American Gastroenterological Association medical position statement: Irritable bowel syndrome

doi:10.1053/gast.2002.37095b

Gastroenterology

Volume 123, Issue 6, December 2002, Pages 2105-2107

https://doi.org/10.1053/gast.2002.37095b Get rights and content

Abstract

The following guidelines, based on a comprehensive review,¹ were developed as an update to assist the physician in the clinical understanding, diagnosis, and management of patients with irritable bowel syndrome (IBS). They may also be of assistance to allied health care professionals, the pharmaceutical industry, and regulatory agencies. IBS is a functional bowel disorder characterized by symptoms of abdominal pain or discomfort and associated with disturbed defecation.² 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.

GASTROENTEROLOGY 2002;123:2105-2107

Section snippets

Pathophysiology of IBS symptoms

The symptoms of IBS have a physiological basis. Although no specific physiological mechanism is unique to, or characterizes IBS, there are at least 3 interrelated factors that affect symptoms to varying degrees in individuals with IBS: (1) altered gut reactivity (motility, secretion) in response to luminal (e.g., meals, gut distention, inflammation, bacterial factors) or provocative environmental (psychosocial stress) stimuli, resulting in symptoms of diarrhea and/or constipation; (2) a

Role of psychosocial factors in IBS

Although IBS patients show enhanced stress responsiveness, and more severe and prolonged impairment of bowel function related to various inciting factors, specific psychosocial factors are not characteristic of the disorder; they are not considered in diagnosis. However, their identification may help in planning psychological or psychopharmacological treatment, particularly for those with more moderate or severe symptoms, where psychosocial factors contribute to the clinical presentation.

Symptom-based criteria

A diagnosis is based on identifying positive symptoms (e.g., Rome criteria) consistent with the condition (Table 1) and excluding other conditions with similar clinical presentations in a cost-effective manner.

. Rome II diagnostic criteria for irritable bowel syndrome²

At least 12 weeks, which need not be consecutive, in the preceding 12 months of abdominal discomfort or pain that has 2 of 3 features:

1. Relieved with defecation; and/or

2. Onset associated with a change in frequency of stool; and/or

Treatment

The treatment strategy is based on the nature and severity of the symptoms, the characteristics and degree of functional impairment, and the presence of psychosocial difficulties affecting the course of the illness. Patients with mild symptoms usually respond to education, reassurance, and simple treatments not requiring prescription medication. A smaller group of patients with moderate symptoms have more disability and require pharmacological treatments directed at altered gut physiology or

Conclusions

IBS is a true medical disorder with significant impact on those afflicted with regard to symptom severity, disability, and impaired quality of life, and there is a burden to society in terms of direct health care costs and indirect effects including work absenteeism, which exceeds that of most GI disorders. Studies are needed to understand the mechanisms underlying these symptoms and to develop effective treatments. Currently, evidence exists for a diagnostic and treatment approach based on

References (3)

DA Drossman et al.
AGA technical review on irritable bowel syndrome
Gastroenterology
(2002)

There are more references available in the full text version of this article.

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^☆: This document presents the official recommendations of the American Gastroenterological Association (AGA) on Irritable Bowel Syndrome. It was approved by the Clinical Practice committee on August 5, 2002 and by the AGA Governing Board on September 13, 2002.

^☆☆: Address requests for reprints to: Chair, Clinical Practice Committee, AGA National Office, c/o Membership Department, 7910 Woodmont Avenue, 7th Floor, Bethesda, Maryland 20814. Fax: (301) 654-5920.

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American Gastroenterological AssociationAmerican Gastroenterological Association medical position statement: Irritable bowel syndrome☆,☆☆