The irritable bowel syndrome: Mechanisms and a practical approach to management

Objective: To develop a practical strategy that facilitates the management of patients with the irritable bowel syndrome (IBS). Study Selection and Data Extraction: Review of the pertinent literature published in major English-language journals for the last 25 years, describing the pathophysiology and treatment of subgroups of patients with IBS. Results: A stepwise approach for practical management of patients with suspected IBS is identified. The first step includes a combination of positive diagnosis of symptoms with limited investigations to exclude underlying structural or biochemical disorders. In the second step, therapeutic trials focus on alleviating the predominant symptoms. For patients with intractable symptoms, the third step combines novel tests to assess altered function and therapeutic trials to correct the dysfunction identified in the individual patient. Conclusions: A practical approach has been developed for management of IBS. It is based on advances in our understanding of the mechanisms resulting in IBS and on targeting therapy to correct the dysfunctions in these patients.