Harvard Women's Health Watch

In the journals: Experts revise guidelines for irritable bowel syndrome

In the journals

Experts revise guidelines for irritable bowel syndrome

Irritable bowel syndrome (IBS) is a chronic disorder characterized by recurrent bouts of constipation, diarrhea, or both, as well as abdominal pain, bloating, and gas. Twice as common in women as in men, it's the most common diagnosis made by gastroenterologists and second only to the common cold as a cause for absence from work. IBS is a functional disorder, which means that it's not attributable, as far as we know, to any underlying disease process or structural abnormality. It's thought to involve various, often interacting, factors — infection, faulty brain-gut communication, heightened pain sensitivity, hormones, allergies, and emotional stress.

The good news is that IBS doesn't increase the risk for more serious conditions, such as ulcerative colitis or colon cancer (see chart). On the other hand, a disorder resulting in (at best) annoying and (at worst) debilitating and worrisome symptoms with no known cause can be difficult to diagnose and treat, not to mention live with. Managing IBS typically involves some trial and error, which can be challenging for patients and clinicians alike. Various tests or procedures may be ordered to rule out other conditions. Many diverse therapies, not all of them proven, are used in treating the symptoms, including antibiotics, antispasmodics, antidepressants, dietary changes, relaxation techniques, and psychotherapy, as well as drugs to relieve constipation and diarrhea.

Guidelines from the American College of Gastroenterology (ACG) may aid in the search for effective IBS management strategies. Written by an expert panel of ACG gastroenterologists and published as a supplement to the January 2009 issue of The American Journal of Gastroenterology, the recommendations update the ACG's first statement, which was published in 2002. The new guidelines incorporate the latest evidence on newer therapies, such as probiotics and certain IBS-specific drugs, as well as older treatments.

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