Irritable bowel syndrome and functional gi disorders in inflammatory bowel disease

Abstract

Irritable bowel syndrome (IBS) is characterized by abdominal pain and altered bowel habits in the absence of an identifiable structural abnormality. Abdominal bloating, loose stools, urgency associated with bowel movements, and feelings of incomplete evacuation are common symptoms. Since there are no diagnostic laboratory tests to confirm the diagnosis, IBS is usually a clinical diagnosis, and symptom-based diagnostic criteria have been proposed. Unlike adults, there are few published studies in pediatric age group, especially in young children, validating these criteria. It is generally thought that IBS symptoms result from the convergence of multiple factors, including a genetic predisposition, an infectious or inflammatory injury to the gastrointestinal (GI) tract leading to altered sensory perception by the brain, and an underlying bowel dysmotility. Children with inflammatory bowel disease are prone to developing visceral hypersensitivity due to chronic GI tract inflammation. Abdominal pain and loose stools in the absence of detectable and clinically significant gut mucosal inflammation should prompt one to consider this diagnosis in patients with IBD. Judicious use of endoscopic examination in addition to laboratory test to screen for bowel mucosal inflammation can be helpful in differentiating symptoms due to relapse of IBD for visceral hypersensitivity and IBS. Symptom relief is the primary goal of management in IBS; targeting the most distressing symptom is recommended. Current treatment includes diet modification, antibiotics for small bowel bacterial overgrowth and probiotics, cognitive behavioral therapy (CBT) to empower the patient to cope with chronic illness and learn to control their symptoms, and drugs for neuropathic pain.