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Abdominal Pain in Irritable Bowel Syndrome (IBS)

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Chronic Abdominal Pain

Abstract

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder. Although not life threatening IBS causes years of suffering and impaired quality of life. The pathogenesis of IBS is not completely understood but probably involves interplay between peripheral and central mechanisms. IBS patients demonstrate peripheral visceral hypersensitivity and motility disturbances as well as maladaptive central processing of visceral pain inputs. Stress and comorbid psychopathologies, such as anxiety, depression, and somatization, are frequently seen and are associated with a more severe clinical presentation. Since IBS lacks any diagnostic finding or biomarker the diagnosis is based on the presence of a typical cluster of symptoms and the absence of clinical warning signs also known as “red flags.”

Although IBS treatment is suboptimal and palliative in nature, still much can be done to help these patients. The corner stone of therapy must be a good doctor–patient relationship based on the biopsychosocial model. Treatment options include a wide range of dietary modifications, pharmacological agents, and behavioral interventions.

This chapter reviews the epidemiology pathophysiology and treatment of IBS. Special focus is given to the rationale, evidence, and practical use of psychotropic agents in IBS.

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References

  1. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. In: Drossman SA, Corazziari E, Delvaux M, Spiller RC, Talley NJ, Thompson WG, et al., editors. Rome III the functional gastrointestinal disorders. McLean, VA: Degnon Associates; 2006. p. 487–555.

    Google Scholar 

  2. Sperber AD. The challenge of cross-cultural, multi-national research: potential benefits in the functional gastrointestinal disorders. Neurogastroenterol Motil. 2009;21:351–60.

    Article  CAS  PubMed  Google Scholar 

  3. Drossman DA, Camilleri M, Mayer EA, Whitehead WE. AGA technical review on irritable bowel syndrome. Gastroenterology. 2002;123:2108–31.

    Article  PubMed  Google Scholar 

  4. Andrews EB, Eaton SC, Hollis KA, Hopkins JS, Ameen V, Hamm LR, et al. Prevalence and demographics of irritable bowel syndrome: results from a large web-based survey. Aliment Pharmacol Ther. 2005;22:935–42.

    Article  CAS  PubMed  Google Scholar 

  5. Sperber AD, Friger M, Shvartzman P, Abu-Rabia M, Abu-Rabia R, Abu Rashed M, et al. Rates of functional bowel disorders among Israeli Bedouins in rural areas compared to those who moved to permanent towns. Clin Gastroenterol Hepatol. 2005;3:342–8.

    Article  PubMed  Google Scholar 

  6. Lu CL, Chang FY, Lang HC, Chen CY, Luo JC, Lee SD. Gender difference on the symptoms, health-seeking behaviour, social impact and sleep quality in irritable bowel syndrome: a Rome II-based survey in an apparent healthy adult Chinese population in Taiwan. Aliment Pharmacol Ther. 2005;21:1497–505.

    Article  PubMed  Google Scholar 

  7. Xiong LS, Chen MH, Chen HX, Xu AG, Wang WA, Hu PJ. A population-based epidemiologic study of irritable bowel syndrome in South China: stratified randomized study by cluster sampling. Aliment Pharmacol Ther. 2004;19:1217–24.

    Article  CAS  PubMed  Google Scholar 

  8. Makharia GK, Verma AK, Amarchand R, Goswami A, Singh P, Agnihotri A, et al. Prevalence of irritable bowel syndrome: a community based study from northern India. J Neurogastroenterol Motil. 2011;17:82–7.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Ghoshal UC, Abraham P, Bhatt C, Choudhuri G, Bhatia SJ, Shenoy KT, et al. Epidemiological and clinical profile of irritable bowel syndrome in India: report of the Indian Society of Gastroenterology Task Force. Indian J Gastroenterol. 2008;27:22–8.

    PubMed  Google Scholar 

  10. Hungin AP, Chang L, Locke GR, Dennis EH, Barghout V. Irritable bowel syndrome in the United States: prevalence, symptom patterns and impact. Aliment Pharmacol Ther. 2005;21:1365–75.

    Article  CAS  PubMed  Google Scholar 

  11. Hungin AP, Whorwell PJ, Tack J, Mearin F. The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40,000 subjects. Aliment Pharmacol Ther. 2003;17:643–50.

