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Advances in the management of irritable bowel syndrome

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Abstract

Irritable bowel syndrome (IBS) is a commonly encountered condition seen in multiple medical specialties. Recent research has brought dramatic advances in our understanding of the epidemiology, burden of illness, diagnosis, and management of IBS. It is now widely accepted that the prevalence of IBS is between 10% and 20% of the US population and that the direct and indirect costs associated with IBS are significant. The processes required for diagnosis of IBS remain controversial. Scant evidence exists to support exhaustive diagnostic evaluations, and IBS is no longer considered a diagnosis of exclusion. The use of standardized symptom-based criteria remains to be perfected, and the diagnosis is often arrived at only after multiple laboratory, endoscopic, and radiologic examinations. The effects of treatment for IBS mirror the heterogeneous nature of the condition. No single medication has proven to be universally effective, and multiple therapeutic approaches exist. Greater understanding of gastrointestinal neurophysiology has led to promising advances in medical and nonmedical approaches to IBS.

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References

  1. Saito YA, Schoenfeld P, Locke GR: The epidemiology of irritable bowel syndrome in North America: a systematic review. Am J Gastroenterol 2002, 97:1910–1915.

    PubMed  Google Scholar 

  2. Sandler RS: Epidemiology of irritable bowel syndrome in the United States. Gastroenterology 1990, 99:409–415.

    PubMed  CAS  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. Brown WH, Chey WD, Elta GH: Number of responses on a review of systems questionnaire predicts the diagnosis of functional GI disorders. J Clin Gastroenterol 2003, 36:222–227.

    Article  PubMed  Google Scholar 

  5. Drossman DA, Li Z, Andruzzi E, et al.: U.S. householder survey of functional GI disorders: prevalence, sociodemography, and health impact. Dig Dis Sci 1993, 38:1569–1580.

    Article  PubMed  CAS  Google Scholar 

  6. Kozma CM, Bargout V, Slaton T, et al.: A comparison of officebased physician visits for irritable bowel syndrome and for migraine and asthma. Manag Care Interface 2002, 9:40–43,49.

    Google Scholar 

  7. Hasler WL, Schoenfeld P: Systematic review: abdominal and pelvic surgery in patients with irritable bowel syndrome. Aliment Pharmacol Ther 2003, 17:997–1005.

    Article  PubMed  CAS  Google Scholar 

  8. Ricci JF, Jhingran P, McLaughlin T, et al.: Costs of care for irritable bowel syndrome in managed care. J Clin Outcomes Manage 2000, 7:23–28.

    Google Scholar 

  9. 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.

    Article  PubMed  CAS  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. Sandler RS, Everhart JE, Donowitz M, et al.: The burden of selected digestive diseases in the United States. Gastroenterology 2002, 122:1500–1511.

    Article  PubMed  Google Scholar 

  12. Müller-Lissner SA, Pirk O: Irritable bowel syndrome in Germany: a cost of illness study. Eur J Gastroenterol Hepatol 2002, 14:1325–1329.

    Article  PubMed  Google Scholar 

  13. Talley NJ, Gabriel SE, Harmsen WS, et al.: Medical costs in community subjects with irritable bowel syndrome. Gastroenterology 1995, 109:1736–1741.

    Article  PubMed  CAS  Google Scholar 

  14. 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.

    Article  PubMed  CAS  Google Scholar 

  15. Hahn BA, Songkai Y, Strassels S: Impact of irritable bowel syndrome quality of life and resource use in the United States and United Kingdom. Digestion 1999, 60:77–81.

    Article  PubMed  CAS  Google Scholar 

  16. Icks A, Haastert B, Enck P, et al.: Health-related quality of life in subjects with functional bowel disorders in Germany. Z Gastroenterol 2002, 40:863–867.

    Article  PubMed  CAS  Google Scholar 

  17. Manning AP, Thompson WG, Heaton KW, et al.: Towards a positive diagnosis of the irritable bowel syndrome. Br Med J 1978, 2:653–654.

    Article  PubMed  CAS  Google Scholar 

  18. Thompson WG, Dotewall G, Drossman DA, et al.: Irritable bowel syndrome: guidelines for the diagnosis. Gastroenterol Int 1989, 2:92–95

    Google Scholar 

  19. Thompson WG, Longstreth GF, Drossman DA, et al.: Functional bowel disorders and functional abdominal pain. Gut 1999, 45(Suppl II):II43-II47.

    Article  PubMed  Google Scholar 

  20. Chey WD, Olden K, Carter E, et al.: Utility of Rome I and Rome II criteria for IBS in U.S. women. Am J Gastroenterol 2002, 97:2803–2811.

    Article  PubMed  Google Scholar 

  21. 21.American Gastroenterological Association Medical Position Statement: Irritable bowel syndrome. Gastroenterology 1997 112:2118–2119.

