Irritable bowel syndrome: basis of clinical management strategies

Patients with irritable bowel syndrome (IBS) are often described as challenging. The diagnosis of IBS can safely be made using the Rome II criteria in conjunction with a thorough physical examination and a limited number of diagnostic studies. Although the diagnosis is generally made with a high degree of accuracy, the pathophysiology of IBS remains elusive, and treatment can be frustrating for both patient and physician alike. Important areas of research focus on the psychology of IBS, visceral hypersensitivity, motility abnormalities (e.g., heightened gastrocolonic response), and the "brain-gut axis." A multidisciplinary effort is often required to ameliorate symptoms and improve the patients' quality of life. This review article will discuss the myriad of treatments available for patients with IBS, and provide both a clinical and practical discussion of their use, providing evidence where available and clinical experience where it is not.