Irritable Bowel Syndrome

Key Points ÎIrritable bowel syndrome (IBS) is estimated to affect 7-15% of the general population in the USA. ÎA large proportion of individuals with IBS (33-90%) do not seek health care for their symptoms. ÎIn most patients, IBS can be diagnosed with symptom-based criteria in the absence of alarm signs. In those under age 50 without alarm features, the presence of symptom-based criteria is sufficient to make a diagnosis of IBS, while excluding serious neoplastic/inflammatory conditions as the etiology with a reasonable (< 3% chance) degree of certainty. ÎManagement of IBS includes an effective patient-provider relationship, education, reassurance and dietary recommendations. Pharmacological, behavioral and psychological treatments may be necessary for more severe symptoms. ÎFiber, laxatives, and a chloride channel activator (lubiprostone) are used to treat constipation-predominant IBS (IBS-C) symptoms. ÎAntidiarrheal agents, gut-selective antibiotics, tricyclic antidepressants and, in severe cases, a 5-HT3 antagonist (alosetron) are used to treat diarrhea-predominant IBS (IBS-D) symptoms. ÎDietary measures, probiotics and gut-selective antibiotics may be efficacious for reducing bloating and gas; antidepressants and anticholinergics can help relieve abdominal pain. ÎEffective psychological and behavioral treatment interventions for IBS include cognitive behavioral therapy, hypnosis, psychotherapy and stress management. Abbreviations 5-HT, 5-hydroxytriptophan; bid, twice times a day; FDA, U.S. Food and Drug Administration; HIV, human immunodeficiency virus; IBS, irritable bowel syndrome; IBS-C, constipation predominant IBS; IBS-D, diarrhea-predominant IBS; IBS-M, mixed pattern IBS; NSAID, nonsteroidal anti-inflammatory drug; PPI, proton pump inhibitor; PO, by mouth; prn, as needed; qid, four times a day; RCT, randomized controlled trial; SIBO, small intestinal bacterial overgrowth; SSRIs, selective serotonin reuptake inhibitors; tid, three times a day; y, year

• Cover