The Irritable Bowel Syndrome: Review and a Graduated Multicomponent Treatment Approach

Drossman, Douglas A.; Thompson, W. Grant

doi:10.7326/0003-4819-116-12-1009

Cited by 309Gastrointestinal motility and disordersInfant Health and DevelopmentPsychosomatic Disorders and Their Treatments

The Irritable Bowel Syndrome: Review and a Graduated Multicomponent Treatment Approach

Drossman, Douglas A., Thompson, W. Grant·1992·Annals of Internal Medicine

DOI 10.7326/0003-4819-116-12-1009

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Abstract

The irritable bowel syndrome is a common chronic disorder having a broad clinical spectrum of severity. Although only a small proportion of those afflicted seek medical help for their symptoms, a subset have severe and intractable symptoms. A positive diagnosis should be established from the history and physical examination; endoscopic and radiologic investigations should be minimized. We suggest that the physician also assess the severity of the illness based on its symptomatic and functional features and the patient's behavioral response. Classifying the disorder in this manner permits a graduated treatment approach that emphasizes education, reassurance, and dietary adjustment for mild symptoms. Moderate symptom severity requires, in addition, identification and modification of factors exacerbating symptoms, psychotherapeutic and behavioral techniques and, if a certain symptom type predominates, pharmacologic agents directed toward the presumed gastrointestinal motor dysfunction. For severe symptoms, physician-based behavior modification and psychopharmacologic agents are helpful. When the disorder is intractable, referral may be needed, for example, to a pain treatment center. In all cases, the skillful physician must ensure continued psychosocial support to enhance coping and continued focus on the palliative aspects of care rather than on cure.

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The functional gastrointestinal disorders and the Rome III process
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The combination of medical treatment plus multicomponent behavioral therapy is superior to medical treatment alone in the therapy of irritable bowel syndrome
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Authors: Drossman, D. A., & Thompson, W. G.
Affiliations: University of North Carolina at Chapel Hill (US)
ORCID: Drossman, Douglas A.
Thompson, W. Grant
Venue: Annals of Internal Medicine
Publisher: American College of Physicians
Published: 1992-06-15
Volume: 116
Issue: 12_Part_1
Pages: 1009-1016
ISSN: 0003-4819 (ISSN-L)
1539-3704
DOI: 10.7326/0003-4819-116-12-1009
OpenAlex: W2072613337
Cited by: 309
References: 105
Citations by year: 2025: 2 · 2024: 4 · 2023: 7 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 6 · 2018: 3 · 2017: 7 · 2016: 5 · 2015: 5 · 2014: 4 · 2013: 8 · 2012: 9
FWCI: 4.31
Type: journal article
Language: en
Open access: closed
Locations: Annals of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
Health Sciences › Health Professions › Pharmacy › Infant Health and Development
Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Keywords: irritable bowel syndrome, symptom severity classification, dietary change, psychotherapy, behavior change, psychopharmacology, gastrointestinal motility, psychosocial support, palliative care
MeSH terms: Colonic Diseases, Functional, Combined Modality Therapy, Constipation, Diarrhea, Humans, Psychotherapy, Pain Management

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The Irritable Bowel Syndrome: Review and a Graduated Multicomponent Treatment Approach

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