  22. Drossman DA: An integrated approach to the irritable bowel syndrome. Aliment Pharmacol Ther 1999, 13(Suppl 2):3–14.

    Article  PubMed  Google Scholar 

  23. Camilleri M, Parther CM: The irritable bowel syndrome: mechanisms and a practical approach to management. Ann Int Med 1992, 116:1001–1008.

    PubMed  CAS  Google Scholar 

  24. Schmulson MW, Chang L: Diagnostic approach to the patient with irritable bowel syndrome. Am J Med 1999, 107:20S-26S.

    Article  PubMed  CAS  Google Scholar 

  25. Cash BD, Schoenfeld PS, Chey WD: The utility of diagnostic tests in irritable bowel syndrome patients: a systematic review. Am J Gastroenterol 2002, 97:2812–2819.

    Article  PubMed  Google Scholar 

  26. Hamm LR, Sorrells SC, Harding JP, et al.: Additional investigations fail to alter the diagnosis of irritable bowel syndrome in subjects fulfilling the Rome criteria. Am J Gastroenterol 1999, 94:1279–1282.

    Article  PubMed  CAS  Google Scholar 

  27. Tolliver BA, Herrera JL, DiPalma JA: Evaluation of patients who meet clinical criteria for irritable bowel syndrome. Am J Gastroenterol 1994, 89:176–178.

    PubMed  CAS  Google Scholar 

  28. MacIntosh DG, Thompson WG, Patel DG, et al.: Is rectal biopsy necessary in irritable bowel syndrome? Am J Gastroenterol 1992, 87:1407–1409.

    PubMed  CAS  Google Scholar 

  29. Francis CY, Duffy JN, Whorwell PJ, et al.: Does routine ultrasound enhance diagnostic accuracy in irritable bowel syndrome? Am J Gastroenterol 1996, 91:1348–1350.

    PubMed  CAS  Google Scholar 

  30. Sanders DS, Carter MJ, Hurlstone DP, et al.: Association of adult coeliac disease with irritable bowel syndrome: a casecontrol study in patients fulfilling the ROME II criteria referred to secondary care. Lancet 2001, 358:1504–1508.

    Article  PubMed  CAS  Google Scholar 

  31. 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.

    Article  PubMed  CAS  Google Scholar 

  32. 32.American Gastroenterological Association: Technical review on irritable bowel syndrome. Gastroenterology 2002, 123:2108–2131. Updated technical review covering all aspects of IBS.

    Article  Google Scholar 

  33. 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. Important systematic review addressing the epidemiology, diagnosis, and treatment of IBS.

    PubMed  Google Scholar 

  34. Fasano A, Berti I, Gerarduzzi T, et al.: Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med 2003, 163:286–292.

    Article  PubMed  Google Scholar 

  35. O’Leary C, Wieneke P, Buckley S, et al.: Celiac disease and irritable bowel-type symptoms. Am J Gastroenterol 2002, 97:1463–1467.

    Article  PubMed  Google Scholar 

  36. Bytzer P, Hansen JM, Schaffalitzky de Muckadell OB: Empirical H2-blocker therapy or prompt endoscopy in management of dyspepsia. Lancet 1994, 343:811–816.

    Article  PubMed  CAS  Google Scholar 

  37. Lassen AT, Pedersen FM, Bytzer P, et al.: Helicobacter pylori test-and-eradicate versus prompt endoscopy for management of dyspeptic patients: a randomised trial, Lancet 356:455–460.

  38. Bouin M, Plourde V, Boivin M, et al.: Rectal distention testing in patients with irritable bowel syndrome: sensitivity, specificity, and predictive values of pain sensory thresholds. Gastroenterology 2002, 122:1771–1777.

    Article  PubMed  Google Scholar 

  39. Chadwick VS, Chen W, Shu D, et al.: Activation of the mucosal immune system in irritable bowel syndrome. Gastroenterology 2002, 122:1778–1783.

    Article  PubMed  Google Scholar 

  40. Tornblom H, Lindberg G, Nyberg B, et al.: Full-thickness biopsy of the jejunum reveals inflammation and enteric neuropathy in the irritable bowel syndrome. Gastroenterology 2002, 123:1972–1979.

    Article  PubMed  Google Scholar 

  41. Tibble JA, Sigthorsson G, Foster R, et al.: Use of surrogate markers of inflammation and Rome criteria to distinguish organic from nonorganic intestinal disease. Gastroenterology 2002, 123:450–460.

    Article  PubMed  Google Scholar 

  42. Pimentel M, Chow EJ, Lin HC: Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome: a double-blind, randomized, placebocontrolled study. Am J Gastroenterol 2003, 98:412–419.

