Irritable bowel syndrome: a syndrome in evolution.

As a group, functional gastrointestinal disorders are the most common gastrointestinal disorder seen by both generalists and specialists. These disorders can be frustrating to both patients and physicians as they are usually chronic in nature and difficult to treat. These disorders are associated with frequent healthcare visits, the scheduling of multiple, expensive diagnostic tests, and the use of both over-the-counter and prescription medications. All of these factors lead to a significant economic burden to society. In addition, functional gastrointestinal disorders are associated with a reduction in quality of life for the patient. Irritable bowel syndrome (IBS) is the most common of the functional gastrointestinal disorders. This syndrome has been the focus of a large number of research studies over the past two decades. These studies have resulted in a number of significant changes in our definition of IBS. In addition, these research studies have produced considerable changes in our understanding of the etiology and pathogenesis of IBS. In this section, we will review some of the evolutionary changes that have occurred in IBS. We will discuss how the definition of IBS has changed, consider our evolving strategies to evaluate and diagnose IBS, and finally, provide a brief overview of treatment options for this common disorder.

[1]  A. Kilbourne,et al.  The impact of irritable bowel syndrome on health-related quality of life. , 2000, Gastroenterology.

[2]  M. Merli,et al.  Polytetrafluoroethylene-Covered Stent Grafts for TIPS Procedure: 1-Year Patency and Clinical Results , 2004, American Journal of Gastroenterology.

[3]  H. Bockus,et al.  NEUROGENIC MUCOUS COLITIS , 1928 .

[4]  N. Talley,et al.  The Irritable Bowel Syndrome: Long-Term Prognosis and the Physician-Patient Interaction , 1995, Annals of Internal Medicine.

[5]  M. Heitkemper,et al.  Symptoms Across the Menstrual Cycle in Women With Irritable Bowel Syndrome , 2003, American Journal of Gastroenterology.

[6]  M. Crowell,et al.  Physicians’ attitudes and practices in the evaluation and treatment of irritable bowel syndrome , 2006, Scandinavian journal of gastroenterology.

[7]  M. Lefkowitz,et al.  A randomized, double‐blind, placebo‐controlled trial of tegaserod in female patients suffering from irritable bowel syndrome with constipation , 2002, Alimentary pharmacology & therapeutics.

[8]  E. Kaltenthaler,et al.  Treatment of irritable bowel syndrome: a review of randomised controlled trials , 2001, Gut.

[9]  W. Whitehead,et al.  Tolerance for rectosigmoid distention in irritable bowel syndrome. , 1990, Gastroenterology.

[10]  R. Spiller,et al.  Increased rectal mucosal enteroendocrine cells, T lymphocytes, and increased gut permeability following acuteCampylobacter enteritis and in post-dysenteric irritable bowel syndrome , 2000, Gut.

[11]  W. Chey,et al.  The utility of diagnostic tests in irritable bowel syndrome patients: a systematic review , 2002, American Journal of Gastroenterology.

[12]  E. Ernst,et al.  Peppermint oil for irritable bowel syndrome: a critical review and metaanalysis , 1998, American Journal of Gastroenterology.

[13]  Alisha Ali,et al.  Feminine Gender Role and Illness Behavior in Irritable Bowel Syndrome , 1998 .

[14]  P. Masand,et al.  Paroxetine in Patients With Irritable Bowel Syndrome: A Pilot Open-Label Study. , 2002, Primary care companion to the Journal of clinical psychiatry.

[15]  Nicholas J. Talley,et al.  U. S. Householder survey of functional gastrointestinal disorders , 1993, Digestive Diseases and Sciences.

[16]  P. Openshaw,et al.  Towards positive diagnosis of the irritable bowel. , 1978, British medical journal.

[17]  D. Drossman,et al.  AGA technical review on irritable bowel syndrome. , 2002, Gastroenterology.

[18]  A. Zinsmeister,et al.  A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea‐predominant irritable bowel syndrome , 2003, Alimentary pharmacology & therapeutics.

[19]  R. Kessler,et al.  Regional cerebral activation in irritable bowel syndrome and control subjects with painful and nonpainful rectal distention. , 2000, Gastroenterology.

[20]  T. Abell,et al.  Effect of Leuprolide Acetate in Treatment of Abdominal Pain and Nausea in Premenopausal Women with Functional Bowel Disease: A Double-Blind, Placebo-Controlled, Randomized Study , 1998, Digestive Diseases and Sciences.

[21]  M. Crowell,et al.  Molecular defects in mucosal serotonin content and decreased serotonin reuptake transporter in ulcerative colitis and irritable bowel syndrome. , 2004, Gastroenterology.

