Functional bowel disorders and functional abdominal pain.
TL;DR: 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.
Abstract: 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.
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TL;DR: Employing a consensus approach, the working team critically considered the available evidence and multinational expert criticism, revised the Rome II diagnostic criteria for the functional bowel disorders, and updated diagnosis and treatment recommendations.
4,302 citations
TL;DR: The prevalence of IBS varies among countries, as well as criteria used to define its presence, and women are at slightly higher risk for IBS than men.
1,620 citations
TL;DR: This introductory article sets the stage for the remaining 17 articles that follow and offers an historical overview of the FGIDs field, differentiates FGIDs from motility and structural disorders, discusses the changes from Rome III, reviews the Rome committee process, and provides a biopsychosocial pathophysiological conceptualization of FGIDs.
1,406 citations
TL;DR: B infantis 35624 alleviates symptoms in IBS; this symptomatic response was associated with normalization of the ratio of an anti-inflammatory to a proinflammatory cytokine, suggesting an immune-modulating role for this organism, in this disorder.
1,358 citations
TL;DR: Psychosocial factors, although not part of IBS per se, have an important role in modulating the illness experience and its clinical outcome.
1,348 citations
Cites background from "Functional bowel disorders and func..."
..., major depression, anxiety disorders usually using full therapeutic doses) associated with IBS,199–201 (2) alteration of GI physiology (e....
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...Here, the physician must: (1) listen actively to determine the patient’s understanding of the illness and his or her concerns, (2) provide a thorough explanation of the disorder, (3) identify and respond to the patient’s concerns and expectations, (4) set realistic and consistent limits, (5) involve the patient in the treatment, and (6) establish a long-term relationship with a primary care provider....
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...196 Predictors of a positive response to psychological treatment124,196 are: (1) awareness that stress exacerbates their bowel symptoms, (2) at least mild anxiety or depression, (3) the predominant bowel symptom is abdominal pain or diarrhea and not constipation, (4) the abdominal pain waxes and wanes (rather than being constant) in response to eating, defecation, or stress, and (5) the symptoms are of relatively short duration....
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...4 Based on a critical review and analysis of the existing literature, we address: (1) the epidemiology and impact of the disorder, (2) its pathophysiological determinants, (3) the role of psychosocial factors in symptom experience and behavior, (4) the diagnostic approach, and (5) recommendations for treatment....
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...Screening studies are recommended when certain historical information is present143: (1) short symptom duration or worsening severity and trajectory of symptoms, (2) demographic features (e....
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References
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TL;DR: Symptom reporting, except for incontinence, declines with age, and low income is associated with greater symptom reporting, and the rate of work/school absenteeism and physician visits is increased for those having a functional gastrointestinal disorder.
Abstract: Our objective was to obtain national data of the estimated prevalence, sociodemographic relationships, and health impact of persons with functional gastrointestinal disorders. We surveyed a stratified probability random sample of U.S householders selected from a data base of a national market firm (National Family Opinion, Inc.). Questions were asked about bowel symptoms, sociodemographic associations, work absenteeism, and physician visits. The sampling frame was constructed to be demographically similar to the U.S. householder population based on geographic region, age of householder, population density, household income and household size. Of 8250 mailings, 5430 were returned suitable for analysis (66% response). The survey assessed the prevalence of 20 functional gastrointestinal syndromes based on fulfillment of multinational diagnostic (Rome) criteria. Additional variables studied included: demographic status, work absenteeism, health care use, employment status, family income, geographic area of residence, population density, and number of persons in household. For this sample, 69% reported having at least one of 20 functional gastrointestinal syndromes in the previous three months. The symptoms were attributed to four major anatomic regions: esophageal (42%), gastroduodenal (26%), bowel (44%), and anorectal (26%), with considerable overlap. Females reported greater frequencies of globus, functional dysphagia, irritable bowel syndrome, functional constipation, functional abdominal pain, functional biliary pain and dyschezia; males reported greater frequencies of aerophagia and functional bloating. Symptom reporting, except for incontinence, declines with age, and low income is associated with greater symptom reporting. The rate of work/school absenteeism and physician visits is increased for those having a functional gastrointestinal disorder. Furthermore, the greatest rates are associated with those having gross fecal incontinence and certain more painful functional gastrointestinal disorders such as chronic abdominal pain, biliary pain, functional dyspepsia and IBS. Preliminary information on the prevalence, socio-demographic features and health impact is provided for persons who fulfill diagnostic criteria for functional gastrointestinal disorders.
