Irritable bowel syndrome
Irritable bowel syndrome | |
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Specialty | Gastroenterology ![]() |
Irritable bowel syndrome (IBS, or spastic colon) is a symptom-based diagnosis characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits. As a functional bowel disorder, IBS has no known organic cause.[1] Diarrhea or constipation may predominate, or they may alternate (classified as IBS-D, IBS-C or IBS-A, respectively). Historically a diagnosis of exclusion, a diagnosis of IBS can now be made on the basis of symptoms alone, in the absence of alarm features such as age of onset greater than 50 years, weight loss, gross hematochezia, systemic signs of infection or colitis, or family history of inflammatory bowel disease.[2][3] Onset of IBS is more likely to occur after an infection (post-infectious, IBS-PI), a stressful life event, or onset of maturity.
Although there is no cure for IBS, there are treatments that attempt to relieve symptoms, including dietary adjustments, medication and psychological interventions. Patient education and a good doctor-patient relationship are also important.[4]
Several conditions may present as IBS including coeliac disease, fructose malabsorption,[5] mild infections, parasitic infections like giardiasis,[6] several inflammatory bowel diseases, bile acid malabsorption, functional chronic constipation, and chronic functional abdominal pain. In IBS, routine clinical tests yield no abnormalities, although the bowels may be more sensitive to certain stimuli, such as balloon insufflation testing. The exact cause of IBS is unknown. The most common theory is that IBS is a disorder of the interaction between the brain and the gastrointestinal tract, although there may also be abnormalities in the gut flora or the immune system.[7][8]
IBS has no effect on life expectancy. However, it is a source of chronic pain, fatigue, and other symptoms and contributes to work absenteeism.[9][10] The high prevalence of IBS[11][12][13] and significant effects on quality of life make IBS a disease with a high social cost.[14][15]
Classification
IBS can be classified as either diarrhea-predominant (IBS-D), constipation-predominant (IBS-C) or IBS with alternating stool pattern (IBS-A or pain-predominant[16]). In some individuals, IBS may have an acute onset and develop after an infectious illness characterized by two or more of the following: fever, vomiting, diarrhea, or positive stool culture. This post-infective syndrome has consequently been termed "post-infectious IBS" (IBS-PI)
Signs and symptoms
The primary symptoms of IBS are abdominal pain or discomfort in association with frequent diarrhea or constipation, a change in bowel habits.[17] There may also be urgency for bowel movements, a feeling of incomplete evacuation (tenesmus), bloating or abdominal distention.[18] In some cases, the symptoms are relieved by bowel movements.[4] People with IBS, more commonly than others, have gastroesophageal reflux, symptoms relating to the genitourinary system, chronic fatigue syndrome, fibromyalgia, headache, backache and psychiatric symptoms such as depression and anxiety.[18][19] Some studies indicate that up to 60% of persons with IBS also have a psychological disorder, typically anxiety or depression.[20]
Causes
The cause of IBS is unknown, but several hypotheses have been proposed. The risk of developing IBS increases sixfold after acute gastrointestinal infection. Post-infection, further risk factors are young age, prolonged fever, anxiety, and depression.[21] Publications suggesting the role of brain-gut "axis" appeared in the 1990s, such as the study "Brain-gut response to stress and cholinergic stimulation in IBS" published in the Journal of Clinical Gastroenterology in 1993.[22] A 1997 study published in Gut magazine suggested that IBS was associated with a "derailing of the brain-gut axis."[23] Psychological factors may be important in the etiology of IBS.[19]
Active infections
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.[26] While some researchers see this as evidence that IBS is related to an undiscovered agent, others believe IBS patients suffer from overgrowth of intestinal flora and the antibiotics are effective in reducing the overgrowth (known as "small intestinal bacterial overgrowth").[27] 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.[28]
Other researchers have focused on an unrecognized protozoal infection as a cause of IBS[8] as certain protozoal infections occur more frequently in IBS patients.[29][30] 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.
Blastocystis is a single-cell organism that has been reported to produce symptoms of abdominal pain, constipation and diarrhea in patients[31] though these reports are contested by some physicians.[32] Studies from research hospitals have identified high Blastocystis infection rates in IBS patients, with 38% being reported from London School of Hygiene & Tropical Medicine,[33] 47% reported from the Department of Gastroenterology at Aga Khan University in Pakistan[29] and 18.1% reported from the Institute of Diseases and Public Health at University of Ancona in Italy.[30] Reports from all three groups indicate a Blastocystis prevalence of approximately 7% in non-IBS patients. Researchers have noted that clinical diagnostics fail to identify infection,[34] and Blastocystis may not respond to treatment with common antiprotozoals.[32][35][36][37]
Dientamoeba fragilis is a single-cell organism that produces abdominal pain and diarrhea. Studies have reported a high incidence of infection in developed countries, and symptoms of patients resolve following antibiotic treatment.[24][38] One study reported on a large group of patients with IBS-like symptoms who were found to be infected with Dientamoeba fragilis, and experienced resolution of symptoms following treatment.[39] Researchers have noted that methods used clinically may fail to detect some Dientamoeba fragilis infections.[38] It is also found in people without IBS.[40]
Diagnosis
There is no specific laboratory or imaging test that can be performed to diagnose irritable bowel syndrome. Diagnosis of IBS involves excluding conditions that produce IBS-like symptoms, and then following a procedure to categorize the patient's symptoms. Ruling out parasitic infections, lactose intolerance, small intestinal bacterial overgrowth and celiac disease is recommended for all patients before a diagnosis of irritable bowel syndrome is made. In patients over 50 years old it is recommended that they undergo a screening colonoscopy.[41]
Differential diagnosis
Colon cancer, inflammatory bowel disease, thyroid disorders and giardiasis can all feature abnormal defecation and abdominal pain. Less common causes of this symptom profile are carcinoid syndrome, microscopic colitis, bacterial overgrowth, and eosinophilic gastroenteritis; IBS is, however, such a common presentation and testing for these conditions would yield such low numbers of positive results that it is considered difficult to justify the expense.[42] Because there are many causes of diarrhea that give IBS-like symptoms, the American Gastroenterological Association published a set of guidelines for tests to be performed to rule out other causes for these symptoms. These include gastrointestinal infections, lactose intolerance, and coeliac disease. Research has suggested that these guidelines are not always followed.[41] Once other causes have been excluded, the diagnosis of IBS is performed using a diagnostic algorithm. Well-known algorithms include the Manning Criteria, the obsolete Rome I and II criteria, the Kruis Criteria, and studies have compared their reliability.[43] The more recent Rome III Process was published in 2006. Physicians may choose to use one of these guidelines, or may simply choose to rely on their own anecdotal experience with past patients. The algorithm may include additional tests to guard against mis-diagnosis of other diseases as IBS. Such "red flag" symptoms may include weight loss, gastrointestinal bleeding, anemia, or nocturnal symptoms. However, researchers have noted that red flag conditions may not always contribute to accuracy in diagnosis – for instance, as many as 31% of IBS patients have blood in their stool many possibly from hemorrhoidal bleeding.[43]
The diagnostic algorithm identifies a name that can be applied to the patient's condition based on the combination of the patient's symptoms of diarrhea, abdominal pain, and constipation. For example, the statement "50% of returning travelers had developed functional diarrhea while 25% had developed IBS" would mean that half the travelers had diarrhea while a quarter had diarrhea with abdominal pain. While some researchers believe this categorization system will help physicians understand IBS, others have questioned the value of the system and suggested that all IBS patients have the same underlying disease but with different symptoms.[44]
Investigations
Investigations are performed to exclude other conditions:
- Stool microscopy and culture (to exclude infectious conditions)
- Blood tests: Full blood examination, Liver function tests, Erythrocyte sedimentation rate, serological testing for coeliac disease
- Abdominal ultrasound (to exclude gallstones and other biliary tract diseases)
- Endoscopy and biopsies (to exclude peptic ulcer disease, coeliac disease, inflammatory bowel disease, malignancies)
- Hydrogen breath testing (to exclude fructose and lactose malabsorption)
Misdiagnosis
Published research has demonstrated that some poor patient outcomes are due to treatable causes of diarrhea being mis-diagnosed as IBS. Common examples include infectious diseases, coeliac disease,[45] Helicobacter pylori,[46][47] parasites.[8][48][49]
Coeliac disease in particular is often misdiagnosed as IBS. The American College of Gastroenterology recommends that all patients with symptoms of IBS be tested for coeliac disease.[50]
Bile acid malabsorption is also often missed in patients with diarrhea-predominant IBS. SeHCAT tests suggest that around 30% of D-IBS have this condition and most respond to bile acid sequestrants.[51]
Chronic use of certain sedative-hypnotic drugs especially the benzodiazepines may cause irritable bowel like symptoms that can lead to a misdiagnosis of irritable bowel syndrome.[52]
Comorbidities
Researchers have identified several medical conditions, or comorbidities, which appear with greater frequency in patients diagnosed with IBS.
