Talk:Irritable bowel syndrome/Archive 2

New review article is online

"An Evidence-Based Systematic Review on the Management of Irritable Bowel Syndrome" has been published as a supplement to The American Journal of Gastroenterology, Volume 104, supplement 1, January 2009.

Concretely reference 30 needs to be fixed since the supplement itself is available on line at no cost (as opposed to so much of the medical literature locked away behind journal's doors)...

You can find it at: http://www.nature.com/ajg/journal/v104/n1s/index.html

I suspect this supplement of ajg could help shape this article. It also has lots of useful references, and analysis of the quality of various studies. For example, the section on "Active Infections" references a single study; the ajg supplement says there have been three high quality studies with similar results (using a somewhat higher dosage of the antibiotic than usually given for traveler's diarrhea.

It has many other conclusions and rates the certainty/lack thereof of various treatments. JimGettys (talk) 13:34, 7 March 2009 (UTC)

Seperation Discussion

Should the different types of IBS be seperated? such as IBS-D and IBC-S to make the page easier to read. Many patients suffer from only one condition and many medications or help is only avail to a certain type Wesgarner 17:33, 17 February 2009 (UTC)

save just 1 patient

if you wish to mention everything that could save just 1 patient from being misdiagnosed as IBS, this is going to be a rather long article. it will have to include all gastroenteroloy pages and a lot of other internal medicine pages, too. this will be a really encyclopedic article :) Dbach 19:46, 7 Jan 2005 (UTC)

When you take Motrin or Ibuprofen they will mess up your Stomach and Intestine linings. The military messed me up be giving me several bottles of 800mg of Ibuprofen for pain for a coarse of 2 to 4 years. This is not mentioned anywhere that I could find. If you have IBS, you will bleed if you take anything with this in it. Some NSAIDS such as Aspirin will also do the same thing.

I am not a doctor but my doctor backs me up on everything that I tell him. He tells me that he is only my doctor, because I do not have a license. He has even asked me to work for him. I am disabled and can not do that though. I hope that this helps at least 1 person. Some people might dispute me, but after 18 years living with IBS, I think that I know a little about it. Signed by:Dean Terrell March 11,2008.T&N Family Electronics (talk) 10:12, 11 March 2008 (UTC)

Seek reliable sources if you wish to add this information to the page. Also note that the original comment is from over three years ago, so you might be better starting a new heading to discuss expanding this aspect of the page. WLU (talk) 16:35, 11 March 2008 (UTC)

• I have to agree with the intent of this posts.

When you know that 'some tests' for known infections, ie giardia, may take 4-6 tests to find them. Then IBS is merely the inability of bacterial science to find them.

--Caesar J.B. Squitti: Son of Maryann Rosso and Arthur Natale Squitti (talk) 20:21, 1 December 2008 (UTC)

Gynae surgery

In a cohort of women undergoing gynaecological surgery for non-painful indications, 17% developed IBS. This was predicted largely by psychological factors, indicating a predisposition. doi:10.1053/j.gastro.2007.10.041. JFW | T@lk 07:23, 3 February 2008 (UTC)

Archived

Archived the very long page, tried to keep everything that was still kicking. WLU (talk) 16:35, 11 March 2008 (UTC)

IBS Charities section

The Gut Trust, The National Charity for Irritable Bowel Syndrome I deleted this because when I looked at it it seems to be an advertisement and/or spam. If I am incorrect, please explain before putting it back in, thanks. --CrohnieGal^Talk 21:30, 21 March 2008 (UTC)

Good catch. It fails WP:SPAM, WP:EL, and was added by an editor with a clear WP:COI. --Ronz (talk) 05:12, 22 March 2008 (UTC)

Not a good catch though, It isn't an advertisement, they are one of the leading charities for supporting people with Irritable Bowel Syndrome, they also have additional information and contributed a significant amount of information to this page. Plus there previous name 'the ibs network' was previously linked from this document without complaint. Neil Evans (talk) 19:43, 22 March 2008 (UTC)

I agree, The IBS Network, now the The Gut Trust, is a highly respectable UK IBS charity that has provided a lot of guidance and support for many years. Ibsgroup (talk) 21:53, 9 April 2008 (UTC)

Comment

Editors, thank you Please add this information

I have IBS-C and I am IgA deficient. I write to you today to ask you to make an addition to your page for the good of other people. Please include in your article the benefit that Acacia Fibre can give to IBS-C patients. It is the only thing that has given many of us any relief from pain [fyi Iberogast did not work] but more importantly, the ONLY thing that has effectively helped me to live a normal life of regularity.

