Irritable bowel syndrome history and symptoms: Difference between revisions

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{{Irritable bowel syndrome}}
{{Irritable bowel syndrome}}


{{CMG}}; {{AE}}  
{{CMG}} ; {{AE}} {{Cherry}}
==Overview==
==Overview==
The diagnosis of [[Irritable bowel syndrome|IBS]] relies on recognition of [[Gastrointestinal tract|gastrointestinal]] [[Symptom|symptoms]] that wax and wane for and are exacerbated by psycho social [[Stress (medicine)|stress]]. Diagnosis of [[Irritable bowel syndrome|IBS]] is based on on clinical [[Symptom|symptoms]] and elimination of other organic [[Gastrointestinal tract|gastrointestinal]] diseases. This is due to lack of definitive [[Radiologic sign|radio logic]] or [[Medical laboratory|laboratory]] diagnostic tests in [[Irritable bowel syndrome|IBS]].The hallmark of [[Irritable bowel syndrome|IBS]] is [[abdominal pain]]. A positive history of [[Stress (medicine)|stress]], [[anxiety]], [[depression]], [[Panic disorder|panic disorders]], gastrointestinal disorders such as [[Inflammatory bowel disease|IBD]] and acute [[Gastrointestinal tract|GI]] [[infection]] predispose individuals to [[Irritable bowel syndrome|IBS]]. The most common symptoms of [[Irritable bowel syndrome|IBS]] include presence of [[abdominal pain]] and alteration of [[Intestine|bowel]] habits. Less common symptoms of [[Irritable bowel syndrome|IBS]] include [[flatulence]] and upper [[Gastrointestinal tract|GI]] [[Symptom|symptoms]] such as [[heartburn]], [[Nausea and vomiting|nausea]], [[dyspepsia]] and [[Nausea and vomiting|vomiting]]. 
The diagnosis of irritable bowel syndrome (IBS) relies on recognition of [[Gastrointestinal tract|gastrointestinal]] [[Symptom|symptoms]] that wax and wane and are exacerbated by psychosocial [[Stress (medicine)|stress]]. [[Diagnosis]] of [[Irritable bowel syndrome|IBS]] is based on clinical [[Symptom|symptoms]] and elimination of other organic [[Gastrointestinal tract|gastrointestinal]] diseases. This is due to lack of definitive [[radiological]] or [[Medical laboratory|laboratory]] diagnostic tests in [[Irritable bowel syndrome|IBS]]. The hallmark of [[Irritable bowel syndrome|IBS]] is [[abdominal pain]]. A positive history of [[Stress (medicine)|stress]], [[anxiety]], [[depression]], [[Panic disorder|panic disorders]], [[Gastrointestinal tract|gastrointestinal]] disorders such as [[inflammatory bowel disease]] ([[Inflammatory bowel disease|IBD]]) and acute [[Gastrointestinal tract|GI]] [[infection]] predispose individuals to [[Irritable bowel syndrome|IBS]]. The most common [[Symptom|symptoms]] of [[Irritable bowel syndrome|IBS]] include presence of [[abdominal pain]] and alteration of [[Intestine|bowel]] habits. Less common [[symptoms]] of [[Irritable bowel syndrome|IBS]] include [[flatulence]] and upper [[Gastrointestinal tract|GI]] [[Symptom|symptoms]] such as [[heartburn]], [[Nausea and vomiting|nausea]], [[dyspepsia]] and [[Nausea and vomiting|vomiting]]. 


==Symptoms==
==Symptoms==
*Clinical features of [[Irritable bowel syndrome|IBS]] include the presence of [[abdominal pain]] with alteration of [[Bowel|bowel habits]], without any systemic symptoms such as blood in stool, [[weight loss]] and [[fever]]. The onset of symptoms usually occurs during periods of [[Stress (medicine)|stress]] and [[anxiety]].<ref name="SCHMULSON_1999">{{cite journal |author=Schmulson MW, Chang L |title=Diagnostic approach to the patient with irritable bowel syndrome |journal=Am. J. Med. |volume=107 |issue=5A |pages=20S-26S |year=1999 |pmid=10588169 |doi=}}</ref><ref name="pmid25574104">{{cite journal| author=Jasper F, Egloff B, Roalfe A, Witthöft M| title=Latent structure of irritable bowel syndrome symptom severity. | journal=World J Gastroenterol | year= 2015 | volume= 21 | issue= 1 | pages= 292-300 | pmid=25574104 | doi=10.3748/wjg.v21.i1.292 | pmc=4284348 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25574104  }} </ref><ref name="pmid23731745">{{cite journal| author=van Tilburg MA, Palsson OS, Whitehead WE| title=Which psychological factors exacerbate irritable bowel syndrome? Development of a comprehensive model. | journal=J Psychosom Res | year= 2013 | volume= 74 | issue= 6 | pages= 486-92 | pmid=23731745 | doi=10.1016/j.jpsychores.2013.03.004 | pmc=3673027 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23731745  }} </ref><ref name="TALLEY_2006">{{cite journal |author=Talley NJ |title=A unifying hypothesis for the functional gastrointestinal disorders: really multiple diseases or one irritable gut? |journal=Reviews in gastroenterological disorders|volume=6 |issue=2 |pages=72-8 |year=2006 |pmid=16699476 |doi=}}</ref><ref name="pmid23449495">{{cite journal |vauthors=Occhipinti K, Smith JW |title=Irritable bowel syndrome: a review and update |journal=Clin Colon Rectal Surg |volume=25 |issue=1 |pages=46–52 |year=2012 |pmid=23449495 |pmc=3348735 |doi=10.1055/s-0032-1301759 |url=}}</ref>   
*Clinical features of [[Irritable bowel syndrome|IBS]] include the presence of [[abdominal pain]] with alteration of [[Bowel|bowel habits]], without any systemic [[symptoms]] such as [[blood]] in [[Stools|stool]], [[weight loss]] and [[fever]]. The onset of [[Symptom|symptoms]] usually occurs during periods of [[Stress (medicine)|stress]] and [[anxiety]].<ref name="SCHMULSON_1999">{{cite journal |author=Schmulson MW, Chang L |title=Diagnostic approach to the patient with irritable bowel syndrome |journal=Am. J. Med. |volume=107 |issue=5A |pages=20S-26S |year=1999 |pmid=10588169 |doi=}}</ref><ref name="pmid25574104">{{cite journal| author=Jasper F, Egloff B, Roalfe A, Witthöft M| title=Latent structure of irritable bowel syndrome symptom severity. | journal=World J Gastroenterol | year= 2015 | volume= 21 | issue= 1 | pages= 292-300 | pmid=25574104 | doi=10.3748/wjg.v21.i1.292 | pmc=4284348 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25574104  }} </ref><ref name="pmid23731745">{{cite journal| author=van Tilburg MA, Palsson OS, Whitehead WE| title=Which psychological factors exacerbate irritable bowel syndrome? Development of a comprehensive model. | journal=J Psychosom Res | year= 2013 | volume= 74 | issue= 6 | pages= 486-92 | pmid=23731745 | doi=10.1016/j.jpsychores.2013.03.004 | pmc=3673027 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23731745  }} </ref><ref name="TALLEY_2006">{{cite journal |author=Talley NJ |title=A unifying hypothesis for the functional gastrointestinal disorders: really multiple diseases or one irritable gut? |journal=Reviews in gastroenterological disorders|volume=6 |issue=2 |pages=72-8 |year=2006 |pmid=16699476 |doi=}}</ref><ref name="pmid23449495">{{cite journal |vauthors=Occhipinti K, Smith JW |title=Irritable bowel syndrome: a review and update |journal=Clin Colon Rectal Surg |volume=25 |issue=1 |pages=46–52 |year=2012 |pmid=23449495 |pmc=3348735 |doi=10.1055/s-0032-1301759 |url=}}</ref>   
*Straining during [[defecation]], urgency, sense of incomplete evacuation, [[mucus]] passage, [[bloating]] are also associated symptoms, not included under the [[Diagnosis|diagnostic criteria]].
*Straining during [[defecation]], [[urgency]], sensation of incomplete evacuation, [[mucus]] passage, [[bloating]] are also associated [[symptoms]], not included under the [[Diagnosis|diagnostic criteria]].
*The presence of other comorbidities including other functional disorders such as stress disorders, anxiety, depression, sleep disturbance, chronic [[fatigue]], [[fibromyalgia]] favor [[Irritable bowel syndrome|IBS]].<ref name="pmid19631762">{{cite journal |vauthors=Ford AC, Marwaha A, Lim A, Moayyedi P |title=Systematic review and meta-analysis of the prevalence of irritable bowel syndrome in individuals with dyspepsia |journal=Clin. Gastroenterol. Hepatol. |volume=8 |issue=5 |pages=401–9 |year=2010 |pmid=19631762 |doi=10.1016/j.cgh.2009.07.020 |url=}}</ref><ref name="pmid17258513">{{cite journal |vauthors=Sayuk GS, Elwing JE, Lustman PJ, Clouse RE |title=High somatic symptom burdens and functional gastrointestinal disorders |journal=Clin. Gastroenterol. Hepatol. |volume=5 |issue=5 |pages=556–62 |year=2007 |pmid=17258513 |doi=10.1016/j.cgh.2006.11.024 |url=}}</ref><ref name="pmid17900326">{{cite journal |vauthors=Whitehead WE, Palsson OS, Levy RR, Feld AD, Turner M, Von Korff M |title=Comorbidity in irritable bowel syndrome |journal=Am. J. Gastroenterol. |volume=102 |issue=12 |pages=2767–76 |year=2007 |pmid=17900326 |doi=10.1111/j.1572-0241.2007.01540.x |url=}}</ref><ref name="pmid12590233">{{cite journal |vauthors=Brown WH, Chey WD, Elta GH |title=Number of responses on a review of systems questionnaire predicts the diagnosis of functional gastrointestinal disorders |journal=J. Clin. Gastroenterol. |volume=36 |issue=3 |pages=222–7 |year=2003 |pmid=12590233 |doi= |url=}}</ref>
*The presence of other [[Comorbidity|comorbidities]] including other functional disorders such as stress disorders, [[anxiety]], [[depression]], sleep disturbance, chronic [[fatigue]], [[fibromyalgia]] favor [[Irritable bowel syndrome|IBS]].<ref name="pmid19631762">{{cite journal |vauthors=Ford AC, Marwaha A, Lim A, Moayyedi P |title=Systematic review and meta-analysis of the prevalence of irritable bowel syndrome in individuals with dyspepsia |journal=Clin. Gastroenterol. Hepatol. |volume=8 |issue=5 |pages=401–9 |year=2010 |pmid=19631762 |doi=10.1016/j.cgh.2009.07.020 |url=}}</ref><ref name="pmid17258513">{{cite journal |vauthors=Sayuk GS, Elwing JE, Lustman PJ, Clouse RE |title=High somatic symptom burdens and functional gastrointestinal disorders |journal=Clin. Gastroenterol. Hepatol. |volume=5 |issue=5 |pages=556–62 |year=2007 |pmid=17258513 |doi=10.1016/j.cgh.2006.11.024 |url=}}</ref><ref name="pmid17900326">{{cite journal |vauthors=Whitehead WE, Palsson OS, Levy RR, Feld AD, Turner M, Von Korff M |title=Comorbidity in irritable bowel syndrome |journal=Am. J. Gastroenterol. |volume=102 |issue=12 |pages=2767–76 |year=2007 |pmid=17900326 |doi=10.1111/j.1572-0241.2007.01540.x |url=}}</ref><ref name="pmid12590233">{{cite journal |vauthors=Brown WH, Chey WD, Elta GH |title=Number of responses on a review of systems questionnaire predicts the diagnosis of functional gastrointestinal disorders |journal=J. Clin. Gastroenterol. |volume=36 |issue=3 |pages=222–7 |year=2003 |pmid=12590233 |doi= |url=}}</ref>
*Alarm features or red flag symptoms/signs point towards other diagnoses. These features include family history of [[Inflammatory bowel disease|IBD]] or [[Colorectal cancer|colon cancer]], [[fever]], recent [[antibiotic]] use, [[weight loss]], blood in the stools and nocturnal awakening due to [[Symptom|symptoms]]. However, some [[Irritable bowel syndrome|IBS]] patients may have blood in the [[Human feces|stool]] due to coexisting [[hemorrhoids]].<ref name="FASS_2001">{{cite journal |author=Fass R, Longstreth GF, Pimentel M, ''et al''|title=Evidence- and consensus-based practice guidelines for the diagnosis of irritable bowel syndrome |journal=Arch. Intern. Med.|volume=161 |issue=17 |pages=2081-8 |year=2001 |pmid=11570936 |doi=}}</ref><ref name="pmid24413506">{{cite journal |vauthors=Paul SP, Barnard P, Bigwood C, Candy DC |title=Challenges in management of irritable bowel syndrome in children |journal=Indian Pediatr |volume=50 |issue=12 |pages=1137–43 |year=2013 |pmid=24413506 |doi= |url=}}</ref>
*Alarm features or red flag [[symptoms]]/[[signs]] point towards other diagnoses. These features include family history of [[Inflammatory bowel disease|IBD]] or [[Colorectal cancer|colon cancer]], [[fever]], recent [[antibiotic]] use, [[weight loss]], blood in the [[stools]] and night time awakening due to [[Symptom|symptoms]]. However, some [[Irritable bowel syndrome|IBS]] patients may have [[blood]] in the [[Human feces|stool]] due to coexisting [[hemorrhoids]].<ref name="FASS_2001">{{cite journal |author=Fass R, Longstreth GF, Pimentel M, ''et al''|title=Evidence- and consensus-based practice guidelines for the diagnosis of irritable bowel syndrome |journal=Arch. Intern. Med.|volume=161 |issue=17 |pages=2081-8 |year=2001 |pmid=11570936 |doi=}}</ref><ref name="pmid24413506">{{cite journal |vauthors=Paul SP, Barnard P, Bigwood C, Candy DC |title=Challenges in management of irritable bowel syndrome in children |journal=Indian Pediatr |volume=50 |issue=12 |pages=1137–43 |year=2013 |pmid=24413506 |doi= |url=}}</ref>
=== Common symptoms ===
Common [[symptoms]] of IBS include [[abdominal pain]], altered [[Intestine|bowel]] habits, [[bloating]] and [[flatulence]].
{| class="wikitable"
{| class="wikitable"
!Common symptoms
! colspan="3" style="background:#4479BA; color: #FFFFFF;" ! |COMMON SYMPTOMS OF IBS
!Less common symptoms
|-
|-
|[[Abdominal pain]]
| style="background:#DCDCDC;" align="center" |'''[[Abdominal pain]]''' (major prerequisite for [[Irritable bowel syndrome|IBS]])
|Straining, urgency during [[defecation]]
| colspan="2" |Site: Variable location
Onset: Sudden/Insidious
 
