Patient Case A 47-year-old woman presents with complaints of occasional constipation during the past several years (Table 1). She states that she has experienced increasing abdominal […]
G&H What are the key parts of the brain and nervous system that play a role in irritable bowel syndrome symptoms? PB Communication between the […]
Abstract: There is growing appreciation that functional gastrointestinal disorders (FGIDs) such as functional dyspepsia and irritable bowel syndrome are heterogeneous conditions linked by subtle inflammation […]
G&H What is the relationship between irritable bowel syndrome and the microbiome? WC There is evidence to suggest that the microbiome is implicated in the […]
Abstract: Irritable bowel syndrome (IBS) is the most prevalent functional gastrointestinal disorder, affecting approximately 14% of the global population. Symptoms of IBS are some of […]
G&H What is the relationship between food and irritable bowel syndrome? SC Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by abdominal […]
G&H What is food intolerance? WC Food intolerance refers to a condition in which patients develop an adverse outcome as a consequence of eating certain […]
G&H What factors contribute to the pathogenesis of irritable bowel syndrome? GB The diagnosis of irritable bowel syndrome (IBS) is based on symptom criteria, and […]
G&H What is the evidence to support a role of the microbiome in the pathogenesis of irritable bowel syndrome? EM Four recent studies have demonstrated […]
Improving the Treatment of Irritable Bowel Syndrome With the Rome IV Multidimensional Clinical Profile
G&H How do the Rome IV criteria differ from the Rome III criteria? DD One of the biggest changes with the Rome IV criteria is […]
G&H Which medical therapies are currently available to treat irritable bowel syndrome? MC Most of the currently available treatment options for irritable bowel syndrome (IBS) […]
G&H What are the Rome IV criteria, and how were they developed? LC The Rome criteria were originally developed to understand functional gastrointestinal disorders (FGIDs), […]
Functional bowel disorders, including irritable bowel syndrome (IBS), are common disorders that have a significant impact on patients’ quality of life. These disorders present major challenges to healthcare providers, as few effective medical therapies are currently available. Recently, there has been increasing interest in dietary therapies for IBS, particularly a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs). Since ingestion of FODMAPs increases the delivery of readily fermentable substrates and water to the distal small intestine and colon—which results in luminal distention and gas—the reduction of FODMAPs in a patient’s diet may improve functional gastrointestinal symptoms. This paper will review the pathophysiology of IBS and the role of FODMAPs for the treatment of this condition.
Abstract: Abdominal bloating is commonly reported by men and women of all ages. Bloating occurs in nearly all patients with irritable bowel syndrome, and it also occurs in patients with other functional and organic disorders. Bloating is frequently disturbing to patients and frustrating to clinicians, as effective treatments are limited and are not universally successful. Although the terms bloating and abdominal distention are often used interchangeably, these symptoms likely involve different pathophysiologic processes, both of which are still not completely understood. The goal of this paper is to review the pathophysiology, evaluation, and treatment of bloating and abdominal distention.
Abstract: Pain is a common complaint in inflammatory bowel disease, and it has significant consequences for patients’ quality of life. A thorough evaluation to determine the source of patients’ pain should include clinical, laboratory, radiologic, and endoscopic assessments as indicated. Differentiating among active inflammation, secondary complications, and functional pain can be complicated. Even when all active disease is adequately treated, clinicians are often left with the difficulty of managing chronic pain. This paper will review the benefits and limitations of several commonly used treatments and promising future therapies. A suggested treatment algorithm will provide some guidance in this challenging area of inflammatory bowel disease management.
Abstract: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder with an estimated worldwide prevalence of 10–20%. IBS can be associated with severe gastrointestinal symptoms, including abdominal pain, bloating, and altered bowel function. Although the causes of IBS remain undefined, recent research has increasingly suggested roles for gut flora in IBS. These roles involve postinfectious IBS, which can occur after a single episode of acute gastroenteritis, and small intestinal bacterial overgrowth, in which elevated populations of aerobic and anaerobic bacteria cause abdominal pain and altered bowel function. More recently, potential roles for methanogens in contributing to IBS subtypes have also been identified. In this paper, we review the different mechanisms by which gut flora may contribute to IBS and also discuss the efficacy and safety of various antibiotic therapies for treating IBS symptoms.
Abstract: Traveler’s diarrhea (TD) is a crucial area for research, as it affects millions of tourists each year and creates a large economic burden. More than 60% of TD cases are caused by a variety of bacterial enteropathogens: diarrhea-producing Escherichia coli, Shigella, Campylobacter, Salmonella, Aeromonas, Plesiomonas, and noncholera Vibrios. Noroviruses are also an important cause of morbidity among travelers. Recent studies have identified host genetic risk factors associated with susceptibility to pathogen-specific TD. Prevention strategies should be emphasized, as all individuals with TD experience approximately 24 hours of disability and 5–10% experience chronic functional bowel disease. Poorly absorbed rifaximin provides protection for trips lasting 2 weeks or less. TD vaccines are also currently in development. All individuals planning trips to developing regions should be armed with 1 of the 3 agents that have shown efficacy for self-treatment of TD: ciprofloxacin (or levofloxacin), rifaximin, or azithromycin, depending upon the location of the trip. Although global epidemiologic changes in etiologic agents as well as antibiotic resistance patterns have been better understood recently, changes should be expected during the next decade due to new prevention and treatment approaches.