Irritable bowel syndrome (IBS) is the commonest of the functional gastrointestinal disorders (FGIDs). Its key presenting features are recurrent abdominal pain and change in bowel habit (diarrhea and/or constipation), which may be severe, such that for an individual, there may be a marked negativity on quality of life, and for the population, a major social and economic burden.
Irritable bowel syndrome is common, with research showing a prevalence as high as 20%, the wide variability related to the area of the world studied and the diagnostic criteria employed.
The causes for IBS remain mysterious, despite many efforts to unveil them, which usually means multiple factors are involved. Recently a widespread protozoan called Blastocystis sp. have been implicated as a significant risk factor. The exact mechanism through which it may cause IBS is not known.
The two central characteristics are episodic abdominal pain and a change in bowel habit:
- recurrent abdominal pain
- change in bowel habit (CBH)
- diarrhea (IBS-D)
- 50% mucus discharge
- constipation (IBS-C)
- alternating diarrhea and constipation (IBS-M)
- opening of the bowels usually occurs after a bout of lower abdominal colicky pain
- diarrhea (IBS-D)
- post infectious IBS
- subdivision of IBS-D patients who experience the presentation following an episode of acute infective enterocolitis
- other GI manifestations
- abdominal bloating
- difficulty in swallowing
- early satiety
- episodic heartburn
- chest pain (non-cardiac)
Diagnosis of irritable bowel syndrome may be difficult and rests upon the Rome criteria, now in their fourth iteration, i.e. "Rome IV".
It is not unusual for patients to have other co-existing functional gastrointestinal disorders, e.g. functional dyspepsia, which is thought to be related to the underlying, poorly-understood common pathogenic processes of these functional disorders.
History and etymology
Irritable bowel syndrome was first described in the literature over 150 years ago by W Cumming, and it is revealing that despite numerous advances since then the condition remains very puzzling in its causation 3.
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