    PubMed  Google Scholar 

  43. Talley NJ: Pharmacologic therapy for the irritable bowel syndrome. Am J Gastroenterol 2003, 98:750–758.

    Article  PubMed  CAS  Google Scholar 

  44. Schoenfeld P, Chey WD: An evidence-based approach to clinical practice guidelines: diagnosis and treatment of irritable bowel syndrome. Clin Gastroenterol Hepatol 2003, 1:322–327.

    Article  PubMed  Google Scholar 

  45. Veldhuyzen van Zanten SJO: Design of treatment trials for the functional gastrointestinal disorders. In Rome II: The Functional Gastrointestinal Disorders, edn 2. Edited by Drossman DA. McLean, VA: Degnon Associates; 2000:577–622.

    Google Scholar 

  46. Blomhoff S, Jacobsen MB, Spetalen S, et al.: Perceptual hyperreactivity to auditory stimuli in patients with irritable bowel syndrome. Scand J Gastroenterol 2000, 35:583–589.

    Article  PubMed  CAS  Google Scholar 

  47. Dickhaus B, Mayer EA, Firooz N, et al.: Irritable bowel syndrome patients show enhanced modulation of visceral perception by auditory stress. Am J Gastroenterol 2003, 98:135–143.

    Article  PubMed  Google Scholar 

  48. Drossman DA, Lesserman J, Nachman G, et al.: Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann Intern Med 1990, 113:828–833.

    PubMed  CAS  Google Scholar 

  49. Walker EA, Gelfand AN, Gelfand MD, et al.: Medical and psychiatric symptoms in female gastroenterology clinic patients with histories of sexual victimization. Gen Hosp Psychiatry 1995, 17:85–92.

    Article  PubMed  CAS  Google Scholar 

  50. Lesserman J, Drossman DA, Li Z, et al.: Sexual and physical abuse history in gastroenterology practice: how types of abuse impact health status. Psychosom Med 1996, 58:4–15.

    Google Scholar 

  51. Miller AR, North CS, Clouse RE, et al.: The association of irritable bowel syndrome and somatization disorder. Ann Clin Psychiatry 2001, 13:25–30.

    Article  PubMed  CAS  Google Scholar 

  52. Jackson JL, O’Malley PG, Tomkins G, et al.: Treatment of functional bowel gastrointestinal disorders with antidepressant medications: a meta-analysis. Am J Med 2000, 108:65–72.

    Article  PubMed  CAS  Google Scholar 

  53. 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. Well-designed randomized trial evaluating the effectiveness of desipramine or cognitive-behavioral therapy for IBS.

    Article  PubMed  Google Scholar 

  54. Clouse RE: Antidepressants for irritable bowel syndrome. Gut 2003, 52:598–599.

    Article  PubMed  CAS  Google Scholar 

  55. Akehurst R, Kaltenthaler E: Treatment of irritable bowel syndrome: a review of randomised controlled trials. Gut 2001, 48:272–282.

    Article  PubMed  CAS  Google Scholar 

  56. Creed FH, Joy R, Guthrie EA: Cost-effective randomised controlled trial of psychotherapy and antidepressants for severe irritable bowel syndrome. Psychosom Med 2000, 62:108–109.

    Google Scholar 

  57. Clouse RE: Antidepressants for functional gastrointestinal syndromes. Dig Dis Sci 1994, 39:2352–2363.

    Article  PubMed  CAS  Google Scholar 

  58. Chial HJ, Camilleri M, Ferber I, et al.: Effects of venlafaxine, buspirone, and placebo on colonic sensorimotor functions in healthy humans. Clin Gastroenterol Hepatol 2003, 1:211–218.

    Article  PubMed  CAS  Google Scholar 

  59. Kuiken SD, Tytgat GNJ, Boeckxstaens GEE: The selective serotonin reuptake inhibitor fluoxetine does not change rectal sensitivity and symptoms in patients with irritable bowel syndrome: a double blind, randomized, placebo-controlled study. Clin Gastroenterol Hepatol 2003, 1:219–228.

    Article  PubMed  CAS  Google Scholar 

  60. 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. Important randomized trial evaluating the efficacy and cost-effectiveness of psychotherapy or paroxetine for IBS.

    Article  PubMed  Google Scholar 

  61. Gershon M: Roles played by 5-hydroxytryptamine in the physiology of the bowel. Aliment Pharmacol Ther 1999, 13:15–30.

    Article  PubMed  Google Scholar 

  62. Houghton LA, Atkinson W: Increased platelet depleted plasma 5-hydroxytryptamine concentration following meal ingestion in symptomatic female subjects with diarrhoea predominant irritable bowel syndrome. Gut 2003, 52:663–70.