Character: Episodic and crampy with a background of constant [[pain]]
 
Relieving factors: Relief on [[defecation]]
 
Aggravating factors: Eating, emotional stress, premenstrual and [[Menstrual cycle|menstrual]] phases
 
Associated factors: Change in frequency or form of [[Human feces|stool]]
 
Timing: [[Pain]] is usually present during waking hours. [[Nocturnal]] [[symptoms]] are usually present only in severe [[Irritable bowel syndrome|IBS]]
 
Severity: Variable (varies from mild to severe enough to impair quality of life)
|-
|-
|Altered [[Intestine|bowel]] habits
| rowspan="2" style="background:#DCDCDC;" align="center" |'''Altered bowel habits'''
|Sense of incomplete evacuation
| colspan="2" |Altered [[Intestine|bowel]] habits usually present as [[diarrhea]] alternating with [[constipation]]. One of these tends to be the predominant [[symptom]] in the patient. <ref name="pmid12454866">{{cite journal |vauthors=Drossman DA, Camilleri M, Mayer EA, Whitehead WE |title=AGA technical review on irritable bowel syndrome |journal=Gastroenterology |volume=123 |issue=6 |pages=2108–31 |year=2002 |pmid=12454866 |doi=10.1053/gast.2002.37095 |url=}}</ref><ref name="pmid16678561">{{cite journal |vauthors=Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC |title=Functional bowel disorders |journal=Gastroenterology |volume=130 |issue=5 |pages=1480–91 |year=2006 |pmid=16678561 |doi=10.1053/j.gastro.2005.11.061 |url=}}</ref><ref name="pmid16678561" />
|-
|-
|[[Bloating]] and [[flatulence]]
|''[[Constipation]] predominant [[Irritable bowel syndrome|IBS]]:  <3 [[Intestine|bowel]] movements per week''
|[[Mucus]] passage with [[Human feces|stools]]
* [[Constipation]] in patients is initially episodic, but gradually becomes continuous and intractable to [[laxative]] treatment.
* Patients develop weeks- months of [[constipation]] interrupted by [[diarrhea]]. <ref name="pmid18456567">{{cite journal |vauthors=Camilleri M, McKinzie S, Busciglio I, Low PA, Sweetser S, Burton D, Baxter K, Ryks M, Zinsmeister AR |title=Prospective study of motor, sensory, psychologic, and autonomic functions in patients with irritable bowel syndrome |journal=Clin. Gastroenterol. Hepatol. |volume=6 |issue=7 |pages=772–81 |year=2008 |pmid=18456567 |pmc=2495078 |doi=10.1016/j.cgh.2008.02.060 |url=}}</ref><ref name="pmid3955515">{{cite journal |vauthors=Fromm M, Littman P, Raney RB, Nelson L, Handler S, Diamond G, Stanley C |title=Late effects after treatment of twenty children with soft tissue sarcomas of the head and neck. Experience at a single institution with a review of the literature |journal=Cancer |volume=57 |issue=10 |pages=2070–6 |year=1986 |pmid=3955515 |doi= |url=}}</ref><ref name="pmid22334251">{{cite journal |vauthors=Törnblom H, Van Oudenhove L, Sadik R, Abrahamsson H, Tack J, Simrén M |title=Colonic transit time and IBS symptoms: what's the link? |journal=Am. J. Gastroenterol. |volume=107 |issue=5 |pages=754–60 |year=2012 |pmid=22334251 |doi=10.1038/ajg.2012.5 |url=}}</ref><ref name="pmid20456760">{{cite journal |vauthors=Prott G, Shim L, Hansen R, Kellow J, Malcolm A |title=Relationships between pelvic floor symptoms and function in irritable bowel syndrome |journal=Neurogastroenterol. Motil. |volume=22 |issue=7 |pages=764–9 |year=2010 |pmid=20456760 |doi=10.1111/j.1365-2982.2010.01503.x |url=}}</ref>
* Patients have
*# Hard [[Human feces|stools]]
*# [[Human feces|Stools]] with narrow caliber, due to [[dehydration]] caused by [[Colon (anatomy)|colonic]] [[retention]]
*# Sensation of incomplete evacuation
|''Diarrhea predominant IBS: >3 bowel movements per day'' <ref name="pmid18456567" /><ref name="pmid22334251" />Patients have:
# Loose [[Human feces|stools]] in small volumes, aggravated by eating or emotional [[Stress (medicine)|stress]]
# [[Human feces|Stool]] volume of <200 ml
# [[Human feces|Stool]] accompanied by [[mucus]] passage
# Absence of [[nocturnal]] [[diarrhea]]
# Absence of [[bleeding]]
# Absence of [[weight loss]] or [[malabsorption]]
|-
| style="background:#DCDCDC;" align="center" |'''Gas and flatulence'''
| colspan="2" |
* Patients develop [[distension]] of [[abdomen]], [[flatulence]], increased [[Burping|belching]] due to impaired transit and tolerance of [[gas]] loads in the [[intestine]].
* Patients have a tendency to develop reflux gas from the [[Anatomical terms of location|distal]] to [[Anatomical terms of location|proximal]] [[bowel]] which causes [[Burping|belching]].
|}
|}