[22]  N. Read,et al.  Psychometric scores and persistence of irritable bowel after infectious diarrhoea , 1996, The Lancet.

[23]  W. Whitehead,et al.  Evidence for exacerbation of irritable bowel syndrome during menses. , 1990, Gastroenterology.

[24]  T. King.  Psychometric scores and persistence of irritable bowel after infectious diarrhoea. , 1996, Clinical nutrition.

[25]  G. Koch,et al.  Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. , 2003, Gastroenterology.

[26]  B. Yawn,et al.  The patient's perspective of irritable bowel syndrome. , 2001, The Journal of family practice.

[27]  M. Wallander,et al.  Is hormone replacement therapy associated with an increased risk of irritable bowel syndrome? , 2003, Maturitas.

[28]  W. Chey,et al.  Utility of the Rome I and Rome II criteria for irritable bowel syndrome in U.S. women. , 2002 .

[29]  J. Vandenberghe,et al.  A double-blind randomised placebo-controled crossover trial of citalopram, a selective 5-hydroxytryptamine reuptake inhibitor, in irritable bowel syndrome , 2001 .

[30]  E. Rondonotti,et al.  Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases. , 2004, Gastroenterology.

[31]  J. Mathias,et al.  Debilitating “functional” bowel disease controlled by leuprolide acetate, gonadotropin-releasing hormone (GnRH) analog , 1989, Digestive Diseases and Sciences.

[32]  S. K. Yadav,et al.  Irritable bowel syndrome: therapeutic evaluation of indigenous drugs. , 1989, The Indian journal of medical research.

[33]  W. Paterson,et al.  Predictive value of the rome criteria for diagnosing the irritable bowel syndrome , 1999, American Journal of Gastroenterology.

[34]  P. Gionchetti,et al.  Intestinal microflora and oral bacteriotherapy in irritable bowel syndrome. , 2002, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[35]  M. Schuster.  Defining and diagnosing irritable bowel syndrome. , 2001, The American journal of managed care.

[36]  M. Heitkemper,et al.  Gender differences in irritable bowel syndrome. , 2002, Gastroenterology.

[37]  Henry C. Lin,et al.  Small intestinal bacterial overgrowth: a framework for understanding irritable bowel syndrome. , 2004, JAMA.

[38]  Maryanne Martin,et al.  Illness-Related Parenting in Mothers with Functional Gastrointestinal Symptoms , 2004, American Journal of Gastroenterology.

[39]  A R Zinsmeister,et al.  Medical costs in community subjects with irritable bowel syndrome. , 1995, Gastroenterology.

[40]  The role of psychological and biological factors in postinfective gut dysfunction , 1999 .

[41]  M. Tulin,et al.  Alterations in colonic function in man under stress; experimental production of changes simulating the irritable colon. , 1947, Gastroenterology.

[42]  B. Lacy,et al.  Tegaserod: a new 5-HT4 agonist. , 2002, Journal of clinical gastroenterology.

[43]  N. Talley,et al.  Treatment of irritable bowel syndrome with Chinese herbal medicine: a randomized controlled trial. , 1998, JAMA.

[44]  I. Holme,et al.  A double‐blind, placebo‐controlled, randomized study to evaluate the efficacy, safety and tolerability of tegaserod in patients with irritable bowel syndrome , 2004, Scandinavian journal of gastroenterology.

[45]  H. Yuen,et al.  An Asia-Pacific, double blind, placebo controlled, randomised study to evaluate the efficacy, safety, and tolerability of tegaserod in patients with irritable bowel syndrome , 2003, Gut.

[46]  P. Costa,et al.  Symptoms of psychologic distress associated with irritable bowel syndrome. Comparison of community and medical clinic samples. , 1988, Gastroenterology.

[47]  A. Ruigómez,et al.  Increased risk of irritable bowel syndrome after bacterial gastroenteritis: cohort study , 1999, BMJ.

[48]  G. Dirnberger,et al.  Treatment of the irritable bowel syndrome with Bentyl (dicyclomine hydrochloride). , 1981 .

[49]  L. Laine,et al.  The epidemiology of ischaemic colitis , 2004, Alimentary pharmacology & therapeutics.

[50]  W. Chey,et al.  Colonic motility abnormality in patients with irritable bowel syndrome exhibiting abdominal pain and diarrhea , 2000, American Journal of Gastroenterology.

[51]  K. Kroenke,et al.  Pharmacologic treatment of the irritable bowel syndrome: a systematic review of randomized, controlled trials. , 2000, Annals of internal medicine.