2,082 citations
TL;DR: It is concluded that a careful history can increase diagnostic confidence and reduce the amount of investigation in many patients with chronic abdominal pain.
Abstract: A questionnaire to establish the presence of 15 symptoms thought to be typical of the irritable bowel syndrome (IBS) was given to 109 unselected patients referred to gastroenterology or surgery clinics with abdominal pain or a change in bowel habit or both. Review of case records 17--26 months later established a definite diagnosis of IBS in 32 patients and of organic disease in 33. Four symptoms were significantly more common among patients with IBS--namely, distension, relief of pain with bowel movement, and looser and more frequent bowel movements with the onset of pain. Mucus and a sensation of incomplete evacuation were also common in these patients. The more of these symptoms that were present the more likely was it that the patient's pain or altered bowel habit, or both, was due to IBS. We conclude that a careful history can increase diagnostic confidence and reduce the amount of investigation in many patients with chronic abdominal pain.
1,271 citations
TL;DR: It is concluded that conventionally normal bowel function is enjoyed by less than half the population and that, in this aspect of human physiology, younger women are especially disadvantaged.
Abstract: Because the range of bowel habits and stool types in the community is unknown we questioned 838 men and 1059 women, comprising 72.2% of a random stratified sample of the East Bristol population. Most of them kept records of three consecutive defecations, including stool form on a validated six point scale ranging from hard, round lumps to mushy. Questionnaire responses agreed moderately well with recorded data. Although the most common bowel habit was once daily this was a minority practice in both sexes; a regular 24 hour cycle was apparent in only 40% of men and 33% of women. Another 7% of men and 4% of women seemed to have a regular twice or thrice daily bowel habit. Thus most people had irregular bowels. A third of women defecated less often than daily and 1% once a week or less. Stools at the constipated end of the scale were passed more often by women than men. In women of child bearing age bowel habit and the spectrum of stool types were shifted towards constipation and irregularity compared with older women and three cases of severe slow transit constipation were discovered in young women. Otherwise age had little effect on bowel habit or stool type. Normal stool types, defined as those least likely to evoke symptoms, accounted for only 56% of all stools in women and 61% in men. Most defecations occurred in the early morning and earlier in men than in women. We conclude that conventionally normal bowel function is enjoyed by less than half the population and that, in this aspect of human physiology, younger women are especially disadvantaged.
650 citations
"Functional bowel disorders and func..." refers background in this paper
...revealed liquid stools were the predominant type described by 5.3% of men and 4.3% of women....
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TL;DR: The prevention of cot deaths is dependent firstly on the recognition by parents of the significance of certain non-specific symptoms and on their decision to involve the primary care services, and secondly on the efficacy of medical intervention at this stage.
Abstract: of the symptoms preceding sudden and unexpected deaths at home when these are compared with their general rate of occurrence in the child population. Since the conclusions of the study are based on these findings some independent assessment of their reliability is desirable. The conclusion of this paper is that the prevention of cot deaths is dependent firstly on the recognition by parents ofthe significance of certain non-specific symptoms and on their decision to involve the primary care services, and secondly on the efficacy of medical intervention at this stage. Consideration does not appear to have been given to the difficulties that will face parents who are asked to undertake such close surveillance of their children or the anxieties that this is likely to cause; nor has any estimate been made of the presumably very large proportion of cases in which this will prove \"unnecessary.\" Conversely, the implications of the increased work load for the primary care services has yet to be determined. Concerning intervention, the investigators recognise that the value of either hospital referral or drug therapy is at present doubtful, leaving close supervision and observation of the child at home as the only alternative. It has yet to be established what this can achieve. By the nature of the condition, sudden and unexpected death in children is an exceedingly difficult area of study, especially in its community aspects, and many of the criticisms raised here are clearly recognised by the study group and are the subject of further investigation. But because of these unresolved difficulties it would seem premature to urge the \"need to improve the recognition by both doctors and parents of non-specific symptoms as markers of severe illness in young children and their understanding of the necessity for rapid and appropriate action.\
625 citations
571 citations
"Functional bowel disorders and func..." refers background in this paper
...Surveys of Western populations have revealed IBS in 15–20% of adolescents and adults, with a higher prevalence in women; the prevalence is variable in other populations....
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