    Article  CAS  PubMed  Google Scholar 

  12. Minocha A, Chad W, Do W, Johnson WD. Racial differences in epidemiology of irritable bowel syndrome alone, un-investigated dyspepsia alone, and “overlap syndrome” among African Americans compared to Caucasians: a population-based study. Dig Dis Sci. 2006;51:218–26.

    Article  PubMed  Google Scholar 

  13. Wilson S, Roberts L, Roalfe A, Bridge P, Singh S. Prevalence of irritable bowel syndrome: a community survey. Br J Gen Pract. 2004;54:495–502.

    PubMed Central  PubMed  Google Scholar 

  14. Maxion-Bergemann S, Thielecke F, Abel F, Bergemann R. Costs of irritable bowel syndrome in the UK and US. Pharmacoeconomics. 2006;24:21–37.

    Article  PubMed  Google Scholar 

  15. Sandler RS, Everhart JE, Donowitz M, adams E, Cronin K, Goodman C, et al. The burden of selected digestive diseases in the United States. Gastroenterology. 2002;122:1500–11.

    Article  PubMed  Google Scholar 

  16. Vanner SJ, Depew WT, Paterson WG, DaCosta LR, Groll AG, Simon JB, et al. Predictive value of the Rome criteria for diagnosing the irritable bowel syndrome. Am J Gastroenterol. 1999;94:2912–7.

    Article  CAS  PubMed  Google Scholar 

  17. Hammer J, Eslick GD, Howell SC, Altiparmak E, Talley NJ. Diagnostic yield of alarm features in irritable bowel syndrome and functional dyspepsia. Gut. 2004;53:666–72.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006;130:1480–91.

    Article  PubMed  Google Scholar 

  19. Talley NJ, Zinsmeister AR, Melton 3rd LJ. Irritable bowel syndrome in a community: symptom subgroups, risk factors, and health care utilization. Am J Epidemiol. 1995;142:76–83.

    CAS  PubMed  Google Scholar 

  20. 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.

    Article  CAS  PubMed  Google Scholar 

  21. Harvey RF, Mauad EC, Brown AM. Prognosis in the irritable bowel syndrome: a 5-year prospective study. Lancet. 1987;1(8539):963–5.

    Article  CAS  PubMed  Google Scholar 

  22. Svendsen JH, Munck LK, Andersen LR. Irritable bowel syndrome: prognosis and diagnostic safety. A 5-year follow up study. Scand J Gastroenterol. 1985;20:415–8.

    Article  CAS  PubMed  Google Scholar 

  23. Drossman DA. Functional abdominal pain syndrome. Clin Gastroenterol Hepatol. 2004;2:353–65.

    Article  PubMed  Google Scholar 

  24. Coderre TJ, Katz J, Vaccarino AL, Melzack R. Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain. 1993;52:259–85.

    Article  CAS  PubMed  Google Scholar 

  25. Sperber AD, Drossman DA. Review article: the functional abdominal pain syndrome. Aliment Pharmacol Ther. 2011;33:514–24.

    Article  CAS  PubMed  Google Scholar 

  26. Yunus MB. Central sensitivity syndromes: a new paradigm and group nosology for fibromyalgia and overlapping conditions, and the related issue of disease versus illness. Semin Arthritis Rheum. 2008;37:339–52.

    Article  PubMed  Google Scholar 

  27. Elsenbruch S. Abdominal pain in irritable bowel syndrome: a review of putative psychological, neural and neuro-immune mechanisms. Brain Behav Immun. 2011;25:386–94.

    Article  CAS  PubMed  Google Scholar 

  28. Halvorson HA, Schlett CD, Riddle MS. Postinfectious irritable bowel syndrome–a meta-analysis. Am J Gastroenterol. 2006;101:1894–9.

    Article  PubMed  Google Scholar 

  29. Dunlop SP, Jenkins D, Neal KR, Spiller RC. Relative importance of enterochromaffin cell hyperplasia, anxiety, and depression in postinfectious IBS. Gastroenterology. 2003;125:1651–9.

