PubMed · 10208120
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1999. Herbs for bowel problems?. https://pubmed.ncbi.nlm.nih.gov/10208120/
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Irritable bowel syndrome is characterised by constant or recurrent abdominal complaints over more than three months, in the absence of any pathological changes in the routinely employed examination procedures. The diagnosis is established on the basis of typical symptoms and specific exclusion of relevant differential diagnoses. The heart of the diagnostic evaluation comprises a limited routine laboratory investigation, and endoscopic exploration to exclude organic disease of the gastrointestinal tract. Diagnostic re-evaluation is necessary only when there is a change in the patient's symptoms. A psychosomatic diagnostic evaluation and, where necessary, psychotherapy is indicated in about 5% of the patients. For IBS, causal treatment is not available. Apart from symptomatic drug treatment, intensive counseling and regular interviews are of particular importance.
After establishing the diagnosis, reassuring the patient, and applying non-drug measures, pharmacotherapy forms a major pillar in the treatment of IBS, despite the fact that because the pathophysiology is still unknown, we have no causal drug treatment available. In the first instance, medication is a recommended supportive measure for application during the symptom-free intervals. It is oriented to the patient's leading complaints, and is directed towards the regulation of bowel movements, treatment of flatulency, and amelioration of painful motility disorders (e.g. spasms).
Irritable bowel syndrome is a chronic, relapsing functional bowel disorder of unknown aetiology. Methods of studying intestinal motor function, nociception, and interactions of the central nervous system and enteric nervous system are not applicable for clinical use. The diagnosis is therefore made on the symptoms, but it is necessary to exclude relevant organic disease. Establishment of the diagnosis, information about the disorder, elimination of foods and other factors that provoke the symptoms, and a change in life-style are sufficient in most cases. Treatment is hampered by the lack of effective treatment and the psychological aspects. The therapeutic gain of drug administration is modest and the rate of response to placebo is high. Fibre supplementation, magnesium oxide or cisapride may be tried for constipation, diphenoxylate or loperamide for diarrhoea, and low dose tricyclic antidepressants or serotonin reuptake blockers for severe pain. The introduction of 5-hydroxytryptamine-3 (5-HT3) receptor antagonists seems promising.