Irritable bowel syndrome history and symptoms: Difference between revisions

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{{Irritable bowel syndrome}}
{{Irritable bowel syndrome}}
{{CMG}}


==History and symptoms==
{{CMG}} ; {{AE}} {{Cherry}}
The symptoms of IBS are abdominal pain in association with frequent diarrhea, constipation, or a change in bowel habits.<ref name="SCHMULSON_1999">{{cite journal |author=Schmulson MW, Chang L |title=Diagnostic approach to the patient with irritable bowel syndrome |journal=Am. J. Med. |volume=107 |issue=5A |pages=20S-26S |year=1999 |pmid=10588169 |doi=}}</ref>
==Overview==
The diagnosis of irritable bowel syndrome (IBS) relies on recognition of [[Gastrointestinal tract|gastrointestinal]] [[Symptom|symptoms]] that wax and wane and are exacerbated by psychosocial [[Stress (medicine)|stress]]. [[Diagnosis]] of [[Irritable bowel syndrome|IBS]] is based on clinical [[Symptom|symptoms]] and elimination of other organic [[Gastrointestinal tract|gastrointestinal]] diseases. This is due to lack of definitive [[radiological]] or [[Medical laboratory|laboratory]] diagnostic tests in [[Irritable bowel syndrome|IBS]]. The hallmark of [[Irritable bowel syndrome|IBS]] is [[abdominal pain]]. A positive history of [[Stress (medicine)|stress]], [[anxiety]], [[depression]], [[Panic disorder|panic disorders]], [[Gastrointestinal tract|gastrointestinal]] disorders such as [[inflammatory bowel disease]] ([[Inflammatory bowel disease|IBD]]) and acute [[Gastrointestinal tract|GI]] [[infection]] predispose individuals to [[Irritable bowel syndrome|IBS]]. The most common [[Symptom|symptoms]] of [[Irritable bowel syndrome|IBS]] include presence of [[abdominal pain]] and alteration of [[Intestine|bowel]] habits. Less common [[symptoms]] of [[Irritable bowel syndrome|IBS]] include [[flatulence]] and upper [[Gastrointestinal tract|GI]] [[Symptom|symptoms]] such as [[heartburn]], [[Nausea and vomiting|nausea]], [[dyspepsia]] and [[Nausea and vomiting|vomiting]]. 


The underlying biochemical causes of IBS are not well established. As such, there is no specific laboratory test which can be performed to diagnose this condition.<ref name="YAWN_2001">{{cite journal |author=Yawn BP, Lydick E, Locke GR, Wollan PC, Bertram SL, Kurland MJ|title=Do published guidelines for evaluation of irritable bowel syndrome reflect practice? |journal=BMC gastroenterology |volume=1|issue= |pages=11 |year=2001 |pmid=11701092 |doi=}}</ref>  Diagnosis of IBS involves excluding conditions that produce with IBS-like symptoms and then following a procedure to categorize the patient's symptoms.
==Symptoms==
*Clinical features of [[Irritable bowel syndrome|IBS]] include the presence of [[abdominal pain]] with alteration of [[Bowel|bowel habits]], without any systemic [[symptoms]] such as [[blood]] in [[Stools|stool]], [[weight loss]] and [[fever]]. The onset of [[Symptom|symptoms]] usually occurs during periods of [[Stress (medicine)|stress]] and [[anxiety]].<ref name="SCHMULSON_1999">{{cite journal |author=Schmulson MW, Chang L |title=Diagnostic approach to the patient with irritable bowel syndrome |journal=Am. J. Med. |volume=107 |issue=5A |pages=20S-26S |year=1999 |pmid=10588169 |doi=}}</ref><ref name="pmid25574104">{{cite journal| author=Jasper F, Egloff B, Roalfe A, Witthöft M| title=Latent structure of irritable bowel syndrome symptom severity. | journal=World J Gastroenterol | year= 2015 | volume= 21 | issue= 1 | pages= 292-300 | pmid=25574104 | doi=10.3748/wjg.v21.i1.292 | pmc=4284348 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25574104  }} </ref><ref name="pmid23731745">{{cite journal| author=van Tilburg MA, Palsson OS, Whitehead WE| title=Which psychological factors exacerbate irritable bowel syndrome? Development of a comprehensive model. | journal=J Psychosom Res | year= 2013 | volume= 74 | issue= 6 | pages= 486-92 | pmid=23731745 | doi=10.1016/j.jpsychores.2013.03.004 | pmc=3673027 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23731745  }} </ref><ref name="TALLEY_2006">{{cite journal |author=Talley NJ |title=A unifying hypothesis for the functional gastrointestinal disorders: really multiple diseases or one irritable gut? |journal=Reviews in gastroenterological disorders|volume=6 |issue=2 |pages=72-8 |year=2006 |pmid=16699476 |doi=}}</ref><ref name="pmid23449495">{{cite journal |vauthors=Occhipinti K, Smith JW |title=Irritable bowel syndrome: a review and update |journal=Clin Colon Rectal Surg |volume=25 |issue=1 |pages=46–52 |year=2012 |pmid=23449495 |pmc=3348735 |doi=10.1055/s-0032-1301759 |url=}}</ref>   
*Straining during [[defecation]], [[urgency]], sensation of incomplete evacuation, [[mucus]] passage, [[bloating]] are also associated [[symptoms]], not included under the [[Diagnosis|diagnostic criteria]].
*The presence of other [[Comorbidity|comorbidities]] including other functional disorders such as stress disorders, [[anxiety]], [[depression]], sleep disturbance, chronic [[fatigue]], [[fibromyalgia]] favor [[Irritable bowel syndrome|IBS]].<ref name="pmid19631762">{{cite journal |vauthors=Ford AC, Marwaha A, Lim A, Moayyedi P |title=Systematic review and meta-analysis of the prevalence of irritable bowel syndrome in individuals with dyspepsia |journal=Clin. Gastroenterol. Hepatol. |volume=8 |issue=5 |pages=401–9 |year=2010 |pmid=19631762 |doi=10.1016/j.cgh.2009.07.020 |url=}}</ref><ref name="pmid17258513">{{cite journal |vauthors=Sayuk GS, Elwing JE, Lustman PJ, Clouse RE |title=High somatic symptom burdens and functional gastrointestinal disorders |journal=Clin. Gastroenterol. Hepatol. |volume=5 |issue=5 |pages=556–62 |year=2007 |pmid=17258513 |doi=10.1016/j.cgh.2006.11.024 |url=}}</ref><ref name="pmid17900326">{{cite journal |vauthors=Whitehead WE, Palsson OS, Levy RR, Feld AD, Turner M, Von Korff M |title=Comorbidity in irritable bowel syndrome |journal=Am. J. Gastroenterol. |volume=102 |issue=12 |pages=2767–76 |year=2007 |pmid=17900326 |doi=10.1111/j.1572-0241.2007.01540.x |url=}}</ref><ref name="pmid12590233">{{cite journal |vauthors=Brown WH, Chey WD, Elta GH |title=Number of responses on a review of systems questionnaire predicts the diagnosis of functional gastrointestinal disorders |journal=J. Clin. Gastroenterol. |volume=36 |issue=3 |pages=222–7 |year=2003 |pmid=12590233 |doi= |url=}}</ref>
*Alarm features or red flag [[symptoms]]/[[signs]] point towards other diagnoses. These features include family history of [[Inflammatory bowel disease|IBD]] or [[Colorectal cancer|colon cancer]], [[fever]], recent [[antibiotic]] use, [[weight loss]], blood in the [[stools]] and night time awakening due to [[Symptom|symptoms]]. However, some [[Irritable bowel syndrome|IBS]] patients may have [[blood]] in the [[Human feces|stool]] due to coexisting [[hemorrhoids]].<ref name="FASS_2001">{{cite journal |author=Fass R, Longstreth GF, Pimentel M, ''et al''|title=Evidence- and consensus-based practice guidelines for the diagnosis of irritable bowel syndrome |journal=Arch. Intern. Med.|volume=161 |issue=17 |pages=2081-8 |year=2001 |pmid=11570936 |doi=}}</ref><ref name="pmid24413506">{{cite journal |vauthors=Paul SP, Barnard P, Bigwood C, Candy DC |title=Challenges in management of irritable bowel syndrome in children |journal=Indian Pediatr |volume=50 |issue=12 |pages=1137–43 |year=2013 |pmid=24413506 |doi= |url=}}</ref>
=== Common symptoms ===
Common [[symptoms]] of IBS include [[abdominal pain]], altered [[Intestine|bowel]] habits, [[bloating]] and [[flatulence]].
{| class="wikitable"
! colspan="3" style="background:#4479BA; color: #FFFFFF;" ! |COMMON SYMPTOMS OF IBS
|-
| style="background:#DCDCDC;" align="center" |'''[[Abdominal pain]]''' (major prerequisite for [[Irritable bowel syndrome|IBS]])
| colspan="2" |Site: Variable location
Onset: Sudden/Insidious