==== Abdominal Pain ====
=== Less common symptoms ===
[[Abdominal pain]] or [[discomfort]] is the major prerequisite for the diagnosis of [[Irritable bowel syndrome|IBS]].
{| class="wikitable"
{| class="wikitable"
! colspan="2" |ABDOMINAL PAIN
! colspan="2" style="background:#4479BA; color: #FFFFFF;" ! |LESS COMMON SYMPTOMS OF IBS
|-
|Site
|Variable location
|-
|Onset
|Sudden/Insidious
|-
|Character
|Episodic and crampy with a background of constant pain
|-
|Relieving factors
|Relief on defecation
|-
|Aggravating factors
|Eating, emotional stress, premenstrual and menstrual phases
|-
|Associated factors
|Change in frequency or form of stool
|-
|-
|Timing
| style="background:#DCDCDC;" align="center" |'''Upper gastrointestinal symptoms'''
|Pain is usually present during waking hours. Nocturnal symptoms are usually present only in severe IBS
|One fourth of all [[Irritable bowel syndrome|IBS]] patients complain of [[heartburn]], [[Nausea and vomiting|nausea]], [[dyspepsia]] and [[Nausea and vomiting|vomiting]]. 
|-
|-
|Severity
| style="background:#DCDCDC;" align="center" |'''Lower gastrointestinal symptoms'''
|Variable (varies from mild to severe enough to impair Quality of Life)
|
* Straining, urgency during [[defecation]]
* Sensation of incomplete evacuation
* [[Mucus]] passage with [[Human feces|stools]]
|}
|}
==== Altered Bowel Habits ====
* Altered [[Intestine|bowel]] habits usually present as [[diarrhea]] alternating with [[constipation]]. One of these tends to be the predominant [[symptom]] in the patient. <ref name="pmid12454866">{{cite journal |vauthors=Drossman DA, Camilleri M, Mayer EA, Whitehead WE |title=AGA technical review on irritable bowel syndrome |journal=Gastroenterology |volume=123 |issue=6 |pages=2108–31 |year=2002 |pmid=12454866 |doi=10.1053/gast.2002.37095 |url=}}</ref><ref name="pmid16678561">{{cite journal |vauthors=Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC |title=Functional bowel disorders |journal=Gastroenterology |volume=130 |issue=5 |pages=1480–91 |year=2006 |pmid=16678561 |doi=10.1053/j.gastro.2005.11.061 |url=}}</ref><ref name="pmid16678561">{{cite journal |vauthors=Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC |title=Functional bowel disorders |journal=Gastroenterology |volume=130 |issue=5 |pages=1480–91 |year=2006 |pmid=16678561 |doi=10.1053/j.gastro.2005.11.061 |url=}}</ref>
** ''[[Constipation]] predominant [[Irritable bowel syndrome|IBS]]:  <3 [[Intestine|bowel]] movements per week''
*** [[Constipation]] in patients is initially episodic, but gradually becomes continuous and intractable to [[laxative]] treatment.
*** Patients develop weeks- months of [[constipation]] interrupted by [[diarrhea]]. <ref name="pmid18456567">{{cite journal |vauthors=Camilleri M, McKinzie S, Busciglio I, Low PA, Sweetser S, Burton D, Baxter K, Ryks M, Zinsmeister AR |title=Prospective study of motor, sensory, psychologic, and autonomic functions in patients with irritable bowel syndrome |journal=Clin. Gastroenterol. Hepatol. |volume=6 |issue=7 |pages=772–81 |year=2008 |pmid=18456567 |pmc=2495078 |doi=10.1016/j.cgh.2008.02.060 |url=}}</ref><ref name="pmid3955515">{{cite journal |vauthors=Fromm M, Littman P, Raney RB, Nelson L, Handler S, Diamond G, Stanley C |title=Late effects after treatment of twenty children with soft tissue sarcomas of the head and neck. Experience at a single institution with a review of the literature |journal=Cancer |volume=57 |issue=10 |pages=2070–6 |year=1986 |pmid=3955515 |doi= |url=}}</ref><ref name="pmid22334251">{{cite journal |vauthors=Törnblom H, Van Oudenhove L, Sadik R, Abrahamsson H, Tack J, Simrén M |title=Colonic transit time and IBS symptoms: what's the link? |journal=Am. J. Gastroenterol. |volume=107 |issue=5 |pages=754–60 |year=2012 |pmid=22334251 |doi=10.1038/ajg.2012.5 |url=}}</ref><ref name="pmid20456760">{{cite journal |vauthors=Prott G, Shim L, Hansen R, Kellow J, Malcolm A |title=Relationships between pelvic floor symptoms and function in irritable bowel syndrome |journal=Neurogastroenterol. Motil. |volume=22 |issue=7 |pages=764–9 |year=2010 |pmid=20456760 |doi=10.1111/j.1365-2982.2010.01503.x |url=}}</ref>
*** Patients have
***# Hard [[Human feces|stools]]
***# [[Human feces|Stools]] with narrow caliber, due to [[dehydration]] caused by [[Colon (anatomy)|colonic]] [[retention]]
***# Sensation of incomplete evacuation
** ''Diarrhea predominant IBS: >3 bowel movements per day'' <ref name="pmid18456567">{{cite journal |vauthors=Camilleri M, McKinzie S, Busciglio I, Low PA, Sweetser S, Burton D, Baxter K, Ryks M, Zinsmeister AR |title=Prospective study of motor, sensory, psychologic, and autonomic functions in patients with irritable bowel syndrome |journal=Clin. Gastroenterol. Hepatol. |volume=6 |issue=7 |pages=772–81 |year=2008 |pmid=18456567 |pmc=2495078 |doi=10.1016/j.cgh.2008.02.060 |url=}}</ref><ref name="pmid22334251">{{cite journal |vauthors=Törnblom H, Van Oudenhove L, Sadik R, Abrahamsson H, Tack J, Simrén M |title=Colonic transit time and IBS symptoms: what's the link? |journal=Am. J. Gastroenterol. |volume=107 |issue=5 |pages=754–60 |year=2012 |pmid=22334251 |doi=10.1038/ajg.2012.5 |url=}}</ref>
*** Patients have
***# Loose [[Human feces|stools]] in small volumes, aggravated by eating or emotional [[Stress (medicine)|stress]]
***# [[Human feces|Stool]] volume of <200 ml
***# [[Human feces|Stool]] accompanied by [[mucus]] passage
***# Absence of nocturnal [[diarrhea]]
***# Absence of [[bleeding]]
***# Absence of [[weight loss]] or [[malabsorption]]
==== Gas and flatulence ====
* Patients develop [[distension]] of [[abdomen]], [[flatulence]], increased [[Burping|belching]] due to impaired transit and tolerance of [[gas]] loads in the [[intestine]].
* Patients have a tendency to develop reflux gas from the [[Anatomical terms of location|distal]] to [[Anatomical terms of location|proximal]] bowel which causes [[Burping|belching]].


==== Upper Gastrointestinal Symptoms ====
==History==
* One fourth of all [[Irritable bowel syndrome|IBS]] patients complain of [[heartburn]], [[Nausea and vomiting|nausea]], [[dyspepsia]] and [[Nausea and vomiting|vomiting]]. 


