Talk:Irritable bowel syndrome

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Former good article nominee Irritable bowel syndrome was a good articles nominee, but did not meet the good article criteria at the time. There are suggestions below for improving the article. Once these issues have been addressed, the article can be renominated. Editors may also seek a reassessment of the decision if they believe there was a mistake.
October 17, 2006 Good article nominee Not listed
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20-50% gastroenterology visits?[edit]

http://www.expresspharmaonline.com/20100115/market01.shtml

Why was this number deleted? —Preceding unsigned comment added by Hypernovic (talkcontribs) 22:25, 14 March 2010 (UTC)

Depression[edit]

I found a much more recent review article[1] which also cites the Ledochowski study. The interpretation is somewhat different:

"Fructose malabsorption has been associated with depression in young women with mood improvement following restriction of free fructose intake.68, 69 The mechanisms of these effects are poorly understood, but may involve low circulating levels of tryptophan, the precursor of serotonin.70 Such association is also consistent with the frequency of fatigue and lethargy in IBS."

"Other symptoms linked with fructose malabsorption, particularly mood and depression, have also been improved in patients following a ‘fructose-free’ diet. Thus, a 4-week exclusion diet in fructose malabsorbers has been shown to improve mood and depressive symptoms.69"

As far as I can see, major depression was not talked about by the Ledochowski study,[2] (source for the removed material), only an association with an increased Beck depression score. The Ledochowski study was also small (16 men, 34 women), with no blinding or controls. It only concludes, "Fructose malabsorption should be considered in patients with symptoms of depression and disturbances of tryptophan metabolism."

The material removed from the article was claiming much more than the Ledochowski study source. Ward20 (talk) 19:22, 10 April 2010 (UTC)

You need to be careful with studies like this because depression is highly susceptible to the placebo effect, and if there is no control then there is no way of knowing how much of the benefit is due to the placebo effect. Also the mechanism of fructose causing depression doesn't seem very plausible, so a lot of good evidence would be required before taking it seriously. --sciencewatcher (talk) 22:55, 10 April 2010 (UTC)
Agree. Editor Eloerc added more about fructose in the article then just the section that was removed [3]. Some material is obviously redundant and the rest should probably be examined for relevance and weight. Ward20 (talk) 23:20, 10 April 2010 (UTC)

Name change[edit]

Unsure why the name of this article was changed? Doc James (talk · contribs · email) 09:43, 11 April 2010 (UTC)

I explained on my talk page that I screwed up. There should be no redirect between these two articles, Irritable bowel syndrome and Irritable bowel disease. What I tried to do was remove the redirect and instead all I did was reverse the redirect. I tried to undo it but it didn't work. Would appreciate any help in removing the redirect completely. I've never done a redirect in all my time here so this would be a learning experience too. I read and read all I could about this but I guess I still didn't understand it. Sorry, --CrohnieGalTalk 09:55, 11 April 2010 (UTC)
Well it looks like an editor found my error. This editor undid my move but there is still a problem with the IBD article being redirected to this article which it shouldn't be. Maybe the IBD article should be redirected to Inflammatory bowel disease or just left to stand on it's own? I don't know when the redirect was done and I don't know how to undo it. I still have it requested where you also commented. Thanks, --CrohnieGalTalk 14:25, 11 April 2010 (UTC)
Is there even such a thing as 'irriable bowel disease'? I thought that was just people getting confused between IBS and IBD. Doing a quick search on google scholar seems to reveal that 'irritable bowel disease' is an occasionally used synonym for IBS, so I'd suggest either leaving the redirect so it points to IBS or just removing it entirely. It definitely shouldn't redirect to inflammatory bowel disease. --sciencewatcher (talk) 15:19, 11 April 2010 (UTC)
The initials IBD is commonly used for people with Inflammatory bowel disease like Crohn's disease or Ulcerative colitis. So it should redirect to that article or be deleted completely with anything in it that is salvagable put on the Inflammatory bowel disease article. I personally would like to see the redirect to there since a lot of people use the term IBD and it would take them to the correct article. IBD and IBS are not at all the same. Thanks, --CrohnieGalTalk 15:50, 11 April 2010 (UTC)
Yes, IBD should definitely redirect to inflammatory bowel disease. However 'irritable bowel disease' should redirect to IBS, which I see it does. So I think everything is ok now. --sciencewatcher (talk) 17:33, 11 April 2010 (UTC)
Yes agree with sciencewatcher. Doc James (talk · contribs · email) 18:16, 11 April 2010 (UTC)

──────────────────────────────────────────────────────────────────────────────────────────────────── The problem with have the article Irritable bowel disease being redirected here is that it is incorrect. IBD stands for Inflammatory bowel disease which can be seen at that article. IBD and IBS are always confused as being the same thing which it is not. The main thing I can think of is that IBS never causes bleeding whereas IBD can. I think the redirect to this article should be removed and a redirect put to the Inflammatory bowel disease. Thanks, --CrohnieGalTalk 16:48, 12 April 2010 (UTC)

Maybe a disambig page would be best which lists both and properly distinguishes them? Doc James (talk · contribs · email) 16:53, 12 April 2010 (UTC)
Crohnie, 'Irritable bowel disease' is not the same as 'Inflammatory bowel disease'. Just because they have the same first letters does not mean they are the same thing. 'Irritable bowel disease' is another term for IBS, although it seems to be infrequently used. If you redirected 'irritable bowel disease' to 'inflammatory bowel disease' that would be incorrect. I don't see the problem with IBD getting confused with IBS - as long as the IBD page lists 'inflammatory bowel disease' (which it does) and not 'irritable bowel disease' there should not be any confusion.
The only potential issue I can think of is people typing in 'irritable bowel disease' when they actually mean 'inflammatory bowel disease'. If that is an issue then maybe we should use Jmh649's suggestion to clearly distinguish between the two. --sciencewatcher (talk) 18:20, 12 April 2010 (UTC)
I agree with what Jmh649 and Sciencewatcher suggest. Thanks for all the input. I will not be doing anything since I do have a strong POV about this. I shouldn't be the one to make any changes like this. I'm sure you all understand. Thanks again, --CrohnieGalTalk 18:50, 12 April 2010 (UTC)

Suppose I should have posted earlier here - per a discusson at WT:MED, I added disambiguation hat notes on 13th April.[4] David Ruben Talk 20:36, 25 April 2010 (UTC)

Thank you, yes that takes care of things nicely and puts my concerns to rest. Thanks again, --CrohnieGalTalk 10:28, 26 April 2010 (UTC)

Fibromyalgia is not a psychiatric disease[edit]

This is biased information. Current thought on fibromyalgia is that it is an illness of central sensitization, an illness of the central nervous system.