- Headache, Fibromyalgia, Chronic fatigue syndrome and Depression: A study of 97,593 individuals with IBS identified comorbidities such as headache, fibromyalgia, and depression.[53] A systematic review found that IBS occurs in 51% of chronic fatigue syndrome patients and 49% of fibromyalgia patients, and psychiatric disorders were found to occur in 94% of IBS patients.[19]
- Inflammatory bowel disease (IBD): Some researchers have suggested that IBS is a type of low-grade inflammatory bowel disease.[54] Researchers have suggested that IBS and IBD are interrelated diseases,[55] noting that patients with IBD experience IBS-like symptoms when their IBD is in remission.[56][57] A 3-year study found that patients diagnosed with IBS were 16.3 times more likely to be diagnosed with IBD during the study period.[58] Serum markers associated with inflammation have also been found in patients with IBS (see Causes).
- Abdominal surgery: A recent (2008) study found that IBS patients are at increased risk of having unnecessary cholecystectomy (gall bladder removal surgery) not due to an increased risk of gallstones, but rather to abdominal pain, awareness of having gallstones, and inappropriate surgical indications.[59] A 2005 study reported that IBS patients are 87% more likely to undergo abdominal and pelvic surgery, and three times more likely to undergo gallbladder surgery.[60] A study published in Gastroenterology came to similar conclusions, and also noted IBS patients were twice as likely to undergo hysterectomy.[61]
- Endometriosis: One study reported a statistically significant link between migraine headaches, IBS, and endometriosis.[62]
- Other chronic disorders: Interstitial cystitis may be associated with other chronic pain syndromes, such as irritable bowel syndrome and fibromyalgia. The connection between these syndromes is unknown.[63]
Management
A number of treatments have been found to be better than placebo, including fiber, antispasmodics, and peppermint oil.[64]
Diet
Some people with IBS are likely to have food intolerances. In 2007 the evidence base was not strong enough to recommend restrictive diets.[65]
Many different dietary modifications have been attempted to improve the symptoms of IBS. Some are effective in certain sub-populations. As lactose intolerance and IBS have such similar symptoms a trial of a lactose-free diet is often recommended.[66] A diet restricting fructose and fructan intake has been shown to successfully treat the symptoms in a dose-dependant manner in patients with fructose malabsorption and IBS.[67]
While many IBS patients believe they have some form of dietary intolerance, tests attempting to predict food sensitivity in IBS have been disappointing. One study reported that an IgG antibody test was effective in determining food sensitivity in IBS patients, with patients on the elimination diet experiencing 10% greater symptom reduction than those on a sham diet.[68] More data is necessary before IgG testing can be recommended.[69]
There is no evidence that digestion of food or absorption of nutrients is problematic for those with IBS at rates different from those without IBS. However, the very act of eating or drinking can provoke an overreaction of the gastrocolic response in some patients with IBS due to their heightened visceral sensitivity, and this may lead to abdominal pain, diarrhea, and/or constipation.[70]
- Fiber
There is convincing evidence that soluble fiber supplementation (e.g., psyllium) is effective in the general IBS population. It acts as a bulking agent, and for many IBS-D patients, it allows for a more consistent stool. For IBS-C patients, it seems to allow for a softer, moister, more easily passable stool.
Insoluble fiber (e.g., bran) has not been found to be effective for IBS.[71] In some people, insoluble fiber supplementation may aggravate symptoms.[65]
Fiber might be beneficial in those who have a predominance of constipation. In patients who have constipation predominant irritable bowel, soluble fiber at doses of 20 grams per day can reduce overall symptoms but will not reduce pain. The research supporting dietary fiber contains conflicting, small studies that are complicated by the heterogeneity of types of fiber and doses used.[72]
One meta-analysis found that only soluble fiber improved global symptoms of irritable bowel, but neither type of fiber reduced pain.[72] However, an updated meta-analysis by the same authors found that soluble fiber reduced symptoms.[73] Positive studies have used 10–30 grams per day of psyllium seed.[74][75] One study specifically examined the effect of dose and found that 20 grams of ispaghula husk was better than 10 grams and equivalent to 30 grams per day.[76] An uncontrolled study noted increased symptoms with insoluble fibers.[77] It is unclear if these symptoms are truly increased compared with a control group. If the symptoms are increased, it is unclear if these patients were diarrhea predominant (which can be exacerbated by insoluble fiber[78][79]), or if the increase is temporary before benefit occurs.
Medication
Medications may consist of stool softeners and laxatives in constipation-predominant IBS, and antidiarrheals (e.g., opiate, opioid, or opioid analogs such as loperamide, codeine, diphenoxylate) in diarrhea-predominant IBS for mild symptoms and stronger opiates such as morphine and oxycodone for severe cases.[80][81][82]
Drugs affecting serotonin (5-HT) in the intestines can help reduce symptoms.[83] Serotonin stimulates the gut motility and so agonists can help constipation-predominate irritable bowel, while antagonists can help diarrhea-predominant irritable bowel.
- Laxatives
For patients who do not adequately respond to dietary fiber, osmotic laxatives such as polyethylene glycol, sorbitol, and lactulose can help avoid "cathartic colon" which has been associated with stimulant laxatives.[84] Among the osmotic laxatives, 17–26 grams/day of polyethylene glycol (PEG) has been well studied.
Lubiprostone (Amitiza), is a gastrointestinal agent used for the treatment of idiopathic chronic constipation and constipation-predominant IBS. It is well-tolerated in adults, including elderly patients. As of July 20, 2006, Lubiprostone had not been studied in pediatric patients. Lubiprostone is a bicyclic fatty acid (prostaglandin E1 derivative) that acts by specifically activating ClC-2 chloride channels on the apical aspect of gastrointestinal epithelial cells, producing a chloride-rich fluid secretion. These secretions soften the stool, increase motility, and promote spontaneous bowel movements (SBM). Unlike many laxative products, Lubiprostone does not show signs of tolerance, dependency, or altered serum electrolyte concentration.
- Antispasmodics
The use of antispasmodic drugs (e.g., anticholinergics such as hyoscyamine or dicyclomine) may help patients, especially those with cramps or diarrhea. A meta-analysis by the Cochrane Collaboration concludes that if seven patients are treated with antispasmodics, one patient will benefit.[80] Antispasmodics can be divided in two groups: neurotropics and musculotropics.
- Neurotropics, such as a phenobarbital like Donnatal or atropine, act at the nerve fibre of the parasympathicus but also affect other nerves and have side effects.
