Optimizing treatment for patients with irritable bowel syndrome with constipation

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Date: July 2013
Publisher: Expert Reviews Ltd.
Document Type: Report
Length: 1,161 words
Lexile Measure: 1440L

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Author(s): Juan-Ramon Malagelada [*] 1

Irritable bowel syndrome (IBS) has finally reached the category of established illness, and gained both social recognition and acceptability. Nowadays, both patients and physicians feel comfortable with an IBS diagnosis as a solid basis for a therapeutic plan. It has been a long and eventful journey. As Stanghellini points out in his thoughtful review of the evolution of the IBS concept [1] , it began as an exclusion diagnosis. Therefore, patients with various types of abdominal pain, disturbed bowel pattern and other abdominal symptoms were considered to suffer from IBS only after exhaustive, and often repeated, work-up that indicated significant lesion or disease was not present. This approach to IBS diagnosis almost inevitably left patients and their physicians with the nagging feeling that something important may have been missed, which perhaps could be identified by further diagnostic evaluation. Today we view IBS as a biopsychosocial disorder in which a number of established pathophysiological factors act together to a variable extent to create an individualized but recognizable clinical picture. Hence, we strive to make a positive diagnosis of IBS by applying validated symptom criteria and pointedly restricting investigations to a minimum, triggered by specific alarm features. Positive diagnosis of IBS results in significant economic savings by avoiding unnecessarily extensive diagnostic tests and better acceptance by patients that a firm diagnosis has been reached.

Unfortunately, elation with diagnostic success often evolves into frustration owing to unsatisfactory treatment. In his article, Layer outlines in detail the current therapeutic arsenal comprising behavioral modification, diet, pharmacological agents and other instruments at our disposal to help relieve IBS symptoms and improve the patient's quality of life [2] . It is a somewhat depressing list (even though antidepressants are part of it!), for effectiveness is meagre....

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Gale Document Number: GALE|A337010063