title: Irritable bowel syndrome: pathogenesis, diagnosis, treatment, and evidence-based medicine.
abstract: Irritable bowel syndrome (IBS) is a chronic and debilitating functional gastrointestinal disorder that affects 9%-23% of the population across the world. The percentage of patients seeking health care related to IBS approaches 12% in primary care practices and is by far the largest subgroup seen in gastroenterology clinics. It has been well documented that these patients exhibit a poorer quality of life and utilize the health care system to a greater degree than patients without this diagnosis. The pathophysiology of IBS is not clear. Many theories have been put forward, but the exact cause of IBS is still uncertain. According to the updated ROME III criteria, IBS is a clinical diagnosis and presents as one of the three predominant subtypes: (1) IBS with constipation (IBS-C); (2) IBS with diarrhea (IBS-D); and (3) mixed IBS (IBS-M); former ROME definitions refer to IBS-M as alternating IBS (IBS-A). Across the IBS subtypes, the presentation of symptoms may vary among patients and change over time. Patients report the most distressing symptoms to be abdominal pain, straining, myalgias, urgency, bloating and feelings of serious illness. The complexity and diversity of IBS presentation makes treatment difficult. Although there are reviews and guidelines for treating IBS, they focus on the efficacy of medications for IBS symptoms using high-priority endpoints, leaving those of lower priority largely unreported. Therefore, the aim of this review is to provide a comprehensive evidence-based review of the diagnosis, pathogenesis and treatment to guide clinicians diagnosing and treating their patients.
authors.affiliation: Lekha Saha, Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
authors.forename: Lekha
authors.initials: L
authors.lastname: Saha
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D008019:Life Style; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D040242:Risk Reduction Behavior; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D005765:Gastrointestinal Agents
keywords: Diagnosis; Evidence-based medicine; Irritable bowel syndrome; Pathogenesis; Treatment