Irritable bowel syndrome

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Irritable bowel syndrome (IBS), also called spastic colon, is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating and alteration of bowel habits in the absence of any organic cause. In some cases, the symptoms are relieved by bowel movements.[1] Diarrhea or constipation may predominate, or they may alternate (classified as IBS-D, IBS-C or IBS-A, respectively). IBS may begin after an infection (post-infectious, IBS-PI) or a stressful life event. Other functional or pain disorders and certain psychological conditions are more common in those with IBS.

Although there is no cure for IBS, there are treatments which attempt to relieve symptoms, including dietary adjustments, medication and psychological interventions. Patient education and a good doctor-patient relationship are also important.[1]

Several conditions may present as IBS including celiac disease, mild infections, parasitic infections like giardiasis[2], several inflammatory bowel diseases, functional chronic constipation and chronic functional abdominal pain. In IBS, routine clinical tests yield no abnormalities, though the bowels may be more sensitive to certain stimuli, such as balloon insufflation testing. The exact cause of IBS is unknown. The most common theory is that IBS is a disorder of the interaction between the brain and the gastrointestinal tract, although there may also be abnormalities in the gut flora or the immune system.[3] [4]

IBS does not lead to more serious conditions in most patients.[5][6][7][8][9] But it is a source of chronic pain, fatigue and other symptoms, and it increases a patient’s medical costs,[10][11] and contributes to work absenteeism.[12][13] Researchers have reported that the high prevalence of IBS,[14][15][16] in conjunction with increased costs produces a disease with a high societal cost.[17] It is also regarded as a chronic illness and can dramatically affect the quality of a sufferer’s life.

IBS can be classified as either diarrhea-predominant (IBS-D), constipation-predominant (IBS-C) or IBS with alternating stool pattern (IBS-A or pain-predominant[18]). In some individuals, IBS may have an acute onset and develop after an infectious illness characterized by two or more of the following: fever, vomiting, diarrhea, or positive stool culture. This post-infective syndrome has consequently been termed “post-infectious IBS” (IBS-PI).

The primary symptoms of IBS are abdominal pain or discomfort in association with frequent diarrhea and/or constipation, a change in bowel habits.[19] There may also be urgency for bowel movements, a feeling of incomplete evacuation (tenesmus), bloating or abdominal distention.[20] People with IBS more commonly than others have gastroesophageal reflux, symptoms relating to the genitourinary system, psychological symptoms, fibromyalgia, headache and backache.[20]

There is no specific laboratory or imaging test which can be performed to diagnose irritable bowel syndrome.[21] Diagnosis of IBS involves excluding conditions which produce IBS-like symptoms, and then following a procedure to categorize the patient’s symptoms.

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