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Approach to Irritable Bowel Syndrome

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Stress and Somatic Symptoms

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Abstract

Irritable bowel syndrome (IBS) is characterized by diarrhea or constipation, abdominal pain, and abdominal bloating. Biological and psychological factors are currently believed to influence the pathogenesis of IBS. Biological factors include alteration in gut microbiome, gut motility, visceral sensation, intestinal permeability, gut immune function, and brain-gut interactions. Some IBS patients are difficult to cope with abdominal symptoms due to their emotional distress. For constipation, high fiber diet or bulking agents can be helpful, whereas for diarrhea, anticholinergic agents are effective. In IBS cases comorbid with anxiety or depressive disorders, tricyclic antidepressants are recommended. However, antianxiety agents and antipsychotics should be avoided because the former may lead to drug dependence and the latter may develop tardive dyskinesia. Explanation, reassurance, and supportive psychotherapy can also be helpful for some IBS patients. In addition, hypnosis and cognitive behavioral therapy (CBT) have beneficial effects in improving gastrointestinal symptoms of patients with IBS.

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References

  1. Singh P, Staller K, Barshop K, et al. Patients with irritable bowel syndrome-diarrhea have lower disease-specific quality of life than irritable bowel syndrome-constipation. World J Gastroenterol. 2015;21:8103–9.

    Article  Google Scholar 

  2. Holtmann GJ, Ford AC, Talley NJ. Pathophysiology of irritable bowel syndrome. Lancet Gastroenterol Hepatol. 2016;1:133–46.

    Article  Google Scholar 

  3. Garrick TR. Gastrointestinal disorders. In: Kaplan HI, Sadock BJ, editors. Comprehensive textbook of psychiatry, vol. 2. 6th ed. Baltimore: Williams & Wilkins; 1995.

    Google Scholar 

  4. Longstreth GF, Wilson A, Knight K, et al. Irritable bowel syndrome, health care use, and costs: a U.S. managed care perspective. Am J Gastroenterol. 2003;98:600–7.

    Article  Google Scholar 

  5. Sammons MT, Karoly P. Psychosocial variables in irritable bowel syndrome: a review and proposal. Clin Psychol Rev. 1987;7:187–204.

    Article  Google Scholar 

  6. Lazaraki G, Chatzimavroudis G, Katsinelos P. Recent advances in pharmacological treatment of irritable bowel syndrome. World J Gastroenterol. 2014;20:8867–85.

    PubMed  PubMed Central  Google Scholar 

  7. Lee V, Guthrie E, Robinson A, et al. Functional bowel disorders in primary care: factors associated with health-related quality of life and doctor consultation. J Psychosom Res. 2008;64:129–38.

    Article  Google Scholar 

  8. Deiteren A, de Wit A, van der Linden L, et al. Irritable bowel syndrome and visceral hypersensitivity: risk factors and pathophysiological mechanisms. Acta Gastroenterol Belg. 2016;79:29–38.

    PubMed  Google Scholar 

  9. Holtmann G, Shah A, Morrison M. Pathophysiology of functional gastrointestinal disorders: a holistic overview. Dig Dis. 2017;35(Suppl 1):5–13.

    Article  Google Scholar 

  10. Thompson WG. The irritable bowel: one disease, or several, or none? In: Read NW, editor. Irritable bowel syndrome. New York: Grune & Stratton; 1985.

    Google Scholar 

  11. Manning AP, Thompson WG, Heaton KW. Towards positive diagnosis of the irritable bowel. Br Med J. 1978;2:653–4.

    Article  Google Scholar 

  12. Thompson DG, Laidlow JM, Wingate DL. Abnormal small-bowel motility demonstrated by radiotelemetry in a patient with irritable colon. Lancet. 1979;2:1321–3.

    Article  Google Scholar 

  13. Waston WC, Sullivan SN, Corke M. Globus and headache: common symptoms of the irritable bowel syndrome. Can Med Assoc J. 1978;118:387–8.

    Google Scholar 

  14. Kellner R. Psychosomatic syndromes and somatic symptoms. Washington, DC: Am Psychiatric Press; 1991. p. 111–44.

    Google Scholar 

  15. Crowell MD, Harris L, Jones MP, et al. New insights into the pathophysiology of irritable bowel syndrome: implications for future treatments. Curr Gastroenterol Rep. 2005;7:272–9.