People come to this page seeking information; I was one of them! ...And the whole story is not found on your pages. Please for the good of people like myself include this information. I have not mentioned brand names and do not intend to. This is something that I think is essential to include as this is a reference website and peopl need to be able to find this information out from your page.

Thanks and best wishesUgo79flyt (talk) 06:36, 18 March 2008 (UTC)

Information requires reliable sources. Seek them out, and expand the page with them. WLU (talk) 03:29, 22 March 2008 (UTC)

Hi Ugo, fiber products help a lot of people that have problems with their digestive system like IBS and IBD. I am thrilled that this one brand of fiber helped you but please keep in mind that everyone is different, so what I mean is even though it helped you it might not help others. [1] This section mentions the use of fiber under different sub topics, ie: Diet as an example. There are a lot of fiber products on the market plus a lot of foods that are fiberous (that is if you can tolerate them). So what I am saying is naming all the fiber products available in stores would be many and picking just one that helped you wouldn't work in the article because of what I said above, people react differently to meds, dietary needs and so on. On another note, I have read just part of this article, today is not a healthy day for me to concentrate, that I really think this article need an edit copy to move things around and make it a bit more accurrate. IBS used to be thought of as 'in your head' sort of thing but it is not now. I will try to get some referrences as soon as I am feeling better. I have major medical problems and my meds are getting in my way of focusing. You can learn more about me if you would like on my user page. --CrohnieGal^Talk 18:03, 22 March 2008 (UTC)

I added some external links

I did a quick search and added three links I believe it was. Feel free to delete them if they are not appropriate. A couple of them can be used to add into the article. I have more links that I found but I am stopping for now since I am having trouble focusing. Again, do not hesitate to remove what I add, I don't get my feeling hurt or get upset about things like this.

When I am feeling better, maybe I can be more productive here. Sorry in advance if what I put in was inappropriate. --CrohnieGal^Talk 18:08, 22 March 2008 (UTC)

Hi Crohnie,

I removed one, the wikipedia link, 'cause as a wikilink, it should be Butabarbital rather than an external link. As such, external links is the wrong section, perhaps See also. But ideally the link should be embedded in the text, with a citation, to elaborate on how it is related to IBS. I also removed the medline link to the Butabarbital page - the EL section is for links only about the specific page - IBS, not treatments (though the link would be appropriate for the Butabarbital page). The final link I left, but if you look at the top of the page, in the disease box, there's already a link to MedlinePlus, though it's to the encyclopedia rather than the health topics section (or vice-versa). I'm not sure about this being kosher, but the link does seem to have a lot of other good links, and it's a RS, so it seems OK to me. WLU (talk) 19:16, 22 March 2008 (UTC)

I knew some of the WP:EL were questionable that's why I posted the above. I have had to take a lot of meds today and with moving and all the work that comes with it I was trying to give it a shot to help the article but when I got done with what I added I started to second guess myself. The first link that you mention I felt was questionable because it seemed to be a farm of EL's. I will try to work on this article,and others, when I am doing better. Right now I'm not and I am totally exhausted which doesn't help CD at all. Thanks for taking a look for me and making the corrections, I really appreciate it that. --CrohnieGal^Talk 20:00, 22 March 2008 (UTC)

If you look at {{DMOZ}} and it's uses - we don't want to be a linkfarm, but we are perfectly willing to link to external linkfarms that have some degree of oversight and quality. Basically, by linking to DMOZ and other 'good' linkfarms, we get a whole bunch of links at the expense of only a single addition on our page. I'd say an NIH is a sufficiently reliable/quality source/external page, that their links are trustworthy. WLU (talk) 00:33, 23 March 2008 (UTC)

I personally would say that {{DMOZ}} is no longer an accurate reflection of what's available for IBS links. There seems to be an attitude at {{DMOZ}} of don't bother us with new or updated links, we know what's best. They seem to arbitrarily know what's best even though experts have volunteered to be the editor - but keep getting rejected. Well, rejected would be nice. They just get the usual silent treatment. The best external link, from my perspective is a link to Google with the key words "Irritable Bowel Syndrome". It gives a truer reflection of what is helpful from a link perspective. Ibsgroup (talk) 21:51, 9 April 2008 (UTC)

