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Toward a Psitive and Comprehensive Diagnosis of IBS
Toward a Positive and Comprehensive Diagnosis of Irritable Bowel Syndrome
Yehuda Ringel, MD, and Douglas A. Drossman, MD, University of North Carolina, Chapel Hill
Medscape General Medicine.?2000;2(4)?
Irritable bowel syndrome (IBS) is one of the most frequently diagnosed disorders in general population and medical settings. It accounts for an estimated 28% of patients seen in gastroenterology practice and up to 12% of patients seen in primary care practice. IBS affects about 10% to 20% of adolescents and adults (14% to 24% female, 5% to 19% male) in Western countries. The disorder can substantially impair the patients quality of life and increase annual healthcare costs; it poses a considerable socioeconomic burden on the healthcare system overall.[1-3]?The high prevalence and significant sequelae of IBS have led to increased interest in this disorder among clinicians, clinical investigators, basic scientists, physiologists, and mental health professionals.
Indeed, over the last 2 decades there has been a 10-fold increase in citations on IBS.[4]?The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and various gastroenterologic societies have increased the exposure of IBS through educational and research programs. Most recently, the pharmaceutical industry has begun international marketing campaigns related to new enteric receptor agents. Nevertheless, the etiology and pathogenesis of IBS still are not completely characterized, and no unique morphologic, physiologic, or pathologic pattern that can serve as a marker for the disorder has been identified. Such circumstances where an illness exists without a defined disease create certain diagnostic dilemmas for the clinician: (1) Is IBS a genuine disorder, with clearly definable determinants? (2) How can the diagnosis be made in the absence of a biological marker? (3) How confident can the clinician be in making the diagnosis?
During the last 20 years, significant changes have occurred in how we
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