The Psychiatric Perspective of Irritable Bowel Syndrome

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Irritable bowel syndrome (IBS) is a functional GI disorder (FGID) characterized by abdominal pain in association with altered bowel habits in the absence of any identifiable structural or biochemical abnormalities. It is a very common disorder that can have a profound negative impact on a patient’s quality of life and constitutes a considerable social and economic burden on society. Extensive research over the last few decades has led to a better understanding of this complex syndrome and improvements in treatment. After a brief review of the clinical manifestations and diagnosis of IBS, the current understanding of the complex physiological mechanisms contributing to the syndrome will be addressed. The remainder of this paper will focus on a number of important topics at the interface of IBS and psychiatry, including psychiatric comorbidity in IBS, the complex role of psychosocial stressors in the onset and perpetuation of symptoms in IBS, and various considerations in the management of IBS from the perspective of psychiatry. IBS is a functional GI disorder, meaning it cannot be explained by any specific structural or biochemical abnormality. The disorder is subdivided into three different types, which are named on the basis of the predominant symptom – IBS-D (diarrhea-predominant), IBS-C (constipation-predominant), IBS-M (mixed diarrhea and constipation). Clinical presentation varies considerably with regard to the quality of the predominant feature and the overall severity of symptoms. Formal diagnosis is based on the most recent Rome III criteria, which require that a patient experience recurrent abdominal discomfort of at least 3 days per month over the previous 3 months, with a total symptom duration of at least 6 months, in... ... middle of paper ... ...of IBS. A final important consideration in the management of IBS patients from a psychiatric perspective revolves around the use of psychopharmacologic agents in treatment. The rationale for use of anti-depressant medications in IBS patients is based not only the observed psychiatric comorbidity in this population, but also on the role of these medications in improving central pain perception and physiologic response of the gut to descending signals. The evidence-based position statement of the American College of Gastroenterology (2008) affirms that both low-dose TCAs and SSRIs are more effective than placebo at reducing global IBS symptoms and abdominal pain. More evidence exists for the benefit of TCAs in IBS treatment, and they have been shown to decrease global symptoms and abdominal pain at lower doses than those required for the treatment of depression (2).

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