The problem with that solution is that search engine results are identified as links normally to be avoided, item #9 ... while dmoz is identified as a link to be considered. --- Barek (talk • contribs) - 22:17, 9 April 2008 (UTC)

If the DMOZ is lacking links that meet the criteria for external links, then suggest or add those links (but be sure they're in line with WP:EL!) Dmoz isn't the only link that can be added, just the only one that's there right now. WLU (talk) 22:55, 9 April 2008 (UTC)

Oops! Didn't realize that using a search was a no no. In general, having tracked this article for years, the external link has always been a contentious issue. The article has come a long way since it's start. In my opinion having {{DMOZ}} as the only external link degrades the quality and credibility of the article. A more sensible and credible link is perhaps UNC Center for Functional GI & Motility Disorders [[2]]. Ibsgroup (talk) 23:21, 9 April 2008 (UTC)

I think a better link for the EL section would be one of their subpages. Keeping with the dmoz formatting, maybe show it as:

"Irritable bowel syndrome at UNC Center for Functional GI & Motility Disorders". --- Barek (talk • contribs) - 23:43, 9 April 2008 (UTC)

That's fine, although I was under the impression that the external links didn't just point to links, but rather to more information about the article. In which case I thought the landing page for UNC was fine. Anyways, the format that you have suggested seems to look right. Ibsgroup (talk) 01:06, 10 April 2008 (UTC)

(undent)I believe DMOZ is used because it often provides a large number of links that are 'of interest' but aren't strictly speaking suitable for wikipedia's EL sections. Of the two suggested the UNCfFGMD page of links would be my preference as it links to a large number of other notable agencies. WLU (talk) 01:16, 10 April 2008 (UTC)

I was wondering about that myself; but I didn't see anything under WP:ELNO against it (feel free to double check, I could've missed it). Where I'm thinking it will be okay is the section about links to consider which says: "Where editors have not reached consensus on an appropriate list of links, a link to a well chosen web directory category could be used until such consensus can be reached. The Open Directory Project is often a neutral candidate, and may be added using the {{dmoz}} template." I think the UNC links page should be as acceptable as the dmoz page. Although, the wording does suggest we would need either the UNC or the dmoz links list, not both - in that case, I'm okay with the UNC link list. If someone objects, then the dmoz list could be re-added and the UNC landing page with it. --- Barek (talk • contribs) - 01:22, 10 April 2008 (UTC)

The only reason I could see to not link to both DMOZ and the UNC list page is a large duplication of content. I'm not seeing one based on a quick review of both - one's a list of organizations, the other is a list of info pages. I'd say there's consensus to have DMOZ and UNC's list. Put both. WLU (talk) 01:28, 10 April 2008 (UTC)

If you think the UNC link page makes sense vs. the landing page, I vote for just that as it is more credible and it is scrutinized by experts who work with IBS everyday. Ibsgroup (talk) 12:42, 10 April 2008 (UTC)

IBS and Aloe Vera Juice

Is there a reference to support the assertion that aloe vera juice is an effective treatment for irritable bowel syndrome?

William TS (talk) 03:45, 28 March 2008 (UTC)

Most likely not, Aloe Vera is an anti-inflammatory, as there is no inflammation with IBS there is nothing other than placebo effect going on when patients take Aloe.

Neil Evans (talk) 15:42, 29 March 2008 (UTC)

Aloe vera juice has a laxative effect so for IBS-C it is likely to be helpful.

Katienz01 (talk) 11:00, 3 April 2009 (UTC)

Acacia Fiber

Please add info regarding acacia fiber to your article. I resent the comment above stating it needs to be well studies and documented. IT IS one of the most well studies and documented fibers in recent history, offering help for IBS C as well as IBS D. Acacia fiber is well tolerated, and also serves as a probiotic.

A simple google search would suffice, if any one cares to include this content. I am a terrible writer so cannot.

People with IBS looking for complete information need to know about the benefits of Acacia fiber. Also Flax.

