BMJ  2006;332:280-283 (4 February), doi:10.1136/bmj.332.7536.280

Practice

BMJ Learning

Irritable bowel syndrome: diagnosis and management

¹ Department of Medicine and Gastroenterology, Wythenshawe Hospital, Manchester M23 9LT, ² Education and Research Centre, Wythenshawe Hospital

Irritable bowel syndrome is often dismissed as just being a nuisance rather than anything more serious, but its symptoms can seriously diminish a patient's quality of life. When the disease is better understood and treatment is tailored to the individual patient, it can often be rewarding to manage

The first 150 words of the full text of this article appear below.

What is it, and who gets it?

Irritable bowel syndrome (IBS) is a chronic condition characterised by abdominal pain, bowel dysfunction, and abdominal bloating in the absence of any structural abnormality. A number of pathophysiological abnormalities, however, can often be identified.¹ About 10-15% of the adult population in the United Kingdom is affected by irritable bowel syndrome.²

Aetiology

IBS is now clearly understood to be a multifactorial condition, with a variety of factors contributing to expression of the disease rather than its just being due to psychopathology.. These include motility, visceral sensation, central processing, genetics, dietary factors, inflammation, and neurotransmitters.¹

Exacerbating factors

Stress exacerbates IBS rather than being causative in any way. If stress is severe and chronic—for example, stress caused by continuous domestic strife—it can result in the disorder being virtually untreatable.³

Antibiotics need to be used with care in patients with IBS. Some antibiotics, particularly erythromycin, can make the condition worse.⁴

Non-steroidal anti-inflammatory drugs are often prescribed for . . . [Full text of this article]

How do I diagnose it?

History
Examination
Investigations

How should I treat it?

Dietary manipulation
Antispasmodics
Antidiarrhoeals
Laxatives
Antidepressants
Behavioural treatments

New treatments

Probiotics
Type 3 serotonin receptor antagonists
Type 4 serotonin receptor agonists

When should I refer my patient?

What is the outlook?

IBS in secondary care

Pain
Bowel dysfunction
Distension
Flatus
Sexual function
Suicide
Extracolonic symptoms
Absenteeism
Stigmatisation
Quality of life

Conclusion

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This article has been cited by other articles:

• Dalrymple, J, Bullock, I (2008). Diagnosis and management of irritable bowel syndrome in adults in primary care: summary of NICE guidance. BMJ 336: 556-558 [Full text]