    Article  Google Scholar 

  16. Hasler WL. Traditional thoughts on the pathophysiology of irritable bowel syndrome. Gastroenterol Clin N Am. 2011;40:21–43.

    Article  Google Scholar 

  17. Pimentel M, Chang C. Inflammation and microflora. Gastroenterol Clin N Am. 2011;40:69–85.

    Article  Google Scholar 

  18. Chaudhary NA, Truelove SC. Human colonic motility: a comparative study of normal subjects, patients with ulcerative colitis and patients with irritable colon syndrome. Gastroenterology. 1961;40:1–36.

    PubMed  Google Scholar 

  19. Ritchie J. Pain from distension of the pelvic colon by inflating a balloon in the irritable colon syndrome. Gut. 1973;14:125–32.

    Article  Google Scholar 

  20. Elsenbruch S. Abdominal pain in irritable bowel syndrome: a review of putative psychological, neural and neuro-immune mechanisms. Brain Behav Immun. 2011;25:386–94.

    Article  Google Scholar 

  21. Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. JAMA. 2015;313:949–58.

    Article  Google Scholar 

  22. Cook IJ, van Eeden A, Collins SM. Patients with irritable bowel syndrome have greater pain tolerance than normal subjects. Gastroenterology. 1987;93:727–33.

    Article  Google Scholar 

  23. Almy TP. Experimental studies on the irritable colon. Am J Med. 1951;10:60–7.

    Article  Google Scholar 

  24. Hislop IG. Psychological significance of the irritable colon syndrome. Gut. 1971;12:452–7.

    Article  Google Scholar 

  25. Welgan P, Meshkinpour H, Beeler M. Effect of anger on colon motor and myoelectric activity in irritable bowel syndrome. Gastroenterology. 1988;94:1150–6.

    Article  Google Scholar 

  26. Konturek PC, Brzozowski T, Konturek SJ. Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options. J Physiol Pharmacol. 2011;62:591–9.

    PubMed  Google Scholar 

  27. Qin HY, Cheng CW, Tang XD, et al. Impact of psychological stress on irritable bowel syndrome. World J Gastroenterol. 2014;20:14126–31.

    Article  Google Scholar 

  28. Esler MD, Goulston KJ. Levels of anxiety in colonic disorders. N Engl J Med. 1973;288:16–20.

    Article  Google Scholar 

  29. Drossman DA, McKee DC, Sandler RS. Psychosocial factors in the irritable bowel syndrome: a multivariate study of patients and non-patients with irritable bowel syndrome. Gastroenterology. 1988;95:701–8.

    Article  Google Scholar 

  30. Smith RC, Greenbaum DS, Vancouver JB. Psychosocial factors are associated with health care seeking rather than diagnosis in irritable bowel syndrome. Gastroenterology. 1990;98:293–301.

    Article  Google Scholar 

  31. Whitehead WE, Bosmajian L, Zonderman AB. Symptoms of psychologic distress associated with irritable bowel syndrome. Gastroenterology. 1988;95:709–14.

    Article  Google Scholar 

  32. Lowman BC, Drossman DA, Cramer EM. Recollection of childhood events in adults with irritable bowel syndrome. J Clin Gastroenterol. 1987;9:324–30.

    Article  Google Scholar 

  33. Hill OW, Blendis L. Physical and psychological evaluation of non-organic abdominal pain. Gut. 1967;8:221–9.

    Article  Google Scholar 

  34. Whitehead WE, Schuster MM. Gastrointestinal disorders: behavioral and physiological basis for treatment. New York: Academic; 1985.

    Google Scholar 

  35. Latimer PR. Irritable bowel syndrome: a behavioral model. Behav Res Ther. 1981;19:475–83.

    Article  Google Scholar 

  36. Latimer PR, Campbell D. Behavioral medicine and the functional bowel disorders. Int J Ment Health. 1980;9:111–28.

    Article  Google Scholar 

  37. Walker EA, Roy-Byrne PP, Katon WJ. Irritable bowel syndrome and psychiatric illness. Am J Psychiatry. 1990;147:365–72.

    Article  Google Scholar 

  38. Whitehead WE, Engel BT, Schuster MM. Irritable bowel syndrome: physiological and psychological differences between diarrhea-predominant and constipation-predominant patients. Dig Dis Sci. 1980;25:404–13.