Because there are many [[List of causes of diarrhea|causes of diarrhea]] and IBS-like symptoms, the [[American Gastroenterological Association]] has published a [[AGA Guidelines for IBS testing| set of guidelines]] for tests to be performed to diagnose other conditions that may have symptoms similar to IBS.  These include gastrointestinal infections, [[lactose intolerance]] and [[coeliac disease]].  Research has suggested that these guidelines are not always followed.<ref name="YAWN_2001" />  Once other causes have been excluded, the diagnosis of IBS is performed using a diagnostic [[algorithm]].  Well-known [[algorithms]] include the [[Manning Criteria]], the [[Rome process|Rome I Criteria]], the [[Rome process|Rome II Process]], the Kruis Criteria, and studies have compared their reliability.<ref name="FASS_2001">{{cite journal |author=Fass R, Longstreth GF, Pimentel M, ''et al''|title=Evidence- and consensus-based practice guidelines for the diagnosis of irritable bowel syndrome |journal=Arch. Intern. Med.|volume=161 |issue=17 |pages=2081-8 |year=2001 |pmid=11570936 |doi=}}</ref> The more recent [[Rome process|Rome III Process]] was published in 2006. Physicians may choose to use one of these criteria, or may use other guidelines based on their own experience and the patient's history.  The [[algorithm]] may include additional tests to guard against misdiagnosis of other diseases as IBS.  Such "red flag" symptoms may include weight loss, GI bleeding, anemia, or nocturnal symptoms.  However, researchers have noted that red flag conditions may not always contribute to accuracy in diagnosis &mdash; for instance, as many as 31% of IBS patients have blood in their stool.<ref name="FASS_2001" /> 
Character: Episodic and crampy with a background of constant [[pain]]


The diagnostic [[algorithm]] identifies a name that can be applied to the patient's condition based on the combination of the patient's symptoms of [[diarrhea]], abdominal pain, and constipation.  For example, the statement "50% of returning travelers had developed functional [[diarrhea]], while 25% had developed IBS" would mean that half the travelers had [[diarrhea]] while a quarter had [[diarrhea]] with abdominal pain.  While some researchers believe this categorization system will help physicians understand IBS, others have questioned the value of the system and suggested that all IBS patients have the same underlying disease but with different symptoms.<ref name="TALLEY_2006">{{cite journal |author=Talley NJ |title=A unifying hypothesis for the functional gastrointestinal disorders: really multiple diseases or one irritable gut? |journal=Reviews in gastroenterological disorders|volume=6 |issue=2 |pages=72-8 |year=2006 |pmid=16699476 |doi=}}</ref>
Relieving factors: Relief on [[defecation]]