Thanks angie —Preceding unsigned comment added by 66.103.112.253 (talk) 14:22, 4 April 2008 (UTC)

Reviews

Practical review in NEJM recently: URL. JFW | T@lk 14:16, 4 May 2008 (UTC)

'nother review in Evidence-based CAM: Mind/Body Psychological Treatments for Irritable Bowel Syndrome. II | (t - c) 18:32, 8 July 2008 (UTC)

New intro

Suggestion for new intro: see this diff. The previous introduction was too short, not covering diagnosis or treatment (per WP:MOS and WP:MEDMOS).

My suggestion is not perfect either: I would perhaps suggest shortening the section on classification (mentioning the either diarrhea or constipation might predominate, and that IBS might follow infection).

Please comment on what could be improved further.

--Steven Fruitsmaak (Reply) 23:39, 21 May 2008 (UTC)

I agree that the existing introduction could be expanded and support those efforts; but the initial addition to that section was substantial/large enough to almost need sub-sections of its own. As the material already existed in the article, I believed it more prudent to revert (for now) to the prior version.

To shorten it, I would suggest condensing the "typical symptoms" paragraph (it's just a summary and does not need to explain the meanings - that can be expanded in the body of the article). The "Several conditions may mimick IBS" section could drop the last sentence - while informative, the distinctions should be in the body of the article. I would remove the "further classified" section, that's going beyond a summary. The "treatments" section I would keep the first and last sentence, but the material in-between goes beyond an introductory summary. The "exact cause" paragraph seems perfect as-is to me. --- Barek (talk • contribs) - 01:00, 22 May 2008 (UTC)

I understand your concerns and have tried to adapt my suggestion accordingly. Further comments or copy-editing is welcome, of course. --Steven Fruitsmaak (Reply) 18:26, 22 May 2008 (UTC)

Thanks. Sorry we got off on the wrong foot - I should have been clearer with my concerns/reasons up-front. I just ran out of time to comment on the talk page at that time. The latest version clears up thosee concerns, and makes the needed improvements to the intro. If I have time later this week, I may search the body of the article for some refs to copy into the intro paragraphs, and may do some tweaking to the wording. --- Barek (talk • contribs) - 19:14, 22 May 2008 (UTC)

I've edited a bit to reduce some of the redundancies. WLU (talk) 19:19, 22 May 2008 (UTC)

Refs should be kept to a minimum in the intro, I think. Only for numbers and controversial statements. --Steven Fruitsmaak (Reply) 20:28, 22 May 2008 (UTC)

Xylitol SUCKS!!!!! —Preceding unsigned comment added by 68.238.92.70 (talk) 02:13, 21 July 2008 (UTC)

IBS - Is Bull S...

There is a high probablity that one of hte major reasons for not finding a cause of IBS, because had they found the actual cause they would not call it IBS and they would have a treatment.

Most notable, is giardia very common, except that the test to find it can range up to 4-5 tests in one week.

If 'the tests' don't find it'....then you are given the label IBS...and your troubles really begin.

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 03:16, 11 September 2008 (UTC)

• You will note that many of the herbal or complimentary treatments to deal with the symptoms of IBS are in fact part of the treatment for parasites....fiber, wide spectrum anti-biotic (grapefruit seed extract, oregano oil, garlic...) and probiotics.

Perhaps a section on related complimentary treatments should be added....

(Seems the system has done a great job in dividing up the symptoms into different diseases, which are probably caused by the same infeciton, with different symptoms depending on the persons system...

Related diseases, ie Crohns, IBD, etc...MS, stomach cancer, may be linked in a referral section.

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 03:19, 11 September 2008 (UTC)

Where is the logic of the researchers...you return from Mexico and develop IBS...? Of course it a bacterial infection of sorts...seems the research is more motivated in treating the symptoms than finding the cause. (great case of paradigm paralysis)

The article does an excellent job in suggesting these links as it now stands...

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 03:23, 11 September 2008 (UTC)

"Having soluble fiber foods and supplements, substituting milk products with soy or rice products, being careful with fresh fruits and vegetables that are high in insoluble fiber,"

Clarification please

Not clear: "being careful" means to avoid them, or have them?

76.71.211.18 (talk) 14:08, 28 December 2008 (UTC)stewart

Cause

The cause section is very unbalanced. It is trying to draw an analogy between H.pylori and IBS. This is original research. It presents infectious diseases as a cause but all this is theoretical.