- Musculotropics such as mebeverine act directly at the smooth muscle of the gastrointestinal tract, relieving spasm without affecting normal gut motility.[citation needed] Since this action is not mediated by the autonomic nervous system, the usual anticholinergic side effects are absent.[citation needed]
- Tricyclic antidepressants
There is strong evidence that low doses of tricyclic antidepressants can be effective for irritable bowel syndrome. However, there is less robust evidence as to the effectiveness of other antidepressant classes such as SSRIs.[65][71]
- Serotonin agonists
- Tegaserod (Zelnorm), a selective 5-HT4 agonist for IBS-C, is available for relieving IBS constipation in women and chronic idiopathic constipation in men and women. On March 30, 2007, the Food and Drug Administration (FDA) requested that Novartis Pharmaceuticals voluntarily discontinue marketing of tegaserod based on the recently identified finding of an increased risk of serious cardiovascular adverse events (heart problems) associated with use of the drug. Novartis agreed to voluntarily suspend marketing of the drug in the United States and in many other countries. On July 27, 2007 the Food and Drug Administration (FDA) approved a limited treatment IND program for tegaserod in the USA to allow restricted access to the medication for patients in need if no comparable alternative drug or therapy is available to treat the disease. The USA FDA had issued two previous warnings about the serious consequences of tegaserod. In 2005, tegaserod was rejected as an IBS medication by the European Union. Tegaserod, marketed as Zelnorm in the United States, was the only agent approved to treat the multiple symptoms of IBS (in women only), including constipation, abdominal pain and bloating.
- 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[85] and randomized controlled trials[86][87][88] support this role.
- Serotonin antagonists
Alosetron, a selective 5-HT3 antagonist for IBS-D and cilansetron (also a selective 5-HT3 antagonist) were trialed for irritable bowel syndrome. Due to severe adverse effects, namely ischemic colitis and severe constipation, they are not available or recommended for irritable bowel syndrome.[65]
- Other agents
Magnesium aluminum silicates and alverine citrate drugs can be effective for irritable bowel syndrome.[65]
There is conflicting evidence about the benefit of antidepressants in IBS. Some meta-analysis have found a benefit while others have not.[89] A meta-analysis of randomized controlled trials of mainly TCAs found 3 patients have to be treated with TCAs for one patient to improve.[90] A separate randomized controlled trial found that TCAs are best for patients with diarrhea-predominant IBS.[91]
Recent studies have suggested that rifaximin can be used as an effective treatment for abdominal bloating and flatulence,[26][92] giving more credibility to the potential role of bacterial overgrowth in some patients with IBS.[93]
Domperidone, a dopamine receptor blocker and a parasympathomimetic, has been shown to reduce bloating and abdominal pain as a result of an accelerated colon transit time and reduced faecal load, that is a relief from hidden constipation; defecation was similarly improved.[94]
The use of opioids is controversial due to the potential risk of tolerance, physical dependence and addiction but can be the only relief for some diarrhea predominant cases when other treatment has been ineffective.[95]
Psychotherapy
The mind-body or brain-gut interactions has been proposed for irritable bowel syndrome and is gaining increasing research attention.[71] For some patients psychological therapies may help with symptoms. Cognitive behavioural therapy and hypnosis have been found to be the most beneficial. Hypnosis can improve mental wellbeing and cognitive behavioural therapy can provide psychological coping strategies for dealing with distressing symptoms as well as help suppress thoughts and behaviours that increase the symptoms of irritable bowel syndrome.[65][71] Cognitive behavioral therapy has been found to improve symptoms in a number of studies.[96][97] Relaxation therapy has also been found to be helpful.[98]
A questionnaire in 2006 designed to identify patients’ perceptions about IBS, their preferences on the type of information they need, as well as educational media and expectations from health care providers, revealed misperceptions about IBS developing into other conditions, including colitis, malnutrition, and cancer.[99]
The survey found IBS patients were most interested in learning about foods to avoid (60%), causes of IBS (55%), medications (58%), coping strategies (56%), and psychological factors related to IBS (55%). The respondents indicated that they wanted their physicians to be available via phone or e-mail following a visit (80%), have the ability to listen (80%), and provide hope (73%) and support (63%).
Stress relief
Reducing stress may reduce the frequency and severity of IBS symptoms. Techniques that may be helpful include:
- Relaxation techniques such as meditation
- Physical activities such as yoga or tai chi
- Regular exercise such as swimming, walking or running[100]
Exercise
Many patients find that exercise helps with IBS. At least 30 minutes of strenuous exercise 5 times a week is recommended.[100]
Alternative medicine
Due to often unsatisfactory results from medical treatments for IBS up to 50 percent of people turn to complementary alternative medicine.[71]
- Probiotics
Probiotics can be beneficial in the treatment of IBS, taking 10 billion to 100 billion beneficial bacteria per day is recommended for beneficial results. However, further research is needed on individual strains of beneficial bacteria for more refined recommendations.[71][101] A number of probiotics have been found to be effective including: Lactobacillus plantarum[102] and Bifidobacteria infantis;[103] however, one review found that only Bifidobacteria infantis showed efficacy.[104] Some yogurt is made using probiotics that may help ease symptoms of irritable bowel syndrome.[105]
- Herbal remedies
- Peppermint oil: Enteric coated peppermint oil capsules have been suggested for IBS symptoms in adults and children.[106] There is evidence of a beneficial effect of these capsules and it is recommended that peppermint be trialed in all irritable bowel syndrome patients.[71][107] Safety during pregnancy has not been established however and caution is required not to chew or break the enteric coating otherwise gastroesophageal reflux may occur as a result of lower esophageal sphincter relaxation. Occasionally nausea and perianal burning occur as side effects.[71]
- Iberogast: The multi-herbal extract Iberogast was found to be significantly superior to placebo via both an abdominal pain scale and an IBS symptom score after four weeks of treatment.[108][109]
- Cannabis[110]
- Kiwifruit IBS/C[111]
- Commiphora mukul[112]
- Plantago ovata[112]
There is only limited evidence for the effectiveness of other herbal remedies for irritable bowel syndrome. As with all herbs it is wise to be aware of possible drug interactions and adverse effects.[71]
- Yoga
Yoga may be effective for some with irritable bowel syndrome, especially poses which exercise the lower abdomen.[65]
- Acupuncture
Acupuncture may be worth a trial in select patients, but the evidence base for effectiveness is weak.[71] A meta-analysis by the Cochrane Collaboration found no benefits of acupuncture relative to placebo for IBS symptom severity or IBS-related quality of life.[113]
Epidemiology
![](http://upload.wikimedia.org/wikipedia/commons/thumb/7/7d/Ibs_prevalence.svg/200px-Ibs_prevalence.svg.png)
Studies have reported that the prevalence of IBS varies by country and by age range examined. The bar graph at right shows the percentage of the population reporting symptoms of IBS in studies from various geographic regions (see table below for references).
The following table contains a list of studies performed in different countries that measured the prevalence of IBS and IBS-like symptoms:
Percentage of population reporting symptoms of IBS in various studies from various geographic areas | |||
---|---|---|---|
Country | Prevalence | Author/Year | Notes |
Canada | 6%[11] | Boivin, 2001 | |
Japan | 10%[114] | Quigley, 2006 | Study measured prevalence of GI abdominal pain/cramping |
United Kingdom | 8.2%[115]
10.5%[12] |
Ehlin, 2003 Wilson, 2004 |
Prevalence increased substantially 1970–2004 |
United States | 14.1%[116] | Hungin, 2005 | Most undiagnosed |
United States | 15%[11] | Boivin, 2001 | Estimate |
Pakistan | 14%[117] | Jafri, 2007 | Much more common in 16–30 age range. Of IBS patients, 56% male, 44% female |
Pakistan | 34%[118] | Jafri, 2005 | College students |
Mexico City | 35%[13] | Schmulson, 2006 | n=324. Also measured functional diarrhea and functional vomiting. High rates attributed to "stress of living in a populated city." |
Brazil | 43%[114] | Quigley, 2006 | Study measured prevalence of GI abdominal pain/cramping |
Mexico | 46%[114] | Quigley, 2006 | Study measured prevalence of GI abdominal pain/cramping |
A study of United States residents returning from international travel found a high rate of IBS and persistent diarrhea that developed during travel and persisted upon return. The study examined 83 subjects in Utah, most of whom were returning missionaries. Of the 68 who completed the gastrointestinal questionnaire, 27 reported persistent diarrhea that developed while traveling, and 10 reported persistent IBS that developed while traveling.[119]
Sex and gender differences
Women are approximately two to three times more likely to be diagnosed with IBS and four to five times more likely to seek specialty care for IBS than are men.[120] These differences likely reflect a combination of both biological (sex) and social (gender) factors. Studies of female patients with IBS show that symptom severity often fluctuates with the menstrual cycle, suggesting that hormonal differences may play a role.[121] Endorsement of gender-related traits has been associated with quality of life and psychological adjustment in IBS.[122] Greater reductions in quality of life may make women with IBS more likely to seek treatment for their symptoms. More generally, gender differences in healthcare-seeking may also play a role.[123] Gender differences in trait anxiety may contribute to lower pain thresholds in women, putting them at greater risk for a number of chronic pain disorders.[124] Finally, sexual trauma is a major risk factor for IBS, with as many as 33% of all patients reporting such abuse.[125] Because women are at higher risk of sexual abuse than men, gender-related risk of abuse may contribute to the higher prevalence of IBS in women.
