Volume 5 Issue 7 July 2015
Consultation Liaison Psychiatry Focus: “Gastroenterology‟
Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder associated with high morbidity. It is characterized by abdominal pain or discomfort and altered bowel habit in the absence of specific organic pathology. Throughout the world, about 10–20% of adults and adolescents have symptoms consistent with IBS, and most studies show a female predominance. For its diagnosis, recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months (with symptoms for 6 months prior to diagnosis) associated with two or more of following should be present: improvement with defecation; onset associated with a change in frequency of stool; and onset associated with a change in form of stool.
In brief the disease result as a complex of altered GI motility, visceral hyperalgesia, psychopathology, post infectious IBS, abnormal serotonin pathways and altered gastrointestinal microbiome. Four bowel pattern may be seen in irritable bowel syndrome – IBS-D (diarrhea predominant), IBS-C (constipation predominant), IBS-M (mixed diarrhea and constipation), and IBS-A (alternating diarrhea and constipation).
It is important to establish an effective physician-patient relationship and make a positive firm diagnosis to reassure the patient once the diagnosis of IBS is made. IBS is a multifactorial disease hence it needs integrated treatment approach which includes dietary modifications, psychological therapies, and pharmacotherapy like antispasmodic, stool-bulking agents, antidiarrheal agents, antidepressants, antiflatulence therapy, serotonin receptor agonist and antagonists, and modulation of gut flora. Serotonin antagonist (alosetron) is helpful in IBS-D type and serotonin agonist (tegaserod) helpful in IBS-C type. Tricyclic antidepressants (e.g. desipramine) are found to be useful in IBS-D type by delaying whole gut and orocecal transient, whereas SSRI accelerate orocecal transit so its efficacy in IBS-C needs further confirmation.
Reducing stress may reduce the frequency and severity of IBS symptoms. A recent systematic review by Park et al (2014) revealed positive effects of relaxation therapy on IBS symptoms in adults. NICE clinical guidelines recommend that consideration should be given to psychological treatment strategies such as cognitive behavioural therapy (CBT), hypnotherapy and/or psychological therapy such as deep or abdominal breathing, progressive muscular relaxation, guided imagery, visualization techniques, yoga, Pranayam, meditation etc.
Dr Gaurav Gupta, Assistant Professor, Dept of Gastroenterology, S.M.S. Medical College, Jaipur (Email: kumarggauravpgi@gmail.com); Swapnil Tripathi, final year, MBBS student, AIIMS, Jodhpur
