https://www.ibstreatmentcenter.com/Articles/ROMEIIIFBDpaper.pdf

Functional Bowel Disorders

Global Prevalence of and Risk Factors for Irritable Bowel Syndrome: A Meta-analysis

Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV.

https://www.gastrojournal.org/article/S0016-5085(04)02155-9/pdf

Lactobacillus and bifidobacterium in irritable bowel syndrome: Symptom responses and relationship to cytokine profiles

AGA technical review on irritable bowel syndrome

The Rome diagnostic criteria for the functional bowel disorders and functional abdominal pain are used widely in research and practice. A committee consensus approach, including criticism from multinational expert reviewers, was used to revise the diagnostic criteria and update diagnosis and treatment recommendations, based on research results. The terminology was clarified and the diagnostic criteria and management recommendations were revised. A functional bowel disorder (FBD) is diagnosed by characteristic symptoms for at least 12 weeks during the preceding 12 months in the absence of a structural or biochemical explanation. The irritable bowel syndrome, functional abdominal bloating, functional constipation, and functional diarrhea are distinguished by symptom-based diagnostic criteria. Unspecified FBD lacks criteria for the other FBDs. Diagnostic testing is individualized, depending on patient age, primary symptom characteristics, and other clinical and laboratory features. Functional abdominal pain (FAP) is defined as either the FAP syndrome, which requires at least six months of pain with poor relation to gut function and loss of daily activities, or unspecified FAP, which lacks criteria for the FAP syndrome. An organic cause for the pain must be excluded, but aspects of the patient's pain behavior are of primary importance. Treatment of the FBDs relies upon confident diagnosis, explanation, and reassurance. Diet alteration, drug treatment, and psychotherapy may be beneficial, depending on the symptoms and psychological features.

https://gut.bmj.com/content/gutjnl/45/suppl_2/II43.full.pdf

Functional bowel disorders and functional abdominal pain.

BACKGROUND AND AIMS Little is known about the prevalence, symptoms, diagnosis, attitude, and referral to specialists of patients with irritable bowel syndrome (IBS) in general practice. This study aimed to determine these characteristics. METHODS 3111 patients attending 36 general practitioners (GPs) at six varied locations in and near Bristol, UK, were screened to identify those with a gastrointestinal problem. These patients (n=255) and their doctors were given questionnaires. Six months later the case notes were examined to reach criteria based diagnoses of functional bowel disorders. RESULTS Of 255 patients with a gastrointestinal complaint, 30% were judged to have IBS and 14% other functional disorders. Compared with 100 patients with an “organic” diagnoses, those with IBS were more often women and more often judged by their GP to be polysymptomatic and to have unexplained symptoms. The majority of patients with IBS (58%) were diagnosed as such by the GP; 22% had other functional diagnoses. Conversely, among 54 patients diagnosed as having IBS by the GPs, the criteria based diagnosis was indeed functional in 91%; only one patient had organic disease (proctitis). More patients with IBS than those with organic disease feared cancer. In most some fear remained after the visit to the doctor. On logistic regression analysis, predictors of referral to a specialist (29% referred) were denial of a role for stress, multiple tests, and frequent bowel movements. CONCLUSIONS Half the patients with gut complaints seen by GPs have functional disorders. These are usually recognised, and few patients are referred. In IBS, cancer fears often remain, suggesting unconfident diagnosis or inadequate explanation.

https://gut.bmj.com/content/gutjnl/46/1/78.full.pdf

Irritable bowel syndrome in general practice: prevalence, characteristics, and referral

The irritable bowel syndrome (IBS) is an enigmatic and variable constellation of symptoms accounting for 20 to 30 percent of patients referred to a gastroenterologist who devotes much of his time proving that they do not have a more serious disease. Were it not for the IBS, fewer physicians would be required and the diagnosis of organic gut disorders would be much easier. This chapter will emphasize the great prevalence of the IBS, the lack of any reliable pathophysiologic marker or test, the patient’s hidden agenda, which may have little to do with physical symptoms, the importance of a positive diagnosis, and Sir William Osler’s principle of “do no harm” in investigation and treatment. Because this syndrome is troubling enough, inappropriate tests or treatments can only make matters worse.

https://gut.bmj.com/content/gutjnl/25/3/305.full.pdf

W G Thompson

Papers

Functional bowel disorders and functional abdominal pain.

Irritable bowel syndrome in general practice: prevalence, characteristics, and referral

The irritable bowel.