===Diagnostic Criteria===
Aggravating factors: Eating, emotional stress, premenstrual and [[Menstrual cycle|menstrual]] phases
The diagnostic criteria based on the American Gastroenterological Association (AGA),<ref name="pmid23261065">{{cite journal| author=Bharucha AE, Pemberton JH, Locke GR| title=American Gastroenterological Association technical review on constipation. | journal=Gastroenterology | year= 2013 | volume= 144 | issue= 1 | pages= 218-38 | pmid=23261065 | doi=10.1053/j.gastro.2012.10.028 | pmc=PMC3531555 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23261065  }} </ref> Rome III criteria<ref name="Longstreth-2006">{{Cite journal  | last1 = Longstreth | first1 = GF. | last2 = Thompson | first2 = WG. | last3 = Chey | first3 = WD. | last4 = Houghton | first4 = LA. | last5 = Mearin | first5 = F. | last6 = Spiller | first6 = RC. | title = Functional bowel disorders. | journal = Gastroenterology | volume = 130 | issue = 5 | pages = 1480-91 | month = Apr | year = 2006 | doi = 10.1053/j.gastro.2005.11.061 | PMID = 16678561 }}</ref> and pharmacologic studies based criteria<ref name="Johnston-2010">{{Cite journal  | last1 = Johnston | first1 = JM. | last2 = Kurtz | first2 = CB. | last3 = Macdougall | first3 = JE. | last4 = Lavins | first4 = BJ. | last5 = Currie | first5 = MG. | last6 = Fitch | first6 = DA. | last7 = O'Dea | first7 = C. | last8 = Baird | first8 = M. | last9 = Lembo | first9 = AJ. | title = Linaclotide improves abdominal pain and bowel habits in a phase IIb study of patients with irritable bowel syndrome with constipation. | journal = Gastroenterology | volume = 139 | issue = 6 | pages = 1877-1886.e2 | month = Dec | year = 2010 | doi = 10.1053/j.gastro.2010.08.041 | PMID = 20801122 }}</ref> is as follows.


{|class="wikitable"
Associated factors: Change in frequency or form of [[Human feces|stool]]
! Rome III criteria<ref name="pmid23261065">{{cite journal| author=Bharucha AE, Pemberton JH, Locke GR| title=American Gastroenterological Association technical review on constipation. | journal=Gastroenterology | year= 2013 | volume= 144 | issue= 1 | pages= 218-38 | pmid=23261065 | doi=10.1053/j.gastro.2012.10.028 | pmc=PMC3531555 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23261065  }} </ref><ref name="Longstreth-2006">{{Cite journal  | last1 = Longstreth | first1 = GF. | last2 = Thompson | first2 = WG. | last3 = Chey | first3 = WD. | last4 = Houghton | first4 = LA. | last5 = Mearin | first5 = F. | last6 = Spiller | first6 = RC. | title = Functional bowel disorders. | journal = Gastroenterology | volume = 130 | issue = 5 | pages = 1480-91 | month = Apr | year = 2006 | doi = 10.1053/j.gastro.2005.11.061 | PMID = 16678561 }}</ref>!! Pharmacologic studies based criteria<ref name="pmid23261065">{{cite journal| author=Bharucha AE, Pemberton JH, Locke GR| title=American Gastroenterological Association technical review on constipation. | journal=Gastroenterology | year= 2013 | volume= 144 | issue= 1 | pages= 218-38 | pmid=23261065 | doi=10.1053/j.gastro.2012.10.028 | pmc=PMC3531555 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23261065  }} </ref><ref name="Johnston-2010">{{Cite journal  | last1 = Johnston | first1 = JM. | last2 = Kurtz | first2 = CB. | last3 = Macdougall | first3 = JE. | last4 = Lavins | first4 = BJ. | last5 = Currie | first5 = MG. | last6 = Fitch | first6 = DA. | last7 = O'Dea | first7 = C. | last8 = Baird | first8 = M. | last9 = Lembo | first9 = AJ. | title = Linaclotide improves abdominal pain and bowel habits in a phase IIb study of patients with irritable bowel syndrome with constipation. | journal = Gastroenterology | volume = 139 | issue = 6 | pages = 1877-1886.e2 | month = Dec | year = 2010 | doi = 10.1053/j.gastro.2010.08.041 | PMID = 20801122 }}</ref>
 
Timing: [[Pain]] is usually present during waking hours. [[Nocturnal]] [[symptoms]] are usually present only in severe [[Irritable bowel syndrome|IBS]]
 
