Fortnightly Review: Irritable bowel, irritable body, or irritable brain?

BMJ 1995;310:171-175 (21 January)

Education and debate

Fortnightly Review: Irritable bowel, irritable body, or irritable brain?

Michael J G Farthing, professor of gastroenterology ^a

^a Digestive Diseases Research Centre, Medical College of St Bartholomew's Hospital, London EC1M 6BQ

Summary points

The irritable bowel syndrome affects about 20% of adults in the industrialised world
The condition is a disturbance of gastrointestinal function of unknown cause, but abnormalities of intestinal motility and visceral sensation are found in some patients
Symptoms of the irritable bowel syndrome are often associated with extraintestinal manifestations, including urinary symptoms, dyspareunia, and fatigue
Overall, 40-60% of patients with the irritable bowel syndrome who seek medical advice have psychological symptoms of depression or anxiety, or both
Diagnosis of the irritable bowel syndrome can usually be made on the basis of clinical history and examination, but exclusion of organic disease is advisable in patients aged >45 years who present with new bowel symptoms
No uniformly successful treatment exists for the irritable bowel syndrome. End organ treatment aimed at relieving abdominal pain (antispasmodic drugs) or disturbed bowel habit (antidiarrhoeal and bulking agents) can produce symptomatic relief, and "central" treatment (for example, anti-depressants, hypnotherapy, psychotherapy) should be considered in patients with associated affective disorders

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Relevant Article

Food intolerance may play a part: Peter J Lewis
BMJ 1995 310: 1067. [Extract] [Full Text]

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