History
One of the first references to the concept of an "irritable bowel" appeared in the Rocky Mountain Medical Journal in 1950.[126] The term was used to categorize patients who developed symptoms of diarrhea, abdominal pain, constipation, but where no well-recognized infective cause could be found. Early theories suggested that the irritable bowel was caused by a psychosomatic or mental disorder.
Economics
![]() | The examples and perspective in this section may not represent a worldwide view of the subject. (July 2011) |
The aggregate cost of irritable bowel syndrome in the United States has been estimated at $1.7–$10 billion in direct medical costs, with an additional $20 billion in indirect costs, for a total of $21.7–$30 billion.[15] A study by a managed care company comparing medical costs of IBS patients to non-IBS controls identified a 49% annual increase in medical costs associated with a diagnosis of IBS.[127] A 2007 study from a managed care organization found that IBS patients incurred average annual direct costs of $5,049 and $406 in out-of-pocket expenses.[128] A study of workers with IBS found that they reported a 34.6% loss in productivity, corresponding to 13.8 hours lost per 40 hour week.[9] A study of employer-related health costs from a Fortune 100 company conducted with data from the 1990s found IBS patients incurred US $4527 in claims costs vs. $3276 for controls.[129] A study on Medicaid costs conducted in 2003 by the University of Georgia's College of Pharmacy and Novartis found IBS was associated in an increase of $962 in Medicaid costs in California, and $2191 in North Carolina. IBS patients had higher costs for physician visits, outpatients visits, and prescription drugs. The study suggested the costs associated with IBS were comparable to those found in asthma patients.[130]
Research
Gibson and Shepherd state a diet restricted in fermentable oligo- di- and mono-saccharides and polyols (FODMAPs) now has an evidence base sufficiently strong to recommend its widespread application in conditions such as IBS and IBD.[131] They also state the restriction of FODMAPs globally, rather than individually, controls the symptoms of functional gut disorders (e.g., IBS), and the majority of IBD patients respond just as well. It is more successful than restricting only fructose and fructans, which are also FODMAPs, as is recommended for those with fructose malabsorption. Longer term compliance with the diet was high.
A randomised controlled trial on IBS patients found relaxing an IgG-mediated food intolerance diet led to a 24% greater deterioration in symptoms compared to those on the elimination diet and concluded food elimination based on IgG antibodies may be effective in reducing IBS symptoms and is worthy of further biomedical research.[68]
The National Institutes of Health provides a searchable database for grant awards since 1974 on its CRISP database, and provides dollar amounts for recent awards on its Intramural Grant Award Page. In 2006, the NIH awarded approximately 56 grants related to IBS, totalling approximately $18.7 million.
See also
- Chronic functional abdominal pain
- Food intolerance
- Functional constipation
- Functional dyspepsia
- Fructose malabsorption
- Hypersensitivity
- Lactose intolerance
- Bile acid malabsorption
References
- ^ "irritable bowel syndrome" at Dorland's Medical Dictionary
- ^ Malagelada, JR (2006). "A symptom-based approach to making a positive diagnosis of irritable bowel syndrome with constipation". International journal of clinical practice. 60 (1): 57–63. doi:10.1111/j.1368-5031.2005.00744.x. PMID 16409429.
- ^ Cash, BD; Schoenfeld, P; Chey, WD (2002). "The utility of diagnostic tests in irritable bowel syndrome patients: A systematic review". The American journal of gastroenterology. 97 (11): 2812–9. doi:10.1111/j.1572-0241.2002.07027.x. PMID 12425553.
- ^ a b Mayer EA (2008). "Clinical practice. Irritable bowel syndrome". N. Engl. J. Med. 358 (16): 1692–9. doi:10.1056/NEJMcp0801447. PMID 18420501.
{{cite journal}}
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ignored (help) - ^ Ledochowski M et al.: Fruktosemalabsorption. Journal für Ernährungsmedizin, 2001 (German)
- ^ Intestinal Infection[dead link]
- ^ Yang CM, Li YQ (2007). "[The therapeutic effects of eliminating allergic foods according to food-specific IgG antibodies in irritable bowel syndrome]". Zhonghua Nei Ke Za Zhi (in Chinese). 46 (8): 641–3. PMID 17967233.
- ^ a b c Stark D, van Hal S, Marriott D, Ellis J, Harkness J (2007). "Irritable bowel syndrome: a review on the role of intestinal protozoa and the importance of their detection and diagnosis". Int. J. Parasitol. 37 (1): 11–20. doi:10.1016/j.ijpara.2006.09.009. PMID 17070814.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ a b Paré P; Gray J; Lam S; et al. (2006). "Health-related quality of life, work productivity, and health care resource utilization of subjects with irritable bowel syndrome: baseline results from LOGIC (Longitudinal Outcomes Study of Gastrointestinal Symptoms in Canada), a naturalistic study". Clinical therapeutics. 28 (10): 1726–35, discussion 1710–1. doi:10.1016/j.clinthera.2006.10.010. PMID 17157129.
{{cite journal}}
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ignored (help) - ^ Maxion-Bergemann S, Thielecke F, Abel F, Bergemann R (2006). "Costs of irritable bowel syndrome in the UK and US". PharmacoEconomics. 24 (1): 21–37. doi:10.2165/00019053-200624010-00002. PMID 16445300.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ a b c
Boivin M (2001). "Socioeconomic impact of irritable bowel syndrome in Canada". Can. J. Gastroenterol. 15 (Suppl B): 8B–11B. PMID 11694908.
{{cite journal}}
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ignored (help) - ^ a b Wilson S, Roberts L, Roalfe A, Bridge P, Singh S (2004). "Prevalence of irritable bowel syndrome: a community survey". Br J Gen Pract. 54 (504): 495–502. PMC 1324800. PMID 15239910.
{{cite journal}}
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ignored (help)CS1 maint: multiple names: authors list (link) - ^ a b Schmulson M, Ortiz O, Santiago-Lomeli M, Gutierrez-Reyes G, Gutierrez-Ruiz MC, Robles-Diaz G, Morgan D (2006). "Frequency of functional bowel disorders among healthy volunteers in Mexico City" (PDF). Dig Dis. 24 (3–4): 342–7. doi:10.1159/000092887. PMID 16849861.
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: Unknown parameter|oissue=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ ref name="LEA-WHORWELL-2001"
- ^ a b Hulisz D (2004). "The burden of illness of irritable bowel syndrome: current challenges and hope for the future". J Manag Care Pharm. 10 (4): 299–309. PMID 15298528.