Severity: Variable (varies from mild to severe enough to impair quality of life)
|-
|-
| Abdominal pain or discomfort recurring at least 3 days per month in the past 3 months and associated with 2 or more of the following:<BR>
| rowspan="2" style="background:#DCDCDC;" align="center" |'''Altered bowel habits'''
● Improves with defecation<BR>
| colspan="2" |Altered [[Intestine|bowel]] habits usually present as [[diarrhea]] alternating with [[constipation]]. One of these tends to be the predominant [[symptom]] in the patient. <ref name="pmid12454866">{{cite journal |vauthors=Drossman DA, Camilleri M, Mayer EA, Whitehead WE |title=AGA technical review on irritable bowel syndrome |journal=Gastroenterology |volume=123 |issue=6 |pages=2108–31 |year=2002 |pmid=12454866 |doi=10.1053/gast.2002.37095 |url=}}</ref><ref name="pmid16678561">{{cite journal |vauthors=Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC |title=Functional bowel disorders |journal=Gastroenterology |volume=130 |issue=5 |pages=1480–91 |year=2006 |pmid=16678561 |doi=10.1053/j.gastro.2005.11.061 |url=}}</ref><ref name="pmid16678561" />
● Onset associated with change in frequency of stool<BR>
● Onset associated with change in appearance of stool<BR>
● 25% of bowel movements are loose stools
|| Spontaneous bowel movements 3 per week and 1 of the following symptoms for at least 12 weeks during the past 12 months:<BR>
● Straining in one-fourth or more of defecation<BR>
● Lumpy or hard stools in one-fourth or more of defecation<BR>
● Sensation of incomplete evacuation in one-fourth or more of defecation<BR>
● Mean score of 2.0 for daily nonmenstrual abdominal pain or discomfort<BR>
● Mean of 3 complete spontaneous bowel movements and >6 spontaneous bowel movements per week
|-
|-
|''[[Constipation]] predominant [[Irritable bowel syndrome|IBS]]:  <3 [[Intestine|bowel]] movements per week''
* [[Constipation]] in patients is initially episodic, but gradually becomes continuous and intractable to [[laxative]] treatment.
* Patients develop weeks- months of [[constipation]] interrupted by [[diarrhea]]. <ref name="pmid18456567">{{cite journal |vauthors=Camilleri M, McKinzie S, Busciglio I, Low PA, Sweetser S, Burton D, Baxter K, Ryks M, Zinsmeister AR |title=Prospective study of motor, sensory, psychologic, and autonomic functions in patients with irritable bowel syndrome |journal=Clin. Gastroenterol. Hepatol. |volume=6 |issue=7 |pages=772–81 |year=2008 |pmid=18456567 |pmc=2495078 |doi=10.1016/j.cgh.2008.02.060 |url=}}</ref><ref name="pmid3955515">{{cite journal |vauthors=Fromm M, Littman P, Raney RB, Nelson L, Handler S, Diamond G, Stanley C |title=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 |journal=Cancer |volume=57 |issue=10 |pages=2070–6 |year=1986 |pmid=3955515 |doi= |url=}}</ref><ref name="pmid22334251">{{cite journal |vauthors=Törnblom H, Van Oudenhove L, Sadik R, Abrahamsson H, Tack J, Simrén M |title=Colonic transit time and IBS symptoms: what's the link? |journal=Am. J. Gastroenterol. |volume=107 |issue=5 |pages=754–60 |year=2012 |pmid=22334251 |doi=10.1038/ajg.2012.5 |url=}}</ref><ref name="pmid20456760">{{cite journal |vauthors=Prott G, Shim L, Hansen R, Kellow J, Malcolm A |title=Relationships between pelvic floor symptoms and function in irritable bowel syndrome |journal=Neurogastroenterol. Motil. |volume=22 |issue=7 |pages=764–9 |year=2010 |pmid=20456760 |doi=10.1111/j.1365-2982.2010.01503.x |url=}}</ref>
* Patients have
*# Hard [[Human feces|stools]]
*# [[Human feces|Stools]] with narrow caliber, due to [[dehydration]] caused by [[Colon (anatomy)|colonic]] [[retention]]
*# Sensation of incomplete evacuation
|''Diarrhea predominant IBS: >3 bowel movements per day'' <ref name="pmid18456567" /><ref name="pmid22334251" />Patients have:
# Loose [[Human feces|stools]] in small volumes, aggravated by eating or emotional [[Stress (medicine)|stress]]
# [[Human feces|Stool]] volume of <200 ml
# [[Human feces|Stool]] accompanied by [[mucus]] passage
# Absence of [[nocturnal]] [[diarrhea]]
# Absence of [[bleeding]]
# Absence of [[weight loss]] or [[malabsorption]]
|-
| style="background:#DCDCDC;" align="center" |'''Gas and flatulence'''
| colspan="2" |
* Patients develop [[distension]] of [[abdomen]], [[flatulence]], increased [[Burping|belching]] due to impaired transit and tolerance of [[gas]] loads in the [[intestine]].
* Patients have a tendency to develop reflux gas from the [[Anatomical terms of location|distal]] to [[Anatomical terms of location|proximal]] [[bowel]] which causes [[Burping|belching]].
|}
|}


==Misdiagnosis==
=== Less common symptoms ===
Published research has demonstrated that some poor patient outcomes are due to treatable causes of diarrhea being misdiagnosed as IBS. Common examples include [[infectious diseases]], [[celiac disease]],<ref>{{cite journal |author=Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS |title=Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis |journal=Gastroenterology |volume=126 |issue=7 |pages=1721-32 |year=2004 |pmid=15188167 |doi=}}</ref> parasites,<ref>{{cite journal |author=Stark D, van Hal S, Marriott D, Ellis J, Harkness J. |title=Irritable bowel syndrome: a review on the role of intestinal protozoa and the importance of their detection and diagnosis. |journal=Int J Parasitol. |volume= 31 |issue=1 |pages=11-20|year=2007 |pmid=17070814 |doi=}}</ref> food allergies<ref>{{cite journal |author=Drisko ''et al'' |title=Treating Irritable Bowel Syndrome with a Food Elimination Diet Followed by Food Challenge and Probiotics |journal=Journal of the American College of Nutrition |volume=25 |issue=6 |pages=514-22 |year=2006 |pmid=17229899 |doi=}}</ref>
{| class="wikitable"
(though considered controversial), and [[lactose intolerance]].<ref>{{cite journal |author=Vernia P, Ricciardi MR, Frandina C, Bilotta T, Frieri G |title=Lactose malabsorption and irritable bowel syndrome. Effect of a long-term lactose-free diet |journal=The Italian journal of gastroenterology |volume=27 |issue=3 |pages=117-21 |year=1995 |pmid=7548919 |doi=}}</ref>  See the [[list of causes of diarrhea]] for other conditions which can cause diarrhea.
! colspan="2" style="background:#4479BA; color: #FFFFFF;" ! |LESS COMMON SYMPTOMS OF IBS
|-
| style="background:#DCDCDC;" align="center" |'''Upper gastrointestinal symptoms'''
|One fourth of all [[Irritable bowel syndrome|IBS]] patients complain of [[heartburn]], [[Nausea and vomiting|nausea]], [[dyspepsia]] and [[Nausea and vomiting|vomiting]]. 
|-
| style="background:#DCDCDC;" align="center" |'''Lower gastrointestinal symptoms'''
|
* Straining, urgency during [[defecation]]  
* Sensation of incomplete evacuation
* [[Mucus]] passage with [[Human feces|stools]]
|}
 
