Irritable bowel syndrome historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]
Overview
Historical Perspective
Discovery
- The first ever mention of the concept of Irritable Bowel syndrome(IBS) without the recognition of any particular etiology was in the Rocky Mountain Medical Journal in 1950. In this article, IBS was described as a psychosomatic disorder, not explained by any biochemical or structural abnormalities. [1]
- Apley and Nash conducted a study on 1000 children in Bristol, United Kingdom and were the first to describe Recurrent Abdominal Pain (RAP), as the predominant feature of IBS. RAP was defined as pain in the abdomen occurring over a duration of at least 3 months, with the severity enough to cause significant impairment of function.[2]
- IBS was not recognized in children prior to 1995 and affected children were diagnosed with RAP instead.
- In Rome in 1995, an international group of gastroenterologists defined the diagnostic criteria for IBS and this was published in 1999 under the title of the Rome II criteria.
- This criteria underwent modification with the reduction of symptom duration from three to two months to allow for early intervention and described as the Rome III criteria. Unlike the Manning criteria, incomplete sense of evacuation is not included under the Rome III criteria.[3]
- All the criteria described for IBS are listed below in reverse chronological order:
| Diagnostic criteria | Symptoms, signs and labs |
|---|---|
| 2016: Rome IV | To establish the diagnosis, the patient must have recurrent pain in the abdomen (On an average, ≥1 day per week, in the previous 3 months) with an onset of ≥6 months before diagnosis-
Pain in the abdomen must be associated with at least two of the following:
Patient must have none of the following warning signs:
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| 2006: Rome Ⅲ | Recurrent pain in the abdomen or discomfort at least once per week, for two months associated with two or more of the following(should be present for at least twenty five percent of the time)
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| 1999: Rome Ⅱ | Pain in the abdomen or abdominal discomfort that has two of the following three features for twelve weeks(which may not be consecutive) in the last one year:
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| 1990: Rome Ⅰ | Abdominal discomfort or pain relieved with defecation or associated with change in frequency or consistency of stool in addition to two or more of the following (on at least twenty five percent of occasions/days for three months):
1. Altered stool form 2. Altered stool frequency 3. Altered stool passage 4. Passage of mucus in stool 5. Abdominal bloating or distension |
| 1984: Kruis | Symptoms of IBS must be present for more than two years. These symptoms include the following:
1. Pain in the abdomen, flatulence 2. Alternating constipation and diarrhea Signs that exclude IBS are determined by the physician. They are as follows: 1. Abnormal physical findings and/or history suggestive of any other diagnosis 2. ESR more than 20mm/2h 3. Anemia(Hemoglobin < 12 for women or < 14 for men) 4. Leukocytosis > 10000/cc 5. Bleeding per rectum found on physical exam |
| 1978: Manning | A threshold of at least three positive symptoms needs to be present to diagnose IBS with no duration of symptoms described under this classification.
1) Loose stools with onset of pain 2) Increased frequency of stools with onset of pain 3) Mucus per rectum 4) Visible distension of abdomen reported by the patient 5) Pain in the abdomen relieved by defecation 6) Sensation of incomplete evacuation |
Famous Cases
- The following are a few famous cases of IBS:
- Adolf Hitler
- John F Kennedy
- Kurt Cobain
References
- ↑ BROWN PW (1950). "The irritable bowel syndrome". Rocky Mt Med J. 47 (5): 343–6. PMID 15418074.
- ↑ APLEY J, NAISH N (1958). "Recurrent abdominal pains: a field survey of 1,000 school children". Arch. Dis. Child. 33 (168): 165–70. PMC 2012205. PMID 13534750.
- ↑ Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, Walker LS (2006). "Childhood functional gastrointestinal disorders: child/adolescent". Gastroenterology. 130 (5): 1527–37. doi:10.1053/j.gastro.2005.08.063. PMID 16678566.