Irritable bowel syndrome history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]
Overview
The diagnosis of irritable bowel syndrome (IBS) relies on recognition of gastrointestinal symptoms that wax and wane and are exacerbated by psychosocial stress. Diagnosis of IBS is based on clinical symptoms and elimination of other organic gastrointestinal diseases. This is due to lack of definitive radiological or laboratory diagnostic tests in IBS. The hallmark of IBS is abdominal pain. A positive history of stress, anxiety, depression, panic disorders, gastrointestinal disorders such as inflammatory bowel disease (IBD) and acute GI infection predispose individuals to IBS. The most common symptoms of IBS include presence of abdominal pain and alteration of bowel habits. Less common symptoms of IBS include flatulence and upper GI symptoms such as heartburn, nausea, dyspepsia and vomiting.
Symptoms
- Clinical features of IBS include the presence of abdominal pain with alteration of bowel habits, without any systemic symptoms such as blood in stool, weight loss and fever. The onset of symptoms usually occurs during periods of stress and anxiety.[1][2][3][4][5]
- Straining during defecation, urgency, sensation of incomplete evacuation, mucus passage, bloating are also associated symptoms, not included under the diagnostic criteria.
- The presence of other comorbidities including other functional disorders such as stress disorders, anxiety, depression, sleep disturbance, chronic fatigue, fibromyalgia favor IBS.[6][7][8][9]
- Alarm features or red flag symptoms/signs point towards other diagnoses. These features include family history of IBD or colon cancer, fever, recent antibiotic use, weight loss, blood in the stools and night time awakening due to symptoms. However, some IBS patients may have blood in the stool due to coexisting hemorrhoids.[10][11]
Common symptoms
Common symptoms of IBS include abdominal pain, altered bowel habits, bloating and flatulence.
| COMMON SYMPTOMS OF IBS | ||
|---|---|---|
| Abdominal pain (major prerequisite for IBS) | Site: Variable location
Onset: Sudden/Insidious Character: Episodic and crampy with a background of constant pain Relieving factors: Relief on defecation Aggravating factors: Eating, emotional stress, premenstrual and menstrual phases Associated factors: Change in frequency or form of stool Timing: Pain is usually present during waking hours. Nocturnal symptoms are usually present only in severe IBS Severity: Variable (varies from mild to severe enough to impair quality of life) | |
| Altered bowel habits | Altered bowel habits usually present as diarrhea alternating with constipation. One of these tends to be the predominant symptom in the patient. [12][13][13] | |
Constipation predominant IBS: <3 bowel movements per week
|
Diarrhea predominant IBS: >3 bowel movements per day [14][16]Patients have:
| |
| Gas and flatulence |
| |
Less common symptoms
| LESS COMMON SYMPTOMS OF IBS | |
|---|---|
| Upper gastrointestinal symptoms | One fourth of all IBS patients complain of heartburn, nausea, dyspepsia and vomiting. |
| Lower gastrointestinal symptoms |
|
History
Psychosocial history
- Psychological history such as stress, anxiety[18][12][19][20][21][22]
- Past history of abuse
- Psychiatric history such as depression, panic disorders[18][20][21][23][24]
- History of physical or sexual abuse or adverse early life events
- History of pain disorders such as fibromyalgia[23][25]
Past Medical history
- History of gastrointestinal disorders such as IBD[26][27]
- History of acute GI infections such as traveler's diarrhea i.e post infectious state [28][29][30][31][32][33][34][35][36][37]
- Salmonella infection
- Giardiasis
- History of antibiotic use[38][39][40][41]
- History of celiac disease and microscopic colitis[26]
- History of migraine headaches[23][42][43][44]
Menstrual history
Family history
History of allergies
Medication history
- History of medication use should be obtained as many drugs such as opioids cause constipation as a side effect.
References
- ↑ Schmulson MW, Chang L (1999). "Diagnostic approach to the patient with irritable bowel syndrome". Am. J. Med. 107 (5A): 20S–26S. PMID 10588169.
- ↑ Jasper F, Egloff B, Roalfe A, Witthöft M (2015). "Latent structure of irritable bowel syndrome symptom severity". World J Gastroenterol. 21 (1): 292–300. doi:10.3748/wjg.v21.i1.292. PMC 4284348. PMID 25574104.
- ↑ van Tilburg MA, Palsson OS, Whitehead WE (2013). "Which psychological factors exacerbate irritable bowel syndrome? Development of a comprehensive model". J Psychosom Res. 74 (6): 486–92. doi:10.1016/j.jpsychores.2013.03.004. PMC 3673027. PMID 23731745.