Well there is some debate about that. The general consensus is that it probably is psychiatric, although it isn't classified as a psychiatric illness at present. However if you look at the reference for that statement in the article it actually lumps fibromyalgia in with 'nonpsychiatric conditions', so I think someone needs to take a closer look at that sentence and fix it. --sciencewatcher (talk) 15:18, 29 April 2010 (UTC)
Actually, on re-reading the article it does NOT say that fibromyalgia is psychiatric, but it isn't entirely clear. I'll just tweak it to make it more clear. --sciencewatcher (talk) 18:55, 29 April 2010 (UTC)

SarMarTay Suggestions 5-4-10 (Citations 1-26)[edit]

SarMarTay (talk) 16:47, 4 May 2010 (UTC)

In addition to these citation suggestions, I made minor text edits.


Irritable Bowel Syndrome:

1-(brief description of the disease) is a reliable source. This textbook can also be used:

Gastroenterology: an illustrated colour text By Graham P. Butcher

2-(bowel movement may relieve symptoms) is a primary literature article that should be replaced with a secondary source. Suggest deleting and replacing with [5]

For the second use of citation 2, the phrase "psychological interventions" is not supported by this source, so a separate source is required OR the wording can be changed to "...including dietary adjustments and medication." A secondary source that discusses psychological abnormalities and IBS is this textbook:

Gastroenterology: an illustrated colour text By Graham P. Butcher

3-(fructose malabsorption) is a primary literature article in German that should be replaced (See ref 4 comment).

4-(parasitic infections) is a dead link. I suggest deleting cites 3 and 4 and using a general reference such as a textbook or review for the entire sentence "Several conditions may present as IBS including celiac disease, Fructose malabsorption, mild infections, parasitic infections like giardiasis, several inflammatory bowel diseases, functional chronic constipation, and chronic functional abdominal pain." Citation 20 will work here, but "fructose" and "like giardiasis" should be removed.

5-(brain/body, gut flora or immune system) is a primary literature article that is not appropriate in this context (does not support the statement).

6-(brain/body, gut flora or immune system) is a primary literature review of IBS and gut flora and is relevent as of 2007. Citations for brain/body and immune system roles in IBS must be included here, too.

7-11-(IBS does not lead to other complications) are primary literature reviews that do not support the statement. I suggest replacing with a single secondary source such as[6].

12-15-(increased medical costs and absenteeism) are primary literature reviews that all basically come to similar conclusions. I suggest deleting all of these and replacing them with a single reference. I suggest citation 19 (The Burden of Illness of Irritable Bowel Syndrome: Current Challenges and Hope for the Future by DARRELL HULISZ, RPh, PharmD). Absenteeism is also in [7].

16-19-(prevalence and societal costs of IBS) are primary literature reviews that should also be deleted and replaced with citation 19.


Classification:

20-(types of IBS) is an appropriate primary literature review.


Symptoms:

21-23-(symptoms) are appropriate primary literature reviews [8] can also be added here.


Causes:

24-(infection increases IBS) is an appropriate primary literature review. However, the wording of the sentence "Post-infection, further risk factors are young age, prolonged fever, anxiety, and depression." is unclear. Are these additional factors that may lead to IBS, or are these symptoms due to IBS?

25-26-(brain/gut) are primary literature articles that are directly referred to in the text, so they should remain in the article.

SarMarTay (talk) 16:47, 4 May 2010 (UTC)

SarMarTay Suggestions 5-5-10 (Citations 27-42)[edit]

SarMarTay (talk) 16:31, 5 May 2010 (UTC)

-One or more citations are required for the "Immune reaction" section, preferably from secondary sources. This 2007 primary literature review discusses increased cytokine production in colons of IBS patients and will fit well here:

Role of infection in irritable bowel syndrome.[9]

27-28-(protozoa infection rates) are graphs that are not referred to in the text. 28 is a primary source and should be deleted. 27 (a review) can be cited later in the wiki after "Two of the protozoa investigated have a high prevalence in industrialized countries and infect the bowel, but little is known about them as they are recently emerged pathogens."

29-(Rifaximin) is a primary literature article that should be replaced with a secondary source. I am unable to find a non-primary source to support this section. Perhaps this should be moved to the Research or Treatment sections of this wiki.

30-(overgrowth of intestinal flora) is a primary literature article that should be replaced with a secondary source. I suggest using this 2009 primary literature review:

Small intestinal bacterial overgrowth in irritable bowel syndrome: systematic review and meta-analysis. [10]

6-(protozoa and IBS) is an acceptable primary literature review.

31-32-(increase in protozoa infection in IBS patients) are primary literature articles that should be replaced with a secondary source. The following review discusses this topic with regards to Blastocystis, but it is not from a mainstream journal (a textbook or mainstream review cite is desired):

Blastocystis hominis and bowel diseases[11]

33-(blastocystis symptoms) is a primary literature article that should be replaced in this context with a secondary source. This CDC website will work:

http://www.cdc.gov/ncidod/dpd/parasites/blastocystishominis/factsht_blastocystis_hominis.htm

34-(blastocystis symptoms contested by some physicians) is a primary literature article that should be replaced with a secondary source. The CDC website will also work here:

http://www.cdc.gov/ncidod/dpd/parasites/blastocystishominis/factsht_blastocystis_hominis.htm

35-(London infection rates) is a primary literature article that is appropriate because it is directly cited. It is currently a dead link.

31-(Pakistan infection rates) is a primary literature article that is appropriate here because it is directly cited.

32-(Italy infection rates) is a primary literature article that is appropriate here because it is directly cited.

