Irritable Bowel Syndrome: Current Approach to Symptoms, Evaluation, and Treatment

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There are frequent advances in knowledge about the clinical presentation, pathophysiology, and treatment of irritable bowel syndrome. It is important for clinicians to be aware of available therapies and the supporting evidence for those therapies to increase patient satisfaction. This is best achieved with a collaborative and long-term clinician-patient relationship and mutual commitment to modify therapy and try new modalities until the greatest relief of symptoms and improvement in health-related quality of life is achieved. This article reviews symptoms, comorbidities, gender differences, and measure of severity in irritable bowel syndrome and current and evidence-based approaches to evaluation and treatment, and the new symptom-based Rome III diagnostic criteria are reviewed and explained.

Section snippets

Gastrointestinal Symptoms

The main symptom of IBS is chronic or recurrent abdominal pain or discomfort associated with altered bowel habits. The new Rome III criteria for the diagnosis of IBS were published in 2006 and are listed in Box 1 [1]. The following are not part of the diagnostic criteria but are considered supportive symptoms: abnormal stool frequency (<3 bowel movements per week or >3 bowel movements per day); abnormal stool form (lumpy-hard stool or loose-watery stool); defecation; straining; urgency; a

Diagnostic Evaluation of Irritable Bowel Syndrome

The diagnosis of IBS is symptom-based because there are not yet diagnostic biomarkers for IBS. The symptom-based Rome III criteria had a sensitivity of 0.707 and a specificity of 0.878 in the validation sample of 328 patients who had received a clinical diagnosis of IBS [40]. Although the presence of “red flag” or alarm signs and symptoms may indicate a need for further diagnostic work-up, it is not recommended that patients with red flag symptoms be excluded from the diagnosis of IBS. On

Patient-Centered Care

A good health care provider–patient relationship is the cornerstone of effective care of IBS. The quality of this relationship has been shown to improve patient outcomes [51]. Elements of a good provider-patient relationship include a nonjudgmental patient-centered interview, a careful and cost-effective evaluation, inquiry into the patient's understanding of the illness, patient education, and involvement of the patient in treatment decisions [6]. Because IBS is a chronic disease, it is

Summary

IBS is a prevalent and heterogeneous disorder and patient care should be focused on reducing costs and improving patient satisfaction and HRQOL. The cultivation of a trusting and cooperative clinician-patient relationship reduces the ordering of unnecessary diagnostic tests and facilitates a collaborative effort of patient and clinician to find the treatment that provides the most relief of symptoms, and the greatest management of their illness and improvement of HRQOL.

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