Education And Debate

Controversies in Management: Medical treatment works for those with clear diagnosis

BMJ 1994; 309 doi: (Published 17 December 1994) Cite this as: BMJ 1994;309:1646
  1. R C Spiller
  1. University Hospital Nottingham, Queen's Medical Centre, Nottingham, consultant physician.

    Irritable bowel or irritable mind?

    Medical treatment works for those with clear diagnosis

    Imprecise and inconsistent definition of the irritable bowel syndrome has created much confusion. A clear definition has, however, recently been agreed.1 The Rome consensus states that symptoms should be chronic and recurring and consist of abdominal pain that is clearly related to bowel function, being either relieved by defecation or associated with a change in frequency or consistency of stool with or without disturbed defecation, which is defined as two or more of the following: altered stool frequency, altered stool form (hard, loose, or watery), altered stool passage (straining, urgency, or feeling of incomplete defecation), and passage of mucus. The above symptoms are usually associated with bloating or a sense of abdominal distension. The syndrome excludes painless constipation and diarrhoea and also chronic abdominal pain that is unrelated to bowel movement in which psychiatric features predominate.

    Irritable bowel symptoms are experienced by 8-22% of the population,2 but most learn to cope with their symptoms and less than one third actually consult a doctor. Consulters differ from non-consulters in being less easily reassured and more anxious, depressive, and prone to multiple complaints.2 3 4 This pattern is …

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