===History===
=== Psychosocial history ===
Patients with [[Irritable bowel syndrome|IBS]] may have a positive history of:
*[[Psychological]] history such as [[Stress (medicine)|stress]], [[anxiety]]<ref name="pmid12108819">{{cite journal |vauthors=Mayer EA, Craske M, Naliboff BD |title=Depression, anxiety, and the gastrointestinal system |journal=J Clin Psychiatry |volume=62 Suppl 8 |issue= |pages=28–36; discussion 37 |year=2001 |pmid=12108819 |doi= |url=}}</ref><ref name="pmid12454866">{{cite journal |vauthors=Drossman DA, Camilleri M, Mayer EA, Whitehead WE |title=AGA technical review on irritable bowel syndrome |journal=Gastroenterology |volume=123 |issue=6 |pages=2108–31 |year=2002 |pmid=12454866 |doi=10.1053/gast.2002.37095 |url=}}</ref><ref name="pmid216977452">{{cite journal |vauthors=Devanarayana NM, Mettananda S, Liyanarachchi C, Nanayakkara N, Mendis N, Perera N, Rajindrajith S |title=Abdominal pain-predominant functional gastrointestinal diseases in children and adolescents: prevalence, symptomatology, and association with emotional stress |journal=J. Pediatr. Gastroenterol. Nutr. |volume=53 |issue=6 |pages=659–65 |year=2011 |pmid=21697745 |doi=10.1097/MPG.0b013e3182296033 |url=}}</ref><ref name="pmid253398012">{{cite journal |vauthors=Qin HY, Cheng CW, Tang XD, Bian ZX |title=Impact of psychological stress on irritable bowel syndrome |journal=World J. Gastroenterol. |volume=20 |issue=39 |pages=14126–31 |year=2014 |pmid=25339801 |pmc=4202343 |doi=10.3748/wjg.v20.i39.14126 |url=}}</ref><ref name="pmid274929162">{{cite journal |vauthors=Bharucha AE, Chakraborty S, Sletten CD |title=Common Functional Gastroenterological Disorders Associated With Abdominal Pain |journal=Mayo Clin. Proc. |volume=91 |issue=8 |pages=1118–32 |year=2016 |pmid=27492916 |pmc=4985027 |doi=10.1016/j.mayocp.2016.06.003 |url=}}</ref><ref name="pmid266749802">{{cite journal |vauthors=Ibrahim NK |title=A systematic review of the prevalence and risk factors of irritable bowel syndrome among medical students |journal=Turk J Gastroenterol |volume=27 |issue=1 |pages=10–6 |year=2016 |pmid=26674980 |doi=10.5152/tjg.2015.150333 |url=}}</ref>
 