==History==


[[Coeliac disease]] in particular is often misdiagnosed as IBS: <blockquote>
=== Psychosocial history ===
Recognizing celiac disease can be difficult because some of its symptoms are similar to those of other diseases. In fact, sometimes celiac disease is confused with irritable bowel syndrome, iron-deficiency anemia caused by menstrual blood loss, Crohn’s disease, diverticulitis, intestinal infections, and chronic fatigue syndrome. As a result, celiac disease is commonly underdiagnosed or misdiagnosed.<ref>http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/ - The United States National Institutes of Health Celiac Disease Page</ref></blockquote>
*[[Psychological]] history such as [[Stress (medicine)|stress]], [[anxiety]]<ref name="pmid12108819">{{cite journal |vauthors=Mayer EA, Craske M, Naliboff BD |title=Depression, anxiety, and the gastrointestinal system |journal=J Clin Psychiatry |volume=62 Suppl 8 |issue= |pages=28–36; discussion 37 |year=2001 |pmid=12108819 |doi= |url=}}</ref><ref name="pmid12454866">{{cite journal |vauthors=Drossman DA, Camilleri M, Mayer EA, Whitehead WE |title=AGA technical review on irritable bowel syndrome |journal=Gastroenterology |volume=123 |issue=6 |pages=2108–31 |year=2002 |pmid=12454866 |doi=10.1053/gast.2002.37095 |url=}}</ref><ref name="pmid216977452">{{cite journal |vauthors=Devanarayana NM, Mettananda S, Liyanarachchi C, Nanayakkara N, Mendis N, Perera N, Rajindrajith S |title=Abdominal pain-predominant functional gastrointestinal diseases in children and adolescents: prevalence, symptomatology, and association with emotional stress |journal=J. Pediatr. Gastroenterol. Nutr. |volume=53 |issue=6 |pages=659–65 |year=2011 |pmid=21697745 |doi=10.1097/MPG.0b013e3182296033 |url=}}</ref><ref name="pmid253398012">{{cite journal |vauthors=Qin HY, Cheng CW, Tang XD, Bian ZX |title=Impact of psychological stress on irritable bowel syndrome |journal=World J. Gastroenterol. |volume=20 |issue=39 |pages=14126–31 |year=2014 |pmid=25339801 |pmc=4202343 |doi=10.3748/wjg.v20.i39.14126 |url=}}</ref><ref name="pmid274929162">{{cite journal |vauthors=Bharucha AE, Chakraborty S, Sletten CD |title=Common Functional Gastroenterological Disorders Associated With Abdominal Pain |journal=Mayo Clin. Proc. |volume=91 |issue=8 |pages=1118–32 |year=2016 |pmid=27492916 |pmc=4985027 |doi=10.1016/j.mayocp.2016.06.003 |url=}}</ref><ref name="pmid266749802">{{cite journal |vauthors=Ibrahim NK |title=A systematic review of the prevalence and risk factors of irritable bowel syndrome among medical students |journal=Turk J Gastroenterol |volume=27 |issue=1 |pages=10–6 |year=2016 |pmid=26674980 |doi=10.5152/tjg.2015.150333 |url=}}</ref>
*Past history of abuse
*Psychiatric history such as [[depression]], [[Panic disorder|panic disorders]]<ref name="pmid12108819">{{cite journal |vauthors=Mayer EA, Craske M, Naliboff BD |title=Depression, anxiety, and the gastrointestinal system |journal=J Clin Psychiatry |volume=62 Suppl 8 |issue= |pages=28–36; discussion 37 |year=2001 |pmid=12108819 |doi= |url=}}</ref><ref name="pmid253398012" /><ref name="pmid274929162" /><ref name="pmid170076342">{{cite journal |vauthors=Cole JA, Rothman KJ, Cabral HJ, Zhang Y, Farraye FA |title=Migraine, fibromyalgia, and depression among people with IBS: a prevalence study |journal=BMC Gastroenterol |volume=6 |issue= |pages=26 |year=2006 |pmid=17007634 |pmc=1592499 |doi=10.1186/1471-230X-6-26 |url=}}</ref><ref name="pmid248767252">{{cite journal |vauthors=Hausteiner-Wiehle C, Henningsen P |title=Irritable bowel syndrome: relations with functional, mental, and somatoform disorders |journal=World J. Gastroenterol. |volume=20 |issue=20 |pages=6024–30 |year=2014 |pmid=24876725 |pmc=4033442 |doi=10.3748/wjg.v20.i20.6024 |url=}}</ref>
*History of physical or [[Sexual assault|sexual abuse]] or adverse early life events
*History of pain disorders such as [[fibromyalgia]]<ref name="pmid170076342" /><ref name="pmid248799162">{{cite journal |vauthors=Vehof J, Zavos HM, Lachance G, Hammond CJ, Williams FM |title=Shared genetic factors underlie chronic pain syndromes |journal=Pain |volume=155 |issue=8 |pages=1562–8 |year=2014 |pmid=24879916 |doi=10.1016/j.pain.2014.05.002 |url=}}</ref>


