Sanda Pletikosić

Cognitive behavioral approach to understanding irritable bowel syndrome

Irritable bowel syndrome (IBS) is considered a biopsychosocial disorder, whose onset and precipitation are a consequence of interaction among multiple factors which include motility disturbances, abnormalities of gastrointestinal sensation, gut inflammation and infection, altered processing of afferent sensory information, psychological distress, and affective disturbances. Several models have been proposed in order to describe and explain IBS, each of them focusing on specific aspects or mechanisms of the disorder. This review attempts to present and discuss different determinants of IBS and its symptoms, from a cognitive behavioral therapy framework, distinguishing between the developmental predispositions and precipitants of the disorder, and its perpetuating cognitive, behavioral, affective and physiological factors. The main focus in understanding IBS will be placed on the numerous psychosocial factors, such as personality traits, early experiences, affective disturbances, altered attention and cognitions, avoidance behavior, stress, coping and social support. In conclusion, a symptom perpetuation model is proposed.

Diagnosis of Irritable Bowel Syndrome: Role of Potential Biomarkers

Irritable bowel syndrome is a disorder diagnosed on symptom-based criteria without inclusion of any objective parameter measurable by known diagnostic methods. Heterogeneity of the disorder and overlapping with more serious organic diseases increase uncertainty for the physicians work and increase the cost of confirming the diagnosis. This paper is an attempt to summarize the efforts to find adequate biomarkers for irritable bowel syndrome, which should shorten the time to diagnosis and reduce the cost. Most of the reviewed papers were observational studies from secondary care institutions. Since publication of the Rome III criteria in 2006, most recent studies use these for the recruitment of IBS patients. This is a positive step forward as future studies should use the same criteria, facilitating comparison of their results. Among the studied biomarkers, most evidence is provided for fecal calprotectin. Cutoff values for fecal calprotectin have still to be investigated prior to inclusion in the irritable bowel syndrome diagnostic algorithm.

Erythrocyte sedimentation rate - Possible role in determining the existence of the low grade inflammation in Irritable Bowel Syndrome patients

Irritable Bowel Syndrome (IBS), the most prevalent functional gastrointestinal disorder, is best described by the presence of recurrent symptoms of abdominal pain, diarrhea and/or constipation. It has been thought that IBS is stress-related disorder with no known structural abnormalities, e.g. infectious, biochemical or metabolic causes. But, recent evidence suggests that inflammation within the gastrointestinal tract may be of great importance in the pathogenesis of IBS. Our question is could the conventional and widely available general biological markers of inflammation such as erythrocyte sedimentation rate (ESR) be indicator of microscopic inflammatory process in some IBS patients? We hypothesize that mild inflammation in IBS patients could be detected by meaning of a sensitive but cheap and ubiquitous test - ESR. Furthermore we assume that ESR would be related with the disease severity index and decreased general and disease-specific health-related quality of life (HRQoL). A pilot study has been conducted with 86 outpatients (65% female) with IBS, average age 47.76 (SD=13.68). The preliminary results were partly in favor of our hypothesis. They showed that IBS patients with higher ESR expressed lower disease-specific HRQoL (e.g. they expressed more bowel symptoms, social and emotional disturbances related to disease). No significant correlations were found between ESR and the disease severity as well as general HRQoL.