*Past history of abuse
*Psychological history such as [[Stress (medicine)|stress]], [[anxiety]]<ref name="pmid12108819">{{cite journal |vauthors=Mayer EA, Craske M, Naliboff BD |title=Depression, anxiety, and the gastrointestinal system |journal=J Clin Psychiatry |volume=62 Suppl 8 |issue= |pages=28–36; discussion 37 |year=2001 |pmid=12108819 |doi= |url=}}</ref><ref name="pmid12454866">{{cite journal |vauthors=Drossman DA, Camilleri M, Mayer EA, Whitehead WE |title=AGA technical review on irritable bowel syndrome |journal=Gastroenterology |volume=123 |issue=6 |pages=2108–31 |year=2002 |pmid=12454866 |doi=10.1053/gast.2002.37095 |url=}}</ref><ref name="pmid216977452">{{cite journal |vauthors=Devanarayana NM, Mettananda S, Liyanarachchi C, Nanayakkara N, Mendis N, Perera N, Rajindrajith S |title=Abdominal pain-predominant functional gastrointestinal diseases in children and adolescents: prevalence, symptomatology, and association with emotional stress |journal=J. Pediatr. Gastroenterol. Nutr. |volume=53 |issue=6 |pages=659–65 |year=2011 |pmid=21697745 |doi=10.1097/MPG.0b013e3182296033 |url=}}</ref><ref name="pmid253398012">{{cite journal |vauthors=Qin HY, Cheng CW, Tang XD, Bian ZX |title=Impact of psychological stress on irritable bowel syndrome |journal=World J. Gastroenterol. |volume=20 |issue=39 |pages=14126–31 |year=2014 |pmid=25339801 |pmc=4202343 |doi=10.3748/wjg.v20.i39.14126 |url=}}</ref><ref name="pmid274929162">{{cite journal |vauthors=Bharucha AE, Chakraborty S, Sletten CD |title=Common Functional Gastroenterological Disorders Associated With Abdominal Pain |journal=Mayo Clin. Proc. |volume=91 |issue=8 |pages=1118–32 |year=2016 |pmid=27492916 |pmc=4985027 |doi=10.1016/j.mayocp.2016.06.003 |url=}}</ref><ref name="pmid266749802">{{cite journal |vauthors=Ibrahim NK |title=A systematic review of the prevalence and risk factors of irritable bowel syndrome among medical students |journal=Turk J Gastroenterol |volume=27 |issue=1 |pages=10–6 |year=2016 |pmid=26674980 |doi=10.5152/tjg.2015.150333 |url=}}</ref>
*Psychiatric history such as [[depression]], [[Panic disorder|panic disorders]]<ref name="pmid12108819">{{cite journal |vauthors=Mayer EA, Craske M, Naliboff BD |title=Depression, anxiety, and the gastrointestinal system |journal=J Clin Psychiatry |volume=62 Suppl 8 |issue= |pages=28–36; discussion 37 |year=2001 |pmid=12108819 |doi= |url=}}</ref><ref name="pmid253398012" /><ref name="pmid274929162" /><ref name="pmid170076342">{{cite journal |vauthors=Cole JA, Rothman KJ, Cabral HJ, Zhang Y, Farraye FA |title=Migraine, fibromyalgia, and depression among people with IBS: a prevalence study |journal=BMC Gastroenterol |volume=6 |issue= |pages=26 |year=2006 |pmid=17007634 |pmc=1592499 |doi=10.1186/1471-230X-6-26 |url=}}</ref><ref name="pmid248767252">{{cite journal |vauthors=Hausteiner-Wiehle C, Henningsen P |title=Irritable bowel syndrome: relations with functional, mental, and somatoform disorders |journal=World J. Gastroenterol. |volume=20 |issue=20 |pages=6024–30 |year=2014 |pmid=24876725 |pmc=4033442 |doi=10.3748/wjg.v20.i20.6024 |url=}}</ref>
*Psychiatric history such as [[depression]], [[Panic disorder|panic disorders]]<ref name="pmid12108819">{{cite journal |vauthors=Mayer EA, Craske M, Naliboff BD |title=Depression, anxiety, and the gastrointestinal system |journal=J Clin Psychiatry |volume=62 Suppl 8 |issue= |pages=28–36; discussion 37 |year=2001 |pmid=12108819 |doi= |url=}}</ref><ref name="pmid253398012" /><ref name="pmid274929162" /><ref name="pmid170076342">{{cite journal |vauthors=Cole JA, Rothman KJ, Cabral HJ, Zhang Y, Farraye FA |title=Migraine, fibromyalgia, and depression among people with IBS: a prevalence study |journal=BMC Gastroenterol |volume=6 |issue= |pages=26 |year=2006 |pmid=17007634 |pmc=1592499 |doi=10.1186/1471-230X-6-26 |url=}}</ref><ref name="pmid248767252">{{cite journal |vauthors=Hausteiner-Wiehle C, Henningsen P |title=Irritable bowel syndrome: relations with functional, mental, and somatoform disorders |journal=World J. Gastroenterol. |volume=20 |issue=20 |pages=6024–30 |year=2014 |pmid=24876725 |pmc=4033442 |doi=10.3748/wjg.v20.i20.6024 |url=}}</ref>
*History of physical or [[Sexual assault|sexual abuse]] or adverse early life events
*History of physical or [[Sexual assault|sexual abuse]] or adverse early life events
*History of pain disorders such as [[fibromyalgia]]<ref name="pmid170076342" /><ref name="pmid248799162">{{cite journal |vauthors=Vehof J, Zavos HM, Lachance G, Hammond CJ, Williams FM |title=Shared genetic factors underlie chronic pain syndromes |journal=Pain |volume=155 |issue=8 |pages=1562–8 |year=2014 |pmid=24879916 |doi=10.1016/j.pain.2014.05.002 |url=}}</ref>
=== Past Medical history ===
*History of [[Gastrointestinal tract|gastrointestinal]] disorders such as [[Inflammatory bowel disease|IBD]]<ref name="pmid242964622">{{cite journal |vauthors=Major G, Spiller R |title=Irritable bowel syndrome, inflammatory bowel disease and the microbiome |journal=Curr Opin Endocrinol Diabetes Obes |volume=21 |issue=1 |pages=15–21 |year=2014 |pmid=24296462 |pmc=3871405 |doi=10.1097/MED.0000000000000032 |url=}}</ref><ref name="pmid280580092">{{cite journal |vauthors=Ceuleers H, Van Spaendonk H, Hanning N, Heirbaut J, Lambeir AM, Joossens J, Augustyns K, De Man JG, De Meester I, De Winter BY |title=Visceral hypersensitivity in inflammatory bowel diseases and irritable bowel syndrome: The role of proteases |journal=World J. Gastroenterol. |volume=22 |issue=47 |pages=10275–10286 |year=2016 |pmid=28058009 |pmc=5175241 |doi=10.3748/wjg.v22.i47.10275 |url=}}</ref>
*History of [[Gastrointestinal tract|gastrointestinal]] disorders such as [[Inflammatory bowel disease|IBD]]<ref name="pmid242964622">{{cite journal |vauthors=Major G, Spiller R |title=Irritable bowel syndrome, inflammatory bowel disease and the microbiome |journal=Curr Opin Endocrinol Diabetes Obes |volume=21 |issue=1 |pages=15–21 |year=2014 |pmid=24296462 |pmc=3871405 |doi=10.1097/MED.0000000000000032 |url=}}</ref><ref name="pmid280580092">{{cite journal |vauthors=Ceuleers H, Van Spaendonk H, Hanning N, Heirbaut J, Lambeir AM, Joossens J, Augustyns K, De Man JG, De Meester I, De Winter BY |title=Visceral hypersensitivity in inflammatory bowel diseases and irritable bowel syndrome: The role of proteases |journal=World J. Gastroenterol. |volume=22 |issue=47 |pages=10275–10286 |year=2016 |pmid=28058009 |pmc=5175241 |doi=10.3748/wjg.v22.i47.10275 |url=}}</ref>
*History of acute [[Gastrointestinal tract|GI]] [[Infection|infections]] such as [[Traveler's diarrhea]] i.e post [[Infection|infectious]] state <ref name="pmid243796222">{{cite journal |vauthors=Halliez MC, Buret AG |title=Extra-intestinal and long term consequences of Giardia duodenalis infections |journal=World J. Gastroenterol. |volume=19 |issue=47 |pages=8974–85 |year=2013 |pmid=24379622 |pmc=3870550 |doi=10.3748/wjg.v19.i47.8974 |url=}}</ref><ref name="pmid227304682">{{cite journal |vauthors=Simrén M, Barbara G, Flint HJ, Spiegel BM, Spiller RC, Vanner S, Verdu EF, Whorwell PJ, Zoetendal EG |title=Intestinal microbiota in functional bowel disorders: a Rome foundation report |journal=Gut |volume=62 |issue=1 |pages=159–76 |year=2013 |pmid=22730468 |pmc=3551212 |doi=10.1136/gutjnl-2012-302167 |url=}}</ref><ref name="pmid228950812">{{cite journal |vauthors=Jeffery IB, Quigley EM, Öhman L, Simrén M, O'Toole PW |title=The microbiota link to irritable bowel syndrome: an emerging story |journal=Gut Microbes |volume=3 |issue=6 |pages=572–6 |year=2012 |pmid=22895081 |pmc=3495796 |doi=10.4161/gmic.21772 |url=}}</ref><ref name="pmid275982742">{{cite journal |vauthors=Ibarra C, Herrera V, Pérez de Arce E, Gil LC, Madrid AM, Valenzuela L, Beltrán CJ |title=[Parasitosis and irritable bowel syndrome] |language=Spanish; Castilian |journal=Rev Chilena Infectol |volume=33 |issue=3 |pages=268–74 |year=2016 |pmid=27598274 |doi=10.4067/S0716-10182016000300003 |url=}}</ref><ref name="pmid269001162">{{cite journal |vauthors=Giddings SL, Stevens AM, Leung DT |title=Traveler's Diarrhea |journal=Med. Clin. North Am. |volume=100 |issue=2 |pages=317–30 |year=2016 |pmid=26900116 |pmc=4764790 |doi=10.1016/j.mcna.2015.08.017 |url=}}</ref><ref name="pmid254161622">{{cite journal |vauthors=Keithlin J, Sargeant J, Thomas MK, Fazil A |title=Systematic review and meta-analysis of the proportion of Campylobacter cases that develop chronic sequelae |journal=BMC Public Health |volume=14 |issue= |pages=1203 |year=2014 |pmid=25416162 |pmc=4391665 |doi=10.1186/1471-2458-14-1203 |url=}}</ref><ref name="pmid246040372">{{cite journal |vauthors=Grover M |title=Role of gut pathogens in development of irritable bowel syndrome |journal=Indian J. Med. Res. |volume=139 |issue=1 |pages=11–8 |year=2014 |pmid=24604037 |pmc=3994726 |doi= |url=}}</ref><ref name="pmid244047802">{{cite journal |vauthors=Keithlin J, Sargeant J, Thomas MK, Fazil A |title=Chronic sequelae of E. coli O157: systematic review and meta-analysis of the proportion of E. coli O157 cases that develop chronic sequelae |journal=Foodborne Pathog. Dis. |volume=11 |issue=2 |pages=79–95 |year=2014 |pmid=24404780 |pmc=3925333 |doi=10.1089/fpd.2013.1572 |url=}}</ref><ref name="pmid239925732">{{cite journal |vauthors=Connor BA, Riddle MS |title=Post-infectious sequelae of travelers' diarrhea |journal=J Travel Med |volume=20 |issue=5 |pages=303–12 |year=2013 |pmid=23992573 |doi=10.1111/jtm.12049 |url=}}</ref><ref name="pmid16319671">{{cite journal |vauthors=Spiller R, Campbell E |title=Post-infectious irritable bowel syndrome |journal=Curr. Opin. Gastroenterol. |volume=22 |issue=1 |pages=13–7 |year=2006 |pmid=16319671 |doi= |url=}}</ref>
*History of acute [[Gastrointestinal tract|GI]] [[Infection|infections]] such as [[traveler's diarrhea]] i.e post [[Infection|infectious]] state <ref name="pmid243796222">{{cite journal |vauthors=Halliez MC, Buret AG |title=Extra-intestinal and long term consequences of Giardia duodenalis infections |journal=World J. Gastroenterol. |volume=19 |issue=47 |pages=8974–85 |year=2013 |pmid=24379622 |pmc=3870550 |doi=10.3748/wjg.v19.i47.8974 |url=}}</ref><ref name="pmid227304682">{{cite journal |vauthors=Simrén M, Barbara G, Flint HJ, Spiegel BM, Spiller RC, Vanner S, Verdu EF, Whorwell PJ, Zoetendal EG |title=Intestinal microbiota in functional bowel disorders: a Rome foundation report |journal=Gut |volume=62 |issue=1 |pages=159–76 |year=2013 |pmid=22730468 |pmc=3551212 |doi=10.1136/gutjnl-2012-302167 |url=}}</ref><ref name="pmid228950812">{{cite journal |vauthors=Jeffery IB, Quigley EM, Öhman L, Simrén M, O'Toole PW |title=The microbiota link to irritable bowel syndrome: an emerging story |journal=Gut Microbes |volume=3 |issue=6 |pages=572–6 |year=2012 |pmid=22895081 |pmc=3495796 |doi=10.4161/gmic.21772 |url=}}</ref><ref name="pmid275982742">{{cite journal |vauthors=Ibarra C, Herrera V, Pérez de Arce E, Gil LC, Madrid AM, Valenzuela L, Beltrán CJ |title=[Parasitosis and irritable bowel syndrome] |language=Spanish; Castilian |journal=Rev Chilena Infectol |volume=33 |issue=3 |pages=268–74 |year=2016 |pmid=27598274 |doi=10.4067/S0716-10182016000300003 |url=}}</ref><ref name="pmid269001162">{{cite journal |vauthors=Giddings SL, Stevens AM, Leung DT |title=Traveler's Diarrhea |journal=Med. Clin. North Am. |volume=100 |issue=2 |pages=317–30 |year=2016 |pmid=26900116 |pmc=4764790 |doi=10.1016/j.mcna.2015.08.017 |url=}}</ref><ref name="pmid254161622">{{cite journal |vauthors=Keithlin J, Sargeant J, Thomas MK, Fazil A |title=Systematic review and meta-analysis of the proportion of Campylobacter cases that develop chronic sequelae |journal=BMC Public Health |volume=14 |issue= |pages=1203 |year=2014 |pmid=25416162 |pmc=4391665 |doi=10.1186/1471-2458-14-1203 |url=}}</ref><ref name="pmid246040372">{{cite journal |vauthors=Grover M |title=Role of gut pathogens in development of irritable bowel syndrome |journal=Indian J. Med. Res. |volume=139 |issue=1 |pages=11–8 |year=2014 |pmid=24604037 |pmc=3994726 |doi= |url=}}</ref><ref name="pmid244047802">{{cite journal |vauthors=Keithlin J, Sargeant J, Thomas MK, Fazil A |title=Chronic sequelae of E. coli O157: systematic review and meta-analysis of the proportion of E. coli O157 cases that develop chronic sequelae |journal=Foodborne Pathog. Dis. |volume=11 |issue=2 |pages=79–95 |year=2014 |pmid=24404780 |pmc=3925333 |doi=10.1089/fpd.2013.1572 |url=}}</ref><ref name="pmid239925732">{{cite journal |vauthors=Connor BA, Riddle MS |title=Post-infectious sequelae of travelers' diarrhea |journal=J Travel Med |volume=20 |issue=5 |pages=303–12 |year=2013 |pmid=23992573 |doi=10.1111/jtm.12049 |url=}}</ref><ref name="pmid16319671">{{cite journal |vauthors=Spiller R, Campbell E |title=Post-infectious irritable bowel syndrome |journal=Curr. Opin. Gastroenterol. |volume=22 |issue=1 |pages=13–7 |year=2006 |pmid=16319671 |doi= |url=}}</ref>
**[[Salmonella]] infection
**[[Salmonella]] infection
**[[Giardiasis]]
**[[Giardiasis]]
*History of [[antibiotic]] use<ref name="pmid282741082">{{cite journal |vauthors=Ghoshal UC, Shukla R, Ghoshal U |title=Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy |journal=Gut Liver |volume=11 |issue=2 |pages=196–208 |year=2017 |pmid=28274108 |pmc=5347643 |doi=10.5009/gnl16126 |url=}}</ref><ref name="pmid276215672">{{cite journal |vauthors=Gallo A, Passaro G, Gasbarrini A, Landolfi R, Montalto M |title=Modulation of microbiota as treatment for intestinal inflammatory disorders: An uptodate |journal=World J. Gastroenterol. |volume=22 |issue=32 |pages=7186–202 |year=2016 |pmid=27621567 |pmc=4997632 |doi=10.3748/wjg.v22.i32.7186 |url=}}</ref><ref name="pmid269002862">{{cite journal |vauthors=Distrutti E, Monaldi L, Ricci P, Fiorucci S |title=Gut microbiota role in irritable bowel syndrome: New therapeutic strategies |journal=World J. Gastroenterol. |volume=22 |issue=7 |pages=2219–41 |year=2016 |pmid=26900286 |pmc=4734998 |doi=10.3748/wjg.v22.i7.2219 |url=}}</ref><ref name="pmid253942362">{{cite journal |vauthors=Shreiner AB, Kao JY, Young VB |title=The gut microbiome in health and in disease |journal=Curr. Opin. Gastroenterol. |volume=31 |issue=1 |pages=69–75 |year=2015 |pmid=25394236 |pmc=4290017 |doi=10.1097/MOG.0000000000000139 |url=}}</ref>
*History of [[antibiotic]] use<ref name="pmid282741082">{{cite journal |vauthors=Ghoshal UC, Shukla R, Ghoshal U |title=Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy |journal=Gut Liver |volume=11 |issue=2 |pages=196–208 |year=2017 |pmid=28274108 |pmc=5347643 |doi=10.5009/gnl16126 |url=}}</ref><ref name="pmid276215672">{{cite journal |vauthors=Gallo A, Passaro G, Gasbarrini A, Landolfi R, Montalto M |title=Modulation of microbiota as treatment for intestinal inflammatory disorders: An uptodate |journal=World J. Gastroenterol. |volume=22 |issue=32 |pages=7186–202 |year=2016 |pmid=27621567 |pmc=4997632 |doi=10.3748/wjg.v22.i32.7186 |url=}}</ref><ref name="pmid269002862">{{cite journal |vauthors=Distrutti E, Monaldi L, Ricci P, Fiorucci S |title=Gut microbiota role in irritable bowel syndrome: New therapeutic strategies |journal=World J. Gastroenterol. |volume=22 |issue=7 |pages=2219–41 |year=2016 |pmid=26900286 |pmc=4734998 |doi=10.3748/wjg.v22.i7.2219 |url=}}</ref><ref name="pmid253942362">{{cite journal |vauthors=Shreiner AB, Kao JY, Young VB |title=The gut microbiome in health and in disease |journal=Curr. Opin. Gastroenterol. |volume=31 |issue=1 |pages=69–75 |year=2015 |pmid=25394236 |pmc=4290017 |doi=10.1097/MOG.0000000000000139 |url=}}</ref>
*[[Immune-mediated disease|Immune]] causes:<ref name="pmid242964622" />
*[[Immune-mediated disease|History of]] [[celiac disease]] and [[Colitis|microscopic colitis]]<ref name="pmid242964622" />
**History of [[Inflammatory bowel disease|IBD]]
*History of [[Migraine Headache|migraine]] [[headaches]]<ref name="pmid170076342" /><ref name="pmid164195712">{{cite journal |vauthors=Mulak A, Paradowski L |title=[Migraine and irritable bowel syndrome] |language=Polish |journal=Neurol. Neurochir. Pol. |volume=39 |issue=4 Suppl 1 |pages=S55–60 |year=2005 |pmid=16419571 |doi= |url=}}</ref><ref name="pmid276886562">{{cite journal |vauthors=Cámara-Lemarroy CR, Rodriguez-Gutierrez R, Monreal-Robles R, Marfil-Rivera A |title=Gastrointestinal disorders associated with migraine: A comprehensive review |journal=World J. Gastroenterol. |volume=22 |issue=36 |pages=8149–60 |year=2016 |pmid=27688656 |pmc=5037083 |doi=10.3748/wjg.v22.i36.8149 |url=}}</ref><ref name="pmid224471322">{{cite journal |vauthors=Cady RK, Farmer K, Dexter JK, Hall J |title=The bowel and migraine: update on celiac disease and irritable bowel syndrome |journal=Curr Pain Headache Rep |volume=16 |issue=3 |pages=278–86 |year=2012 |pmid=22447132 |doi=10.1007/s11916-012-0258-y |url=}}</ref>
**[[Celiac disease]]
 