- ↑ Talley NJ (2006). "A unifying hypothesis for the functional gastrointestinal disorders: really multiple diseases or one irritable gut?". Reviews in gastroenterological disorders. 6 (2): 72–8. PMID 16699476.
- ↑ Occhipinti K, Smith JW (2012). "Irritable bowel syndrome: a review and update". Clin Colon Rectal Surg. 25 (1): 46–52. doi:10.1055/s-0032-1301759. PMC 3348735. PMID 23449495.
- ↑ Ford AC, Marwaha A, Lim A, Moayyedi P (2010). "Systematic review and meta-analysis of the prevalence of irritable bowel syndrome in individuals with dyspepsia". Clin. Gastroenterol. Hepatol. 8 (5): 401–9. doi:10.1016/j.cgh.2009.07.020. PMID 19631762.
- ↑ Sayuk GS, Elwing JE, Lustman PJ, Clouse RE (2007). "High somatic symptom burdens and functional gastrointestinal disorders". Clin. Gastroenterol. Hepatol. 5 (5): 556–62. doi:10.1016/j.cgh.2006.11.024. PMID 17258513.
- ↑ Whitehead WE, Palsson OS, Levy RR, Feld AD, Turner M, Von Korff M (2007). "Comorbidity in irritable bowel syndrome". Am. J. Gastroenterol. 102 (12): 2767–76. doi:10.1111/j.1572-0241.2007.01540.x. PMID 17900326.
- ↑ Brown WH, Chey WD, Elta GH (2003). "Number of responses on a review of systems questionnaire predicts the diagnosis of functional gastrointestinal disorders". J. Clin. Gastroenterol. 36 (3): 222–7. PMID 12590233.
- ↑ Fass R, Longstreth GF, Pimentel M; et al. (2001). "Evidence- and consensus-based practice guidelines for the diagnosis of irritable bowel syndrome". Arch. Intern. Med. 161 (17): 2081–8. PMID 11570936.
- ↑ Paul SP, Barnard P, Bigwood C, Candy DC (2013). "Challenges in management of irritable bowel syndrome in children". Indian Pediatr. 50 (12): 1137–43. PMID 24413506.
- ↑ 12.0 12.1 Drossman DA, Camilleri M, Mayer EA, Whitehead WE (2002). "AGA technical review on irritable bowel syndrome". Gastroenterology. 123 (6): 2108–31. doi:10.1053/gast.2002.37095. PMID 12454866.
- ↑ 13.0 13.1 Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC (2006). "Functional bowel disorders". Gastroenterology. 130 (5): 1480–91. doi:10.1053/j.gastro.2005.11.061. PMID 16678561.
- ↑ 14.0 14.1 Camilleri M, McKinzie S, Busciglio I, Low PA, Sweetser S, Burton D, Baxter K, Ryks M, Zinsmeister AR (2008). "Prospective study of motor, sensory, psychologic, and autonomic functions in patients with irritable bowel syndrome". Clin. Gastroenterol. Hepatol. 6 (7): 772–81. doi:10.1016/j.cgh.2008.02.060. PMC 2495078. PMID 18456567.
- ↑ Fromm M, Littman P, Raney RB, Nelson L, Handler S, Diamond G, Stanley C (1986). "Late effects after treatment of twenty children with soft tissue sarcomas of the head and neck. Experience at a single institution with a review of the literature". Cancer. 57 (10): 2070–6. PMID 3955515.
- ↑ 16.0 16.1 Törnblom H, Van Oudenhove L, Sadik R, Abrahamsson H, Tack J, Simrén M (2012). "Colonic transit time and IBS symptoms: what's the link?". Am. J. Gastroenterol. 107 (5): 754–60. doi:10.1038/ajg.2012.5. PMID 22334251.
- ↑ Prott G, Shim L, Hansen R, Kellow J, Malcolm A (2010). "Relationships between pelvic floor symptoms and function in irritable bowel syndrome". Neurogastroenterol. Motil. 22 (7): 764–9. doi:10.1111/j.1365-2982.2010.01503.x. PMID 20456760.
- ↑ 18.0 18.1 Mayer EA, Craske M, Naliboff BD (2001). "Depression, anxiety, and the gastrointestinal system". J Clin Psychiatry. 62 Suppl 8: 28–36, discussion 37. PMID 12108819.
