Abstract

Irritable bowel syndrome (IBS) is the most common disorder diagnosed by gastroenterologists and one of the more common ones encountered in general practice. The overall prevalence rate is similar (approximately 10%) in most industrialized counties; the illness has a large economic impact of health care use and indirect costs, chiefly through absenteeism. IBS is a puzzing condition with multple models of pathophysiology including altered motility, visceral hypersensitivity, abnormal brain-gut interaction, autonomic dysfunction, and immune activation. The new guidelines for diagnosing IBS in clinical practice recommend the use of the Rome II criteria. Stress often worsens the symptoms of IBS. Stress induced exaggeration of the neuroendocrine response and visceral perceptual alterations during and after stress may explain some of the stress related gastrointestinal symptoms in IBS. Understanding the brain-gut axis is key to the eventual development of effective therapies for IBS. Treatment of patients is based on positive diagnosis of the symptom complex, limited exclusion of underlying organic disease, and institution of a therapeutic trial. If patient symptoms are intractable, further investigations are needed to exclude specific motility or other disorders. Symptomatic treatment includes supplementing fiber to achieve a total intake of up to 30 g in those with constipation, those taking loperamide of other opioids for diarrhea, and those taking low-dose antidepressants of infrequently using antispasmodics for pain. Behavioral psychotherapy and hypnotherapy are also being evaluated. Novel approaches include alosetron; a 5-HT3 antagonist, tegaserod, a partial 5-HT4 agonist, -opioid agonists, and neurokinin antagonists to address the remaining challenging symptoms of pain, constipation, and bloating.

• Keywords: Irritable bowel syndrome, Stress