Study On Irritable Bowel Syndrome And Design Of A New System Of Diagnosis And Treatment

Backgrounds: Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by recurrent abdominal pain or discomfort associated with altered bowel movements. However, its pathophysiology remains elusive, and more and more studies have been performed. While we still feel confused in IBS related practice and research, and three questions linger in our minds: What is IBS? What direction should the studies pertaining to IBS develop to? What's the best way to diagnose and treat IBS?Objectives: To clarify the concept of IBS, and suggest the direction for the IBS-related research and the medical paradigms, design a new system of diagnosis and treatment for IBS.Methods: By reviewing the literature, we tried to find the common characterization of IBS and to clarify its definition. Questionnaires were performed to determine the gastroenterologists' knowledge about IBS and their perceptions when dealing with IBS patients. We also analyzed the uncertainty in our animal experiments and related articles, and discussed the paradigms we should have. A management strategy concerning the diagnosis and treatment of IBS was suggested.Results: 1. The symptom-based diagnosis of IBS is subjective and casual. IBS patients present multiple symptoms, which are affected by biopsychosocial factors and in a dynamic situation. Some physicians have limited knowledge of IBS, which restricts the practice of the criteria.2. The majority of the animal studies focus on the establishment of models, detection of the pathophysiology and verifying the hypothesis. However, the uncertainties lie among and produced by the results are confusing. The results of clinical researches usually present diversity as well since they based on the retrospective epidemiological studies and trials to improve symptoms. It is hard to make a clinical decision. It seems that the traditional paradigm plays a dominant role in IBS studies.3. Since the patient's symptoms and medical seeking behaviors are influenced by biopsychosocial factors, the new system of diagnosis and treatment of IBS should take all the aspects into account.Conclusions:1. IBS is characterized by abdominal pain and altered bowel movement, associated with discomfort from other organs. It may be a response to both physical and psychological stresses composed by biopsychosocial factors. No pathological abnormality is found till now. In order to be consistent with the dynamic and comprehensive characterization of clinical presentations, we suggest that the name "irritable bowel syndrone" change to be "Irritable State (IS) ".2. IBS is influenced by biopsychosocial factors, the direction for IBS-related researches should focus on the balance of the biopsychosocial impact. Correspondingly, we should not limit to the traditional medical paradigms. Comprehensive and the right brain paradigms are even more needed, and narrative medicine may become a new approach in managing IBS.3. A management system is needed to diagnose and treat IBS, which includes not only the medical diagnosis and treatment system, but also communication and incentive system, tailored prevention, therapy and appraisement system, guarantee system and social support system.