NEUROGASTROENTEROLOGY AND MOTILITY 

Minerva Gastroenterologica e Dietologica 2009 September;55(3):273-87

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Management of irritable bowel sindrome

Ford A. C. ✉

Department of Academic Medicine, St. James’s University Hospital, Leeds, UK

Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract, characterised by abdominal pain and change in bowel habit, with a fluctuating natural history. The exact etiology remains unknown, but it is unlikely there is a single unifying explanation. The prevalence in the general population is between 5% and 20%, and the condition represents a considerable financial burden to the health service. Guidelines for the management of IBS recommend that symptom-based diagnostic criteria should be used to make a positive diagnosis, without the need for recourse to investigations to exclude organic disease. However, current evidence demonstrates that these have either not been well-validated in prospective studies or perform suboptimally. Investigations to exclude underlying organic disease in IBS have a low yield, and the diagnosis is unlikely to be revised during extended follow-up, although screening for celiac disease with serology appeared to be of value in a recent systematic review and meta-analysis, Despite the fact that no therapy is established to alter the natural history of IBS, a series of systematic reviews and meta-analyses, conducted to inform the American College of Gastroenterology’s updated monograph on IBS, have demonstrated that fibre, antispasmodics, antidepressants, psychological therapies, 5-HT3 antagonists, 5-HT4 agonists, and probiotics are all more effective than placebo. Anti-diarrheal agents may be of some benefit, in terms of improved stool frequency and consistency in diarrhea-predominant IBS, and lubiprostone may have a role in constipation-predominant IBS, though data for this drug are preliminary at present.