety of alosetron in men with diarrhea-predominant IBS. Am J Gastroenterol 2005, 100:115–123.
Berman SM, Chang L, Suyenobu B, et al.: Condition-specific deactivation of brain regions by 5-HT3 receptor antagonist alosetron. Gastroenterology 2002, 123:969–977.
Bradette M, Moennikes H, Carter F, et al.: Cilansetron in irritable bowel syndrome with diarrhea predominance (IBS-D): efficacy and safety in a 6 month global study. Gastroenterology 2004, 126:A42.
Coremans G, Clouse RE, Carter F, et al.: Cilansetron, a novel 5-HT3 antagonist, demonstrated efficacy in males with irritable bowel syndrome with diarrhea-predominance (IBS-D). Gastroenterology 2004, 126:A643.
Prather CM, Camilleri M, Zinsmeister AR, et al.: Tegaserod accelerates orocecal transit in patients with constipationpredominant irritable bowel syndrome. Gastroenterology 2000, 118:463–468.
Muller-Lissner SA, Fumagalli I, Bardhan KD, et al.: Tegaserod, a 5-HT(4) receptor partial agonist, relieves symptoms in irritable bowel syndrome patients with abdominal pain, bloating and constipation. Aliment Pharmacol Ther 2001, 15(10):1655–66.
Kellow J, Lee OY, Chang FY, et al.: An Asia-Pacific, double blind, placebo controlled, randomised study to evaluate the efficacy, safety, and tolerability of tegaserod in patients with irritable bowel syndrome. Gut 2003, 52:671–676.
Johanson JF, Wald A, Tougas G, et al.: Effect of tegaserod in chronic constipation: a randomized, double-blind, controlled trial. Clin Gastroenterol Hepatol 2004, 2:796–805.
Tougas G, Snape WJ Jr, Otten MH, et al.: Long-term safety of tegaserod in patients with constipation-predominant irritable bowel syndrome. Aliment Pharmacol Ther 2002, 16:1701–1708.
Drossman DA, Toner BB, Whitehead WE, et al.: Cognitivebehavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Gastroenterology 2003, 125:19–31.
Creed F, Fernandes L, Guthrie E, et al.: The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome. Gastroenterology 2003, 124:303–317.
Tabas G, Beaves M, Wang J, et al.: Paroxetine to treat irritable bowel syndrome not responding to high-fiber diet: A double-blind, placebo-controlled trial. Am J Gastroenterol 2004, 99:914–920.
Lackner JM, Mesmer C, Morley S, et al.: Psychological treatments for irritable bowel syndrome: a systematic review and meta-analysis. J Consult Clin Psychol 2004, 72:1100–1113.
Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ: Long term benefits of hypnotherapy for irritable bowel syndrome. Gut 2003, 52:1623–1629.
Pimentel M, Chow EJ, Lin HC: Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol 2000, 95:3503–3506.
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 Gastroenterol 2003, 98:412–419.
Pimentel M, Soffer EE, Chow EJ, et al.: Lower frequency of MMC is found in IBS subjects with abnormal lactulose breath test, suggesting bacterial overgrowth. Dig Dis Sci 2002, 47:2639–2643.
Hills JM, Aaronson PI: The mechanism of action of peppermint oil on gastrointestinal smooth muscle: an analysis using patch clamp electrophysiology and isolated tissue pharmacology in rabbit and guinea pig. Gastroenterology 1991, 101:55–65.
Bensoussan A, Talley NJ, Hing M, et al.: Treatment of irritable bowel syndrome with Chinese herbal medicine: a randomized controlled trial. JAMA 1998, 280:1585–1589.
Madisch A, Holtmann G, Plein K, Hotz J: Treatment of irritable bowel syndrome with herbal preparations: results of a double-blind, randomized, placebo-controlled, multi-centre trial. Aliment Pharmacol Ther 2004, 19:271–279.
Rohrbock RB, Hammer J, Vogelsang H, et al.: Acupuncture has a placebo effect on rectal perception but not on distensibility and spatial summation: a study in health and IBS. Am J Gastroenterol 2004, 99:1990–1997.
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Tillisch, K., Chang, L. Diagnosis and treatment of irritable bowel syndrome: State of the art. Curr Gastroenterol Rep 7, 249–256 (2005). https://doi.org/10.1007/s11894-005-0016-y
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DOI: https://doi.org/10.1007/s11894-005-0016-y