and presents the risk of ischemic colitis. Tegaserod
also can cause severe diarrhea.
Antidepressants Antidepressant medications
affect the actions of several neurotransmitters,
such as dopamine and serotonin, that play roles
both in brain activity related to emotion and in
gastrointestinal functions. The tricyclic antidepres-
sants, such as amitriptyline (Elavil) and
imipramine (Tofranil), have been instrumental in
treating chronic pain syndromes and provide relief
from IBS symptoms for some people. Selective
serotonin reuptake inhibitor (SSRI) antidepres-
sants, such as paroxetine (Paxil) and fluoxetine
(Prozac), seem to have similar effects. These med-
ications also treat the mild to moderate DEPRESSION
that commonly accompanies IBS.
Lifestyle There is a strong correlation between
episodes of IBS symptoms and stress. Stress man-
agement techniques, MEDITATION, guided imagery,
BIOFEEDBACK, YOGA, ACUPUNCTURE, and therapeutic
counseling are among the methods that can help
keep symptoms in remission. Many people can
control IBS largely through diet and lifestyle, after
they understand the nature of the disorder and
learn to recognize the triggers that bring on
attacks of symptoms. Helpful dietary and lifestyle
changes include
- reduce or eliminate CAFFEINE, which can con-
tribute to diarrhea - add fiber by eating more fruits, vegetables, and
whole grain products, or by taking a fiber sup-
plement such as psyllium (Metamucil) or
methylcellulose (Citrucel) - eliminate foods and beverages that cause intes-
tinal upset (especially foods high in fat) - maintain healthy weight
- develop a daily process for stress relief that may
incorporate exercise, meditation, warm baths,
designated quiet time or alone time, or other
methods for de-stressing - note circumstances and situations that appear
to precipitate exacerbations of symptoms and
work out approaches to mitigate them - get 30 to 45 minutes of physical exercise, such
as walking, daily to improve circulation, MUSCLE
tone, and gastrointestinal function as well as to
aid in relieving stress
Risk Factors and Prevention Efforts
Unlike many other chronic disorders affecting the
gastrointestinal tract, IBS does not cause any dam-
age to gastrointestinal tissue or increase the risk
for CANCER. Even during attacks of symptoms, the
bowel shows no evidence of INFLAMMATIONor dis-
ease process. Tests that measure muscle contrac-
tion activity, usually performed only in clinical
research studies because they have little diagnostic
or therapeutic value, show accelerated peristalsis
(intestinal motility).
A significant contingent of researchers and doc-
tors believes IBS has a strong psychological com-
ponent. This derives in part from the difficulty in
identifying any organic, or physical, changes in
the gastrointestinal tract that account for the
symptoms and in part from a high correlation of
diagnosed psychological conditions, such as GENER-
ALIZED ANXIETY DISORDER (GAD) and depression,
among people who have IBS. As well, a high per-
centage of people who have IBS have experienced
physical or sexual abuse. Though few argue that
these correlations exist, disagreement remains as
to what the correlations mean in the context of
either the psychological disorder or the IBS, espe-
cially in regard to treatment options.
One intriguing direction of research is the
exploration of neurohormonal processes that han-
dle both psychological and autonomic (involun-
tary) functions, raising the possibility of crossover
between the two. Some clinical research studies
have noted similarities in altered brain activity
patterns, as detected via imaging procedures such
as POSITRON EMISSION TOMOGRAPHY(PET) SCANin peo-
ple who have, independently, clinical depression
and IBS. Other directions in research focus on
gaining improved understanding of intestinal
motility mechanisms. Though for some people IBS
is a lifelong condition that requires vigilant man-
agement, for many others symptoms abate with
an appropriate integration of medical and lifestyle
interventions.
See also ACUTE STRESS DISORDER; BOWEL MOVE-
MENT; CELIAC DISEASE; DIET AND HEALTH; DIVERTICULAR
DISEASE; FIBROMYALGIA; INFLAMMATORY BOWEL DISEASE
(IBD).jaundice Yellowish discoloration of the SKINand
whites of the eyes, also called icterus, resulting66 The Gastrointestinal System