==Medical conditions that accompany IBS==
=== Past Medical history ===
Researchers have identified several medical conditions, or [[comorbidities]], which appear with greater frequency in patients diagnosed with IBS.
*History of [[Gastrointestinal tract|gastrointestinal]] disorders such as [[Inflammatory bowel disease|IBD]]<ref name="pmid242964622">{{cite journal |vauthors=Major G, Spiller R |title=Irritable bowel syndrome, inflammatory bowel disease and the microbiome |journal=Curr Opin Endocrinol Diabetes Obes |volume=21 |issue=1 |pages=15–21 |year=2014 |pmid=24296462 |pmc=3871405 |doi=10.1097/MED.0000000000000032 |url=}}</ref><ref name="pmid280580092">{{cite journal |vauthors=Ceuleers H, Van Spaendonk H, Hanning N, Heirbaut J, Lambeir AM, Joossens J, Augustyns K, De Man JG, De Meester I, De Winter BY |title=Visceral hypersensitivity in inflammatory bowel diseases and irritable bowel syndrome: The role of proteases |journal=World J. Gastroenterol. |volume=22 |issue=47 |pages=10275–10286 |year=2016 |pmid=28058009 |pmc=5175241 |doi=10.3748/wjg.v22.i47.10275 |url=}}</ref>
*History of acute [[Gastrointestinal tract|GI]] [[Infection|infections]] such as [[traveler's diarrhea]] i.e post [[Infection|infectious]] state <ref name="pmid243796222">{{cite journal |vauthors=Halliez MC, Buret AG |title=Extra-intestinal and long term consequences of Giardia duodenalis infections |journal=World J. Gastroenterol. |volume=19 |issue=47 |pages=8974–85 |year=2013 |pmid=24379622 |pmc=3870550 |doi=10.3748/wjg.v19.i47.8974 |url=}}</ref><ref name="pmid227304682">{{cite journal |vauthors=Simrén M, Barbara G, Flint HJ, Spiegel BM, Spiller RC, Vanner S, Verdu EF, Whorwell PJ, Zoetendal EG |title=Intestinal microbiota in functional bowel disorders: a Rome foundation report |journal=Gut |volume=62 |issue=1 |pages=159–76 |year=2013 |pmid=22730468 |pmc=3551212 |doi=10.1136/gutjnl-2012-302167 |url=}}</ref><ref name="pmid228950812">{{cite journal |vauthors=Jeffery IB, Quigley EM, Öhman L, Simrén M, O'Toole PW |title=The microbiota link to irritable bowel syndrome: an emerging story |journal=Gut Microbes |volume=3 |issue=6 |pages=572–6 |year=2012 |pmid=22895081 |pmc=3495796 |doi=10.4161/gmic.21772 |url=}}</ref><ref name="pmid275982742">{{cite journal |vauthors=Ibarra C, Herrera V, Pérez de Arce E, Gil LC, Madrid AM, Valenzuela L, Beltrán CJ |title=[Parasitosis and irritable bowel syndrome] |language=Spanish; Castilian |journal=Rev Chilena Infectol |volume=33 |issue=3 |pages=268–74 |year=2016 |pmid=27598274 |doi=10.4067/S0716-10182016000300003 |url=}}</ref><ref name="pmid269001162">{{cite journal |vauthors=Giddings SL, Stevens AM, Leung DT |title=Traveler's Diarrhea |journal=Med. Clin. North Am. |volume=100 |issue=2 |pages=317–30 |year=2016 |pmid=26900116 |pmc=4764790 |doi=10.1016/j.mcna.2015.08.017 |url=}}</ref><ref name="pmid254161622">{{cite journal |vauthors=Keithlin J, Sargeant J, Thomas MK, Fazil A |title=Systematic review and meta-analysis of the proportion of Campylobacter cases that develop chronic sequelae |journal=BMC Public Health |volume=14 |issue= |pages=1203 |year=2014 |pmid=25416162 |pmc=4391665 |doi=10.1186/1471-2458-14-1203 |url=}}</ref><ref name="pmid246040372">{{cite journal |vauthors=Grover M |title=Role of gut pathogens in development of irritable bowel syndrome |journal=Indian J. Med. Res. |volume=139 |issue=1 |pages=11–8 |year=2014 |pmid=24604037 |pmc=3994726 |doi= |url=}}</ref><ref name="pmid244047802">{{cite journal |vauthors=Keithlin J, Sargeant J, Thomas MK, Fazil A |title=Chronic sequelae of E. coli O157: systematic review and meta-analysis of the proportion of E. coli O157 cases that develop chronic sequelae |journal=Foodborne Pathog. Dis. |volume=11 |issue=2 |pages=79–95 |year=2014 |pmid=24404780 |pmc=3925333 |doi=10.1089/fpd.2013.1572 |url=}}</ref><ref name="pmid239925732">{{cite journal |vauthors=Connor BA, Riddle MS |title=Post-infectious sequelae of travelers' diarrhea |journal=J Travel Med |volume=20 |issue=5 |pages=303–12 |year=2013 |pmid=23992573 |doi=10.1111/jtm.12049 |url=}}</ref><ref name="pmid16319671">{{cite journal |vauthors=Spiller R, Campbell E |title=Post-infectious irritable bowel syndrome |journal=Curr. Opin. Gastroenterol. |volume=22 |issue=1 |pages=13–7 |year=2006 |pmid=16319671 |doi= |url=}}</ref>
**[[Salmonella]] infection
**[[Giardiasis]]
*History of [[antibiotic]] use<ref name="pmid282741082">{{cite journal |vauthors=Ghoshal UC, Shukla R, Ghoshal U |title=Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy |journal=Gut Liver |volume=11 |issue=2 |pages=196–208 |year=2017 |pmid=28274108 |pmc=5347643 |doi=10.5009/gnl16126 |url=}}</ref><ref name="pmid276215672">{{cite journal |vauthors=Gallo A, Passaro G, Gasbarrini A, Landolfi R, Montalto M |title=Modulation of microbiota as treatment for intestinal inflammatory disorders: An uptodate |journal=World J. Gastroenterol. |volume=22 |issue=32 |pages=7186–202 |year=2016 |pmid=27621567 |pmc=4997632 |doi=10.3748/wjg.v22.i32.7186 |url=}}</ref><ref name="pmid269002862">{{cite journal |vauthors=Distrutti E, Monaldi L, Ricci P, Fiorucci S |title=Gut microbiota role in irritable bowel syndrome: New therapeutic strategies |journal=World J. Gastroenterol. |volume=22 |issue=7 |pages=2219–41 |year=2016 |pmid=26900286 |pmc=4734998 |doi=10.3748/wjg.v22.i7.2219 |url=}}</ref><ref name="pmid253942362">{{cite journal |vauthors=Shreiner AB, Kao JY, Young VB |title=The gut microbiome in health and in disease |journal=Curr. Opin. Gastroenterol. |volume=31 |issue=1 |pages=69–75 |year=2015 |pmid=25394236 |pmc=4290017 |doi=10.1097/MOG.0000000000000139 |url=}}</ref>
*[[Immune-mediated disease|History of]] [[celiac disease]] and [[Colitis|microscopic colitis]]<ref name="pmid242964622" />
*History of [[Migraine Headache|migraine]] [[headaches]]<ref name="pmid170076342" /><ref name="pmid164195712">{{cite journal |vauthors=Mulak A, Paradowski L |title=[Migraine and irritable bowel syndrome] |language=Polish |journal=Neurol. Neurochir. Pol. |volume=39 |issue=4 Suppl 1 |pages=S55–60 |year=2005 |pmid=16419571 |doi= |url=}}</ref><ref name="pmid276886562">{{cite journal |vauthors=Cámara-Lemarroy CR, Rodriguez-Gutierrez R, Monreal-Robles R, Marfil-Rivera A |title=Gastrointestinal disorders associated with migraine: A comprehensive review |journal=World J. Gastroenterol. |volume=22 |issue=36 |pages=8149–60 |year=2016 |pmid=27688656 |pmc=5037083 |doi=10.3748/wjg.v22.i36.8149 |url=}}</ref><ref name="pmid224471322">{{cite journal |vauthors=Cady RK, Farmer K, Dexter JK, Hall J |title=The bowel and migraine: update on celiac disease and irritable bowel syndrome |journal=Curr Pain Headache Rep |volume=16 |issue=3 |pages=278–86 |year=2012 |pmid=22447132 |doi=10.1007/s11916-012-0258-y |url=}}</ref>