    Article  Google Scholar 

  39. Liss JL, Alpers D, Woodruff RA. The irritable colon syndrome and psychiatric illness. Dis Nerv Syst. 1973;34:151–7.

    PubMed  Google Scholar 

  40. Young SJ, Alpers DH, Norland CC, Woodruff RA. Psychiatric illness and the irritable bowel syndrome. Gastroenterology. 1976;70:162–6.

    PubMed  Google Scholar 

  41. Surdea-Blaga T, Baban A, Nedelcu L, et al. Psychological interventions for irritable bowel syndrome. J Gastrointestin Liver Dis. 2016;25:359–66.

    PubMed  Google Scholar 

  42. Fava GA, Pavan L. Large bowel disorders: illness configuration and life events. Psychother Psychosom. 1976/1977;27:93–99.

    Article  Google Scholar 

  43. Ford MJ, Miller PM, Eastwood J. Life events, psychiatric illness, and the irritable bowel syndrome. Gut. 1987;28:160–5.

    Article  Google Scholar 

  44. Toner BB, Garfinkel PE, Jeejeebhoy KN. Self-schema in irritable bowel syndrome and depression. Psychosom Med. 1990;52:149–55.

    Article  Google Scholar 

  45. West KL. MMPI correlates of ulcerative colitis. J Clin Psychol. 1970;26:214–9.

    Article  Google Scholar 

  46. Schwarz SP, Blanchard EB, Berreman CF, et al. Psychological aspects of irritable bowel syndrome: comparisons with inflammatory bowel disease and nonpatient controls. Behav Res Ther. 1993;31:297–304.

    Article  Google Scholar 

  47. Greenbaum DS, Mayle JE, Vanegeren LE. Effects of desipramine on irritable bowel syndrome compared with atropine and placebo. Dig Dis Sci. 1987;32:257–66.

    Article  Google Scholar 

  48. Clouse RE. Antidepressants for functional gastrointestinal syndromes. Dig Dis Sci. 1994;39:2352–63.

    Article  Google Scholar 

  49. Wise TN. Gastroenterology. In: Stoudemire A, Fogel BS, editors. Principles of medical psychiatry. New York: Grune & Stratton; 1987.

    Google Scholar 

  50. Simrén M. Hypnosis for irritable bowel syndrome: the quest for the mechanism of action. Int J Clin Exp Hypn. 2006;54:65–84.

    Article  Google Scholar 

  51. Whorwell PJ, Prior A, Colgan SM. Hypnotherapy in severe irritable bowel syndrome: further experience. Gut. 1987;28:423–5.

    Article  Google Scholar 

  52. Latimer PR. Irritable bowel syndromes. In: Dorfman W, Cristofar L, editors. Psychosomatic illness review. New York: Macmillan Publishing Co; 1985.

    Google Scholar 

  53. Tang QL, Lin GY, Zhang MQ. Cognitive-behavioral therapy for the management of irritable bowel syndrome. World J Gastroenterol. 2013;19:8605–10.

    Article  Google Scholar 

  54. Lackner JM1, Jaccard J, Krasner SS, et al. How does cognitive behavior therapy for irritable bowel syndrome work? A mediational analysis of a randomized clinical trial. Gastroenterology. 2007;133:433–44.

    Article  Google Scholar 

  55. Li L, Xiong L, Zhang S, et al. Cognitive-behavioral therapy for irritable bowel syndrome: a meta-analysis. J Psychosom Res. 2014;77:1–12.

    Article  Google Scholar 

  56. Kanfer FH, Saslow G. Behavioral analysis. Arch Gen Psychiatry. 1965;12:529–38.

    Article  Google Scholar 

  57. Waller SL, Misiewicz JJ. Prognosis in the irritable-bowel syndrome. Lancet. 1969;1:753–6.

    Article  Google Scholar 

  58. Lancaster-Smith MJ, Prout BJ, Pinto T, et al. Influence of drug treatment on the irritable bowel syndrome and its interaction with psychoneurotic morbidity. Acta Psychiatr Scand. 1982;66:33–41.

    Article  Google Scholar 

  59. Chaudhary NA, Truelove SC. The irritable colon syndrome. Q J Med. 1962;31:307–22.

    PubMed  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea

    Kyung Bong Koh

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  1. Kyung Bong Koh
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Koh, K.B. (2018). Approach to Irritable Bowel Syndrome. In: Stress and Somatic Symptoms. Springer, Cham. https://doi.org/10.1007/978-3-030-02783-4_23

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