- ↑ Devanarayana NM, Mettananda S, Liyanarachchi C, Nanayakkara N, Mendis N, Perera N, Rajindrajith S (2011). "Abdominal pain-predominant functional gastrointestinal diseases in children and adolescents: prevalence, symptomatology, and association with emotional stress". J. Pediatr. Gastroenterol. Nutr. 53 (6): 659–65. doi:10.1097/MPG.0b013e3182296033. PMID 21697745.
- ↑ 20.0 20.1 Qin HY, Cheng CW, Tang XD, Bian ZX (2014). "Impact of psychological stress on irritable bowel syndrome". World J. Gastroenterol. 20 (39): 14126–31. doi:10.3748/wjg.v20.i39.14126. PMC 4202343. PMID 25339801.
- ↑ 21.0 21.1 Bharucha AE, Chakraborty S, Sletten CD (2016). "Common Functional Gastroenterological Disorders Associated With Abdominal Pain". Mayo Clin. Proc. 91 (8): 1118–32. doi:10.1016/j.mayocp.2016.06.003. PMC 4985027. PMID 27492916.
- ↑ Ibrahim NK (2016). "A systematic review of the prevalence and risk factors of irritable bowel syndrome among medical students". Turk J Gastroenterol. 27 (1): 10–6. doi:10.5152/tjg.2015.150333. PMID 26674980.
- ↑ 23.0 23.1 23.2 Cole JA, Rothman KJ, Cabral HJ, Zhang Y, Farraye FA (2006). "Migraine, fibromyalgia, and depression among people with IBS: a prevalence study". BMC Gastroenterol. 6: 26. doi:10.1186/1471-230X-6-26. PMC 1592499. PMID 17007634.
- ↑ Hausteiner-Wiehle C, Henningsen P (2014). "Irritable bowel syndrome: relations with functional, mental, and somatoform disorders". World J. Gastroenterol. 20 (20): 6024–30. doi:10.3748/wjg.v20.i20.6024. PMC 4033442. PMID 24876725.
- ↑ Vehof J, Zavos HM, Lachance G, Hammond CJ, Williams FM (2014). "Shared genetic factors underlie chronic pain syndromes". Pain. 155 (8): 1562–8. doi:10.1016/j.pain.2014.05.002. PMID 24879916.
- ↑ 26.0 26.1 Major G, Spiller R (2014). "Irritable bowel syndrome, inflammatory bowel disease and the microbiome". Curr Opin Endocrinol Diabetes Obes. 21 (1): 15–21. doi:10.1097/MED.0000000000000032. PMC 3871405. PMID 24296462.
- ↑ Ceuleers H, Van Spaendonk H, Hanning N, Heirbaut J, Lambeir AM, Joossens J, Augustyns K, De Man JG, De Meester I, De Winter BY (2016). "Visceral hypersensitivity in inflammatory bowel diseases and irritable bowel syndrome: The role of proteases". World J. Gastroenterol. 22 (47): 10275–10286. doi:10.3748/wjg.v22.i47.10275. PMC 5175241. PMID 28058009.
- ↑ Halliez MC, Buret AG (2013). "Extra-intestinal and long term consequences of Giardia duodenalis infections". World J. Gastroenterol. 19 (47): 8974–85. doi:10.3748/wjg.v19.i47.8974. PMC 3870550. PMID 24379622.
- ↑ Simrén M, Barbara G, Flint HJ, Spiegel BM, Spiller RC, Vanner S, Verdu EF, Whorwell PJ, Zoetendal EG (2013). "Intestinal microbiota in functional bowel disorders: a Rome foundation report". Gut. 62 (1): 159–76. doi:10.1136/gutjnl-2012-302167. PMC 3551212. PMID 22730468.
- ↑ Jeffery IB, Quigley EM, Öhman L, Simrén M, O'Toole PW (2012). "The microbiota link to irritable bowel syndrome: an emerging story". Gut Microbes. 3 (6): 572–6. doi:10.4161/gmic.21772. PMC 3495796. PMID 22895081.
- ↑ Ibarra C, Herrera V, Pérez de Arce E, Gil LC, Madrid AM, Valenzuela L, Beltrán CJ (2016). "[Parasitosis and irritable bowel syndrome]". Rev Chilena Infectol (in Spanish; Castilian). 33 (3): 268–74. doi:10.4067/S0716-10182016000300003. PMID 27598274.
- ↑ Giddings SL, Stevens AM, Leung DT (2016). "Traveler's Diarrhea". Med. Clin. North Am. 100 (2): 317–30. doi:10.1016/j.mcna.2015.08.017. PMC 4764790. PMID 26900116.
