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    Irritable bowel syndrome is a highly prevalent condition responsible for almost one third of visits to the gastroenterologist and huge expenses for diagnosis, treatment and loss of working days. A unique pathophysiologic mechanism has not been elucidated yet and several possibilities have been proposed such as senso-perception and motor disturbances, the effect of stress and anxiety, serotonin receptor failures, activation of abnormal brain areas and pain modulation differences, among others.

    The absence of a biological marker has led the investigators to consider this syndrome as an exclusion diagnostic condition, once the organic diseases have been discarded The changes in gut microbiota have recently raised great interest among gastroenterologists.

    The study of the small intestinal bowel overgrowth syndrome , the effect of antibiotics upon the flora, the recognition of post-infectious irritable bowel syndrome and the action of probiotics, together with the effect of malabsortion of diet carbohydrates have brought some new light in our knowledge. The present update will focus on the published evidence about the subject, bearing in mind that the mechanisms elicited here are only suitable for a subgroup of patients. Defining and diagnosing irritable bowel syndrome.

    The Rome II criteria, a standardized guideline for the diagnosis of IBS, contains in its definition abdominal pain or discomfort associated with altered bowel habits.

    Bloating may often be present. Three patient subgroups are defined according to the predominant bowel symptom: Hematology, fecal occult blood test, flexible sigmoidoscopy, and lactose intolerance evaluations are recommended for all patients demonstrating symptoms of IBS.

    When indicated, tests are recommended to rule out bacterial or parasitic infections, pelvic floor muscle dyssynergia, colonic inertia, peptic ulcer, or inflammatory bowel disease. Irritable bowel syndrome --the main recommendations. Irritable bowel syndrome is characterized by chronic abdominal symptoms and irregular bowel movements without any cause than can be revealed by routine diagnostic assessment.

    In recent years, its pathophysiology has come to be much better understood, and new therapeutic approaches have been developed. These advances were taken into consideration and assessed for their relevance to clinical practice in the framework of a new interdisciplinary S3 guideline. A systematic search of the literature retrieved a total articles, from which were selected on the basis of criteria relating to their form and content, individually assessed, and summarized in evidence tables.

    The recommendations formulated in this way were discussed in a Delphi procedure and a consensus conference, then accordingly modified and finalized. Variable symptom constellations are caused by disturbances of gastrointestinal regulation at multiple levels. The diagnosis of irritable bowel syndrome requires both chronic bowel symptoms that interfere with everyday life and the exclusion of relevant differential diagnoses.

    Its treatment is based on general therapeutic principles, dietary recommendations, psychological components, and symptomatic medication. Bulking agents, laxatives, spasmolytics, loperamide, and probiotic agents are recommended with variable recommendation strengths , as are--for selected patients--antidepressants, 5-HT4 agonists, 5-HT3 antagonists, and topical antibiotics. The first German S3 guideline on irritable bowel syndrome translates up-to-date scientific knowledge as represented in current publications into concrete recommendations for diagnosis and treatment in clinical practice.

    In the future, it is likely that further causative pathophysiological mechanisms will be discovered; this should lead, in turn, to the development of new, causally directed treatments, which will supplement or replace the traditional, purely symptomatic treatments that are still in use today. Psychological factors in the irritable bowel syndrome. This paper reviews recent psychological studies of patients with the irritable bowel syndrome IBS or 'functional abdominal pain'. Many studies have used unreliable or invalid methods of assessment and some have confused personality with treatable psychiatric illness.

    When psychiatric disorder is diagnosed in a patient with IBS there are three possibilities: Further research is needed to clarify when psychological abnormalities play a role in the aetiology of IBS and when they are coincidental, but lead to illness behaviour. The role of psychological factors in the aetiology of the irritable bowel syndrome IBS is far from clear, but a review of the literature suggests that some consistent patterns are emerging in spite of methodological problems.

    There have been three major defects with studies that have linked IBS with neurotic symptomatology. First, the measurement of psychological factors has generally been imprecise. Second, most studies have considered IBS patients as a single group, without making allowance for differing symptom patterns.