===Headache, Fibromyalgia, and Depression===
=== Menstrual history ===
A study of 97,593 individuals with IBS identified comorbidities as [[headache]], [[fibromyalgia]] and [[depression]].<ref>{{cite journal |author=Cole JA, Rothman KJ, Cabral HJ, Zhang Y, Farraye FA |title=Migraine,[[fibromyalgia]], and depression among people with IBS:  a prevalence study |journal=BMC gastroenterology |volume=6 |issue=|pages=26 |year=2006 |pmid=17007634 |doi=10.1186/1471-230X-6-26}}</ref> [[Fibromyalgia]] has also been identified in other studies as a comorbidity of IBS.<ref name="pmid16614951">{{cite journal |author=Kurland JE, Coyle WJ, Winkler A, Zable E |title=Prevalence of irritable bowel syndrome and depression in [[fibromyalgia]] |journal=Dig. Dis. Sci. |volume=51 |issue=3 |pages=454-60 |year=2006|pmid=16614951 |doi=10.1007/s10620-006-3154-7}}</ref><ref name="pmid16042909">{{cite journal |author=Frissora CL, Koch KL|title=Symptom overlap and comorbidity of irritable bowel syndrome with other conditions |journal=Current gastroenterology reports|volume=7 |issue=4 |pages=264-71 |year=2005 |pmid=16042909 |doi=}}</ref>  
*History of irregular [[Menstruation|menses]]<ref name="pmid246275812">{{cite journal |vauthors=Mulak A, Taché Y, Larauche M |title=Sex hormones in the modulation of irritable bowel syndrome |journal=World J. Gastroenterol. |volume=20 |issue=10 |pages=2433–48 |year=2014 |pmid=24627581 |pmc=3949254 |doi=10.3748/wjg.v20.i10.2433 |url=}}</ref><ref name="pmid16611266">{{cite journal |vauthors=Mawe GM, Coates MD, Moses PL |title=Review article: intestinal serotonin signalling in irritable bowel syndrome |journal=Aliment. Pharmacol. Ther. |volume=23 |issue=8 |pages=1067–76 |year=2006 |pmid=16611266 |doi=10.1111/j.1365-2036.2006.02858.x |url=}}</ref>


===Inflammatory Bowel Disease===
=== Family history ===
Some researchers have suggested that IBS is a type of low-grade [[inflammatory bowel disease]].<ref name="BERCIK_2005">{{cite journal |author=Bercik P, Verdu EF, Collins SM |title=Is irritable bowel syndrome a low-grade inflammatory bowel disease? |journal=Gastroenterol. Clin. North Am. |volume=34 |issue=2 |pages=235-45, vi-vii |year=2005|pmid=15862932 |doi=10.1016/j.gtc.2005.02.007}}</ref> Researchers have suggested that IBS and IBD are interrelated diseases,<ref name="QUIGLEY_2005">{{cite journal |author=Quigley EM |title=Irritable bowel syndrome and inflammatory bowel disease: interrelated diseases? |journal=Chinese journal of digestive diseases |volume=6 |issue=3 |pages=122-32 |year=2005 |pmid=16045602|doi=10.1111/j.1443-9573.2005.00202.x}}</ref> noting that patients with IBD experience IBS-like symptoms when their IBD is in remission.<ref name="SIMREN_2002">{{cite journal |author=Simrén M, Axelsson J, Gillberg R, Abrahamsson H, Svedlund J, Björnsson ES|title=Quality of life in inflammatory bowel disease in remission: the impact of IBS-like symptoms and associated psychological factors |journal=Am. J. Gastroenterol. |volume=97 |issue=2 |pages=389-96 |year=2002 |pmid=11866278 |doi=}}</ref><ref name="MINDERHOUD_2004">{{cite journal |author=Minderhoud IM, Oldenburg B, Wismeijer JA, van Berge Henegouwen GP, Smout AJ|title=IBS-like symptoms in patients with inflammatory bowel disease in remission; relationships with quality of life and coping behavior |journal=Dig. Dis. Sci. |volume=49 |issue=3 |pages=469-74 |year=2004 |pmid=15139501 |doi=}}</ref>  A 3-year study found that patients diagnosed with IBS were 16.3 times more likely to develop IBD during the study period.<ref name="GARCIA_2000">{{cite journal |author=García Rodríguez LA, Ruigómez A, Wallander MA, Johansson S, Olbe L |title=Detection of colorectal tumor and inflammatory bowel disease during follow-up of patients with initial diagnosis of irritable bowel syndrome |journal=Scand. J. Gastroenterol. |volume=35 |issue=3 |pages=306-11 |year=2000 |pmid=10766326 |doi=}}</ref>  Serum markers associated with inflammation have also been found in patients with IBS (see Causes).
*[[Family history]] of:
**[[Irritable bowel syndrome|IBS]] <ref name="pmid265257752">{{cite journal |vauthors=Makker J, Chilimuri S, Bella JN |title=Genetic epidemiology of irritable bowel syndrome |journal=World J. Gastroenterol. |volume=21 |issue=40 |pages=11353–61 |year=2015 |pmid=26525775 |pmc=4616211 |doi=10.3748/wjg.v21.i40.11353 |url=}}</ref>
**[[celiac disease]]
** [[inflammatory bowel disease]]
**[[Colorectal cancer|colorectal cancer]]


