The irritable bowel

Abstract

The irritable bowel syndrome and its variants appear to affect about one third of the population, but most sufferers do not see a doctor. Progress in our understanding of this disorder is hampered by imprecise definitions, and the lack of a pathophysiologic marker. There is evidence of abnormal gut motility and myoelectric activity, and a suggestion that nerves and hormones play an important role. Diet, emotions, and infections are undeniable, but variable, contributing factors. While academicians grapple with aetiology it is the physician's duty to precisely and positively diagnose the syndrome, so that he may explain an reassure. The irritable bowel syndrome is a great problem to doctors and patients because of the worry that symptoms might indicate serious pathology such as inflammatory bowel disease or cancer. The short term therapeutic response to placebo is very high and no diet or medication consistently outperforms it. Bran and other bulking agents seem safe and are probably most effective when constipation is present. Peppermint oil shows some promise, and anticholinergics may be tried in persistent postprandial symptoms. It is most important, in this lifelong condition, that the risks of investigation and treatment not exceed those of the disease. As only a minority of irritable bowel syndrome sufferers bring their complaints to a physician it is important to find out why the patient consults. The stressed, the unloved, and the cancer-phobic will have very different needs in diagnosis and in treatment.