- ^ Holten KB, Wetherington A, Bankston L (2003). "Diagnosing the patient with abdominal pain and altered bowel habits: is it irritable bowel syndrome?". Am Fam Physician. 67 (10): 2157–62. PMID 12776965.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Schmulson MW, Chang L (1999). "Diagnostic approach to the patient with irritable bowel syndrome". Am. J. Med. 107 (5A): 20S–26S. doi:10.1016/S0002-9343(99)00278-8. PMID 10588169.
- ^ a b Talley NJ (2006). "Irritable bowel syndrome". Intern Med J. 36 (11): 724–8. doi:10.1111/j.1445-5994.2006.01217.x. PMC 1761148. PMID 17040359.
- ^ a b c Whitehead WE, Palsson O, Jones KR (2002). "Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications?". Gastroenterology. 122 (4): 1140–56. doi:10.1053/gast.2002.32392. PMID 11910364.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ http://www.webmd.com/ibs/irritable-bowel-syndrome-ibs-depression
- ^ Thabane M, Kottachchi DT, Marshall JK (2007). [www3.interscience.wiley.com/cgi-bin/fulltext/117987841/HTMLSTART "Systematic review and meta-analysis: The incidence and prognosis of post-infectious irritable bowel syndrome"]. Aliment Pharmacol Ther. 26 (4): 535–44. doi:10.1111/j.1365-2036.2007.03399.x. PMID 17661757.
{{cite journal}}
: Check|url=
value (help)CS1 maint: multiple names: authors list (link) - ^ Fukudo S, Nomura T, Muranaka M, Taguchi F (1993). "Brain-gut response to stress and cholinergic stimulation in irritable bowel syndrome. A preliminary study". J. Clin. Gastroenterol. 17 (2): 133–41. doi:10.1097/00004836-199309000-00009. PMID 8031340.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Orr WC, Crowell MD, Lin B, Harnish MJ, Chen JD (1997). "Sleep and gastric function in irritable bowel syndrome: derailing the brain-gut axis". Gut. 41 (3): 390–3. doi:10.1136/gut.41.3.390. PMC 1891498. PMID 9378397.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ a b Lagacé-Wiens PR, VanCaeseele PG, Koschik C (2006). "Dientamoeba fragilis: an emerging role in intestinal disease". Canadian Medical Association Journal. 175 (5): 468–9. doi:10.1503/cmaj.060265. PMC 1550747. PMID 16940260.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Amin OM (2002). "Seasonal prevalence of intestinal parasites in the United States during 2000". Am. J. Trop. Med. Hyg. 66 (6): 799–803. PMID 12224595.
- ^ a b 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.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) Cite error: The named reference "pmid17043337" was defined multiple times with different content (see the help page). - ^ 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.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ 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. PMID 22262197.
{{cite journal}}
: Text "DOI: 10.1007/s10620-012-2033-7" ignored (help)CS1 maint: multiple names: authors list (link) - ^ a b Yakoob J; Jafri W; Jafri N; et al. (2004). "Irritable bowel syndrome: in search of an etiology: role of Blastocystis hominis". Am. J. Trop. Med. Hyg. 70 (4): 383–5. PMID 15100450.
{{cite journal}}
: Unknown parameter|author-separator=
ignored (help) - ^ a b Giacometti A, Cirioni O, Fiorentini A, Fortuna M, Scalise G (1999). "Irritable bowel syndrome in patients with Blastocystis hominis infection". Eur. J. Clin. Microbiol. Infect. Dis. 18 (6): 436–9. doi:10.1007/s100960050314. PMID 10442423.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Qadri SM, al-Okaili GA, al-Dayel F (1989). "Clinical significance of Blastocystis hominis". J. Clin. Microbiol. 27 (11): 2407–9. PMC 267045. PMID 2808664.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ a b Markell EK, Udkow MP (1986). "Blastocystis hominis: pathogen or fellow traveler?". Am. J. Trop. Med. Hyg. 35 (5): 1023–6. PMID 3766850.
- ^ Windsor J (2007). "B. hominis and D. fragilis: Neglected human protozoa". British Biomedical Scientist: 524–7.[dead link]
- ^ Stensvold R, Brillowska-Dabrowska A, Nielsen HV, Arendrup MC (2006). "Detection of Blastocystis hominis in unpreserved stool specimens by using polymerase chain reaction". J. Parasitol. 92 (5): 1081–7. doi:10.1645/GE-840R.1. PMID 17152954.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Yakoob J, Jafri W, Jafri N, Islam M, Asim Beg M (2004). "In vitro susceptibility of Blastocystis hominis isolated from patients with irritable bowel syndrome". Br. J. Biomed. Sci. 61 (2): 75–7. PMID 15250669.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Haresh K, Suresh K, Khairul Anus A, Saminathan S (1999). "Isolate resistance of Blastocystis hominis to metronidazole". Trop. Med. Int. Health. 4 (4): 274–7. doi:10.1046/j.1365-3156.1999.00398.x. PMID 10357863.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Ok UZ, Girginkardeşler N, Balcioğlu C, Ertan P, Pirildar T, Kilimcioğlu AA (1999). "Effect of trimethoprim-sulfamethaxazole in Blastocystis hominis infection". Am. J. Gastroenterol. 94 (11): 3245–7. doi:10.1111/j.1572-0241.1999.01529.x. PMID 10566723.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ a b Stensvold CR, Arendrup MC, Mølbak K, Nielsen HV (2007). "The prevalence of Dientamoeba fragilis in patients with suspected enteroparasitic disease in a metropolitan area in Denmark". Clin. Microbiol. Infect. 13 (8): 839–42. doi:10.1111/j.1469-0691.2007.01760.x. PMID 17610603.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Borody T; Warren E; Wettstein A; et al. (2002). "Eradication of Dientamoeba fragilis can resolve IBS-like symptoms". J Gastroenterol Hepatol. 17 (Suppl): A103.
{{cite journal}}
: Unknown parameter|author-separator=
ignored (help) - ^ Windsor JJ, Macfarlane L (2005). "Irritable bowel syndrome: the need to exclude Dientamoeba fragilis". Am. J. Trop. Med. Hyg. 72 (5): 501, author reply 501–2. PMID 15891119. Retrieved November 4, 2009.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ a b Yawn BP, Lydick E, Locke GR, Wollan PC, Bertram SL, Kurland MJ (2001). "Do published guidelines for evaluation of Irritable Bowel Syndrome reflect practice?". BMC gastroenterology. 1: 11. doi:10.1186/1471-230X-1-11. PMC 59674. PMID 11701092.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link) - ^ C. Hauser (August 29, 2005). Mayo Clinic Gastroenterology and Hepatology Board Review. CRC Press. p. 225–. ISBN 978-0-203-50274-7. Retrieved October 24, 2010.
- ^ a b Fass R; Longstreth GF; Pimentel M; et al. (2001). "Evidence- and consensus-based practice guidelines for the diagnosis of irritable bowel syndrome". Arch. Intern. Med. 161 (17): 2081–8. doi:10.1001/archinte.161.17.2081. PMID 11570936.
{{cite journal}}
: Unknown parameter|author-separator=
ignored (help) - ^ Talley NJ (2006). "A unifying hypothesis for the functional gastrointestinal disorders: really multiple diseases or one irritable gut?". Reviews in gastroenterological disorders. 6 (2): 72–8. PMID 16699476.
- ^ Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS (2004). "Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis". Gastroenterology. 126 (7): 1721–32. doi:10.1053/j.gastro.2004.03.012. PMID 15188167.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Su YC; Wang WM; Wang SY; et al. (2000). "The association between Helicobacter pylori infection and functional dyspepsia in patients with irritable bowel syndrome". Am. J. Gastroenterol. 95 (8): 1900–5. doi:10.1111/j.1572-0241.2000.02252.x. PMID 10950033.
{{cite journal}}
: Unknown parameter|author-separator=
ignored (help); Unknown parameter|month=
ignored (help) - ^ Gerards C, Leodolter A, Glasbrenner B, Malfertheiner P (2001). "H. pylori infection and visceral hypersensitivity in patients with irritable bowel syndrome". Dig Dis. 19 (2): 170–3. doi:10.1159/000050673. PMID 11549828.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Grazioli B; Matera G; Laratta C; et al. (2006). "Giardia lamblia infection in patients with irritable bowel syndrome and dyspepsia: a prospective study". World J. Gastroenterol. 12 (12): 1941–4. PMID 16610003.
