Irritable Bowel Syndrome, An Issue of Gastroenterology Clinics Vol 34 Issue 2

IBS is a functional bowel disorder characterized by symptoms of abdominal pain or discomfort and associated with disturbed defecation. The syndrome is understood in terms of multiple physiological determinants contributing to a common set of symptoms rather than as a single disease entity. Current and future diagnostic approaches and treatments will depend on identifying the specific pathophysiological subgroups contributing to these symptoms. This issue is devoted to the diagnosis, treatment, and managment of this disorder. Cover......Page 1 Preface......Page 2 Definition and Classification of Irritable Bowel Syndrome: Current Consensus and Controversies......Page 4 Disease, disorder, syndrome, illness, functional, or organic?......Page 5 Semantics in research and practice......Page 6 Evolution of symptom criteria......Page 7 Duration/frequency criteria......Page 9 Natural history and subtype durability......Page 10 Usefulness of alarm features......Page 11 Use of symptom criteria in practice......Page 13 Summary......Page 14 References......Page 15 Irritable Bowel Syndrome: Epidemiology, Natural History, Health Care Seeking and Emerging Risk Factors......Page 19 Prevalence in western countries......Page 20 Prevalence in Asia......Page 21 Incidence......Page 22 Symptom fluctuation, overlap, and probability of organic disease......Page 23 Surgery and irritable bowel syndrome......Page 24 Health care seeking......Page 25 Psychological factors......Page 26 Postinfectious irritable bowel syndrome......Page 27 Food challenges......Page 28 Familial aggregation and genetic predisposition......Page 29 References......Page 30 Symptom-based criteria for irritable bowel syndrome......Page 35 Utility of diagnostic testing in irritable bowel syndrome......Page 38 Routine blood tests......Page 39 Antibody testing for celiac sprue......Page 40 Stool tests......Page 42 Hydrogen breath testing......Page 43 Abdominal imaging......Page 44 Colonic imaging......Page 45 Diagnosing irritable bowel syndrome in clinical practice......Page 46 References......Page 49 Disturbances of Motility and Visceral Hypersensitivity in Irritable Bowel Syndrome: Biological Markers or Epiphenomenon......Page 51 Gastrointestinal Motor Dysfunction in Irritable Bowel Syndrome; is Irritable Bowel Syndrome a Motility Disorder?......Page 52 Visceral hypersensitivity and hyperalgesia; the ubiquitous phenomena in functional gastrointestinal disorders, including .........Page 54 If dysmotility and visceral hypersensitivity are not biological markers, can another unifying hypothesis explain their .........Page 56 Pathophysiological hypotheses are not mutually exclusive......Page 58 References......Page 59 Is Irritable Bowel Syndrome a Low-Grade Inflammatory Bowel Disease?......Page 64 Irritable bowel syndrome symptoms in inflammatory bowel disease......Page 65 Degree of inflammation, gut function, and symptom generation......Page 66 Low-grade inflammation and irritable bowel syndrome......Page 67 Increased susceptibility to inflammation in irritable bowel syndrome and inflammatory bowel disorder......Page 68 Experimental models of functional gut disorders......Page 69 What drives immune activation and inflammation in functional bowel disorders?......Page 70 References......Page 71 The Role of Food Intolerance in Irritable Bowel Syndrome......Page 75 Dietary fat, fiber, and other factors influencing gut motility......Page 76 Food allergy and irritable bowel syndrome......Page 77 Carbohydrate malabsorption......Page 79 Celiac disease......Page 80 References......Page 81 The Pathogenesis of Bloating and Visible Distension in Irritable Bowel Syndrome......Page 84 Mechanisms of distorted sensation......Page 85 Mechanisms of physical abdominal expansion......Page 86 The potential role of abdominal muscular activity......Page 91 References......Page 93 Brain Responses to Visceral and Somatic Stimuli in Irritable Bowel Syndrome: a Central Nervous System Disorder?......Page 97 Brain activation patterns to visceral and somatic stimuli......Page 98 Irritable bowel syndrome......Page 99 References......Page 103 Psychiatric and Psychological Dysfunction in Irritable Bowel Syndrome and the Role of Psychological Treatments......Page 106 Psychiatric disorders......Page 107 Stressful and traumatic life events......Page 108 Somatization and extraintestinal symptoms......Page 109 Illness behavior......Page 110 Increased health care use and costs......Page 111 Impact on vulnerability to irritable bowel syndrome......Page 112 The integration of psychosocial factors in the biopsychosocial model of irritable bowel syndrome......Page 113 Active listening......Page 115 Setting appropriate expectations and goals......Page 116 Clinical impact of an effective therapeutic relationship......Page 117 Referrals for psychological treatment......Page 118 Cognitive therapy......Page 119 Gut-directed hypnosis......Page 120 Relaxation training......Page 121 Making a successful referral for psychological treatment......Page 122 References......Page 123 Genetics in irritable bowel syndrome......Page 129 Familial aggregation studies......Page 130 Genetic variation in the control of inflammation in irritable bowel syndrome......Page 131 Role of serotonin transporter in animal models......Page 132 Role of serotonin transporter polymorphism in irritable bowel syndrome......Page 134 Ethnic differences......Page 135 Interpretation of data from surrogate measurements......Page 136 G protein polymorphism......Page 137 Summary......Page 138 References......Page 139 Efficacy of Current Drug Therapies in Irritable Bowel Syndrome: What Works and Does Not Work......Page 142 Antispasmodic agents......Page 143 Bulking agents......Page 146 Antidiarrheal agents......Page 148 5HT4 receptor agonists (ie, tegaserod)......Page 149 Osmotic laxatives......Page 151 Antidepressants......Page 152 5HT3 receptor antagonists......Page 153 References......Page 155 Mechanisms of disease......Page 159 Evidence that lactose free diets can cure irritable bowel syndrome?......Page 160 Probiotics......Page 161 Evidence that exclusion diets or cromoglycate can prevent immune response to food......Page 162 Evidence of peripheral inflammation in irritable bowel syndrome......Page 163 Probiotics as anti-inflammatory treatments......Page 164 Therapeutic approaches to central sensitization......Page 165 Relaxation therapy and cognitive-behavioral therapy......Page 166 Psychotherapy......Page 167 Short-term effects......Page 168 Hypnotherapy......Page 169 References......Page 170 IBS is a functional bowel disorder characterized by symptoms of abdominal pain or discomfort and associated with disturbed defecation. The syndrome is understood in terms of multiple physiological determinants contributing to a common set of symptoms. This title deals with the diagnosis, treatment, and management of this disorder.