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Demystifying Irritable Bowel Syndrome (p 555)

August 14, 2002

A seminar in this week's issue of THE LANCET examines the history, epidemiology, and different treatment options for one of the most misunderstood medical complaints-irritable bowel syndrome (IBS).

Nicholas Talley from the University of Sydney, Australia, and Robin Spiller from Queens Medical Centre, Nottingham, UK, describe how IBS affects 10% of adults, and is more common among women than men. They write: 'Although only a few people see their family doctor, the disease causes reduced quality of life and represents a multi-billion pound health-care problem. The disorder clusters in families, which may be because of intra-familial learning and a genetic predisposition.'

Intestinal sensitivity (visceral hypersensitivity) is a key feature in most patients with IBS. The authors outline environmental factors that are strongly implicated in some patients including gastrointestinal infection and inflammation and chronic stress. They discuss how treatment remains unsatisfactory, relying on an excellent doctor-patient relationship, with drugs for symptom exacerbations. Cognitive behavioural treatment, psychotherapy, and hypnosis could provide long-lasting benefit in some patients. Tricyclic antidepressants in low doses seem to be the most effective class of drugs for the disorder on the basis of limited data.

Robin Spiller comments: "Irritable bowel syndrome is a major cause of morbidity and deserves serious attention. Although stress can stimulate the colon in this disorder and in health, this factor cannot be the only cause of symptoms. Evidence is growing that irritable bowel syndrome can no longer be purely regarded as a functional disorder-which is a loose term frequently used to describe anything that we cannot adequately explain, or probable psychiatric disease. We prefer to judge the disorder to be a discrete collection of organic bowel diseases, with characteristic morphological, psychological, and physiological changes now only being fully appreciated. We believe that such a view will benefit research in the area, and eventually our patients."

Lancet