**[[Microscopic colitis]]
=== Menstrual history ===
*Menstrual history
*History of irregular [[Menstruation|menses]]<ref name="pmid246275812">{{cite journal |vauthors=Mulak A, Taché Y, Larauche M |title=Sex hormones in the modulation of irritable bowel syndrome |journal=World J. Gastroenterol. |volume=20 |issue=10 |pages=2433–48 |year=2014 |pmid=24627581 |pmc=3949254 |doi=10.3748/wjg.v20.i10.2433 |url=}}</ref><ref name="pmid16611266">{{cite journal |vauthors=Mawe GM, Coates MD, Moses PL |title=Review article: intestinal serotonin signalling in irritable bowel syndrome |journal=Aliment. Pharmacol. Ther. |volume=23 |issue=8 |pages=1067–76 |year=2006 |pmid=16611266 |doi=10.1111/j.1365-2036.2006.02858.x |url=}}</ref>
*Past history of abuse
 
*Family history of [[Irritable bowel syndrome|IBS]] ([[Genetics]]) <ref name="pmid265257752">{{cite journal |vauthors=Makker J, Chilimuri S, Bella JN |title=Genetic epidemiology of irritable bowel syndrome |journal=World J. Gastroenterol. |volume=21 |issue=40 |pages=11353–61 |year=2015 |pmid=26525775 |pmc=4616211 |doi=10.3748/wjg.v21.i40.11353 |url=}}</ref>
=== Family history ===
*[[Hormone|Hormonal]] changes<ref name="pmid246275812">{{cite journal |vauthors=Mulak A, Taché Y, Larauche M |title=Sex hormones in the modulation of irritable bowel syndrome |journal=World J. Gastroenterol. |volume=20 |issue=10 |pages=2433–48 |year=2014 |pmid=24627581 |pmc=3949254 |doi=10.3748/wjg.v20.i10.2433 |url=}}</ref><ref name="pmid16611266">{{cite journal |vauthors=Mawe GM, Coates MD, Moses PL |title=Review article: intestinal serotonin signalling in irritable bowel syndrome |journal=Aliment. Pharmacol. Ther. |volume=23 |issue=8 |pages=1067–76 |year=2006 |pmid=16611266 |doi=10.1111/j.1365-2036.2006.02858.x |url=}}</ref>
*[[Family history]] of:
*History of [[Migraine Headache|migraine]] headaches<ref name="pmid170076342" /><ref name="pmid164195712">{{cite journal |vauthors=Mulak A, Paradowski L |title=[Migraine and irritable bowel syndrome] |language=Polish |journal=Neurol. Neurochir. Pol. |volume=39 |issue=4 Suppl 1 |pages=S55–60 |year=2005 |pmid=16419571 |doi= |url=}}</ref><ref name="pmid276886562">{{cite journal |vauthors=Cámara-Lemarroy CR, Rodriguez-Gutierrez R, Monreal-Robles R, Marfil-Rivera A |title=Gastrointestinal disorders associated with migraine: A comprehensive review |journal=World J. Gastroenterol. |volume=22 |issue=36 |pages=8149–60 |year=2016 |pmid=27688656 |pmc=5037083 |doi=10.3748/wjg.v22.i36.8149 |url=}}</ref><ref name="pmid224471322">{{cite journal |vauthors=Cady RK, Farmer K, Dexter JK, Hall J |title=The bowel and migraine: update on celiac disease and irritable bowel syndrome |journal=Curr Pain Headache Rep |volume=16 |issue=3 |pages=278–86 |year=2012 |pmid=22447132 |doi=10.1007/s11916-012-0258-y |url=}}</ref>
**[[Irritable bowel syndrome|IBS]] <ref name="pmid265257752">{{cite journal |vauthors=Makker J, Chilimuri S, Bella JN |title=Genetic epidemiology of irritable bowel syndrome |journal=World J. Gastroenterol. |volume=21 |issue=40 |pages=11353–61 |year=2015 |pmid=26525775 |pmc=4616211 |doi=10.3748/wjg.v21.i40.11353 |url=}}</ref>
*History of pain disorders such as [[fibromyalgia]]<ref name="pmid170076342" /><ref name="pmid248799162">{{cite journal |vauthors=Vehof J, Zavos HM, Lachance G, Hammond CJ, Williams FM |title=Shared genetic factors underlie chronic pain syndromes |journal=Pain |volume=155 |issue=8 |pages=1562–8 |year=2014 |pmid=24879916 |doi=10.1016/j.pain.2014.05.002 |url=}}</ref>
**[[celiac disease]]
*History of food sensitivities: Fatty food, wheat, carbonated drinks, sorbitol and alcohol<ref name="pmid232561172">{{cite journal |vauthors=Chirila I, Petrariu FD, Ciortescu I, Mihai C, Drug VL |title=Diet and irritable bowel syndrome |journal=J Gastrointestin Liver Dis |volume=21 |issue=4 |pages=357–62 |year=2012 |pmid=23256117 |doi= |url=}}</ref>
** [[inflammatory bowel disease]]
**[[Colorectal cancer|colorectal cancer]]
 