{{cite journal}}
: Unknown parameter|author-separator=
ignored (help); Unknown parameter|month=
ignored (help) - ^ Vernia P, Ricciardi MR, Frandina C, Bilotta T, Frieri G (1995). "Lactose malabsorption and irritable bowel syndrome. Effect of a long-term lactose-free diet". The Italian journal of gastroenterology. 27 (3): 117–21. PMID 7548919.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^
American College of Gastroenterology Task Force on Irritable Bowel Syndrome (2009). "An Evidence-Based Systematic Review on the Management of Irritable Bowel Syndrome" (PDF). Am J Gastroenterology. 104 (Supplement 1): S1–S35. doi:10.1038/ajg.2008.122. PMID 19521341.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ Wedlake, L (2009). "Systematic review: the prevalence of idiopathic bile acid malabsorption as diagnosed by SeHCAT scanning in patients with diarrhoea-predominant irritable bowel syndrome". Alimentary pharmacology & therapeutics. 30 (7): 707–17. doi:10.1111/j.1365-2036.2009.04081.x. PMID 19570102.
{{cite journal}}
: Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ^ Professor C Heather Ashton (1987). "Benzodiazepine Withdrawal: Outcome in 50 Patients". British Journal of Addiction. 82: 655–671.
- ^ Cole JA, Rothman KJ, Cabral HJ, Zhang Y, Farraye FA (2006). "Migraine, fibromyalgia, and depression among people with IBS: a prevalence study". BMC gastroenterology. 6: 26. doi:10.1186/1471-230X-6-26. PMC 1592499. PMID 17007634.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link) - ^ Bercik P, Verdu EF, Collins SM (2005). "Is irritable bowel syndrome a low-grade inflammatory bowel disease?". Gastroenterol. Clin. North Am. 34 (2): 235–45, vi–vii. doi:10.1016/j.gtc.2005.02.007. PMID 15862932.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Quigley EM (2005). "Irritable bowel syndrome and inflammatory bowel disease: interrelated diseases?". Chinese journal of digestive diseases. 6 (3): 122–32. doi:10.1111/j.1443-9573.2005.00202.x. PMID 16045602.
- ^ Simrén M, Axelsson J, Gillberg R, Abrahamsson H, Svedlund J, Björnsson ES (2002). "Quality of life in inflammatory bowel disease in remission: the impact of IBS-like symptoms and associated psychological factors". Am. J. Gastroenterol. 97 (2): 389–96. doi:10.1111/j.1572-0241.2002.05475.x. PMID 11866278.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Minderhoud IM, Oldenburg B, Wismeijer JA, van Berge Henegouwen GP, Smout AJ (2004). "IBS-like symptoms in patients with inflammatory bowel disease in remission; relationships with quality of life and coping behavior". Dig. Dis. Sci. 49 (3): 469–74. doi:10.1023/B:DDAS.0000020506.84248.f9. PMID 15139501.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ García Rodríguez LA, Ruigómez A, Wallander MA, Johansson S, Olbe L (2000). "Detection of colorectal tumor and inflammatory bowel disease during follow-up of patients with initial diagnosis of irritable bowel syndrome". Scand. J. Gastroenterol. 35 (3): 306–11. doi:10.1080/003655200750024191. PMID 10766326.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Corazziari E, Attili AF, Angeletti C, De Santis A (2008). "Gallstones, cholecystectomy and irritable bowel syndrome (IBS) MICOL population-based study". Dig Liver Dis. 40 (12): 944–50. doi:10.1016/j.dld.2008.02.013. PMID 18406218.
{{cite journal}}
:|first2=
missing|last2=
(help);|first3=
missing|last3=
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missing|last4=
(help)CS1 maint: multiple names: authors list (link) - ^ Cole JA; Yeaw JM; Cutone JA; et al. (2005). "The incidence of abdominal and pelvic surgery among patients with irritable bowel syndrome". Dig. Dis. Sci. 50 (12): 2268–75. doi:10.1007/s10620-005-3047-1. PMID 16416174.
{{cite journal}}
: Unknown parameter|author-separator=
ignored (help) - ^ Longstreth GF, Yao JF (2004). "Irritable bowel syndrome and surgery: a multivariable analysis". Gastroenterology. 126 (7): 1665–73. doi:10.1053/j.gastro.2004.02.020. PMID 15188159.
- ^ Tietjen GE, Bushnell CD, Herial NA, Utley C, White L, Hafeez F (2007). "Endometriosis is associated with prevalence of comorbid conditions in migraine". Headache. 47 (7): 1069–78. doi:10.1111/j.1526-4610.2007.00784.x. PMID 17635599.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ "Interstitial cystitis: Risk factors". Mayo Clinic. January 20, 2009.
- ^ Ford AC; Talley NJ; Spiegel BM; et al. (2008). "Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis". BMJ. 337: a2313. doi:10.1136/bmj.a2313. PMC 2583392. PMID 19008265.
{{cite journal}}
: Unknown parameter|author-separator=
ignored (help) - ^ a b c d e f g Ducrotté, P. (2007). "[Irritable bowel syndrome: current treatment options]". Presse Med. 36 (11 Pt 2): 1619–26. doi:10.1016/j.lpm.2007.03.008. PMID 17490849.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ Böhmer CJ, Tuynman HA (2001). "The effect of a lactose-restricted diet in patients with a positive lactose tolerance test, earlier diagnosed as irritable bowel syndrome: a 5-year follow-up study". Eur J Gastroenterol Hepatol. 13 (8): 941–4. doi:10.1097/00042737-200108000-00011. PMID 11507359.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ http://www.gastro.org/wmspage.cfm?parm1=5549 American Gastroenterological Association
- ^ a b Atkinson W, Sheldon TA, Shaath N, Whorwell PJ (2004). "Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial". Gut. 53 (10): 1459–64. doi:10.1136/gut.2003.037697. PMC 1774223. PMID 15361495.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC (2006). "Functional bowel disorders". Gastroenterology. 131 (2): 688. doi:10.1053/j.gastro.2006.06.027.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Sjölund K, Ekman R, Lindgren S, Rehfeld J (1996). "Disturbed motilin and cholecystokinin release in the irritable bowel syndrome". Scand J Gastroenterol. 31 (11): 1110–4. doi:10.3109/00365529609036895. PMID 8938905.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ a b c d e f g h i j Shen, YH.; Nahas, R. (2009). "Complementary and alternative medicine for treatment of irritable bowel syndrome". Can Fam Physician. 55 (2): 143–8. PMC 2642499. PMID 19221071.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ a b Bijkerk C, Muris J, Knottnerus J, Hoes A, de Wit N (2004). "Systematic review: the role of different types of fiber in the treatment of irritable bowel syndrome". Aliment Pharmacol Ther. 19 (3): 245–51. doi:10.1111/j.0269-2813.2004.01862.x. PMID 14984370.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Bijkerk C; de Wit N; Muris JW; et al. (2009). "Systematic Soluble or insoluble fiber in irritable bowel syndrome in primary care? Randomised placebo controlled trial". BMJ. 339 (b): 3154–. doi:10.1136/bmj.b3154. PMID 19713235.
{{cite journal}}
: Unknown parameter|author-separator=
ignored (help) - ^ Prior A, Whorwell P (1987). "Double blind study of ispaghula in irritable bowel syndrome". Gut. 28 (11): 1510–3. doi:10.1136/gut.28.11.1510. PMC 1433676. PMID 3322956.
- ^ Jalihal A, Kurian G (1990). "Ispaghula therapy in irritable bowel syndrome: improvement in overall well-being is related to reduction in bowel dissatisfaction". J Gastroenterol Hepatol. 5 (5): 507–13. doi:10.1111/j.1440-1746.1990.tb01432.x. PMID 2129822.