===Abdominal Surgery===
=== History of allergies ===
A 2005 study published in ''Digestive Disease Science'' reported that IBS patients are 87% more likely to undergo abdominal and pelvic surgery, and three times more likely to undergo gallbladder surgery.<ref name="pmid16416174">{{cite journal |author=Cole JA, Yeaw JM, Cutone JA, ''et al'' |title=The incidence of abdominal and pelvic surgery among patients with irritable bowel syndrome |journal=Dig. Dis. Sci. |volume=50 |issue=12 |pages=2268–75 |year=2005 |pmid=16416174|doi=10.1007/s10620-005-3047-1}}</ref>  A study published in ''Gastroenterology'' came to similar conclusions, and also noted IBS patients were twice as likely to undergo hysterectomy.<ref name="pmid15188159">{{cite journal |author=Longstreth GF, Yao JF|title=Irritable bowel syndrome and surgery: a multivariable analysis |journal=Gastroenterology |volume=126 |issue=7 |pages=1665–73|year=2004 |pmid=15188159 |doi=}}</ref>  
*History of food sensitivities: Fatty food, wheat, carbonated drinks, [[sorbitol]] and [[alcohol]]<ref name="pmid232561172">{{cite journal |vauthors=Chirila I, Petrariu FD, Ciortescu I, Mihai C, Drug VL |title=Diet and irritable bowel syndrome |journal=J Gastrointestin Liver Dis |volume=21 |issue=4 |pages=357–62 |year=2012 |pmid=23256117 |doi= |url=}}</ref>


===Endometriosis===
=== Medication history ===
One study has reported a statistically significant link between migraine headaches, IBS, and endometriosis.<ref name="pmid17635599">{{cite journal |author=Tietjen GE, Bushnell CD, Herial NA, Utley C, White L, Hafeez F|title=Endometriosis is associated with prevalence of comorbid conditions in migraine |journal=Headache |volume=47 |issue=7|pages=1069-78 |year=2007 |pmid=17635599 |doi=10.1111/j.1526-4610.2007.00784.x}}</ref>
*History of [[medication]] use should be obtained as many [[:Category:Drugs|drugs]] such as [[Opioid|opioids]] cause [[constipation]] as a side effect.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Gastroenterology]]
[[Category:Ailments of unknown etiology]]
[[Category:Syndromes]]
[[Category:Conditions diagnosed by stool test]]
[[Category:Abdominal pain]]
[[Category:Primary care]]
[[Category:Needs overview]]


{{WH}}
{{WH}}
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[[Category: (name of the system)]]
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Latest revision as of 17:17, 3 December 2017

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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

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:
  1. Loose stools in small volumes, aggravated by eating or emotional stress
  2. Stool volume of <200 ml
  3. Stool accompanied by mucus passage
  4. Absence of nocturnal diarrhea
  5. Absence of bleeding
  6. Absence of weight loss or malabsorption
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

Past Medical history

Menstrual history

Family history

History of allergies

Medication history

References

  1. ↑ Schmulson MW, Chang L (1999). "Diagnostic approach to the patient with irritable bowel syndrome". Am. J. Med. 107 (5A): 20S–26S. PMID 10588169.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ 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. ↑ 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. ↑ 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. ↑ 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.
  15. ↑ 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. ↑ 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.
  17. ↑ 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. ↑ 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.
  19. ↑ 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. ↑ 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. ↑ 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.
  22. ↑ 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. ↑ 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.
  24. ↑ 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.
  25. ↑ 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. ↑ 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.
  27. ↑ 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.
  28. ↑ 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.
  29. ↑ 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.
  30. ↑ 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.
  31. ↑ 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.
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  34. ↑ 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.
  35. ↑ 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.
  36. ↑ 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.
  37. ↑ Spiller R, Campbell E (2006). "Post-infectious irritable bowel syndrome". Curr. Opin. Gastroenterol. 22 (1): 13–7. PMID 16319671.
  38. ↑ 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.
  39. ↑ 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.
  40. ↑ 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.
  41. ↑ 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.
  42. ↑ Mulak A, Paradowski L (2005). "[Migraine and irritable bowel syndrome]". Neurol. Neurochir. Pol. (in Polish). 39 (4 Suppl 1): S55–60. PMID 16419571.
  43. ↑ 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.
  44. ↑ 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.
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  46. ↑ 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.
  47. ↑ 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.
  48. ↑ 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.

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