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The Irritable Bowel Syndrome: Review and a Graduated Multicomponent Treatment Approach
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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“Clinical guidelines recommend that IBS patients should be referred to psychological treatments if they show anxiety, activity disruption or poor coping strategies [7,57].”
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“In addition, anxiety and psychosocial problems are common in IBS and have a large impact upon general well-being (Drossman & Thompson 1992).”
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“In general, it is assumed that IBS patients with mild symptoms can be perfectly managed in primary care while those with severe forms will benefit from specialized attention (5).”
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“…of studying persons with IBS is to examine the effects of experiencing a noninflammatory (Bayless and Harris 1990; Talley and others 1990, 1991; Drossman and Thompson 1992; Longstreth and Wolde-Tsadlik 1993; American Gastroenterological Association Patient Care Committee 1997; Borum 1998),…”
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“The role of a multidimensional therapeutic approach in the management of IBS is well recognized.[19] An effective physician–patient relationship, patient education, reassurance, and judicious dietary modification remain central to treatment.”
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“Drossman and Thompson previously considered that IBS distribution according to severity was 70 % mild, 25 % moderate, and 5 % severe [8], but recent evidence and clinical experience suggest that the prevalence of moderate and severe cases has been underestimated [9].”
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Functional Somatic Symptoms, Deception Syndromes, and Somatoform Disorders
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“Moderate and severe IBS needs pharmacotherapy and behavioral interventions, such as cognitive behavior therapy and mindfulness-based therapy.(32,33) A multidisciplinary approach to treating IBS is increasingly becoming the norm.”
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“Therefore, in view of improving the outcome, it seems worthwhile to try to influence psychological factors positively (Drossman & Thompson, 1992).”
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“A graduated multicomponent, nonjudgemental approach is proposed with an open mind to the complaints, fears, worries and medical behaviour of the patient, factors that may determine the success of the therapeutic relationship (19).”
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“IBS is a gastrointestinal disorder characterized by at least 3 months of continuous or recurrent symptoms of abdominal pain or discomfort associated with changes in bowel habits or stool characteristics (Drossman & Thompson, 1992).”
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“Whereas education, reassurance and recommendations on lifestyle changes (aimed largely at reducing symptom-related anxiety and increasing self efficacy) may be sufficient for symptom relief in patients with mild symptoms [18-20], a multidisciplinary approach combining pharmacotherapy and”
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“gut dysmotility (2), or psychological distress (3).”
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Metadata
- Authors
- Drossman, D. A., & Thompson, W. G.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- 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
- 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 › Medicine › Pediatrics, Perinatology and Child Health › 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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