36-(fail to identify blast infection) is a primary literature article that should be replaced with a secondary source. I suggest:

http://www.cdc.gov/ncidod/dpd/parasites/blastocystishominis/factsht_blastocystis_hominis.htm#should

34,37-39-(blast may not respond to treatment) are primary literature articles that should be replaced by a single secondary source. Again, the CDC site is sufficient:

http://www.cdc.gov/ncidod/dpd/parasites/blastocystishominis/factsht_blastocystis_hominis.htm#should

-I suggest citing D. fragilis infection symptoms with:

http://www.cdc.gov/ncidod/dpd/parasites/dientamoeba/factsht_dientamoeba.htm#symptoms

27-(See above) is an appropriate primary literature review.

40-(fragilis resolves with antibiotics) is a primary literature article that should be replaced with a secondary source. I suggest using:

http://www.cdc.gov/ncidod/dpd/parasites/dientamoeba/factsht_dientamoeba.htm#medication

Later, 40 is used to cite "Researchers have noted that methods used clinically may fail to detect some Dientamoeba fragilis infections." I suggest using:

http://www.cdc.gov/ncidod/dpd/parasites/dientamoeba/factsht_dientamoeba.htm#diagnosis

41-(fragilis causes IBS-like symptoms and can be treated) is a primary literature article that is directly cited, so it is appropriate. This is currently a dead link.

42-(fragilis found in non-IBS patients) is a primary literature article that should be deleted. I don't think a source is necessary here.

SarMarTay (talk) 16:31, 5 May 2010 (UTC)

SarMarTay Suggestions 5-5-10 (Citations 43-59)[edit]

SarMarTay (talk) 18:39, 5 May 2010 (UTC)

Diagnosis:

43-(IBS is a diagnosis of exclusion, suggested screening) is an appropriate primary literature review. This information can also be found in the textbook:

Gastroenterology: an illustrated colour text By Graham P. Butcher

44-(compared criteria for diagnosis) is an appropriate primary literature review.

45-(assessment of IBS diagnosis) is an acceptable primary literature review.

46-(patients with hidden constipation) is a primary literature article that is directly referenced in the text and should remain. The rest of this paragraph is a summary of this paper, so I suggest citing 46 again at the end of the paragraph. There is no link for this citation.

47-51-(misdiagnosis as IBS when really other conditions) are primary literature articles that should be replaced with a single secondary reference. Cite 20 can be used except it does not specifically reference heliobacter pylori (a bacteria), though it does have bacteria listed.

52-(IBS Celiacs recommendation) is an appropriate primary literature opinion article.

53-(medications may cause IBS-like symptoms) is a primary literature article that should be replaced with a secondary source. I suggest using citation 20.

23-(%of comorbidity) is an appropriate primary literature review.

54-(comorbidities) is a primary literature article that is directly cited in the text so it is appropriate. However, I suggest changing the wording of the sentence to "Irritable Bowel Syndrome is associated with headache, fibromyalgia, chronic fatigue syndrome and depression." This statement can be supported by a number of sources, including citation 20 and

Gastroenterology: an illustrated colour text By Graham P. Butcher (textbook)

7-10-(IBS and IBD) are acceptable primary literature reviews.

11-(specific IBS/IBD study) is a primary research article that is acceptable b/c it is directly referenced in the text.

55-57-(IBS and unnecessary abdominal surgery) are primary literature articles that are acceptable b/c they are directly mentioned in the article. However, there are a number of secondary sources that describe increased abdominal surgeries in IBS patients, including citation 19.

58-(migraine, endometriosis, IBS link) is a primary literature article that is appropriate because it is directly cited in the text.

59-(link to other chronic disorders) is a mayo clinic link to a small description of Interstitial cystitis. The wiki description was copied and pasted from this website. This section should be deleted, reworded and the mayo clinic link can be used as a citation:

[12]

SarMarTay (talk) 18:39, 5 May 2010 (UTC)

SarMarTay Suggestions 5-5-10 (Citations 60-92)[edit]

SarMarTay (talk) 00:27, 6 May 2010 (UTC)

Management:

60-(overview of treatment success) is an appropriate primary literature review.

61-(restrictive diets) is an appropriate primary literature review.

62-(lactose-free diet) is a primary literature article that should be replaced with a secondary source. I recommend:

[13]

63-(fructose malabsorption) is a website that is currently a dead link.

64-65-(IgG diet) is a primary literature article that is acceptable b/c it is directly referenced in the text. The link to 65 is the same link as 64. I think 65 should be deleted anyway because the statement does not need a reference.

66-(gastrocolic response) is a primary literature article that should be replaced with a secondary source. I am unable to find a secondary source at this time.

67-75-(fiber data) are primary literature sources that are acceptable because they are directly referenced in the wiki text. I would also suggest including one or more general citations regarding fiber, including:

http://digestive.niddk.nih.gov/ddiseases/pubs/ibs/#help

76-79-(medication overview) are acceptable primary literature reviews.

80-(laxatives) is a primary literature article that should be replaced with a secondary source.

-The Lubiprostone section appears to have been copied from answers.com

-The Antispasmotics section appears to have been copied from cureirritablebowel.com

-The Tegaserod section appears to have been copied from mayoclinic.com —Preceding unsigned comment added by SarMarTay (talkcontribs) 02:49, 6 May 2010 (UTC)

81-(Zelnorm effectiveness) is a primary literature article that is appropriate because it is referenced in the wiki, though a secondary source is desired. I suggest:

Updates on treatment of irritable bowel syndrome.[14]

Also, this section describes the history of Zelnorm approval, which is not necessarily appropriate for this article. I suggest describing Zelnorm's effectiveness in one sentence with a link to a Zelnorm wiki that discusses the history of the medication. The suggested citation also hits on Zelnorm approval.

82-85-(SSRI effectiveness) are primary literature articles that should be replaced with a secondary source. I suggest:

Role of serotonin in gastrointestinal motility and irritable bowel syndrome.[15]

86-(antidepressant effectiveness) is a pay-only website and should be replaced with a secondary citation that is accessible to the general public. I suggest citation 87 or:

[16]

87-88-(antidepressant effectiveness) 87 is a review and acceptable (mentioned above). 88 is acceptable because it is a primary research article that is referenced in the text.

89-90-(rafiximin) 89 is a primary literature article that is acceptable because it is referenced in the wiki text. 90 is an acceptable review about gut flora in IBS patients.

