Irritable bowel syndrome is a disease that can be diagnosed positively
on the basis of an established series of criteria and limited exclusi
on of organic disease, It is the most common disease diagnosed by gast
roenterologists and affects about 20% of all people at any one time, S
ymptoms fluctuate, and the overall prevalence rate is relatively const
ant in Western communities, Ten per cent of patients present to their
physicians; the illness has a large economic impact on health-care uti
lization and absenteeism, Irritable bowel syndrome is a biopsychosocia
l disorder in which three major mechanisms interact: psychosocial fact
ors; altered motility; and/or sensory function of the intestine, Manag
ement of patients is based on positive diagnosis of the symptom comple
x, limited exclusion of underlying organic disease and institution of
a therapeutic trial, If patient symptoms are intractable, further inve
stigations are needed to exclude significant motility or other disorde
rs. Symptomatic treatment includes fibre for constipation, loperamide
for diarrhoea and low-dose antidepressants or infrequent use of antisp
asmodics for pain; novel pharmacological agents, psychotherapy and hyp
notherapy are being evaluated.