Review article: an integrated approach to the irritable bowel syndrome

Our understanding of the pathophysiology of irritable bowel syndrome (IBS) has evolved from a disorder of motility to a more integrated understanding of enhanced motility and visceral hypersensitivity associated with brain-gu t dysfunction. Psychosocial factors contribute to the predisposition, preci pitation and perpetuation of IBS symptoms, and affect the clinical outcome. Newer brain imaging techniques (e.g. PET, fMRI) may help us understand the relationship between altered emotional states with pain enhancement and ot her gastrointestinal symptoms. Diagnosis using symptom-based (e.g. Rome) cr iteria and a conservative diagnostic approach is recommended, Treatment is based on an effective physician-patient relationship and a combined pharmac ological and behavioural approach. Newer medications acting at the 5-HT rec eptor may help in reducing pain and bowel dysfunction, For more severe pain , antidepressants may be considered.