91-(domperidone) is a primary literature article that should be replaced with a secondary source. There is no link to citation 91. I am unable to find a secondary reference.

92-(opiods) is a dead link to a textbook.

SarMarTay (talk) 00:27, 6 May 2010 (UTC)

SarMarTay Suggestions 5-5-10 (Citations 93-115)[edit]

SarMarTay (talk) 01:16, 6 May 2010 (UTC)

-Cites 93-95 (phsycological treatments) are primary literature sources that should be replaced with a single secondary source. Citation 67 will work or many textbooks discuss psycological treatments, including:

Gastroenterology: an illustrated colour text By Graham P. Butcher

96-(questionnaire on IBS) is an acceptable primary research article because it is referenced in the wiki text.

97 and 100-(probiotics) are acceptable primary research reviews.

98-(probiotics) is a primary research article and the data is discussed in citation 97.

99-(probiotics) is a press release and should be deleted. A citation is not required because the information is discussed in citation 97.

101-(probiotics) is a dead link to Mayo Clinic.

102-(peppermint oil) is a primary source that should be replaced with a secondary source. I suggest using the citation 60 review. Or, this information is discussed on websites and textboooks.

The section concerning peppermint oil usage to treat IBS suggests that all IBS sufferers should use peppermint oil. This statement is medical advice and should be deleted.

103-(iberogast) is a primary source that should be replaced with a secondary source.

-Cite 104 (acupuncture) is a primary research article that is acceptable because it is directly referenced in the wiki text. However, a secondary article is desired.

-Graph with % population with IBS is not cited in the text. It should be cited OR removed.

-Cites 105-110 (% population with IBS) and table are direct references from primary data and are sufficient as citations.


History:

-Cite 111 (first IBS symptoms reported) is a direct reference from primary literature and is sufficient.


Economics:

-Cites 112-113 (monetary costs of IBS) are direct references from primary literature and are sufficient.


Research:

-Cite 114 (fructose diet) is a direct reference and is sufficient in the Research section.

-Cite 115 (IgG diet) is a direct reference and is sufficient in the Research section.

SarMarTay (talk) 01:16, 6 May 2010 (UTC)

Can you condense and/or shorten some of this. It's gotten to the point where too long; didn't read gets applied. Also, you just need to sign at the end of your post not in the beginning nor in the subject line. Thanks in advance, --CrohnieGalTalk 10:26, 6 May 2010 (UTC)
Agreed. If you want to help fix the references in the article, that is great - just go ahead and do it. No need to post a whole load of references here for us to look through. --sciencewatcher (talk) 14:26, 6 May 2010 (UTC)
I am concerned that reviews and meta-analysis's have been wrongly labeled as primary sources as well as other issues with this analysis of sources which I have addressed on the SarMarTays talk page. I reviewed some of the changes and flagging and saw lots of inappropriate flaggings and decided to boldly revert. Hopefully SarMar will understand my bold revert.--Literaturegeek | T@1k? 15:16, 8 May 2010 (UTC)

(outdent), I think I see one problem, SarMar is interpreting review articles as being primary sources because they are reviewing primary sources, presumably SarMar mistakenly thinks a secondary source is one that only reviews reviews or something. A secondary source comments and reviews or analyses primary source. As a result of this misinterpretation even a meta-analysis by Cochrane Review was labeled a primary source! Primary sources are not forbidden on wikipedia just simply used more cautiously and secondary sources given preference.--Literaturegeek | T@1k? 15:20, 8 May 2010 (UTC)

SarMarTay: You can easily see if something is a review by clicking on the "MeSH Terms" in pubmed and it will say "Review". --sciencewatcher (talk) 16:16, 8 May 2010 (UTC)
I think you'll find it's a bit more complicated than that. What Wikipedia declares to be a secondary source for our purposes is not always what an academic or professional would consider a secondary source. For that matter, what Wikipedia declares to be a secondary source depends on the context: The same article from a newspaper would considered a secondary source for the purpose of notability, but a primary source for the purpose of WP:NPOV. WhatamIdoing (talk) 04:41, 18 May 2010 (UTC)
I understand that, but for medical info in medical articles a secondary source is a high quality review. I'm just saying how you figure out the 'review' bit. Deciding if it is 'high quality' is another issue altogether. --sciencewatcher (talk) 14:45, 18 May 2010 (UTC)

Ref numbers[edit]

It is not always clear which version of the article SarMarTay's ref numbers pertain to, as some were added during the time period for the above comments. The starting point would have been this rev, bit it is possible that the subsequent changes to the article impacted the number/ref mapping. Please use caution.LeadSongDog come howl 17:11, 12 May 2010 (UTC)

Google Project[edit]

Hi guys,

Let me provide a little (possibly useful) context: Google's private foundation is supporting expansions of the Swahili Wikipedia, Spanish Wikipedia, and Arabic Wikipedia. (See this announcement.) Forty medicine- or health-related articles have been identified as targets, including this one. Basically, Google is having these articles reviewed and professionally translated -- and we want the translators looking at good, accurate, globally relevant articles.

The comments above represent one of the first reviews by an outside expert (an expert in medical writing, not an expert in Wikipedia's ways!). Other articles will be reviewed soon. You are not required to do anything at all, but I know all the regular editors on this page, and SarMarTay is fortunate to have been assigned an article with such a great, hard-working group. I hope that you will help identify and implement the best of the suggestions. Even small improvements are very much appreciated and will be very helpful to the other Wikipedias. Think of this as a great opportunity to pick a couple of the comments above that you think are most important, and to improve this article. This is such an important subject for our readers, and I'd really love to see it reach Good Article status.

As a suggestion for managing this long list, another page has been using templates from the {{done}} and {{notdone}} family to keep track of what needs doing, what is finished, what is confusing, and what suggestions have been rejected.

