# Functional GI Disorders IBS at a Glance Diagnosis and Treatment



## Jeffrey Roberts (Apr 15, 1987)

Originally from: http://www.gastro.org/adhf/gi_ibs2.html CME Monograph II: Functional GI Disorders IBS at a Glance Diagnosis and Treatment . Diagnosis The biopsychosocial model of IBS proposes that symptoms arise from the interaction of a host of biological, cultural, social, interpersonal, and psychological factors. There are no structural or biochemical markers for IBS. IBS symptoms often are non-specific and the course of illness is inconsistent. The Rome II panel defines IBS as a clinical symptom complex comprising abdominal discomfort or pain linked to relief with defecation or associated with a change in the frequency or consistency of stool. A patientï¿½s psychosocial and medical history can provide important diagnostic clues in the planning of care. Once a symptom-based diagnosis is made and the dominant symptom pattern established further evaluation should be conservative and undertaken only as appropriate. Performing extensive laboratory, radiologic, or endoscopic procedures does not establish a diagnosis of IBS; it is unnecessary and may be harmful. Physicians and patients benefit from the formation of an open, interactive, empathetic therapeutic partnership. Positive physician-patient interactions yield improved outcomes. Treatment Treatment strategies should be based on severity of symptoms: on average, 70% of patients will have mild symptoms, 25% will have moderate symptoms, and 5% will have severe, seriously disabling symptoms. Negotiate an individualized treatment plan with patients and set reasonable goals. Medications and fiber supplements can be targeted at predominant gut symptoms. Psychotropic medications influence functional GI symptoms through direct effects on pain perception and possibly motility, and by improving comorbid psychiatric conditions. At present, tricyclic antidepressants (TCAs) are considered the most useful psychotropic medications for IBS, and in low doses reduce symptoms independent of their psychiatric actions. Novel approaches include 5-HT3 receptor antagonists, 5-HT4 agonists, CCK-antagonists, alpha2 receptor antagonists, and dopamine2 antagonists. Psychotherapeutic approaches, including cognitive-behavioral therapy, interpersonal psychotherapy, hypnosis, and stress management are often effective in the treatment of IBS, either alone or in conjunction with other therapies.


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## JeanG (Oct 20, 1999)

Thanks for posting this, Jeff.







JeanG


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