Ibs

Irritable Bowel Syndrome: A Concise Guide for Medical Professionals

What is it?

Irritable bowel syndrome (IBS), a specific cluster of chronic abdominal symptoms, is the most common functional gastrointestinal disorder. About 15-20% of the general population suffer from IBS, including all racial/ethnic subsets and adult/adolescent age groups. Females predominate, especially among the most severely affected patients. IBS accounts for enormous direct medical costs as well as work absenteeism and other indirect costs. It is one of the most common diagnoses in primary care practice.

Pathogenesis IBS is not explainable on structural or biochemical grounds. Various pathogenic mechanisms support a biopsychosocial concept: Abnormal motor function Visceral hyperalgesia, the enhanced perception of visceral stimuli Abnormal cerebral processing of bowel stimuli Luminal factors, such as malabsorbed sugars or previous infection

Psychological factors The multifactorial nature of IBS emphasizes the need for an individualized approach to diagnosis and treatment!

Diagnosis IBS usually can be diagnosed confidently by a typical history and limited laboratory and structural evaluation. Careful attention to the description of pain and bowel habit is critical. The characteristic features form the basis for diagnostic criteria developed by multinational consensus.

The characteristic symptoms alone do not always differentiate IBS from organic disease, and inquiry should be made about medication use and potential dietary factors, such as caffeine, fructose in fruit juice and sorbitol in artificially sweetened candy. Psychosocial factors, including recent stress, may influence the clinical presentation. Importantly, warning ("alarm") signs that are not attributable to IBS should be sought: weight loss, hematochezia, fever, frequent nocturnal symptoms. Physical examination reveals no explanation for the symptoms.

Diagnostic testing should be individualized according to the patient’s age, predominant symptom, severity and duration of symptoms, and presence of psychosocial factors. In primary care, the emphasis should be on minimizing tests in patients with typical symptoms and no warning signs. The evaluation can be limited to that required for the physician to confidently provide explanation, reassure, and initiate therapy.

Prolonged, fruitless diagnostic evaluation tends to increase patient anxiety and needlessly raises costs. In young patients, no testing or only basic blood tests, such as a complete blood count and erythrocyte sedimentation rate, may be considered. Other tests, especially large bowel endoscopy or barium enema, may be needed in some young patients and should be used more routinely in older patients.