BMJ  2007;334:1105-1109 (26 May), doi:10.1136/bmj.39199.679236.AE

Clinical Review

Clinical review

Psychological approach to managing irritable bowel syndrome

Department of Gastroenterology, Kings College Hospital, London SE5 9RS

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

"It is more important to know what sort of person has a disease than to know what sort of disease a person has." Hippocrates

The medical management of patients with irritable bowel syndrome is often unsatisfactory. Doctors are still taught that irritable bowel syndrome is a diagnosis of exclusion, and patients readily sense that they are being told that nothing is really wrong with them. Many people soon come to appreciate that the range of medical treatments available is limited in both scope and efficacy. The mood of negativity, once established, is difficult to dispel.

Summary points Irritable bowel syndrome is believed to result from a variety of biological and psychosocial factors Irritable bowel syndrome is not a diagnosis of exclusion; a positive diagnosis can usually be made The usual medical treatment is often highly unsatisfactory; if psychological factors seem important, these should be dealt with Tricyclic antidepressants and some selective serotonin . . . [Full text of this article]

Sources and selection criteria

What actually causes irritable bowel syndrome?

What is the impact of psychology on irritable bowel syndrome?

How and why should I make a positive diagnosis?

Box 1 Rome III criteria* for diagnosing irritable bowel syndrome⁴

What are the options for psychological management?

Antidepressants
Tricyclic antidepressants
Selective serotonin reuptake inhibitors
Cognitive behaviour therapy
Hypnotherapy
Box 2 Gut directed hypnotherapy²⁴

How should I approach the patient with irritable bowel syndrome?

What psychological treatments should I consider?

Additional educational resources

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Related Articles

Cognitive behaviour therapy in addition to antispasmodic treatment for irritable bowel syndrome in primary care: randomised controlled trial

Tom Kennedy, Roger Jones, Simon Darnley, Paul Seed, Simon Wessely, and Trudie Chalder
BMJ 2005 331: 435. [Abstract] [Full Text] [PDF]

Meta-analysis of effects and side effects of low dosage tricyclic antidepressants in depression: systematic review

Toshi A Furukawa, Hugh McGuire, and Corrado Barbui
BMJ 2002 325: 991. [Abstract] [Full Text] [PDF]

Controversies in Management: Psychological treatment is essential for some

Francis Creed
BMJ 1994 309: 1647-1648. [Extract] [Full Text]

Rapid Responses:

Read all Rapid Responses

Tricyclic antidepresants in IBS.

Mohammad Shaikhani
bmj.com, 27 May 2007 [Full text]

Psychotherapy for IBS

Anne Ward
bmj.com, 29 May 2007 [Full text]

Support for IBS as a positive diagnosis

William Cayley
bmj.com, 29 May 2007 [Full text]

Hypnotherapy for IBS.

James Paul Pandarakalam
bmj.com, 31 May 2007 [Full text]

Short-term Psychodynamic Psychotherapies for IBS

Allan A Abbass
bmj.com, 13 Jun 2007 [Full text]