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DEPRESSION IN IRRITABLE BOWEL SYNDROME (IBS)
- Dr.Ravi Abhyankar

Irritable bowel syndrome is perhaps the commonest gastrointestinal disorder. Irritable bowel syndrome is a motor disorder of the bowel consisting of altered bowel habits and abdominal pain, without any organic pathology. Symptoms as given in Table 1 are influenced by psychological & emotional factors and stressful life situations.

Table 1
Symptoms in Irritable Bowel Syndrome
Diarrhoea Constipation Abdominal distress Flatulence Erratic bowel action Annoying discomfort Excruciating pain Abdominal cramps Burning sensation Twisting/Griping Knotting in abdomen Fullness/Heaviness Pressure Belching	Watery stools Hard, dry, pebbly stools Mucous stools String stools Lump in throat Giddiness Palpitation Shortness of breath Frequency of urination Weakness Fatigue Lassitude Ennui Cancerophobia

Although diagnosis requires the exclusion of organic diseases, it is confirmed by positive clinical, psychological, laboratory and motility finding. Irritable Bowel Syndrome or IBS is a syndrome, consisting of a number of conditions with similar manifestations. The symptoms which help to distinguish IBS from organic disease are given in Table 2.

Table 2

Symptoms which are diagnostic of IBS (Manning's Criteria)

Visible abdominal distention
Relief of abdominal pain by bowel movement
More frequent bowel movements with onset of pain
Looser stools with onset of pain
Passage of mucus
A sensation of incomplete evacuation

IBS has also been known as spastic colon, mucous colitis and nervous stomach. It is the prototypical functional gastrointestinal disorder. It is chronic, benign, non-inflammatory and non progressive and is regarded as psychosomatic or psychophysicological disorder.

Epidemiology

IBS is present in about 50% patients seen in gastroenterology clinics, is commonly seen in general medical clinics and in family physicians clinics. Community surveys demonstrate that it is common in community and that more than 60% of patients who have symptoms of IBS have never taken any treatment at all.

It is two to three times more common in females, occurs in early childhood, adolescence and even in middle age. It is more revalent in developed countries and in urban areas. Its incidence and prevalence is increasing over the past 50 years which may be related to increasing stress in daily life, changes in life style and in dietary patterns.

Irritable bowel syndrome exerts a large collective impact on the economy, the health care system and on the quality of life of the individual patient.

Pathophysiology & Etiology

There is general agreement that irritable bowel syndrome is a disorder of intestinal motility. Most of the patients of IBS have an abnormal increase in 3 cycles per minutes contractility which is unrelated to diet or bowel habits and persists even during remission.

Recent discoveries have demonstrated histological and pharmacological similarities between the bowel and the brain e.g. presence of peptides like substance P, serotonin, dopamine, encephalins, prostaglandins and other neurotransmitters in the bowel tissue. These findings suggest the speculation that pharmacological agents that alter mental and neurological function may also prove effective in functional disturbances of the bowel.

Anxiety, fear and depression result in hypermotility. Aggressive feelings such as hostility and resentment also cause motility disturbances. Gastrointestinal complaints are frequently present in psychiatric disorders. Early attitudes, beliefs and family behaviors regarding functions of alimentary tract both at the upper and lower ends may be responsible for conditioning a learned response to bowel function.

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