[52]  W. Paulus,et al.  A diagnostic score for the irritable bowel syndrome. Its value in the exclusion of organic disease. , 1984, Gastroenterology.

[53]  N. Chaudhary,et al.  The irritable colon syndrome. A study of the clinical features, predisposing causes, and prognosis in 130 cases. , 1962, The Quarterly journal of medicine.

[54]  C. O'Morain,et al.  Patient knowledge and educational needs in irritable bowel syndrome , 2000, European journal of gastroenterology & hepatology.

[55]  P. Whorwell,et al.  Do male sex hormones protect from irritable bowel syndrome? , 2000, American Journal of Gastroenterology.

[56]  K. Klein.  Controlled treatment trials in the irritable bowel syndrome: a critique. , 1988, Gastroenterology.

[57]  D. Drossman.  Sexual and physical abuse and gastrointestinal illness. , 1995, Scandinavian journal of gastroenterology. Supplement.

[58]  D. Drossman,et al.  Sexual and physical abuse in women with functional or organic gastrointestinal disorders. , 1990, Annals of internal medicine.

[59]  R. Spiller,et al.  Prognosis in post-infective irritable bowel syndrome: a six year follow up study , 2002, Gut.

[60]  A. Zinsmeister,et al.  Dysmotility of the small intestine in irritable bowel syndrome. , 1988, Gut.

[61]  D. Sanders,et al.  Association of adult coeliac disease with irritable bowel syndrome: a case-control study in patients fulfilling ROME II criteria referred to secondary care , 2001, The Lancet.

[62]  W. Whitehead,et al.  Intergenerational transmission of gastrointestinal illness behavior , 2000, American Journal of Gastroenterology.

[63]  H. Mönnikes,et al.  The combination of medical treatment plus multicomponent behavioral therapy is superior to medical treatment alone in the therapy of irritable bowel syndrome , 2000, American Journal of Gastroenterology.

[64]  Shara I. Feld,et al.  Irritable bowel syndrome in twins: heredity and social learning both contribute to etiology. , 2001, Gastroenterology.

[65]  J. Kellow,et al.  Altered small bowel motility in irritable bowel syndrome is correlated with symptoms. , 1987, Gastroenterology.

[66]  K W Heaton,et al.  Functional bowel disorders and functional abdominal pain , 1999, Gut.

[67]  D. Thompson,et al.  Health-Related Quality of Life and Health Care Costs in Severe, Refractory Irritable Bowel Syndrome , 2001, Annals of Internal Medicine.

[68]  J. Ritchie.  Pain from distension of the pelvic colon by inflating a balloon in the irritable colon syndrome 1 , 1973, Gut.

[69]  Clifford Goodman,et al.  The burden of selected digestive diseases in the United States. , 2002, Gastroenterology.

[70]  G. Longstreth,et al.  Irritable bowel syndrome and surgery: a multivariable analysis. , 2004, Gastroenterology.

[71]  Henry C. Lin,et al.  Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome , 2000, American Journal of Gastroenterology.

[72]  G. Longstreth,et al.  Family practitioners' attitudes and knowledge about irritable bowel syndrome: effect of a trial of physician education. , 2003, Family practice.

[73]  B. Nyberg,et al.  Full-thickness biopsy of the jejunum reveals inflammation and enteric neuropathy in irritable bowel syndrome. , 2002, Gastroenterology.

[74]  F. Pace,et al.  Tegaserod, a 5‐HT4 receptor partial agonist, relieves symptoms in irritable bowel syndrome patients with abdominal pain, bloating and constipation , 2001, Alimentary pharmacology & therapeutics.

[75]  Robin C. Spiller,et al.  Rome II: the Functional Gastrointestinal Disorders. Diagnosis, Pathophysiology and Treatment: a Multinational Consensus , 2000 .

[76]  H. Mardini,et al.  Paroxetine to Treat Irritable Bowel Syndrome Not Responding to High-Fiber Diet: A Double-Blind, Placebo-Controlled Trial , 2004, American Journal of Gastroenterology.

[77]  W. Chey,et al.  Utility of the Rome I and Rome II criteria for irritable bowel syndrome in U.S. women , 2002, American Journal of Gastroenterology.

[78]  T. Poynard,et al.  Meta‐analysis of smooth muscle relaxants in the treatment of irritable bowel syndrome , 2001, Alimentary pharmacology & therapeutics.

[79]  P. Jhingran,et al.  Alosetron controls bowel urgency and provides global symptom improvement in women with diarrhea-predominant irritable bowel syndrome , 2001, American Journal of Gastroenterology.