If you're curious, here's the rest of the target list. If you are interested in helping with the overall project, please consider adding Wikipedia:WikiProject Medicine/Google Project to your watchlist, improving any articles on the list, and/or contributing advice at the talk page. All editors are welcome. Also, if you have opinions about what does or doesn't work for you, please leave a note at the project's talk page. Thanks, WhatamIdoing (talk) 04:33, 18 May 2010 (UTC)

Yes, this is a good idea and hopefully people will take some of SarMayTay's suggestions and improve the article. This article is important because IBS is "one of the most common disorders seen by doctors" and "the most common condition seen by gastroenterologists" (according to a quick google search, although we don't have that info in the article anywhere). --sciencewatcher (talk) 15:05, 18 May 2010 (UTC)

Missing medication[edit]

I was surprised that the medication section did not include Pinaverium Bromide, marketed as dicetel. it is a colon muscle relaxant that I take, and is quite effective in my case. —Preceding unsigned comment added by 96.49.152.4 (talk) 06:36, 24 May 2010 (UTC)

Differential diagnosis[edit]

Most of the text under Differential diagnosis belongs under the main heading Diagnosis. I've added the main diseases eliminated in a thorough differential diagnosis. Anthony (talk) 18:08, 24 October 2010 (UTC)


PoV in alt med section[edit]

I mean: "Due to often unsatisfactory results from medical treatments for IBS". So treatment is apparently ineffective... Then "up to 50 percent of people turn to complementary alternative medicine." Is there are reason to include the percentage other to increase the perceived validity of AM ?

Then it continues: "Probiotics -can be- beneficial in the treatment of IBS" . Finally "There is good evidence of a beneficial effect of these capsules " . Good evidence? does not sound scientific at all, does it? —Preceding unsigned comment added by 190.103.73.109 (talk) 00:50, 15 December 2010 (UTC)

Looking through the first reference, it completely supports the first sentence of this section. Not only that, but it appears to be a pretty good review and it also matches my own perception of IBS. Also, the review states 'Peppermint oil and probiotics are supported by enough evidence to recommend their use' - so 'good evidence' is correct and scientific. I'm certainly not a fan of quackery (check my edits), but I don't see any problem with this section. --sciencewatcher (talk) 15:40, 15 December 2010 (UTC)

PLEASE HELP ME..[edit]

I'm at present 20 years old(male). I'm from south India. I have been suffering from alternating Diarrhea and Constipation over 2-3 years. I had undergone a colonoscopy last year and found to have ulcers in my intestine.He also told me to undergo certain tests. But due to lack of money I avoided them. Doctor asked me to avoid wheat products and to use his prescription for 3 months. I followed his advice and avoided the wheat products completely. From then onwards I still have the same problem but with severe. So I thought that it may take time to cure. But the problem continued over with small periods of mild attacks. Since I'm a college student I'm facing serious problems of lack of attendance during those mild attacks. From last three days this problem became very severe. The main thing is that I usually face this problem in the morning session only. The rest of the day is very cool for me. I can't understand the problem. Please help me in finding out my problem and aiding me in my diet. Please tell what food should I take to get relief from these problems. —Preceding unsigned comment added by 202.133.61.84 (talk) 15:09, 18 December 2010 (UTC)

I'm sorry but we can't give medical advice plus you should ask for medical advise on the net. Go back to your doctor and talk about this. Sorry,--CrohnieGalTalk 15:16, 18 December 2010 (UTC)

SSRIs[edit]

There appears to be a contradiction of sorts in the Management: Medication section with regard to SSRIs. Under the Tricyclic antidepressants subheader it asserts that there is "little evidence of effectiveness of other antidepressant classes such as the SSRIs", but under the Serotonin agonists section, it states that "Selective serotonin reuptake inhibitor anti-depressants (SSRIs), because of their serotonergic effect, would seem to help IBS, especially patients who are constipation predominant. Initial crossover studies and randomized controlled trials support this role." The phrasing "would seem to help" suggests that perhaps there isn't sufficient evidence to say so with more confidence, but if there are studies that support this, isn't that some evidence? Perhaps this could be clarified? — Preceding unsigned comment added by Lzzzl (talkcontribs) 05:44, 18 March 2011 (UTC)

Those 2 reviews used in the first paragraph don't seem to be the most authoritative. The French one only has 1 citation, and the other one is written by a 2nd-year medical student and only has 27 citations. --sciencewatcher (talk) 14:54, 18 March 2011 (UTC)

Opening sentence[edit]

The opening sentence should not be "Irritable bowel syndrome is a diagnosis of exclusion". This is only a fancy way of saying what IBS is not. "Diagnosis of exclusion" probably belongs in the lead somewhere, probably in the second paragraph, but the opening should say what IBS is. 86.41.46.205 (talk) 08:20, 10 August 2011 (UTC)

Just a placeholder for "we don't have a clue"?[edit]

Isn't this "IBS" just a (pseudo-scientific) placeholder for "we don't have a clue"? The same goes for "functional symptom" (in which case, even if the source of disease is of psychological origin, there is still some gland (or what-have-you) acting up). --90.157.252.17 (talk) 06:39, 14 September 2011 (UTC)

If you read my insert about the FODMAP diet (below), it would your statement is no longer true (i would have agreed even a week ago). Everything that is now known was once a puzzle. Looks like IBS is being solved. — Preceding unsigned comment added by 90.193.233.44 (talk) 23:42, 1 December 2011 (UTC)

FODMAP diet[edit]

The Fodmap diet is especially beneficial for IBS sufferers. This contradicts some of the article. The relatively recent diet is based on molecular groups of natural compounds found in food, which ferment in the gut producing the gases and bowel movement symptoms. Will someone please add the fodmap diet to the article. here are some references:

http://fodmap.com/ http://foodhospital.channel4.com/conditions/irritable-bowel-syndrome/low-fodmap-diet

general supporting article: http://ibs.about.com/od/ibsfood/a/The-Fodmap-Diet-For-IBS.htm 90.193.233.44 (talk) 23:39, 1 December 2011 (UTC)

Thanks for your suggestion. The FODMAP diet does look interesting. The last link you provide gives a caution, however:
"Currently, all of the published work on the FODMAP theory for IBS is being done by a related group of researchers. Further studies must be conducted, at a variety of sites, to further test the theory's assumptions and to evaluate the effect of a low FODMAP diet in reducing IBS symptoms."
That suggests that while we might make brief mention of FODMAP, we need to also add the caution that these studies are from an interrelated group of researchers and there have not yet been studies to confirm these findings. Go ahead and add something along those lines, if you wish. Note that a citation from a reliable source is needed. If you would like help with that, please contact me on my talk page. Sunray (talk) 21:17, 4 December 2011 (UTC)
Not a reliable source, but go to any forum of IBS patients, they will tell you that low FODMAP diet reduces their symptoms. tepi (talk) 23:09, 25 August 2012 (UTC)