    Article  PubMed  Google Scholar 

  30. Guilarte M, Santos J, de Torres I, Alonso C, Vicario M, Ramos L, et al. Diarrhoea-predominant IBS patients show mast cell activation and hyperplasia in the jejunum. Gut. 2007;56:203–9.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Marshall JK, Thabane M, Garg AX, Clark WF, Salvadori M, Collins SM. Incidence and epidemiology of irritable bowel syndrome after a large waterborne outbreak of bacterial dysentery. Gastroenterology. 2006;131:445–50.

    Article  PubMed  Google Scholar 

  32. Sperber AD, Blank Morris C, Greemberg L, Bangdiwala SI, Goldstein D, Sheiner E, et al. Development of abdominal pain and IBS following gynecological surgery: a prospective, controlled study. Gastroenterology. 2008;134:75–84.

    Article  PubMed  Google Scholar 

  33. Mertz H, Morgan V, Tanner G, Pickens D, Price R, Shyr Y, et al. Regional cerebral activation in irritable bowel syndrome and control subjects with painful and nonpainful rectal distention. Gastroenterology. 2000;118:842–8.

    Article  CAS  PubMed  Google Scholar 

  34. Naliboff BD, Derbyshire SW, Munakata J, Berman S, Mandelkern M, Chang L, et al. Cerebral activation in patients with irritable bowel syndrome and control subjects during rectosigmoid stimulation. Psychosom Med. 2001;63:365–75.

    Article  CAS  PubMed  Google Scholar 

  35. Chang L, Berman S, Mayer EA, Suyenobu B, Derbyshire S, Naliboff B, et al. Brain responses to visceral and somatic stimuli in patients with irritable bowel syndrome with and without fibromyalgia. Am J Gastroenterol. 2003;98:1354–61.

    Article  PubMed  Google Scholar 

  36. Ringel Y, Drossman DA, Turkington TG, Bradshaw B, Hawk TC, Bangdiwala S, 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;48:1774–81.

    Article  PubMed  Google Scholar 

  37. Drossman DA, Ringel Y, Vogt BA, Leserman J, Lin W, Smith JK, et al. Alterations of brain activity associated with resolution of emotional distress and pain in a case of severe irritable bowel syndrome. Gastroenterology. 2003;124:754–61.

    Article  PubMed  Google Scholar 

  38. Tanaka Y, Kanazawa M, Fukudo S, Drossman DA. Biopsychosocial model of irritable bowel syndrome. J Neurogastroenterol Motil. 2011;17:131–9.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Drossman DA. Psychosocial sound bites: exercises in the patient-doctor relationship. Am J Gastroenterol. 1997;92:1418–23.

    CAS  PubMed  Google Scholar 

  40. Drossman DA. Diagnosing and treating patients with refractory functional gastrointestinal disorders. Ann Intern Med. 1995;123:688–97.

    Article  CAS  PubMed  Google Scholar 

  41. Wong RK, Tan JS, Drossman DA. Here’s my phone number, don’t call me: physician accessibility in the cell phone and e-mail era. Dig Dis Sci. 2010;55:662–7.

    Article  PubMed  Google Scholar 

  42. Sperber AD, Dekel R. Irritable bowel syndrome and co-morbid gastrointestinal and extra-gastrointestinal functional syndromes. J Neurogastroenterol Motil. 2010;16:113–9.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Cremonini F, Delgado-Aros S, Camilleri M. Efficacy of alosetron in irritable bowel syndrome: a meta-analysis of randomized controlled trials. Neurogastroenterol Motil. 2003;15:79–86.

    Article  CAS  PubMed  Google Scholar 

  44. Drossman DA, Chey WD, Johanson JF, Fass R, Scott C, Panas R, et al. Clinical trial: lubiprostone in patients with constipation-associated irritable bowel syndrome–results of two randomized, placebo-controlled studies. Aliment Pharmacol Ther. 2009;29:329–41.

    Article  CAS  PubMed  Google Scholar 

  45. Drossman DA. Beyond tricyclics: new ideas for treating patients with painful and refractory functional gastrointestinal symptoms. Am J Gastroenterol. 2009;104:2897–902.

    Article  PubMed  Google Scholar 

  46. Ford AC, Talley NJ, Schoenfeld PS, Quigley EMM, Moayyedi P. Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis. Gut. 2009;58:367–78.

