Intestinal sensitivity (visceral hypersensitivity) is a key feature in most patients with IBS. The authors outline environmental factors that are strongly implicated in some patients including gastrointestinal infection and inflammation and chronic stress. They discuss how treatment remains unsatisfactory, relying on an excellent doctor-patient relationship, with drugs for symptom exacerbations. Cognitive behavioural treatment, psychotherapy, and hypnosis could provide long-lasting benefit in some patients. Tricyclic antidepressants in low doses seem to be the most effective class of drugs for the disorder on the basis of limited data.
Robin Spiller comments: "Irritable bowel syndrome is a major cause of morbidity and deserves serious attention. Although stress can stimulate the colon in this disorder and in health, this factor cannot be the only cause of symptoms. Evidence is growing that irritable bowel syndrome can no longer be purely regarded as a functional disorder-which is a loose term frequently used to describe anything that we cannot adequately explain, or probable psychiatric disease. We prefer to judge the disorder to be a discrete collection of organic bowel diseases, with characteristic morphological, psychological, and physiological changes now only being fully appreciated. We believe that such a view will benefit research in the area, and eventually our patients."
Professor Robin Spiller, Division of Gastroenterology,
C Floor South Block, University Hospital, Nottingham NG7 2UH, UK;
(NHS secretary Charlotte Pearson 44-115-924-9924 ext 44548);
University Secretary Emma Bradley 44-115-924-9924 ext 35077); F) 44-115-924-2232.
Professor Nicholas J Talley, University of Sydney, Nepean Hospital,
Penrith, NSW 2751, Australia;
F) 61-2-4734 2614;