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An integrated approach to the management of IBS

Nature Clinical Practice Gastroenterology & Hepatology volume 4, pages 354–355 (2007)Cite this article

IBS remains a tantalizing problem for clinicians. It is the most common of the functional gastrointestinal disorders, which together account for over half of the outpatient attendance at gastroenterological clinics. The cause of IBS remains a mystery and treatment continues to pose a real challenge, with dietary, pharmaceutical and psychological therapies jostling for pole therapeutic position. The Rome Committee on functional gastrointestinal disorders has labored to formulate a precise definition of IBS to be used for diagnosis,1 although even the long outdated Manning criteria were rarely employed to make the diagnosis of IBS in primary-care practice.2 Clinicians, however, should recognize the importance of the classification of IBS into subtypes according to predominant bowel pattern: diarrhea-predominant IBS; constipation-predominant IBS and mixed bowel pattern IBS. In this uncertain diagnostic and therapeutic climate, how should clinicians approach the management of their IBS patients?

IBS is a ubiquitous condition with a community prevalence of 10–20% in most Western countries, and lower rates of prevalence in Southeast Asia and Oceania.3 Many patients that meet the diagnostic criteria for IBS, however, do not seek medical attention, and those that do are more likely to have significant psychiatric or psychological problems. About a quarter of patients who develop IBS seem to do so after an episode of infective gastroenteritis, and their psychiatric state at the time of infection determines the chronicity of their symptoms. The long-term course of IBS is poorly documented, but the condition is not thought to lead to serious organic disease apart from the possible development of diverticulitis.

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  1. Department of General Practice and Primary Care, King's College London, 5 Lambeth Walk, London SE11 6SP, UK roger.jones@kcl.ac.uk

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  1. R Jones is Wolfson Professor, and Head of General Practice and Primary Care, at King's College London, London, UK.,

    Roger Jones

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Jones, R. An integrated approach to the management of IBS. Nat Rev Gastroenterol Hepatol 4, 354–355 (2007). https://doi.org/10.1038/ncpgasthep0845

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