ABSTRACT
No reference work covering disorders of the colon would be complete without a chapter covering irritable bowel syndrome (IBS). IBS is the most common disorder seen in gastrointestinal practice. Despite tremendous advances, which have occurred in the care of colonic disorders in the last 30 years, IBS remains a significant challenge for physicians, for a number of reasons. The first is that IBS has no pathognomonic structural, biochemical, or physiologic markers to identify it. Secondly, the symptoms of IBS, i.e., pain, constipation, and/or diarrhea and bloating can be seen in an extremely wide spectrum of gastrointestinal disorders. This presents at first glance a significant diagnostic and therapeutic challenge. However significant advances in our understanding of IBS have occurred in the last 10 years. This is particularly true in the areas of IBS diagnosis and treatment. It will be the purpose of this chapter to review the epidemiology, clinical presentation, and psychosocial correlates of IBS. A rational approach to diagnosis will be proposed, and recommendations for treatment emphasizing new and emerging agents will be discussed in detail. Although the treatment of IBS has been a somewhat nihilistic area of medical practice, an emerging realization of the importance of this somewhat perplexing disorder has produced a body of new knowledge to help us effectively treat these often long-suffering patients.