    Third, conclusions have been drawn. Irritable bowel syndrome is characterized by chronic gastrointestinal symptoms without a demonstrable physical cause. In a subgroup of patients, irritable bowel syndrome may be part of a cluster of psychosomatic symptoms related to childhood sexual abuse. Butyric acid in irritable bowel syndrome. Butyric acid butanoic acid belongs to a group of short-chain fatty acids and is thought to play several beneficial roles in the gastrointestinal tract.

    Butyric anion is easily absorbed by enteric cells and used as a main source of energy. Moreover, butyric acid is an important regulator of colonocyte proliferation and apoptosis, gastrointestinal tract motility and bacterial microflora composition in addition to its involvement in many other processes including immunoregulation and anti-inflammatory activity. The pathogenesis of irritable bowel syndrome IBS , the most commonly diagnosed functional gastrointestinal condition, is complex, and its precise mechanisms are still unclear.

    This article describes the potential benefits of butyric acid in IBS. Managing irritable bowel syndrome IBS is difficult and often a source of dissatisfaction for the patient, explaining the increasingly frequent recourse to alternative treatments. These highly varied treatments are often associated. They can be classed into four categories: Although some studies show interesting results, currently there are not sufficient scientific arguments to recommend one or another of these alternative treatments.

    Multicenter controlled studies are needed to better evaluate the strategies that appear to be cost-effective. The Syndrome of Irritable Intestine SII is a chronic functional dysfunction that it is characterized by abdominal pain and changes of intestinal rhythm without demonstrable organic alteration.

    It is avery prevelent dysfunction in the developed countries, there being involved in its physiopathology, among other, the psychosocial factors illness behavior, social situation, stress, vital events, neuroticism, anxiety and somatization.

    However no study has been carried out on the Rational Intelligence and Experiential Intelligence or Constructive Thought in patient with SII in spite of knowing that the cognitive processes participate in its genesis. On the hypothesis that the patients with SII would have an experiencial intelligence smaller that the fellows controls, cases of SII and controls have been studied, being excluded of both patients groups with intellectual deficit or psychiatric illness in the last year.

    The cases of SII were distributed in two groups, one of 50 cases that habitually consulted with the doctor and other 50 that didn't make it. All the participants completed specific tests to evaluate all the psychological factors and Rational Intelligence and the Constructive Thought.

    The results show an alteration of the psychological factors in the SII, expressed by the antecedents of vital events, m even significant of anxiety feature and anxiety and a neuroticism statistically significant.

    Only in the group of SII that habitually consulted with the doctor a slightly significant decrease of the intellectual coefficient it was observed. As for the Experiential Intelligence a significant decrease of the Constructive Thought was observed in the patients with SII in comparison with the group control. Of their components a decrease of the emotionality exists and of the. Relieving abdominal pain is the principal treatment objective for patients with irritable bowel syndrome.

    No single drug stands out in the treatment strategy for this illness. Antispasmodics, magnesium aluminum silicates, and alverine citrate drugs all remain initial options for treatment, although their prescription is impeded by the fact that an increasing number are no longer approved for reimbursement.

    Increased dietary fibers often have a harmful effect on symptoms. Some patients are probably intolerant to some foods but there is no satisfactory proof on which to base a restrictive diet. Improved knowledge of the pathophysiology of irritable bowel syndrome has made it possible to diversify treatments that act first on one of the key pathophysiologic elements, visceral hypersensitivity.

    Antidepressants especially tricyclics can be used at low doses. Among the serotonergic drugs, serotonin 5-HT4 receptors agonists tegaserod may be available soon, but the development of 5-HT3 antagonists alosetron, cilansetron has been stopped for safety reasons ischemic colitis and severe constipation.

    Non-drug options such as hypnosis, psychotherapy, relaxation, or yoga, may also be proposed to some patients. Probiotics are a possible treatment in the future. The treatment of irritable bowel syndrome. Irritable bowel syndrome IBS is a highly prevalent functional bowel disorder routinely encountered by healthcare providers. Although not life-threatening, this chronic disorder reduces patients' quality of life and imposes a significant economic burden to the healthcare system.