Link to SIBO?[edit]

What about all the papers suggesting most IBS cases are caused by Small intestinal bacterial overgrowth?Tepi (talk) 18:17, 17 August 2012 (UTC)

It looks like we already cover that in the article. --sciencewatcher (talk) 19:56, 17 August 2012 (UTC)

Yes, I see know there were 2 sentences in active infections section. I am currently updating the SIBO page, so I used some of these refs to expand this section. I definitely think it should have more detail, as it looks like there is more evidence behind the SIBO-IBS theory than any other explanation.Tepi (talk) 13:24, 18 August 2012 (UTC)

From what do you base that conclusion? When I do a quick search on google scholar for "etiology irritable bowel syndrome", the highest cited papers still go with the stress/infections/psychiatric as the main theories. A review on SIBO says the evidence is conflicting, and I see we say this in the article. SIBO could just be another symptom rather than a cause. You need to be careful that you're not giving excessive WP:WEIGHT to these theories, which I suspect you might be. --sciencewatcher (talk) 15:30, 18 August 2012 (UTC)

My opinion, (I will not put in the article) is that the bio-psychosocial model of IBS represents an old medical paradigm, and these new approaches represent new enlightened medicine. Comparison can be made with the history of the attitudes towards petpic ulcer disease. Initially, lack of understanding lead to psychosocial causation being widely accepted, however later, the massively important role of H pylori became apparent. I think i gave an unbiased summary of the possible link to SIBO, including the arguments against:

"There is a lack of consensus however, regarding the suggested link between IBS and SIBO. Other authors concluded that the abnormal breath results so common in IBS patients do not suggest SIBO, and state that "abnormal fermentation timing and dynamics of the breath test findings support a role for abnormal intestinal bacterial distribution in IBS." [30] There is general consensus that breath tests are abnormal in IBS, however the disagreement lies in whether this is representative of SIBO.[31] More research is needed to clarifiy this possible link."

And in the SIBO article itself:

"In recent years, several proposed links between SIBO and other disorders have been made. However, the usual methodology of these studies involves the use of breath testing as an indirect investigation for SIBO. Breath testing has been critizised by some authors for being an imperfect test for SIBO, with multiple known false positives.[24]" Tepi (talk) 16:46, 18 August 2012 (UTC)

Your opinion isn't borne out by the opinion of the scholarly research, which still places the bio-psychosocial model high on the list of possible causes, along with infections, so that is what we should be reflecting in the article. Also you seem to be misinformed about peptic ulcer - stress is still thought of as a major cause, along with H.Pylori. You seem to be part of the new American-led crusade to eradicate psychosomatic illness and go back to some sort of weird, unscientific mind-body dualism. That's just my opinion :) --sciencewatcher (talk) 20:03, 18 August 2012 (UTC)

Rollback my added refs, nice. Maybe read some of the ref'd papers? All research pertaining to IBS should be mentioned in the article. As to excessive weight, I fail to see how the few sentences within such a a long article constitutes excessive weight.Tepi (talk) 17:36, 20 August 2012 (UTC) {{admin request}} reason: resolve question of excessive weight pleaseTepi (talk) 17:38, 20 August 2012 (UTC)

As stated in the edit summary, your refs were primary sources. We primarily use secondary sources (ideally reviews) - see WP:MEDRS. Regarding weight: your edits took up over 90% of the 'causes' section, which seemed excessive. Even at the moment the 'active infections' section seems a bit excessive in terms of weight, and it has a lot of primary sources. --sciencewatcher (talk) 20:27, 20 August 2012 (UTC)
Agree with above that the changes led to undue weight to the speculation of the cause to one particular cause and sourced to non MEDRS. I also agree that the current Causes section needs re-writing using secondary sources. Yobol (talk) 20:32, 20 August 2012 (UTC)

There are secondary sources in this section, including a report from the Rome foundation, a very respected international research organization into functional GI disorders. There is no excessive weight here, and it is being used as a cover for people who hold biased points of view and do not wish certain researches to be included in the article. tepi (talk) 18:25, 25 August 2012 (UTC)

Active infections[edit]

There is research to support IBS being caused by an as-yet undiscovered active infection. Studies have shown that the nonabsorbed antibiotic rifaximin can provide sustained relief for some IBS patients.[1] Some researchers see this as evidence that IBS is related to an undiscovered agent.

Proposed link to small intestinal bacterial overgrowth[edit]

Other researchers offer small intestinal bacterial overgrowth (SIBO) as an etiological factor in IBS. SIBO is an overgrowth of intestinal flora, possibly explaining why antibiotics are effective in reducing symptoms.[2] A new study, which has connected cultures of bacteria from the small intestine to a significantly increased occurrence of IBS, may have confirmed this theory.[3]

Some studies reported up to 80% of patients with IBS have abnormal breath test results, which may indicate SIBO. Subsequent studies demonstrated statistically significant reduction in IBS symptoms following therapy for SIBO.[4] [5] [6]

Fibromyalgia is a poorly understood pain condition. Patients with Fibromyalgia often suffer from IBS in addition. One study found that patients who had both IBS and Fibromyalgia also had abnormal breath test results, which could be suggestive of SIBO. [7]

The research that appears to link IBS and SIBO generally involves the use of breath testing, which has been critizised by some authors for being an imperfect and unvalidated test for SIBO, with multiple known false positives.[8] As such, there is a lack of consensus regarding this topic. Other authors concluded that the abnormal breath results so common in IBS patients do not suggest SIBO, and state that "abnormal fermentation timing and dynamics of the breath test findings support a role for abnormal intestinal bacterial distribution in IBS." [9] There is general consensus that breath tests are abnormal in IBS, however the disagreement lies in whether this is representative of SIBO.[10]