- ^ Kumar A, Kumar N, Vij J, Sarin S, Anand B (1987). "Optimum dosage of ispaghula husk in patients with irritable bowel syndrome: correlation of symptom relief with whole gut transit time and stool weight". Gut. 28 (2): 150–5. doi:10.1136/gut.28.2.150. PMC 1432983. PMID 3030900.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Francis CY, Whorwell PJ (1994). "Bran and irritable bowel syndrome: time for reappraisal". Lancet. 344 (8914): 39–40. doi:10.1016/S0140-6736(94)91055-3. PMID 7912305.
- ^ Cann P, Read N, Holdsworth C, Barends D (1984). "Role of loperamide and placebo in management of irritable bowel syndrome (IBS)". Dig Dis Sci. 29 (3): 239–47. doi:10.1007/BF01296258. PMID 6365490.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Cann P, Read N, Holdsworth C (1984). "What is the benefit of coarse wheat bran in patients with irritable bowel syndrome?". Gut. 25 (2): 168–73. doi:10.1136/gut.25.2.168. PMC 1432266. PMID 6319244.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ a b Ruepert L, Quartero AO, de Wit NJ, van der Heijden GJ, Rubin G, Muris JW (2011). "Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome". Cochrane Database Syst Rev (8): CD003460. doi:10.1002/14651858.CD003460.pub3. PMID 21833945.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Lesbros-Pantoflickova D, Michetti P, Fried M, Beglinger C, Blum A (2004). "Meta-analysis: The treatment of irritable bowel syndrome". Aliment Pharmacol Ther. 20 (11–12): 1253–69. doi:10.1111/j.1365-2036.2004.02267.x. PMID 15606387.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Jailwala J, Imperiale T, Kroenke K (2000). "Pharmacologic treatment of the irritable bowel syndrome: a systematic review of randomized, controlled trials". Ann Intern Med. 133 (2): 136–47. PMID 10896640.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Talley N (2001). "Serotoninergic neuroenteric modulators". Lancet. 358 (9298): 2061–8. doi:10.1016/S0140-6736(01)07103-3. PMID 11755632.
- ^ Joo J, Ehrenpreis E, Gonzalez L, Kaye M, Breno S, Wexner S, Zaitman D, Secrest K (1998). "Alterations in colonic anatomy induced by chronic stimulant laxatives: the cathartic colon revisited". J Clin Gastroenterol. 26 (4): 283–6. doi:10.1097/00004836-199806000-00014. PMID 9649012.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Tack J, Broekaert D, Fischler B, Oudenhove L, Gevers A, Janssens J (2006). "A controlled crossover study of the selective serotonin reuptake inhibitor citalopram in irritable bowel syndrome". Gut. 55 (8): 1095–103. doi:10.1136/gut.2005.077503. PMC 1856276. PMID 16401691.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Vahedi H, Merat S, Rashidioon A, Ghoddoosi A, Malekzadeh R (2005). "The effect of fluoxetine in patients with pain and constipation-predominant irritable bowel syndrome: a double-blind randomized-controlled study". Aliment Pharmacol Ther. 22 (5): 381–5. doi:10.1111/j.1365-2036.2005.02566.x. PMID 16128675.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Creed F, Fernandes L, Guthrie E, Palmer S, Ratcliffe J, Read N, Rigby C, Thompson D, Tomenson B (2003). "The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome". Gastroenterology. 124 (2): 303–17. doi:10.1053/gast.2003.50055. PMID 12557136.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Tabas G, Beaves M, Wang J, Friday P, Mardini H, Arnold G (2004). "Paroxetine to treat irritable bowel syndrome not responding to high-fiber diet: a double-blind, placebo-controlled trial". Am J Gastroenterol. 99 (5): 914–20. doi:10.1111/j.1572-0241.2004.04127.x. PMID 15128360.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ "UpToDate Inc" (subscription required).
- ^ Jackson J, O'Malley P, Tomkins G, Balden E, Santoro J, Kroenke K (2000). "Treatment of functional gastrointestinal disorders with antidepressant medications: a meta-analysis". Am J Med. 108 (1): 65–72. doi:10.1016/S0002-9343(99)00299-5. PMID 11059442.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Drossman D, Toner B, Whitehead W, Diamant N, Dalton C, Duncan S, Emmott S, Proffitt V, Akman D, Frusciante K, Le T, Meyer K, Bradshaw B, Mikula K, Morris C, Blackman C, Hu Y, Jia H, Li J, Koch G, Bangdiwala S (2003). "Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders". Gastroenterology. 125 (1): 19–31. doi:10.1016/S0016-5085(03)00669-3. PMID 12851867.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Sharara AI, Aoun E, Abdul-Baki H, Mounzer R, Sidani S, Elhajj I (2006). "A randomized double-blind placebo-controlled trial of rifaximin in patients with abdominal bloating and flatulence". Am J Gastroenterol. 101 (2): 326–33. doi:10.1111/j.1572-0241.2006.00458.x. PMID 16454838.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Quigley EM (2006). "Germs, gas and the gut; the evolving role of the enteric flora in IBS". Am J Gastroenterol. 101 (2): 334–5. doi:10.1111/j.1572-0241.2006.00445.x. PMID 16454839.
- ^ Raahave D, Christensen E, Loud FB, Knudsen LL. Correlation of bowel symptoms with colonic transit, length, and faecal load in functional faecal retention 2009;56:83–8
- ^ Warfield, Carol A. (2003). Principles and Practice of Pain Medicine. McGraw-Hill Professional. ISBN 0-07-144349-5.
{{cite book}}
: Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ^ Kennedy T, Jones R, Darnley S, Seed P, Wessely S, Chalder T (2005). "Cognitive behaviour therapy in addition to antispasmodic treatment for irritable bowel syndrome in primary care: randomised controlled trial". BMJ. 331 (7514): 435. doi:10.1136/bmj.38545.505764.06. PMC 1188111. PMID 16093252.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Heymann-Mönnikes I, Arnold R, Florin I, Herda C, Melfsen S, Mönnikes H (2000). "The combination of medical treatment plus multicomponent behavioral therapy is superior to medical treatment alone in the therapy of irritable bowel syndrome". Am J Gastroenterol. 95 (4): 981–94. doi:10.1111/j.1572-0241.2000.01937.x. PMID 10763948.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ van der Veek PP, van Rood YR, Masclee AA (2007). [www3.interscience.wiley.com/cgi-bin/fulltext/117987882/HTMLSTART "Clinical trial: short- and long-term benefit of relaxation training for irritable bowel syndrome"]. Aliment. Pharmacol. Ther. 26 (6): 943–52. doi:10.1111/j.1365-2036.2007.03437.x. PMID 17767479.
{{cite journal}}
: Check|url=
value (help)CS1 maint: multiple names: authors list (link) - ^ Halpert AD, Thomas AC, Hu Y, Morris CB, Bangdiwala SI, Drossman DA (2006). "A survey on patient educational needs in irritable bowel syndrome and attitudes toward participation in clinical research". J Clin Gastroenterol. 40 (1): 37–43. doi:10.1097/01.mcg.0000190759.95862.08. PMID 16340632.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ a b http://www.nhs.uk/Conditions/Irritable-bowel-syndrome/Pages/Treatment.aspx
- ^ Nikfar S, Rahimi R, Rahimi F, Derakhshani S, Abdollahi M (2008). "Efficacy of probiotics in irritable bowel syndrome: a meta-analysis of randomized, controlled trials". Dis. Colon Rectum. 51 (12): 1775–80. doi:10.1007/s10350-008-9335-z. PMID 18465170.