    IBS is no longer considered a diagnosis of exclusion that can only be made after performing a battery of expensive diagnostic tests. Rather, IBS should be confidently diagnosed in the clinic at the time of the first visit using the Rome III criteria and a careful history and physical examination.

    Treatment options for IBS have increased in number in the past decade and clinicians should not be limited to using only fiber supplements and smooth muscle relaxants. Although all patients with IBS have symptoms of abdominal pain and disordered defecation, treatment needs to be individualized and should focus on the predominant symptom. This paper will review therapeutic options for the treatment of IBS using a tailored approach based on the predominant symptom. Abdominal pain, bloating, constipation and diarrhea are the four main symptoms that can be addressed using a combination of dietary interventions and medications.

    Treatment options include probiotics, antibiotics, tricyclic antidepressants, selective serotonin reuptake inhibitors and agents that modulate chloride channels and serotonin. Each class of agent will be reviewed using the latest data from the literature. Probiotics use to treat irritable bowel syndrome. Irritable bowel syndrome IBS is a common chronic gastrointestinal GI tract disorder with significant disability and a considerable financial burden to health service due to the consumption of resources including investigations, physician time, and cost of treatment.

    Despite availability of multiple treatment options, there is still poor functional recovery. Probiotics has been investigated as a promising treatment for IBS, and have demonstrated beneficial effects in some patients. There are many clinical trials investigating the therapeutic benefits of probiotics in IBS but most of them are heterogenic in terms of dose or species used and clinical endpoints.

    However, recent major meta-analyses revealed benefits of probiotics in patients with IBS. Inhibition of binding of pathogenic bacteria to intestinal epithelial cells, enhancing barrier function of intestinal epithelial, acidification of the colon, suppression of the growth of pathogens, modulation of immunity, inhibition of visceral hypersensitivity, alteration in mucosal response to stress, and improvement of bowel dysmotility are among mechanisms that probiotics may act.

    Most commonly used probiotics come from the genera Bifidobacterium and Lactobacillus but other species are in trial. Although further studies are still needed, current evidences are almost enough to convince experts that probiotics are efficient in the treatment of IBS. Yoga as Remedial Therapy. Irritable bowel syndrome IBS is a group of symptoms manifesting as a functional gastrointestinal GI disorder in which patients experience abdominal pain, discomfort, and bloating that is often relieved with defecation.

    IBS is often associated with a host of secondary comorbidities such as anxiety, depression, headaches, and fatigue. An analogy between the age old, the most profound concept of Adhi-Vyadhi, and modern scientific stress-induced dysregulation of brain-gut axis, as it relates to IBS that could pave way for impacting IBS, is emphasized. Based on these perspectives, a plausible Yoga module as a remedial therapy is provided to better manage the primary and secondary symptoms of IBS.

    Conventional pharmacological treatments to manage IBS-related visceral pain is unsatisfactory. Recently, medications have emerged to treat IBS patients by targeting the gastrointestinal GI tract and peripheral nerves to alleviate visceral pain while avoiding adverse effects on the central nervous system CNS. Evidence of Acquisition In this paper, reputable internet databases from - were searched including Pubmed and ClinicalTrials.

    Search was performed based on the following keywords and combinations: Clonidine, gabapentin and pregabalin can moderately improve IBS symptoms. Alosetron, granisetron and ondansetron can generally treat pain in IBS-D patients, of which alosetron needs to be used with caution due to cardiovascular toxicity.

    Conclusions Conventional pain managing drugs are in general not suitable for treating IBS pain. A cross-cultural perspective on irritable bowel syndrome.

    Irritable bowel syndrome is a functional gastrointestinal illness, defined by symptoms. Irritable bowel syndrome has been described as a biopsychosocial condition, in which colonic dysfunction is affected by psychological and social factors. As a result of this unusual constellation, irritable bowel syndrome may be subject to cultural variables that differ in different parts of the globe.

    In this article, we describe some of the ways in which irritable bowel syndrome may be experienced differently, depending on local belief systems, psychological pressures, acceptance or resistance to a mind-body paradigm, and breakdown in support or relationship structure.