A recent Rome foundation review of intestinal microbiota in functional bowel disorders, stated that both SIBO and altered intestinal microbiota (dysbiosis) are implicated in subgroups of patients with funcitonal bowel disorders. Furthermore, there have been both quantitative and qualitative changes in gut microbiota, demonstrated in IBS by more robust methods than breath testing alone. However the review also critisied the lactulose hydrogen breath test, stating that in IBS patients, it is more of a measure of colonic transit rather than the levels of bacteria in the small intestine. It has been shown that when a lower diagnostic threshold for SIBO is used ( >103 cfu/ml rather than >105 cfu/ml jejunal culture), IBS patients have greater prevalence of SIBO than the general population. The review concluded that "available molecular studies are not adequately designed to establish whether SIBO is involved in IBS but have significant potential". Simren, M.; Barbara, G.; Flint, H. J.; Spiegel, B. M. R.; Spiller, R. C.; Vanner, S.; Verdu, E. F.; Whorwell, P. J.; Zoetendal, E. G.; Rome Foundation, C. (2012). "Intestinal microbiota in functional bowel disorders: A Rome foundation report". Gut 62 (1): 159–176. doi:10.1136/gutjnl-2012-302167. PMC 3551212. PMID 22730468.  edit

References #1, #2, #3, #5, #7 are primary studies and do not deserve weight here. #6 is a popular press book, and while likely meets minimum criteria for reliability, the multitude of other available high quality sources like peer-reviewed review and position papers should probably be used before this. The problem with putting so much emphasis on SIBO here is that there is not definitive cause (reviews note numerous other possible causes); to expand in detail this one cause without expanding in detail the other possible causes gives our readers the wrong impression about the prominence of this one possible factor. Yobol (talk) 22:47, 25 August 2012 (UTC)
Is there not such a concept as expanding parts of an article at a time? (like most editors do) Or must all its concepts be expanded at identical rates to avoid accusation of excessive weight? Another reason for placing more emphasis on something could be that of all these possibilities, it seems to have most evidence. Weighting according to evidence. Demonstrating abnormalities of gut microbiota and its distribution in IBS patients for me offers hugely more convincing evidence than a more intangible bio-psychosocial model. As it stands, I will rework the whole section in a sandbox with as much secondary source as possible, I'm sure there is some since I did not look very hard. tepi (talk) 23:01, 25 August 2012 (UTC)
I would also list ref #4 as reliable. The book contains hundreds of referenced papers.tepi (talk) 23:04, 25 August 2012 (UTC)
Whether or not you or I find something "convincing" is of no importance here, but what the reliable sources find important. You cannot inflate the importance of one particular cause because you personally think it is more important. The relative weight we give to each possible cause should come from reliable secondary sources that discuss all possible causes in context of each other. Yobol (talk) 23:09, 25 August 2012 (UTC)
I did not inflate its importance, I wrote with neutrality giving the arguments against the proposed link. Restricting the edits of those who may only have researched part of a topic is folly. With huge topic like IBS, the greater the variation in specialties that contribute, the better the overall quality of the article. It is unreasonable to expect an article to grow its various aspects at identical rates. Not relevant to this this discussion, but is SIBO an active infection, or a dysbiosis? tepi (talk) 23:16, 25 August 2012 (UTC)
I'm not asking for the entire article to be re-written, but if you want to update a section, it is best to do so in a neutral fashion. Overweighting a particular theory out of prominence to its respective weight in the medical literature breaks one of our core policies. Asking people to edit so that they do not break this policy is not too much to ask. Yobol (talk) 23:19, 25 August 2012 (UTC)
I was talking about reworking only the active infections section, and not anytime soon unfortunately. What is actually going on here is a accusation of excessive weight because "proposed link to SIBO" was expanded without expanding the other proposed links in this section. My comment is that there is is no reason to restrict the edits of part of article because the other parts were not expanded.tepi (talk) 23:33, 25 August 2012 (UTC)
Tepi, I think it would be beneficial for you to also inflate the biopsychosocial section as well. Given that you say it is 'intangible' makes me think you haven't really done your homework. Really, there is very convincing evidence showing how stress causes diarrhea, pain and immune dysfunction (SIBO could very definitely be a result of stress). Some of these things - for example, stress causing diarrhea - you can easily demonstrate in the lab. Now whether this is the ENTIRE cause of IBS or if there are other causes of IBS, we don't really know. Perhaps there are multiple different illnesses being lumped together as IBS. The same can be said for CFS.
As a first step I would recommend reading through the most-cited, highest quality reviews that are available on the subject. The article should reflect the weight of theories given in those reviews. Also see WP:RECENT. While we can include recent advances, we shouldn't give them undue weight. Wikipedia is an encyclopedia, not a journal. We generally wait until research has a high number of citations before giving it weight in the article - this is all explained in WP:MEDRS. --sciencewatcher (talk) 23:32, 25 August 2012 (UTC)
Correct me, but you are asking editors to rework whole sections rather than only their chosen area of interest. It does not matter if the individual editors have opinions about their chosen area of research, as long as their edits are neutral and well written. With such a large article, it becomes harder and harder to rework whole sections at a time. It starts to grow here and there with small edits. I will update this thread with the proposed edit, but it will not be anytime soon. Enjoy your dark ages article in the mean timetepi (talk) 23:47, 25 August 2012 (UTC)
I think we should entirely delete the current Causes section and rewrite it based on the Thabane and similar reviews. As for SIBO, you will need to rewrite based on reviews (i.e. Ford and Rome) and give it appropriate weight. --sciencewatcher (talk) 03:39, 26 August 2012 (UTC)

References[edit]

