This clinical review in the Lancet gives an overview of current knowledge about the management of irritable bowel syndrome, one of the commonest reasons for medical consultation. A difficulty for many doctors is that the syndrome is poorly understood, however the author of the review considers that successful management is possible with some time and effort: this can significantly improve the patient's quality of life. There are internationally agreed diagnostic criteria for irritable bowel syndrome, the Rome-III criteria, and under these, the condition affects around 5 to 10% of the population in both developing and developed countries.
The author describes the typical presentation, noting that many sufferers also have functional dyspepsia and other non-gastrointestinal somatic symptoms. Because of this, a holistic approach is valuable to avoid fragmentation of care. There are alarm symptoms that suggest the need to consider an alternative diagnosis, and in these cases further investigations will be required. Irritable bowel disease tends to be a long-term condition, with many patients being high users of healthcare services; it does not, however, lead to more serious disease.
Management involves primarily reassurance, explanation, and lifestyle advice; dietary modification may be helpful in some cases - the most common culprits are wheat and dairy products. Psychological therapy may be appropriate for patients reporting stress as an important factor and hypnosis has been beneficial in trials. Drug treatment is often sought, by both patient and doctor, however there are few drugs with proven benefits. Antispasmodics may be useful when pain predominates, loperamide reduces bowel frequency (but not pain) when diarrhoea is predominant, and tricyclic antidepressives may help some patients. There is, however, an unmet need for more effective medications in this condition.
Lancet 2007; 369: 1586-8 (link to full text, available to subscribers only)