title: Practical management of irritable bowel syndrome: a clinical review.
abstract: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder, frequently managed by general practitioners and gastroenterologists. It is a complex condition, characterized by abdominal pain or discomfort associated with altered bowel habits, and it affects 11% of the population worldwide. It has a profound effect on quality of life for many patients and poses a substantial cost to society. Due to the complexity and diversity of IBS, diagnosis and treatment can be challenging. Common drawbacks in diagnosing and treating this disorder include unnecessary tests, failure to establish trust in the physician-patient relationship and difficulties in explaining the diagnosis. Research in recent years has however refined the diagnostic criteria and improved our ability to safely identify IBS with a limited number of investigations. A concise diagnostic evaluation, guided adequate information, prompt initiation of symptom-guided treatment and consistency in the patient-doctor relationship can help relieve the suffering experienced by patients with IBS. For patients with mild symptoms, reassurance, education, lifestyle changes and dietary advice are often sufficient. Patients with moderate to severe symptoms might need symptom modifying drugs, and psychological treatments such as CBT or hypnotherapy may be offered at this stage. For patients with severe and incapacitating symptoms, a multidisciplinary approach is recommended and psychotropic drugs are often used. This clinical review offers suggestions for a diagnostic approach as well as a treatment strategy, based on the current evidence on pathophysiology, diagnosis and treatment in IBS.
authors.affiliation: Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden - ellinor.almquist@gmail.com.
authors.forename: Ellinor
authors.initials: E
authors.lastname: Almquist
authors.forename: Hans
authors.initials: H
authors.lastname: Törnblom
authors.forename: Magnus
authors.initials: M
authors.lastname: Simrén
mesh_terms: D000930:Antidiarrheals / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D015994:Incidence; D033183:Interdisciplinary Communication; D043183:Irritable Bowel Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D008019:Life Style; D010348:Patient Care Team; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D019936:Probiotics / Q000627:therapeutic use*; D011613:Psychotherapy / Q000379:methods; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000930:Antidiarrheals; D011619:Psychotropic Drugs