    Article  PubMed  CAS  Google Scholar 

  63. Delvaux M, Louvel D, Mamet JP, et al.: Effect of alosetron on responses to colonic distention in patients with irritable bowel syndrome. Aliment Pharmacol Ther 1998, 12:849–855.

    Article  PubMed  CAS  Google Scholar 

  64. Houghton LA, Forster JM, Whorwell PJ: Alosetron, a 5HT3 receptor antagonist, delays colonic transit in patients with irritable bowel syndrome and healthy volunteers. Aliment Pharmacol Ther 2000, 14:775–782.

    Article  PubMed  CAS  Google Scholar 

  65. Chey WD: Tegaserod and other serotonergic agents: What is the evidence? Rev Gastroenterol Disord 2003, 3:S35-S40.

    PubMed  Google Scholar 

  66. 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, 161:1733–1740.

    Article  PubMed  CAS  Google Scholar 

  67. Jones R, Holtmann G, Rodrigi L, et al.: Alosetron relieves pain and improves bowel function compared with mebeverine in female nonconstipated irritable bowel syndrome patients. Aliment Pharmacol Ther 1999, 13:1419–1427.

    Article  PubMed  CAS  Google Scholar 

  68. 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.

    Article  PubMed  CAS  Google Scholar 

  69. Lembo T, Wright RA, Bagby B, et al.: Alosetron controls bowel urgency and provides global symptom improvement in women with diarrhea-predominant irritable bowel syndrome. Am J Gastroenterol 2001, 96:2662–2670.

    Article  PubMed  CAS  Google Scholar 

  70. Mayer EA, Berman S, Derbyshire SWG, et al.: The effect of the 5-HT3 receptor antagonist, alosetron, on brain responses to visceral stimulation in irritable bowel syndrome patients. Aliment Pharmacol Ther 2002, 16:1357–1366.

    Article  PubMed  CAS  Google Scholar 

  71. Iden K, DeGarmo RG, Jhingran P, et al.: Patient satisfaction with alosetron for the treatment of women with diarrheapredominant irritable bowel syndrome. Am J Gastroenterol 2002, 97:3139–3146.

    Article  Google Scholar 

  72. Müller-Lissner SA, Fumagalli I, Bardhan KD, et al.: Tegaserod, a 5-HT4 receptor partial agonist, relieves symptoms in irritable bowel syndrome patients with abdominal pain, bloating and constipation. Aliment Pharmacol Ther 2001, 15:1655–1666.

    Article  PubMed  Google Scholar 

  73. Whorwell PJ, Krumholz S, Müller-Lisner S, et al.: Tegaserod has a favorable safety and tolerability profile in patients with constipation-predominant irritable bowel syndrome [abstract]. Gastroenterology 2000, 118:A1204.

    Article  Google Scholar 

  74. Novick J, Miner P, Krause R, et al.: A randomized, doubleblind, placebo controlled trial of tegaserod in female patients suffering from irritable bowel syndrome with constipation. Aliment Pharmacol Ther 2002, 16:877–888.

    Article  Google Scholar 

  75. Kellow J, Lee OY, Chang FY, et al.: An Asia-Pacific, double blind, placebo controlled, randomized study to evaluate the efficacy, safety, and tolerability of tegaserod in patients with irritable bowel syndrome. Gut 2003, 52:671–676.

    Article  PubMed  CAS  Google Scholar 

  76. Tougas G, Snape Jr. WJ, Otten MH, et al.: Long-term safety of tegaserod in patients with constipation-predominant irritable bowel syndrome. Aliment Pharmacol Ther 2002, 16:1701–1708.

    Article  PubMed  CAS  Google Scholar 

  77. Morganroth J, Rüegg PC, Dunger-Baldauf C, et al.: Tegaserod, a 5-hydroxytryptamine type 4 receptor partial agonist, is devoid of electrocardiographic effects. Am J Gastroenterol 2002, 97:2321–2337.

    Article  PubMed  CAS  Google Scholar 

  78. Palsson OS, Turner MJ, Johnson DA, et al.: Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms. Dig Dis Sci 2002, 47:2605–2614.

    Article  PubMed  Google Scholar 

  79. Gonsalkorale WM, Houghton LA, Whorwell PJ: Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness. Am J Gastroenterol 2002, 97:954–961.

    Article  PubMed  Google Scholar 

  80. Keefer L, Blanchard EB: A one year follow-up of relaxation response meditation as a treatment for irritable bowel syndrome. Behav Res Ther 2002, 40:541–546.

    Article  PubMed  CAS  Google Scholar 

  81. 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.

    Article  PubMed  Google Scholar 

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Cash, B.D., Chey, W.D. Advances in the management of irritable bowel syndrome. Curr Gastroenterol Rep 5, 468–475 (2003). https://doi.org/10.1007/s11894-003-0035-5

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