    Examples are given in which irritable bowel syndrome investigators from countries around the world describe various aspects of the syndrome that may affect the illness experience of their patients. We describe our own research studies that have demonstrated possible adverse effects on disease severity from relationship conflict, attribution of symptoms to physical rather than emotional cause, and the belief that irritable bowel syndrome is enduring and mysterious.

    Also described is our finding that symptom patterns may differ significantly between different geographic locations. Finally, we discuss the importance of "cultural competence" on the part of healthcare professionals in regard to caring for patients of diverse cultural backgrounds. Medical and psychological aspects of irritable bowel syndrome. Irritable bowel syndrome is a disease process commonly encountered by primary care providers. Although the cause of this illness is unknown, much is known about the pathophysiology and strong psychosocial influences.

    Medical practitioners often are aware of the medical aspects of managing irritable bowel syndrome but are not familiar with specific psychologic options. Long-term care of these patients may be aided by collaboration with mental health professionals. Intestinal adaptation in short bowel syndrome: Short bowel syndrome is a clinical entity that includes loss of energy, fluid, electrolytes or micronutrient balance because of inadequate functional intestinal length.

    This case report demonstrates the case of a woman who compensated for short bowel syndrome through intestinal adaptation, which is a complex process worthy of further investigation for the avoidance of dependence on total parenteral nutrition and of intestinal transplantation in such patients.

    Published by Elsevier B. Technologies in the evaluation of irritable bowel syndrome. During a meeting in The Hague, The Netherlands, the IBiS Club evaluated the most important techniques that can be used in the investigation of irritable bowel syndrome , either in the context of scientific research or as a clinical diagnostic tool.

    In each of these, the relevance of findings made in irritable bowel syndrome was balanced against the applicability of the technique. The discussion of the group is summarized in this paper. Irritable bowel syndrome and food interaction. Irritable bowel syndrome IBS is one of the most common gastrointestinal disorders in Western countries.

    Despite the high prevalence of this disorders, the therapeutic management of these patients is often unsatisfactory. A number of factors have been suggested to be involved in the pathogenesis of IBS, including impaired motility and sensitivity, increased permeability, changes in the gut microbiome and alterations in the brain-gut axis. Also food seems to play a critical role: Recently, an increasing attention has been paid to the role of food in IBS.

    In this review we summarize the most recent evidences about the role of diet on IBS symptoms. A diet restricted in fermentable, poorly absorbed carbohydrates and sugar alcohols has beneficial effects on IBS symptoms. More studies are needed to improve our knowledge about the relationship between food and IBS. However, in the foreseeable future, dietary strategies will represent one of the key tools in the therapeutic management of patients with IBS.

    Asian motility studies in irritable bowel syndrome. Altered motility remains one of the important pathophysiologic factors in patients with irritable bowel syndrome IBS who commonly complain of abdominal pain and stool changes such as diarrhea and constipation.

    The prevalence of IBS has increased among Asian populations these days. Gastrointestinal GI physiology may vary between Asian and Western populations because of differences in diets, socio-cultural backgrounds, and genetic factors. MEDLINE search work was performed including following terms, 'IBS,' 'motility,' 'transit time,' 'esophageal motility,' 'gastric motility,' 'small intestinal motility,' 'colonic motility,' 'anorectal function,' and 'gallbladder motility' and over articles were categorized under 'esophagus,' 'stomach,' 'small intestine,' 'colon,' 'anorectum,' 'gallbladder,' 'transit,' 'motor pattern,' and 'effect of stressors.

    Many conflicting results were found among these studies and there are still controversies to conclude these as unique features of Asian IBS patients. Multinational and multicenter studies are needed to be performed vigorously in order to elaborate characteristics as well as differences of altered motililty in Asian patients with IBS.

    Asian consensus on irritable bowel syndrome. Many of the ideas on irritable bowel syndrome IBS are derived from studies conducted in Western societies. Their relevance to Asian societies has not been critically examined. Our objectives were to bring to attention important data from Asian studies, articulate the experience and views of our Asian experts, and provide a relevant guide on this poorly understood condition for doctors and scientists working in Asia.

