A BIOPSYCHOSOCIAL UNDERSTANDING OF THE IRRITABLE-BOWEL-SYNDROME - A REVIEW

Objectives: To review and examine the clinical and research literature on irritable bowel syndrome (IBS) with a view to establishing the rol e that psychiatric factors play in the pathogenesis and treatment of t his syndrome. Results: Comorbid psychiatric illness is common with IBS , yet only a small proportion of these patients seek medical attention . Many patients are either satisfied by reassurance or experience symp tom relief from medical treatment directed at target symptoms. A small group of patients do not experience much relief and it is largely thi s group who come to the psychiatrist's attention. Psychotropic medicat ion is helpful when clinically indicated, and tricyclic antidepressant s in small doses (for example, 50 mg) may be helpful for those patient s with a pain-predominant pattern of IBS. Psychotherapy (including cog nitive, behavioural, relaxation, thermal-biofeedback, insight-oriented therapy, and hypnosis) has been shown to provide relief although it h as often been difficult to differentiate this improvement from a place bo response. Conclusions: The group of patients with ''refractory IBS' ' used a large amount of health care resources in an attempt to find r elief to their distress. Further study is needed to gain a better unde rstanding of which component of psychotherapy is most cost-effective a nd which patients are most likely to benefit. The large group of those who admit to symptoms compatible with IBS but who do not seek medical attention has to a large extent been excluded from most studies. Expl oring this group may provide further insight into this perplexing synd rome.