- ↑ Keithlin J, Sargeant J, Thomas MK, Fazil A (2014). "Systematic review and meta-analysis of the proportion of Campylobacter cases that develop chronic sequelae". BMC Public Health. 14: 1203. doi:10.1186/1471-2458-14-1203. PMC 4391665. PMID 25416162.
- ↑ Grover M (2014). "Role of gut pathogens in development of irritable bowel syndrome". Indian J. Med. Res. 139 (1): 11–8. PMC 3994726. PMID 24604037.
- ↑ Keithlin J, Sargeant J, Thomas MK, Fazil A (2014). "Chronic sequelae of E. coli O157: systematic review and meta-analysis of the proportion of E. coli O157 cases that develop chronic sequelae". Foodborne Pathog. Dis. 11 (2): 79–95. doi:10.1089/fpd.2013.1572. PMC 3925333. PMID 24404780.
- ↑ Connor BA, Riddle MS (2013). "Post-infectious sequelae of travelers' diarrhea". J Travel Med. 20 (5): 303–12. doi:10.1111/jtm.12049. PMID 23992573.
- ↑ Spiller R, Campbell E (2006). "Post-infectious irritable bowel syndrome". Curr. Opin. Gastroenterol. 22 (1): 13–7. PMID 16319671.
- ↑ Ghoshal UC, Shukla R, Ghoshal U (2017). "Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy". Gut Liver. 11 (2): 196–208. doi:10.5009/gnl16126. PMC 5347643. PMID 28274108.
- ↑ Gallo A, Passaro G, Gasbarrini A, Landolfi R, Montalto M (2016). "Modulation of microbiota as treatment for intestinal inflammatory disorders: An uptodate". World J. Gastroenterol. 22 (32): 7186–202. doi:10.3748/wjg.v22.i32.7186. PMC 4997632. PMID 27621567.
- ↑ Distrutti E, Monaldi L, Ricci P, Fiorucci S (2016). "Gut microbiota role in irritable bowel syndrome: New therapeutic strategies". World J. Gastroenterol. 22 (7): 2219–41. doi:10.3748/wjg.v22.i7.2219. PMC 4734998. PMID 26900286.
- ↑ Shreiner AB, Kao JY, Young VB (2015). "The gut microbiome in health and in disease". Curr. Opin. Gastroenterol. 31 (1): 69–75. doi:10.1097/MOG.0000000000000139. PMC 4290017. PMID 25394236.
- ↑ Mulak A, Paradowski L (2005). "[Migraine and irritable bowel syndrome]". Neurol. Neurochir. Pol. (in Polish). 39 (4 Suppl 1): S55–60. PMID 16419571.
- ↑ Cámara-Lemarroy CR, Rodriguez-Gutierrez R, Monreal-Robles R, Marfil-Rivera A (2016). "Gastrointestinal disorders associated with migraine: A comprehensive review". World J. Gastroenterol. 22 (36): 8149–60. doi:10.3748/wjg.v22.i36.8149. PMC 5037083. PMID 27688656.
- ↑ Cady RK, Farmer K, Dexter JK, Hall J (2012). "The bowel and migraine: update on celiac disease and irritable bowel syndrome". Curr Pain Headache Rep. 16 (3): 278–86. doi:10.1007/s11916-012-0258-y. PMID 22447132.
- ↑ Mulak A, Taché Y, Larauche M (2014). "Sex hormones in the modulation of irritable bowel syndrome". World J. Gastroenterol. 20 (10): 2433–48. doi:10.3748/wjg.v20.i10.2433. PMC 3949254. PMID 24627581.
- ↑ Mawe GM, Coates MD, Moses PL (2006). "Review article: intestinal serotonin signalling in irritable bowel syndrome". Aliment. Pharmacol. Ther. 23 (8): 1067–76. doi:10.1111/j.1365-2036.2006.02858.x. PMID 16611266.
- ↑ Makker J, Chilimuri S, Bella JN (2015). "Genetic epidemiology of irritable bowel syndrome". World J. Gastroenterol. 21 (40): 11353–61. doi:10.3748/wjg.v21.i40.11353. PMC 4616211. PMID 26525775.
- ↑ Chirila I, Petrariu FD, Ciortescu I, Mihai C, Drug VL (2012). "Diet and irritable bowel syndrome". J Gastrointestin Liver Dis. 21 (4): 357–62. PMID 23256117.