=== History of allergies ===
*History of food sensitivities: Fatty food, wheat, carbonated drinks, [[sorbitol]] and [[alcohol]]<ref name="pmid232561172">{{cite journal |vauthors=Chirila I, Petrariu FD, Ciortescu I, Mihai C, Drug VL |title=Diet and irritable bowel syndrome |journal=J Gastrointestin Liver Dis |volume=21 |issue=4 |pages=357–62 |year=2012 |pmid=23256117 |doi= |url=}}</ref>
 
=== Medication history ===
*History of [[medication]] use should be obtained as many [[:Category:Drugs|drugs]] such as [[Opioid|opioids]] cause [[constipation]] as a side effect.
*History of [[medication]] use should be obtained as many [[:Category:Drugs|drugs]] such as [[Opioid|opioids]] cause [[constipation]] as a side effect.
*Family history should include the presence of [[celiac disease]], [[inflammatory bowel disease]] and [[Colorectal cancer|colorectal cancer.]]


==References==
==References==
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Latest revision as of 17:17, 3 December 2017

Irritable bowel syndrome Microchapters

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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

The diagnosis of irritable bowel syndrome (IBS) relies on recognition of gastrointestinal symptoms that wax and wane and are exacerbated by psychosocial stress. Diagnosis of IBS is based on clinical symptoms and elimination of other organic gastrointestinal diseases. This is due to lack of definitive radiological or laboratory diagnostic tests in IBS. The hallmark of IBS is abdominal pain. A positive history of stress, anxiety, depression, panic disorders, gastrointestinal disorders such as inflammatory bowel disease (IBD) and acute GI infection predispose individuals to IBS. The most common symptoms of IBS include presence of abdominal pain and alteration of bowel habits. Less common symptoms of IBS include flatulence and upper GI symptoms such as heartburn, nausea, dyspepsia and vomiting. 

Symptoms

Common symptoms

Common symptoms of IBS include abdominal pain, altered bowel habits, bloating and flatulence.

COMMON SYMPTOMS OF IBS
Abdominal pain (major prerequisite for IBS) Site: Variable location

Onset: Sudden/Insidious

Character: Episodic and crampy with a background of constant pain

Relieving factors: Relief on defecation

Aggravating factors: Eating, emotional stress, premenstrual and menstrual phases

Associated factors: Change in frequency or form of stool

Timing: Pain is usually present during waking hours. Nocturnal symptoms are usually present only in severe IBS

Severity: Variable (varies from mild to severe enough to impair quality of life)

Altered bowel habits Altered bowel habits usually present as diarrhea alternating with constipation. One of these tends to be the predominant symptom in the patient. [12][13][13]
Constipation predominant IBS: <3 bowel movements per week Diarrhea predominant IBS: >3 bowel movements per day [14][16]Patients have:
  1. Loose stools in small volumes, aggravated by eating or emotional stress
  2. Stool volume of <200 ml
  3. Stool accompanied by mucus passage
  4. Absence of nocturnal diarrhea
  5. Absence of bleeding
  6. Absence of weight loss or malabsorption
Gas and flatulence

Less common symptoms

LESS COMMON SYMPTOMS OF IBS
Upper gastrointestinal symptoms One fourth of all IBS patients complain of heartburn, nausea, dyspepsia and vomiting. 
Lower gastrointestinal symptoms