    A multinational group of physicians from Asia with special interest in IBS raised statements on IBS pertaining to symptoms, diagnosis, epidemiology, infection, pathophysiology, motility, management, and diet. A modified Delphi approach was employed to present and grade the quality of evidence, and determine the level of agreement.

    We observed that bloating and symptoms associated with meals were prominent complaints among our IBS patients. In the majority of our countries, we did not observe a female predominance. In some Asian populations, the intestinal transit times in healthy and IBS patients appear to be faster than those reported in the West. High consultation rates were observed, particularly in the more affluent countries. There was only weak evidence to support the perception that psychological distress determines health-care seeking.

    Dietary factors, in particular, chili consumption and the high prevalence of lactose malabsorption, were perceived to be aggravating factors, but the evidence was weak. This detailed compilation of studies from different parts of Asia, draws attention to Asian patients' experiences of IBS. For many years irritable bowel syndrome IBS and celiac disease CD have been considered 2 completely separate entities, with CD being clearly related to a permanent gluten intolerance and IBS having no relation with gluten ingestion.

    However IBS and CD symptoms may be indistinguishable, especially when diarrhea, bloating or abdominal pain predominate. In the last decade several studies have shown that the separation between CD and IBS is not so clear.

    In addition, it seems that there is a group of patients who, without having CD, suffer gluten intolerance that cause them digestive symptoms similar to those of IBS. Gluten sensitivity is defined as the spectrum of morphological, immunological and functional abnormalities that respond to a gluten-free diet.

    This concept includes histological, immunological and clinical manifestations in the absence of evident morphological abnormalities. Therefore, it is mandatory to establish in a scientific way in which patients a gluten-free diet will be beneficial as well as when this is not justified. Dietary fiber in irritable bowel syndrome Review. Irritable bowel syndrome IBS is a common chronic gastrointestinal disorder.

    It is widely believed that IBS is caused by a deficient intake of dietary fiber, and most physicians recommend that patients with IBS increase their intake of dietary fiber in order to relieve their symptoms. However, different types of dietary fiber exhibit marked differences in physical and chemical properties, and the associated health benefits are specific for each fiber type.

    By contrast, long-chain, intermediate viscous, soluble and moderately fermentable dietary fiber, such as psyllium results in a low gas production and the absence of the symptoms related to excessive gas production. The effects of type of fiber have been documented in the management of IBS, and it is known to improve the overall symptoms in patients with IBS.

    Fiber supplementation, particularly psyllium, is both safe and effective in improving IBS symptoms globally. Dietary fiber also has other health benefits, such as lowering blood cholesterol levels, improving glycemic control and body weight management. Gallstone ileus is an uncommon cause of small bowel obstruction.

    When the gallstone lodges inside the duodenum and causes gastric outlet obstruction, it is termed Bouveret's syndrome. However, it is rather unusual to seen the evolution of a migrating gallstone from duodenum to distal small bowel in a patient during the same hospital admission.

    We report a case of gallstone ileus from the initial presentation of gastric outlet obstruction to the development of distal small bowel obstruction within the same hospital admission, and its total laparoscopic treatment.

    Irritable bowel syndrome IBS remains a clinical challenge in the 21st century. Its can affect up to one in five people at some point in their lives, and has a significantly impact of life quality and health care utilization. The prevalence varies according to country and criteria used to define IBS.

    Various mechanisms and theories have been proposed about its etiology, but the biopsychosocial model is the most currently accepted for IBS. The complex of symptoms would be the result of the interaction between psychological, behavioral, psychosocial and environmental factors. The diagnosis of IBS is not confirmed by a specific test or structural abnormality. It is made using criteria based on clinical symptoms such as Rome criteria, unless the symptoms are thought to be atypical.