  1. ^ Pimentel M, Park S, Mirocha J, Kane SV, Kong Y (2006). "The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial". Ann. Intern. Med. 145 (8): 557–63. PMID 17043337. 
  2. ^ Posserud I, Stotzer PO, Björnsson ES, Abrahamsson H, Simrén M (2007). "Small intestinal bacterial overgrowth in patients with irritable bowel syndrome". Gut 56 (6): 802–8. doi:10.1136/gut.2006.108712. PMC 1954873. PMID 17148502. 
  3. ^ Pyleris E, Giamarellos-Bourboulis EJ, Tzivras D, Koussoulas V, Barbatzas C, Pimentel M (2012). "The Prevalence of Overgrowth by Aerobic Bacteria in the Small Intestine by Small Bowel Culture: Relationship with Irritable Bowel Syndrome". Dig. Dis. Sci. 57 (5): 1321–29. doi:10.1007/s10620-012-2033-7. PMID 22262197. 
  4. ^ Pimentel, Mark (2006). A new IBS solution : bacteria, the missing link in treating irritable bowel syndrome. Sherman Oaks, CA: Health Point Press. ISBN 0977435601. 
  5. ^ Reddymasu, SC; Sostarich, S; McCallum, RW (2010 Feb 22). "Small intestinal bacterial overgrowth in irritable bowel syndrome: are there any predictors?". BMC gastroenterology 10: 23. PMID 20175924. 
  6. ^ Lin, HC (2004 Aug 18). "Small intestinal bacterial overgrowth: a framework for understanding irritable bowel syndrome.". JAMA : the journal of the American Medical Association 292 (7): 852–8. PMID 15316000. 
  7. ^ Pimentel, M; Wallace, D; Hallegua, D; Chow, E; Kong, Y; Park, S; Lin, HC (2004 Apr). "A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing.". Annals of the rheumatic diseases 63 (4): 450–2. PMID 15020342. 
  8. ^ Simrén, M; Stotzer, PO (2006 Mar). "Use and abuse of hydrogen breath tests.". Gut 55 (3): 297–303. PMID 16474100. 
  9. ^ Shah, ED; Basseri, RJ; Chong, K; Pimentel, M (2010 Sep). "Abnormal breath testing in IBS: a meta-analysis.". Digestive diseases and sciences 55 (9): 2441–9. PMID 20467896. 
  10. ^ Ford, AC; Spiegel, BM; Talley, NJ; Moayyedi, P (2009 Dec). "Small intestinal bacterial overgrowth in irritable bowel syndrome: systematic review and meta-analysis.". Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 7 (12): 1279–86. PMID 19602448. 

Link with miscarriages.[edit]

Recent studies have cited that patiets with IBS are 20% more likely to have miscarriages. I don't know the reliability of the articles, but it's not mentioned anywhere in THIS article. --95.33.129.145 (talk) 19:12, 14 December 2012 (UTC)

IBS isn't necessarily a single disease[edit]

The article keeps talking about "the cause" of IBS, "no cure for IBS", "the exact cause is unknown", and similar language, but it's a syndrome, not a disease. It's a collection of symptoms that often occur together, meaning "we tested you for a bunch of stuff and you don't have any of that, so we don't know what's causing it yet", right?

It could have multiple causes, no? IBS-D could be caused by one thing, and IBS-C caused by a different thing. The psychosomatic explanation could be correct for some people, while the SIBO explanation could be correct for others, and the FODMAP explanation for others, no? The third paragraph lists several known causes of IBS, but then says "the cause is unknown". That seems contradictory.

I think the language in some places in the article is misleading and should be reworded. — Preceding unsigned comment added by Justanothervisitor (talkcontribs) 21:44, 25 December 2012 (UTC)

Agree, but there's no point trying to improve this article in any serious way, too many angry mastadons here. lesion (talk) 22:09, 25 December 2012 (UTC)
That's ridiculous. The OP is completely correct. Feel free to update the article, all improvements are welcome. --sciencewatcher (talk) 23:45, 25 December 2012 (UTC)

L-GLUTAMINE as IBS remedy[edit]

L-Glutamine is said to help manage IBS symptoms. I have been suffering with IBS for years and just recently I tried using L-Glutamine powder daily mixed with water. It has indeed almost cured IBS. There are several links on the net about this too

<http://www.livestrong.com/article/431680-irritable-bowel-syndrome-l-glutamine/>

There is a separate article on L-glutamine in wikipedia and that too mentions that it helps intestinal function. Also a brief definition of l-glutamine would be helpful. It is an amino acid produced in the body naturally. — Preceding unsigned comment added by 98.169.160.118 (talk) 09:31, 26 December 2012 (UTC)

Unfortunately, those "links on the net" are limited to anecdotal stories similar to yours, and a couple of hysterical advocate portals. If I can find a legitimate peer-reviewed published study (or if you can), I'll be happy to add a cautious sentence or two. There have been so many "promising" treatments for IBS in the past, none of which has panned out, that we have to be careful, and objective, and encyclopedic. DoctorJoeE talk to me! 15:50, 26 December 2012 (UTC)

Right now there is an ongoing medical study whose results will be announced next year.

<http://www.clinicaltrials.gov/ct2/show/NCT01414244>

Please keep up with the status of this study and when the results are announced, you can add a section. — Preceding unsigned comment added by 98.169.166.83 (talk) 01:12, 30 December 2012 (UTC)

Causes of IBS?[edit]

Where exactly in that review does it say that "an interaction between the immune system and the intestinal flora are the main cause of IBS". I didn't read the whole thing, so I might have missed it. Also it looks like this review is mostly a study on probiotics.

If you do a general search for reviews on the etiology of IBS, these reviews come up:

http://www.nature.com/pr/journal/v62/n3/abs/pr2007210a.html http://www.nature.com/ajg/journal/v103/n3/abs/ajg200850148a.html

--sciencewatcher (talk) 17:58, 26 January 2014 (UTC)

It is in the last paragraph of the review that I read that. Undoubtedly there are at least several major theories for the causes of irritable bowel syndrome and probably there are several different causes for different people. I guess we need to be careful particularly in the lede section how we present these different viewpoints.--MrADHD | T@1k? 09:32, 28 January 2014 (UTC)
Here is another well-cited review from Nature which says IBS "is thought to be the result of disturbed neural function along the brain–gut axis. The mechanisms behind this disturbance are not clear, but important roles for low-grade inflammation and immunological alterations in the development of symptoms compatible with IBS have become evident" :

http://www.nature.com/nrgastro/journal/v7/n3/full/nrgastro.2010.4.html

So it looks like IBS is still thought to be caused by some combination of a disrupted brain-gut axis, infections and psychological factors/stressors. I was going to update the article a bit, but I can't be bothered (and since you removed that sentence I think it's mostly okay anyway :) --sciencewatcher (talk) 22:06, 30 January 2014 (UTC)