History

Psychosocial history

Past Medical history

Menstrual history

Family history

History of allergies

Medication history

References

  1. ↑ Schmulson MW, Chang L (1999). "Diagnostic approach to the patient with irritable bowel syndrome". Am. J. Med. 107 (5A): 20S–26S. PMID 10588169.
  2. ↑ Jasper F, Egloff B, Roalfe A, Witthöft M (2015). "Latent structure of irritable bowel syndrome symptom severity". World J Gastroenterol. 21 (1): 292–300. doi:10.3748/wjg.v21.i1.292. PMC 4284348. PMID 25574104.
  3. ↑ van Tilburg MA, Palsson OS, Whitehead WE (2013). "Which psychological factors exacerbate irritable bowel syndrome? Development of a comprehensive model". J Psychosom Res. 74 (6): 486–92. doi:10.1016/j.jpsychores.2013.03.004. PMC 3673027. PMID 23731745.
  4. ↑ Talley NJ (2006). "A unifying hypothesis for the functional gastrointestinal disorders: really multiple diseases or one irritable gut?". Reviews in gastroenterological disorders. 6 (2): 72–8. PMID 16699476.
  5. ↑ Occhipinti K, Smith JW (2012). "Irritable bowel syndrome: a review and update". Clin Colon Rectal Surg. 25 (1): 46–52. doi:10.1055/s-0032-1301759. PMC 3348735. PMID 23449495.
  6. ↑ Ford AC, Marwaha A, Lim A, Moayyedi P (2010). "Systematic review and meta-analysis of the prevalence of irritable bowel syndrome in individuals with dyspepsia". Clin. Gastroenterol. Hepatol. 8 (5): 401–9. doi:10.1016/j.cgh.2009.07.020. PMID 19631762.
  7. ↑ Sayuk GS, Elwing JE, Lustman PJ, Clouse RE (2007). "High somatic symptom burdens and functional gastrointestinal disorders". Clin. Gastroenterol. Hepatol. 5 (5): 556–62. doi:10.1016/j.cgh.2006.11.024. PMID 17258513.
  8. ↑ Whitehead WE, Palsson OS, Levy RR, Feld AD, Turner M, Von Korff M (2007). "Comorbidity in irritable bowel syndrome". Am. J. Gastroenterol. 102 (12): 2767–76. doi:10.1111/j.1572-0241.2007.01540.x. PMID 17900326.
  9. ↑ Brown WH, Chey WD, Elta GH (2003). "Number of responses on a review of systems questionnaire predicts the diagnosis of functional gastrointestinal disorders". J. Clin. Gastroenterol. 36 (3): 222–7. PMID 12590233.
  10. ↑ Fass R, Longstreth GF, Pimentel M; et al. (2001). "Evidence- and consensus-based practice guidelines for the diagnosis of irritable bowel syndrome". Arch. Intern. Med. 161 (17): 2081–8. PMID 11570936.
  11. ↑ Paul SP, Barnard P, Bigwood C, Candy DC (2013). "Challenges in management of irritable bowel syndrome in children". Indian Pediatr. 50 (12): 1137–43. PMID 24413506.
  12. ↑ 12.0 12.1 Drossman DA, Camilleri M, Mayer EA, Whitehead WE (2002). "AGA technical review on irritable bowel syndrome". Gastroenterology. 123 (6): 2108–31. doi:10.1053/gast.2002.37095. PMID 12454866.
  13. ↑ 13.0 13.1 Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC (2006). "Functional bowel disorders". Gastroenterology. 130 (5): 1480–91. doi:10.1053/j.gastro.2005.11.061. PMID 16678561.
  14. ↑ 14.0 14.1 Camilleri M, McKinzie S, Busciglio I, Low PA, Sweetser S, Burton D, Baxter K, Ryks M, Zinsmeister AR (2008). "Prospective study of motor, sensory, psychologic, and autonomic functions in patients with irritable bowel syndrome". Clin. Gastroenterol. Hepatol. 6 (7): 772–81. doi:10.1016/j.cgh.2008.02.060. PMC 2495078. PMID 18456567.
  15. ↑ Fromm M, Littman P, Raney RB, Nelson L, Handler S, Diamond G, Stanley C (1986). "Late effects after treatment of twenty children with soft tissue sarcomas of the head and neck. Experience at a single institution with a review of the literature". Cancer. 57 (10): 2070–6. PMID 3955515.
  16. ↑ 16.0 16.1 Törnblom H, Van Oudenhove L, Sadik R, Abrahamsson H, Tack J, Simrén M (2012). "Colonic transit time and IBS symptoms: what's the link?". Am. J. Gastroenterol. 107 (5): 754–60. doi:10.1038/ajg.2012.5. PMID 22334251.
  17. ↑ Prott G, Shim L, Hansen R, Kellow J, Malcolm A (2010). "Relationships between pelvic floor symptoms and function in irritable bowel syndrome". Neurogastroenterol. Motil. 22 (7): 764–9. doi:10.1111/j.1365-2982.2010.01503.x. PMID 20456760.
  18. ↑ 18.0 18.1 Mayer EA, Craske M, Naliboff BD (2001). "Depression, anxiety, and the gastrointestinal system". J Clin Psychiatry. 62 Suppl 8: 28–36, discussion 37. PMID 12108819.
  19. ↑ Devanarayana NM, Mettananda S, Liyanarachchi C, Nanayakkara N, Mendis N, Perera N, Rajindrajith S (2011). "Abdominal pain-predominant functional gastrointestinal diseases in children and adolescents: prevalence, symptomatology, and association with emotional stress". J. Pediatr. Gastroenterol. Nutr. 53 (6): 659–65. doi:10.1097/MPG.0b013e3182296033. PMID 21697745.
  20. ↑ 20.0 20.1 Qin HY, Cheng CW, Tang XD, Bian ZX (2014). "Impact of psychological stress on irritable bowel syndrome". World J. Gastroenterol. 20 (39): 14126–31. doi:10.3748/wjg.v20.i39.14126. PMC 4202343. PMID 25339801.
  21. ↑ 21.0 21.1 Bharucha AE, Chakraborty S, Sletten CD (2016). "Common Functional Gastroenterological Disorders Associated With Abdominal Pain". Mayo Clin. Proc. 91 (8): 1118–32. doi:10.1016/j.mayocp.2016.06.003. PMC 4985027. PMID 27492916.
  22. ↑ Ibrahim NK (2016). "A systematic review of the prevalence and risk factors of irritable bowel syndrome among medical students". Turk J Gastroenterol. 27 (1): 10–6. doi:10.5152/tjg.2015.150333. PMID 26674980.
  23. ↑ 23.0 23.1 23.2 Cole JA, Rothman KJ, Cabral HJ, Zhang Y, Farraye FA (2006). "Migraine, fibromyalgia, and depression among people with IBS: a prevalence study". BMC Gastroenterol. 6: 26. doi:10.1186/1471-230X-6-26. PMC 1592499. PMID 17007634.
  24. ↑ Hausteiner-Wiehle C, Henningsen P (2014). "Irritable bowel syndrome: relations with functional, mental, and somatoform disorders". World J. Gastroenterol. 20 (20): 6024–30. doi:10.3748/wjg.v20.i20.6024. PMC 4033442. PMID 24876725.
  25. ↑ Vehof J, Zavos HM, Lachance G, Hammond CJ, Williams FM (2014). "Shared genetic factors underlie chronic pain syndromes". Pain. 155 (8): 1562–8. doi:10.1016/j.pain.2014.05.002. PMID 24879916.
  26. ↑ 26.0 26.1 Major G, Spiller R (2014). "Irritable bowel syndrome, inflammatory bowel disease and the microbiome". Curr Opin Endocrinol Diabetes Obes. 21 (1): 15–21. doi:10.1097/MED.0000000000000032. PMC 3871405. PMID 24296462.
  27. ↑ Ceuleers H, Van Spaendonk H, Hanning N, Heirbaut J, Lambeir AM, Joossens J, Augustyns K, De Man JG, De Meester I, De Winter BY (2016). "Visceral hypersensitivity in inflammatory bowel diseases and irritable bowel syndrome: The role of proteases". World J. Gastroenterol. 22 (47): 10275–10286. doi:10.3748/wjg.v22.i47.10275. PMC 5175241. PMID 28058009.
  28. ↑ Halliez MC, Buret AG (2013). "Extra-intestinal and long term consequences of Giardia duodenalis infections". World J. Gastroenterol. 19 (47): 8974–85. doi:10.3748/wjg.v19.i47.8974. PMC 3870550. PMID 24379622.
  29. ↑ Simrén M, Barbara G, Flint HJ, Spiegel BM, Spiller RC, Vanner S, Verdu EF, Whorwell PJ, Zoetendal EG (2013). "Intestinal microbiota in functional bowel disorders: a Rome foundation report". Gut. 62 (1): 159–76. doi:10.1136/gutjnl-2012-302167. PMC 3551212. PMID 22730468.
  30. ↑ Jeffery IB, Quigley EM, Öhman L, Simrén M, O'Toole PW (2012). "The microbiota link to irritable bowel syndrome: an emerging story". Gut Microbes. 3 (6): 572–6. doi:10.4161/gmic.21772. PMC 3495796. PMID 22895081.
  31. ↑ Ibarra C, Herrera V, Pérez de Arce E, Gil LC, Madrid AM, Valenzuela L, Beltrán CJ (2016). "[Parasitosis and irritable bowel syndrome]". Rev Chilena Infectol (in Spanish; Castilian). 33 (3): 268–74. doi:10.4067/S0716-10182016000300003. PMID 27598274.
  32. ↑ Giddings SL, Stevens AM, Leung DT (2016). "Traveler's Diarrhea". Med. Clin. North Am. 100 (2): 317–30. doi:10.1016/j.mcna.2015.08.017. PMC 4764790. PMID 26900116.
  33. ↑ Keithlin J, Sargeant J, Thomas MK, Fazil A (2014). "Systematic review and meta-analysis of the proportion of Campylobacter cases that develop chronic sequelae". BMC Public Health. 14: 1203. doi:10.1186/1471-2458-14-1203. PMC 4391665. PMID 25416162.
  34. ↑ Grover M (2014). "Role of gut pathogens in development of irritable bowel syndrome". Indian J. Med. Res. 139 (1): 11–8. PMC 3994726. PMID 24604037.
  35. ↑ Keithlin J, Sargeant J, Thomas MK, Fazil A (2014). "Chronic sequelae of E. coli O157: systematic review and meta-analysis of the proportion of E. coli O157 cases that develop chronic sequelae". Foodborne Pathog. Dis. 11 (2): 79–95. doi:10.1089/fpd.2013.1572. PMC 3925333. PMID 24404780.
  36. ↑ Connor BA, Riddle MS (2013). "Post-infectious sequelae of travelers' diarrhea". J Travel Med. 20 (5): 303–12. doi:10.1111/jtm.12049. PMID 23992573.
  37. ↑ Spiller R, Campbell E (2006). "Post-infectious irritable bowel syndrome". Curr. Opin. Gastroenterol. 22 (1): 13–7. PMID 16319671.
  38. ↑ Ghoshal UC, Shukla R, Ghoshal U (2017). "Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy". Gut Liver. 11 (2): 196–208. doi:10.5009/gnl16126. PMC 5347643. PMID 28274108.
  39. ↑ Gallo A, Passaro G, Gasbarrini A, Landolfi R, Montalto M (2016). "Modulation of microbiota as treatment for intestinal inflammatory disorders: An uptodate". World J. Gastroenterol. 22 (32): 7186–202. doi:10.3748/wjg.v22.i32.7186. PMC 4997632. PMID 27621567.
  40. ↑ Distrutti E, Monaldi L, Ricci P, Fiorucci S (2016). "Gut microbiota role in irritable bowel syndrome: New therapeutic strategies". World J. Gastroenterol. 22 (7): 2219–41. doi:10.3748/wjg.v22.i7.2219. PMC 4734998. PMID 26900286.
  41. ↑ Shreiner AB, Kao JY, Young VB (2015). "The gut microbiome in health and in disease". Curr. Opin. Gastroenterol. 31 (1): 69–75. doi:10.1097/MOG.0000000000000139. PMC 4290017. PMID 25394236.
  42. ↑ Mulak A, Paradowski L (2005). "[Migraine and irritable bowel syndrome]". Neurol. Neurochir. Pol. (in Polish). 39 (4 Suppl 1): S55–60. PMID 16419571.
  43. ↑ Cámara-Lemarroy CR, Rodriguez-Gutierrez R, Monreal-Robles R, Marfil-Rivera A (2016). "Gastrointestinal disorders associated with migraine: A comprehensive review". World J. Gastroenterol. 22 (36): 8149–60. doi:10.3748/wjg.v22.i36.8149. PMC 5037083. PMID 27688656.
  44. ↑ Cady RK, Farmer K, Dexter JK, Hall J (2012). "The bowel and migraine: update on celiac disease and irritable bowel syndrome". Curr Pain Headache Rep. 16 (3): 278–86. doi:10.1007/s11916-012-0258-y. PMID 22447132.
  45. ↑ Mulak A, Taché Y, Larauche M (2014). "Sex hormones in the modulation of irritable bowel syndrome". World J. Gastroenterol. 20 (10): 2433–48. doi:10.3748/wjg.v20.i10.2433. PMC 3949254. PMID 24627581.
  46. ↑ Mawe GM, Coates MD, Moses PL (2006). "Review article: intestinal serotonin signalling in irritable bowel syndrome". Aliment. Pharmacol. Ther. 23 (8): 1067–76. doi:10.1111/j.1365-2036.2006.02858.x. PMID 16611266.
  47. ↑ Makker J, Chilimuri S, Bella JN (2015). "Genetic epidemiology of irritable bowel syndrome". World J. Gastroenterol. 21 (40): 11353–61. doi:10.3748/wjg.v21.i40.11353. PMC 4616211. PMID 26525775.
  48. ↑ Chirila I, Petrariu FD, Ciortescu I, Mihai C, Drug VL (2012). "Diet and irritable bowel syndrome". J Gastrointestin Liver Dis. 21 (4): 357–62. PMID 23256117.

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