    Secure positive evidence of IBS by means of specific disease marker is currently not possible and cannot be currently recommended for routine diagnosis. There is still no clinical evidence to recommend the use of biomarkers in blood to diagnose IBS. However, a number of different changes in IBS patients were demonstrated in recent years, some of which can be used in the future as a diagnostic support. IBS has no definitive treatment but could be controlled by non-pharmacologic management eliminating of some exacerbating factors such certain drugs, stressor conditions and changes in dietary habits.

    The traditional pharmacologic management of IBS has been symptom based and several drugs have been used. However, the cornerstone of its therapy is a solid patient physician relationship.

    This review will provide a summary of pathophysiology, diagnostic criteria and current and emerging therapies for IBS. Breath tests and irritable bowel syndrome. Breath tests are non-invasive tests and can detect H2 and CH4 gases which are produced by bacterial fermentation of unabsorbed intestinal carbohydrate and are excreted in the breath.

    These tests are used in the diagnosis of carbohydrate malabsorption, small intestinal bacterial overgrowth, and for measuring the orocecal transit time. Abdominal bloating is a common nonspecific symptom which can negatively impact quality of life. It may reflect dietary imbalance, such as excess fiber intake, or may be a manifestation of IBS. However, bloating may also represent small intestinal bacterial overgrowth. Patients with persistent symptoms of abdominal bloating and distension despite dietary interventions should be referred for H2 breath testing to determine the presence or absence of bacterial overgrowth.

    If bacterial overgrowth is identified, patients are typically treated with antibiotics. Evaluation of IBS generally includes testing of other disorders that cause similar symptoms. Carbohydrate malabsorption lactose, fructose, sorbitol can cause abdominal fullness, bloating, nausea, abdominal pain, flatulence, and diarrhea, which are similar to the symptoms of IBS. However, it is unclear if these digestive disorders contribute to or cause the symptoms of IBS.

    Research studies show that a proper diagnosis and effective dietary intervention significantly reduces the severity and frequency of gastrointestinal symptoms in IBS. Thus, diagnosis of malabsorption of these carbohydrates in IBS using a breath test is very important to guide the clinician in the proper treatment of IBS patients.

    The Mexican consensus on irritable bowel syndrome. To present a consensus review of the most current knowledge of IBS, updating the Guidelines by incorporating new internationally published scientific evidence, with a special interest in Mexican studies. The PubMed literature from January to March was reviewed and complemented through a manual search. Articles in English and Spanish were included and preference was given to consensuses, guidelines, systematic reviews, and meta-analyses.

    Statements referring to the different aspects of the disease were formulated and voted upon by 24 gastroenterologists employing the Delphi method. Once a consensus on each statement was reached, the quality of evidence and strength of recommendation were determined through the GRADE system.

    Forty-eight statements were formulated, updating the information on IBS and adding the complementary data that did not appear in the Guidelines regarding the importance of exercise and diet, diagnostic strategies, and current therapy alternatives that were analyzed with more stringent scientific vigor or that emerged within the last 5 years. We present herein a consensus review of the most relevant advances in the study of IBS, updating and complementing the Guidelines.

    Several studies conducted in Mexico were included. Role of alimentation in irritable bowel syndrome. Different food items are made responsible for irritable bowel syndrome IBS symptoms, but the physiopathology of IBS remains unclear. Food allergy remains a difficult diagnosis, but medical and general history, presence of general symptoms such as skin rash, and hypersensitivity tests may help in achieving a positive diagnosis. On the other hand, food intolerance is more confusing because of the subjectivity of the relationship between ingestion of certain foods and the appearance of clinical symptoms.

    Different food items which are commonly implicated in adverse reactions mimicking IBS were found to be stimulants for the gut, suggesting that patients with predominant diarrhea IBS have to be carefully questioned about consumption of different kinds of food i.

    Gas production is discussed on the basis of retention of intestinal gas as well as on malabsorption of fermentable substrates. The role of a large amount of this kind of substrate reaching the colon is suggested as a potential mechanism of IBS-type symptoms in overeating patients. Regarding the role of fiber in IBS, the expert group concluded that fibers are not inert substances and that they could trigger pain or bloating in some IBS patients.