    Article  CAS  PubMed  Google Scholar 

  47. Grover M, Dorn SD, Weinland SR, Dalton CB, Gaynes BN, Drossman DA. Atypical antipsychotic quetiapine in the management of severe refractory functional gastrointestinal disorders. Dig Dis Sci. 2009;54:1284–91.

    Article  CAS  PubMed  Google Scholar 

  48. Lackner JM, Jaccard J, Krasner SS, Katz LA, Gudleski GD, Holroyd K. Self-administered cognitive behavior therapy for moderate to severe irritable bowel syndrome: clinical efficacy, tolerability, feasibility. Clin Gastroenterol Hepatol. 2008;6:899–906.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Kennedy TM, Chalder T, McCrone P, Darnley S, Knapp M, Jones RH, et al. Cognitive behavioural therapy in addition to antispasmodic therapy for irritable bowel syndrome in primary care: randomised controlled trial. Health Technol Assess. 2006;10:iii–iv, ix–x, 1–67.

    Google Scholar 

  50. Blanchard EB, Lackner JM, Sanders K, Krasner S, Keefer L, Payne A, et al. A controlled evaluation of group cognitive therapy in the treatment of irritable bowel syndrome. Behav Res Ther. 2007;45:633–48.

    Article  PubMed  Google Scholar 

  51. Drossman DA, Toner BB, Whitehead WE, Diamant NE, Dalton CB, Duncan S, et al. Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Gastroenterology. 2003;125:19–31.

    Article  PubMed  Google Scholar 

  52. Hyphantis T, Guthrie E, Tomenson B, Creed F. Psychodynamic interpersonal therapy and improvement in interpersonal difficulties in people with severe irritable bowel syndrome. Pain. 2009;145:196–203.

    Article  PubMed  Google Scholar 

  53. Creed F, Fernandes L, Guthrie E, Palmer S, Ratcliffe J, Read N, et al. The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome. Gastroenterology. 2003;124:303–17.

    Article  PubMed  Google Scholar 

  54. Guthrie E, Creed F, Dawson D, Tomenson B. A controlled trial of psychological treatment for the irritable bowel syndrome. Gastroenterology. 1991;100:450–7.

    CAS  PubMed  Google Scholar 

  55. Blanchard EB, Schwarz SP, Suls JM, Gerardi MA, Scharff L, Greene B, et al. Two controlled evaluations of multicomponent psychological treatment of irritable bowel syndrome. Behav Res Ther. 1992;30:175–89.

    Article  CAS  PubMed  Google Scholar 

  56. Gaylord SA, Palsson OS, Garland EL, Faurot KR, Coble RS, Mann JD, et al. Mindfulness training reduces the severity of irritable bowel syndrome in women: results of a randomized controlled trial. Am J Gastroenterol. 2011;106:1678–88.

    Article  PubMed  Google Scholar 

  57. Lindfors P, Unge P, Arvidsson P, Nyhlin H, Bjornsson E, Abrahamsson H, et al. Effects of gut-directed hypnotherapy on IBS in different clinical settings-results from two randomized, controlled trials. Am J Gastroenterol. 2012;107:276–85.

    Article  PubMed  Google Scholar 

  58. 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;97:954–61.

    Article  PubMed  Google Scholar 

  59. Lindfors P, Unge P, Nyhlin H, Ljotsson B, Bjornsson ES, Abrahamsson H, et al. Long-term effects of hypnotherapy in patients with refractory irritable bowel syndrome. Scand J Gastroenterol. 2012;47:414–20.

    Article  PubMed  Google Scholar 

  60. Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ. Long term benefits of hypnotherapy for irritable bowel syndrome. Gut. 2003;52:1623–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  61. Lackner JM, Gudleski GD, Keefer L, Krasner SS, Powell C, Katz LA. Rapid response to cognitive behavior therapy predicts treatment outcome in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2010;8:426–32.

    Article  PubMed Central  PubMed  Google Scholar 

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Correspondence to Roy Dekel M.D. .

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Dekel, R., Drossman, D.A., Sperber, A.D. (2015). Abdominal Pain in Irritable Bowel Syndrome (IBS). In: Kapural, L. (eds) Chronic Abdominal Pain. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1992-5_6

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  • DOI: https://doi.org/10.1007/978-1-4939-1992-5_6

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