[80]  T. Yagi,et al.  Adult murine neurons: their chromatin and chromosome changes and failure to support embryonic development as revealed by nuclear transfer , 2002, Cytogenetic and Genome Research.

[81]  R. Krueger,et al.  Concordance of IBS among monozgotic and dizygotic twins , 2001 .

[82]  M. Özkaya,et al.  Association of the −1438 G/A and 102 T/C Polymorphism of the 5-Ht2A Receptor Gene with Irritable Bowel Syndrome 5-Ht2A Gene Polymorphism in Irritable Bowel Syndrome , 2004, Journal of clinical gastroenterology.

[83]  D. Fuchs,et al.  The role of psychological and biological factors in postinfective gut dysfunction , 2000, Gut.

[84]  A R Zinsmeister,et al.  Epidemiology of colonic symptoms and the irritable bowel syndrome. , 1991, Gastroenterology.

[85]  E A Mayer,et al.  Regional cerebral activity in normal and pathological perception of visceral pain. , 1997, Gastroenterology.

[86]  Henry C. Lin,et al.  Normalization of Lactulose Breath Testing Correlates With Symptom Improvement in Irritable Bowel Syndrome: A Double-Blind, Randomized, Placebo-Controlled Study , 2003, American Journal of Gastroenterology.

[87]  P. Schoenfeld,et al.  Systematic review on the management of irritable bowel syndrome in North America , 2002, American Journal of Gastroenterology.

[88]  B. Birkenfeld,et al.  A controlled, double-blind, randomized study on the efficacy of Lactobacillus plantarum 299V in patients with irritable bowel syndrome , 2001, European journal of gastroenterology & hepatology.

[89]  L. Melton,et al.  A comparison of the Rome and Manning criteria for case identification in epidemiological investigations of irritable bowel syndrome , 2000, American Journal of Gastroenterology.

[90]  E. Blanchard,et al.  Beyond abuse: the association among parenting style, abdominal pain, and somatization in IBS patients. , 2004, Behaviour research and therapy.

[91]  C. M. Mitchell,et al.  Survey of the AGA membership relating to patients with functional gastrointestinal disorders. , 1987, Gastroenterology.

[92]  L. Kleinman,et al.  Health-related quality of life associated with irritable bowel syndrome: comparison with other chronic diseases. , 2002, Clinical therapeutics.

[93]  R. Harvey,et al.  PROGNOSIS IN THE IRRITABLE BOWEL SYNDROME: A 5-YEAR PROSPECTIVE STUDY , 1987, The Lancet.

[94]  M. Camilleri,et al.  A randomized controlled clinical trial of the serotonin type 3 receptor antagonist alosetron in women with diarrhea-predominant irritable bowel syndrome. , 2001, Archives of internal medicine.

[95]  L. Melton,et al.  Familial association in adults with functional gastrointestinal disorders. , 2000, Mayo Clinic proceedings.

[96]  W. Whitehead,et al.  Patients and Nonconsulters with Irritable Bowel Syndrome Reporting a Parental History of Bowel Problems Have More Impaired Psychological Distress , 2004, Digestive Diseases and Sciences.

[97]  J. Hunter,et al.  Effect of Lactobacillus plantarum 299v on Colonic Fermentation and Symptoms of Irritable Bowel Syndrome , 2002, Digestive Diseases and Sciences.

[98]  P. Whorwell,et al.  Long term benefits of hypnotherapy for irritable bowel syndrome , 2003, Gut.

[99]  M. Camilleri,et al.  Serotonin-transporter polymorphism pharmacogenetics in diarrhea-predominant irritable bowel syndrome. , 2002, Gastroenterology.

[100]  J. B. Vancouver,et al.  Gender differences in Manning criteria in the irritable bowel syndrome. , 1991, Gastroenterology.

[101]  D. Drossman,et al.  Sexual and Physical Abuse and Gastrointestinal Illness: Review and Recommendations , 1995, Annals of Internal Medicine.

[102]  N. Talley,et al.  Acupuncture has a Placebo Effect on Rectal Perception but not on Distensibility and Spatial Summation: A Study in Health and IBS , 2004, American Journal of Gastroenterology.

[103]  E. Blanchard,et al.  Cognitive therapy for irritable bowel syndrome. , 1994, Journal of consulting and clinical psychology.

[104]  A. Fasano,et al.  Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum. , 2001, Gastroenterology.

[105]  G. Andrews,et al.  Evidence of a Genetic Contribution to Functional Bowel Disorder , 1998, American Journal of Gastroenterology.