    Despite numerous reviews on this subject, it is very difficult to give general dietary advice to IBS patients, but dieteticians may have a positive role in managing such patients.

    Food patch testing for irritable bowel syndrome. The traditional classification of irritable bowel syndrome IBS as a functional disorder has been challenged in recent years by evidence of ongoing low-grade gastrointestinal tract inflammation.

    Inflammation may alter gastrointestinal motility and thus be central to the pathogenesis of IBS. Many foods and food additives are known to cause allergic contact dermatitis. We hypothesize that allergenic foods and food additives may elicit a similar allergic reaction in the gastrointestinal tract, giving rise to symptoms suggestive of IBS. We sought to determine whether skin patch testing to a panel of foods and food additives may identify food allergens that may be responsible for symptoms of IBS.

    We performed skin patch testing to common allergenic foods and food additives on individuals with a history of or symptoms suggestive of IBS. We used patch test-guided avoidance diets to determine whether avoidance alleviates IBS symptoms. Thirty of the 51 study participants showed at least 1 doubtful or positive patch test result. Allergic contact enteritis to ingested foods, food additives, or both may contribute to IBS symptoms.

    Patch testing may be useful in identifying the causative foods. Published by Mosby, Inc. Bowel obsession syndrome in a patient with ulcerative colitis. Gastroenterologists are often faced with the diagnostic problem of differentiating acute symptoms of ulcerative colitis from functional intestinal disorders. Bowel obsession syndrome BOS is an OCD-like, functional syndrome characterized by fear of fecal incontinence and compulsive behaviors of evacuation-checking.

    Only sparse case studies on treatment of BOS with antidepressants have been published. This is the first study on successful psychotherapy of a male patient with ulcerative colitis overlapping functional bowel symptoms and marked symptoms of BOS. Clinical recognition of BOS may help clinicians in differential diagnosis, prevent unnecessary investigations, and give patients the most appropriate treatment.

    Meditation over medication for irritable bowel syndrome? On exercise and alternative treatments for irritable bowel syndrome. Complimentary alternative treatment regimens are widely used in irritable bowel syndrome IBS , but the evidence supporting their use varies. For psychological treatment options, such as cognitive behavioral therapy, mindfulness, gut-directed hypnotherapy, and psychodynamic therapy, the evidence supporting their use in IBS patients is strong, but the availability limits their use in clinical practice.

    Dietary interventions are commonly included in the management of IBS patients, but these are primarily based on studies assessing physiological function in relation to dietary components, and to a lesser degree upon research examining the role of dietary components in the therapeutic management of IBS. Several probiotic products improve a range of symptoms in IBS patients.

    Physical activity is of benefit for health in general and recent data implicates its usefulness also for IBS patients. Acupuncture does not seem to have an effect beyond placebo in IBS. A beneficial effect of some herbal treatments has been reported. The concept of irritated bowel syndrome as a complex of functional disorders that can not be explained by organic changes and are totally due to intestinal motility and visceral sensitivity needs revision.

    The development of this syndrome also depends on a number of pathogenetic and etiological factors, such as inflammation of intestinal mucosa, changes of its permeability, previous infection, altered microflora, gene polymorphism, and food hypersensitivity.

    Subtypes of irritable bowel syndrome in children and adolescents. Pharmacologic treatments for irritable bowel syndrome IBS and medical management of symptoms are increasingly based on IBS subtype, so it is important to accurately differentiate patients. Few studies have classified subtypes of pediatric IBS, and conclusions have been challenged by methodologic l Underlying molecular and cellular mechanisms in childhood irritable bowel syndrome. Irritable bowel syndrome IBS affects a large number of children throughout the world.

    The symptom expression of IBS is heterogeneous, and several factors which may be interrelated within the IBS biopsychosocial model play a role. These factors include visceral hyperalgesia, intestinal permeability Conditioned pain modulation in women with irritable bowel syndrome. Evidence suggests that patients with irritable bowel syndrome IBS are more vigilant to pain-associated stimuli. Small bowel dilation in children with short bowel syndrome is associated with mucosal damage, bowel -derived bloodstream infections, and hepatic injury.

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