Clinical practice. Irritable bowel syndrome

N Engl J Med. 2008 Apr 17;358(16):1692-9. doi: 10.1056/NEJMcp0801447.

Abstract

A 28-year-old woman presents with a 7-month history of recurrent, crampy pain in the left lower abdominal quadrant, bloating with abdominal distention, and frequent, loose stools. She reports having had similar but milder symptoms since childhood. She spends long times in the bathroom because she is worried about uncontrollable discomfort and fecal soiling if she does not completely empty her bowels before leaving the house. She feels anxious and fatigued and is frustrated that her previous physician did not seem to take her distress seriously. Physical examination is unremarkable except for tenderness over the left lower quadrant. How should her case be evaluated and treated?

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Adult
  • Antidepressive Agents, Tricyclic / therapeutic use
  • Carbolines / therapeutic use
  • Cognitive Behavioral Therapy*
  • Desipramine / therapeutic use
  • Female
  • Gastrointestinal Agents / therapeutic use*
  • Humans
  • Indoles / therapeutic use
  • Irritable Bowel Syndrome / diagnosis
  • Irritable Bowel Syndrome / etiology
  • Irritable Bowel Syndrome / psychology
  • Irritable Bowel Syndrome / therapy*
  • Male
  • Parasympatholytics / therapeutic use
  • Practice Guidelines as Topic

Substances

  • Antidepressive Agents, Tricyclic
  • Carbolines
  • Gastrointestinal Agents
  • Indoles
  • Parasympatholytics
  • alosetron
  • tegaserod
  • Desipramine