[The irritable colon]

Gut dysfunction can be demonstrated in 20-30% of normal adults without ever developing real illness. Irritable bowel syndrome is not merely a gastrointestinal disturbance, but involves the whole organism. With respect to etiology a number of factors such as constitution, mental state and environment, colonic motility, gastrointestinal peptides, low residue diet, food intolerance and infections all seem to play a role. Positive diagnosis by electromyography has not gained any clinical relevance. Treatment of gastrointestinal functional disorders is characterized by a considerable positive response to placebo and is oriented towards individual symptoms. Bran and bulking agents are effective when constipation is present, opiate-agonists have a positive influence in diarrhoea, anti-cholinergics may be of some value in abdominal pain, antidepressants and sedatives given for a limited period of time may be beneficial in psychiatric symptoms. The combination most often used in therapy of irritable bowel syndrome consists of sedatives, anticholinergics and bulking agents. Psychotherapy can prolong the positive effects of medical therapy even beyond the treatment period. Long-term follow-up reveals a satisfactory response of the symptomatology in the majority of patients.