{{cite journal}}
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ignored (help)CS1 maint: multiple names: authors list (link) - ^ Niedzielin K, Kordecki H, Birkenfeld B (2001). "A controlled, double-blind, randomized study on the efficacy of Lactobacillus plantarum 299V in patients with irritable bowel syndrome". Eur J Gastroenterol Hepatol. 13 (10): 1143–7. doi:10.1097/00042737-200110000-00004. PMID 11711768.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ "New Studies Examine the Evidence on Probiotics in IBS" (PDF) (Press release). American College of Gastroenterology. October 31, 2005.
- ^ Brenner DM, Moeller MJ, Chey WD, Schoenfeld PS (2009). "The utility of probiotics in the treatment of irritable bowel syndrome: a systematic review". Am. J. Gastroenterol. 104 (4): 1033–49, quiz 1050. doi:10.1038/ajg.2009.25. PMID 19277023.
{{cite journal}}
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ignored (help)CS1 maint: multiple names: authors list (link) - ^ "IBS diet: Can yogurt ease symptoms?". Mayo Clinic. May 21, 2008.
- ^ Hadley SK, Gaarder SM (2005). "Treatment of irritable bowel syndrome". Am Fam Physician. 72 (12): 2501–6. PMID 16370407.
- ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 19008265, please use {{cite journal}} with
|pmid=19008265
instead. - ^ Madisch A, Holtmann G, Plein K, Holz J (2004). "Treatment of irritable bowel syndrome with herbal preparations: results of a double-blind, randomized, placebo-controlled, multi-centre trial". Aliment Pharmacol Ther. 19 (3): 271–9. doi:10.1111/j.1365-2036.2004.01859.x. PMID 14984373.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Wald K., Kelber O., Weiser D., Laufer S., Heinle H."Effects of STW 5 and its single extracts on ileal oxygen radical production induced by histamine" Planta Medica 2009 75:9
- ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 20117132, please use {{cite journal}} with
|pmid=20117132
instead. - ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 21171231 , please use {{cite journal}} with
|pmid= 21171231
instead. - ^ a b Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 20857519, please use {{cite journal}} with
|pmid=20857519
instead. - ^ Manheimer E, Cheng K, Wieland LS; et al. (2012). "Acupuncture for treatment of irritable bowel syndrome". Cochrane Database Syst Rev. 5 (5): CD005111. doi:10.1002/14651858.CD005111.pub3. PMID 22592702.
{{cite journal}}
: Explicit use of et al. in:|author=
(help)CS1 maint: multiple names: authors list (link) - ^ a b c
Quigley EM, Locke GR, Mueller-Lissner S, Paulo LG, Tytgat GN, Helfrich I, Schaefer E (2006). "Prevalence and management of abdominal cramping and pain: a multinational survey". Aliment. Pharmacol. Ther. 24 (2): 411–9. doi:10.1111/j.1365-2036.2006.02989.x. PMID 16842469.
{{cite journal}}
: Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ Ehlin AG, Montgomery SM, Ekbom A, Pounder RE, Wakefield AJ (2003). "Prevalence of gastrointestinal diseases in two British national birth cohorts". Gut. 52 (8): 1117–21. doi:10.1136/gut.52.8.1117. PMC 1773740. PMID 12865268.
{{cite journal}}
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ignored (help)CS1 maint: multiple names: authors list (link) - ^
Hungin AP, Chang L, Locke GR, Dennis EH, Barghout V (2005). "Irritable bowel syndrome in the United States: prevalence, symptom patterns and impact". Aliment. Pharmacol. Ther. 21 (11): 1365–75. doi:10.1111/j.1365-2036.2005.02463.x. PMID 15932367.
{{cite journal}}
: Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ Jafri W, Yakoob J, Jafri N Islam M, Ali QM (2007). "Irritable bowel syndrome and health seeking behaviour in different communities of Pakistan". J Pak Med Assoc. 57 (6): 285–7. PMID 17629228.
{{cite journal}}
: Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ Jafri W, Yakoob J, Jafri N, Islam M, Ali QM (2005). "Frequency of irritable bowel syndrome in college students". J Ayub Med Coll Abbottabad. 4 (17): 9–11. PMID 16599025.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Tuteja AK, Talley NJ, Gelman SS, Alder SC, Adler SC, Thompson C, Tolman K, Hale DC (2008). "Development of Functional Diarrhea, Constipation, Irritable Bowel Syndrome, and Dyspepsia During and After Traveling Outside the USA". Dig. Dis. Sci. 53 (1): 271–6. doi:10.1007/s10620-007-9853-x. PMID 17549631.
{{cite journal}}
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ignored (help)CS1 maint: multiple names: authors list (link) - ^ Payne, S (2004). "Sex, gender, and irritable bowel syndrome: Making the connections". Gender medicine. 1 (1): 18–28. doi:10.1016/S1550-8579(04)80007-X. PMID 16115580.
- ^ Jackson, NA; Houghton, LA; Whorwell, PJ; Currer, B (1994). "Does the menstrual cycle affect anorectal physiology?". Digestive diseases and sciences. 39 (12): 2607–11. PMID 7995186.
- ^ Voci, SC; Cramer, KM (2009). "Gender-related traits, quality of life, and psychological adjustment among women with irritable bowel syndrome". Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 18 (9): 1169–76. doi:10.1007/s11136-009-9532-9. PMID 19728159.
- ^ Drossman, DA; Li, Z; Andruzzi, E; Temple, RD; Talley, NJ; Thompson, WG; Whitehead, WE; Janssens, J; Funch-Jensen, P (1993). "U.S. Householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact". Digestive diseases and sciences. 38 (9): 1569–80. PMID 8359066.
- ^ Goffaux, P; Michaud, K; Gaudreau, J; Chalaye, P; Rainville, P; Marchand, S (2011). "Sex differences in perceived pain are affected by an anxious brain". Pain. 152 (9): 2065–73. doi:10.1016/j.pain.2011.05.002. PMID 21665365.
- ^ Walker, EA; Katon, WJ; Roy-Byrne, PP; Jemelka, RP; Russo, J (1993). "Histories of sexual victimization in patients with irritable bowel syndrome or inflammatory bowel disease". The American Journal of Psychiatry. 150 (10): 1502–6. PMID 8379554.
- ^ Brown PW (1950). "The irritable bowel syndrome". Rocky Mountain Medical Journal. 47 (5): 343–6. PMID 15418074.
- ^ Levy RL, Von Korff M, Whitehead WE, Stang P, Saunders K, Jhingran P, Barghout V, Feld AD. (2001). "Costs of care for irritable bowel syndrome patients in a health maintenance organization". Am J Gastroenterol. 96 (11): 3122–9. doi:10.1111/j.1572-0241.2001.05258.x. PMID 11721759.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Nyrop KA, Palsson OS, Levy RL, Korff MV, Feld AD, Turner MJ, Whitehead WE (2007). [www3.interscience.wiley.com/cgi-bin/fulltext/117987809/HTMLSTART "Costs of health care for irritable bowel syndrome, chronic constipation, functional diarrhoea and functional abdominal pain"]. Aliment Pharmacol Ther. 26 (2): 237–48. doi:10.1111/j.1365-2036.2007.03370.x. PMID 17593069.
{{cite journal}}
: Check|url=
value (help)CS1 maint: multiple names: authors list (link) - ^ Leong SA; Barghout V; Birnbaum HG; et al. (2003). "The economic consequences of irritable bowel syndrome: a US employer perspective". Arch. Intern. Med. 163 (8): 929–35. doi:10.1001/archinte.163.8.929. PMID 12719202.
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ignored (help) - ^ Martin B, Ganguly R, Pannicker S, Feride F, Barghout V (2003). "Utilization Patterns and Net Direct Medical Costs Medicaid of Irritable Bowel Syndrome". Curr Med Res Opin. 19 (8): 771–80. doi:10.1185/030079903125002540. PMID 14687449.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^
Gibson PR, Shepherd SJ. (2010). "Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach". J Gastroenterol Hepatol. 25 (2): 252–8. doi:10.1111/j.1440-1746.2009.06149.x. PMID 20136989.
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