Irritable bowel syndrome:A clinical review

Irritable bowel syndrome (IBS) remains a clinical challenge in the 21st century. It’s the most commonly diagnosed gastrointestinal condition and also the most common reason for referral to gastroenterology clinics. Its can affect up to one in five people at some point in their lives, and has a significantly impact of life quality and health care utilization. The prevalence varies according to country and criteria used to define IBS. Various mechanisms and theories have been proposed about its etiology, but the biopsychosocial model is the most currently accepted for IBS. The complex of symptoms would be the result of the interaction between psychological, behavioral, psychosocial and environmental factors. The diagnosis of IBS is not confirmed by a specific test or structural abnormality. It is made using criteria based on clinical symptoms such as Rome criteria, unless the symptoms are thought to be atypical. Today the Rome Criteria III is the current gold-standard for the diagnoses of IBS. Secure positive evidence of IBS by means of specific disease marker is currently not possible and cannot be currently recommended for routine diagnosis. There is still no clinical evidence to recommend the use of biomarkers in blood to diagnose IBS. However, a number of different changes in IBS patients were demonstrated in recent years, some of which can be used in the future as a diagnostic support. IBS has no definitive treatment but could be controlled by non-pharmacologic management eliminating of some exacerbating factors such certain drugs, stressor conditions and changes in dietary habits.The traditional pharmacologic management of IBS has been symptom based and several drugs have been used. However, the cornerstone of its therapy is a solid patient physician relationship. This review will provide a summary of pathophysiology, diagnostic criteria and current and emerging therapies for IBS.

Stress reduction via neuro-emotional technique to achieve the simultaneous resolution of chronic low back pain with multiple inflammatory and biobehavioural indicators:A randomized,double-blinded,placebo-controlled trial

Background:Beginning with the concepts of stress developed by Selye,an approach to stress and pain management,known as neuro-emotional technique(NET),has been developed.It is a treatment approach based on the principle that the stressor effects of dormant and/or current unresolved issues or trauma are what determine one’s bodily responses.These responses are relatively personalized to the conditioned,experiential and emotional reality of the individual.Objective:To determine the effect of NET on patients with chronic low back pain(CLBP)over time.Design,setting,participants,and interventions:In a randomized,double-blinded,placebo-controlled study conducted in a single clinic,NET or control treatments were given twice weekly for 4 weeks in a population of 112 patients.Main outcome measures:Outcome measures,including Oswestry Disability Index,Quadruple Visual Analogue Scale,the psychoneuroimmunology markers of blood serum levels of C-reactive protein,tumour necrosis factor-a,interleukin-1(IL-1),IL-6,and IL-10,and 10 dimensions of the Short Form Health Survey scale,were assessed at baseline and at 1,3 and 6 months following the intervention period.Results:Compared to placebo,NET produced clinical and statistical significance(P<0.001)via declines of virtually all physiological,pain and disability markers,accompanied by gains in quality-of-life indicators at 0(baseline),1,3 and 6 months.Reductions of the percentages of patients whose 5 biomarkers lay outside the normative range were achieved at 1,3 and 6 months by NET but not control interventions.Conclusion:A randomized,controlled trial of CLBP patients indicated that 8 NET interventions,compared to placebo,produced clinically and statistically significant reductions in pain,disability and inflammatory biomarkers,and improvements in quality-of-life measures.