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Irritable Bowel Syndrome: Diagnosis and Treatment
  1. R Valori

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Gastroenterologists derive job satisfaction from performing endoscopic procedures, establishing diagnoses, and explaining and treating symptoms. Patients with irritable bowel syndrome (IBS) do not usually require endoscopic procedures, diagnosis is often uncertain, symptoms cannot easily be explained, and there is no effective treatment the health service will pay for. Its not surprising therefore that few gastroenterologists relish the prospect of seeing a patient with IBS. Can this textbook of IBS help their plight? The answer is undoubtedly yes; however, success with IBS patients depends critically on good communication, a skill that cannot be gained from reading a textbook.

The authors (both basic scientists at heart) are to be congratulated on assembling a holistic collection of contributors and paying lip service to the different profiles of IBS in varied clinical settings. Equal weight is given to psychological aspects, serotonergic receptors, physiology, causative factors, the concept of consultation behaviour, and many other factors. Thus the book is much more than a textbook on “diagnosis and treatment”. However, I support the concept that this wider view of IBS is mandatory for effective diagnosis and treatment.

The book is an excellent resource for all health professionals dealing with IBS and it will be a vital starting point for those wishing to research IBS. The chapters are extensively referenced and many questions in areas of uncertainty are left refreshingly open. My favourite chapters are Grant Thompson’s “A world-view of IBS” and Bennett and Kellow’s “Relations between chronic stress and bowel symptoms”. They place IBS in context and provide a foundation for many of the other chapters. Excellent stuff.

Inevitably, compromises are made in a multiauthor book, particularly when it covers such a difficult topic spanning so many disciplines. The editorial hand has been too light: it is a book of individual contributions rather than a cohesive text. For example, the chapter on serotonergic mechanisms by Michael Gershon (while well written and fascinating) loses the plot with a level of detail that seems misplaced among the other chapters. In other places there is unnecessary repetition. On a more practical level, there are no links to internet based resources, no contributions from patients, and little practical advice on how to structure and conduct a consultation or negotiate with a patient. There is no declaration of commercial support in the final chapter. Does this mean there was none?

Perhaps the most disappointing aspect of this book is the failure to put IBS in the context of other unexplained gastrointestinal symptoms. Grant Thompson provides a list of other functional gut disorders. This very medical approach to unexplained symptoms is driven by the need for clean entry criteria for drug trials and physiological research studies. It presumes that it must be possible to define distinct pathophysiological entities and produce drugs to correct them. The real world is not like this: pure, typical, or textbook IBS is unusual. Patients present with a variety of symptoms, originating from many systems, some of which may have features of IBS. Clinicians reading this book might, quite reasonably, ask themselves whether they can apply all of this IBS information to the patients they see in clinics. I suspect that the underlying issues are similar, regardless of the underlying symptoms, but this remains to be proven. A chapter placing IBS in the context of other unexplained bodily sensations (UBS) will be most welcome in the next edition.