Irritable bowel syndrome.

The irritable bowel syndrome (IBS) is very common in the community. Psychosocial factors other than the gut symptoms themselves may contribute to the decision of a few to seek medical care. Examination of these not only suggests that the manifestation of symptoms is multifactorial, but also offers clues for management of individuals. There is evidence for both physical and psychological contributions to IBS symptoms and both together may induce illness behavior. In some, many factors may be present, in others apparently none, but the more factors at work, the more complex the treatment. Management should take advantage of the known features of the disease. Its prevalence, recognizable symptoms, and benign nature underpin the reassurance value of a positive diagnosis. Psychopathology or antecedent stressful life events may indicate psychological treatments. Although drugs are unproved in the global treatment of IBS, certain agents may benefit specific symptoms and use the placebo response to advantage. Patients having more difficulty treating symptoms need continuing care. A graded response to IBS complaints implies reassurance and drug-free management in primary care, with increments of psychosocial support, psychotherapy, and the specific use of drugs in nonresponders. The goal for intractable cases should be improved functioning rather than cure.