13, 14 Such increased immune activation also is manifested as a shift toward inflammatory cytokine profiles with an abnormal interleukin (IL)-10/IL-12 ratio and an increased level of IL-1β. For example, an increase in mast cells, neutrophils, natural killer cells, eosinophils, and intraepithelial lymphocytes has been recorded among individuals with documented postinfectious and non-postinfectious IBS when compared with controls. Some IBS patients also have subtle gut mucosal inflammation and immune activation. Mearin et al 12 found that the relative risk of developing IBS after Salmonella gastroenteritis increased by eightfold over the subsequent year, thereby supporting the role of postinfectious gastroenteritis in the development of IBS. Furthermore, the incidence of IBS was even higher among individuals with clinically documented gastroenteritis than among controls (36.2% vs 10.1% P < 0.01). For example, Marshall and others 11 reported a higher incidence of IBS among individuals exposed to municipal water contamination than among controls (27.5% vs 10.1%, respectively P < 0.01). IBS may follow a bout of bacterial gastritis. Rao, MD, PhD, FACG, Professor of Internal Medicine and Director of Neurogastroenterology and GI Motility at the University of Iowa Hospital and Clinic, Iowa City. Louis University, Missouri and Satish S.C. Prather, MD, MPH, Associate Professor of Internal Medicine at St. Talley, MD, PhD, FACG, Professor of Medicine at the Mayo Clinic College of Medicine, Rochester Minnesota Charlene M. Consensus-based definitions spearheaded by the Rome committee for various functional GI disorders were launched in May of this year during Digestive Disease Week 2006.ĭuring the annual scientific meeting of the American College of Gastroenterology, held in Las Vegas, Nevada, October 20–25, 2006, a panel of experts reviewed the Rome III criteria and their recommended therapeutic interventions. These disorders are believed to be caused by disturbed motor and sensory function, altered immune function and inflammation, and dysregulation of the central and enteric nervous systems. Currently, functional GI disorders are classified into six major domains according to anatomical distribution, from the esophagus to anorectum. Over the past 15 years, the evolving definition of functional bowel disorders has been driven by advanced understanding of symptom patterns. 1 Similarly, patients and their insurers spend considerable amounts of money for the diagnosis and treatment of chronic constipation, an uncomfortable and distressing condition for which few satisfactory therapies are available. The total cost of caring for an IBS patient may reach thousands of dollars in fact, symptoms of IBS are second only to the common cold for causing work absenteeism. Functional gastrointestinal (GI) disorders, such as irritable bowel syndrome (IBS), functional dyspepsia, and chronic constipation, pose an extensive healthcare burden and negatively affect quality of life.
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