Much work needs to be done to balance this article. --Doc James (talk · contribs · email) 20:38, 29 January 2009 (UTC)

I think that H. pylori is worth mentioning in the misdiagnosis section but not in the cause section. It shouldn't be too difficult to find a citation showing that H. pylori can cause stomach cramps and other GI symptoms which mimic certain symptoms of IBS. I have no doubt that infectious diseases are a common misdiagnosis for IBS and CFS for that matter. I have a relative who was will with IBS and M.E. like symptoms when she had infact got chronic ameobiasis which she picked up while in India. I think some of this stuff can be moved to the misdiagnosis section and not the cause section.--Literaturegeek | T@1k? 23:43, 29 January 2009 (UTC)

Completely agree. If it is caused by one of these other things it is not IBS.--Doc James (talk · contribs · email) 13:11, 30 January 2009 (UTC)

NPOV

This article does a poor job of summing up the literature. Many small factual errors and a number of large ones.--Doc James (talk · contribs · email) 14:13, 30 January 2009 (UTC)

Systematic review

Gut - systematic review + meta-analysis. NNT for antidepressants 3, psychological therapies 4. http://gut.bmj.com/cgi/content/abstract/58/3/367 JFW | T@lk 10:11, 1 March 2009 (UTC)

IBS = Ignorant Bull Shit

To say it short.. IBS is NOT a diagnosis. It's the opposite of a diagnosis, a trashcan of symptoms that cannot be explained because doctors don't bother to test for protozoans and other parasites. It takes nothing less but direct microscopy of fresh warm fecal matter(yuk), purged immediately before, to diagnose what's going on in someones stomach(http://www.nzetc.org/tm/scholarly/tei-WH2Surg-pt2-c1-2.html). During WWII, people were routinely diagnosed for protozoans, then given emetine for the same symptoms and they cleared up in +90% of the cases. Protozoan pathology is completely neglected these days, noone even knows how to do a culture of them anymore. It's appaling that so much basic knowledge from the past has gone drown the drain, literally reduced to "prozac and fiber". More than than 20% of the population is suffering with stomach pain and the doctors don't even know the most basic test procedure. Prozac and Fiber! BAH! M99 87.59.78.220 (talk)

There are two common cures for IBS

The most obvious cure is if the problem is related to a bug or germ...antibiotic treatments. The second very sucessful procedure is weightloss surgery. Both the RNY and the DS procedures have proven results in total elimination of IBS. The Roux-En-Y (RNY) was first utilized for IBS problems. It later was discovered that the procedure caused a large amount of weightloss. The weighloss side of the procedure was championed, yet the cure for IBS still remains. —Preceding unsigned comment added by 76.247.173.246 (talk) 04:15, 31 July 2009 (UTC)

IBS can be cured by weightloss surgery...

Both RNY and DS procedures can eliminate IBS... —Preceding unsigned comment added by 76.247.173.246 (talk) 04:39, 31 July 2009 (UTC)

irritable bowel syndorme

it is a blanket term of dieases. It should not be confused with anpther diese of a simsilar name —Preceding unsigned comment added by 209.2.60.97 (talk) 14:45, 8 August 2009 (UTC)

Value of warning about use of Peppermint for patients suffering from both IBS and GERD

The comorbidity between IBS and GERD is well-known. In fact it is already mentioned in the Wiki entry on IBS, and I cited a good reference on the subject in a recent addition that has since been reverted. (I also plan to add a link from the GERD entry to the IBS entry.) If peppermint is known in the literature to exacerbate the symptoms of GERD, and the vast majority (79%) of IBS sufferers exhibit the symptoms of GERD, then it is common sense that this point be mentioned at the correct place within the entry on IBS. GERD can have serious consequences, so it seems appropriate to bring this to the attention of someone who may be considering the use of peppermint to treat IBS. (Note that the Influenza entry warns readers about Reye's Syndrome, even though Influenza and Reye's Syndrome are not the same disease.)

The desire to keep up the standards of the page is laudable, but an application of the anti-synthesis rule seems inappropriate here. Mentioning the side effects of peppermint for IBS patients who also have GERD is not my original idea, since web pages like [3] independently make the same point. It does not appear to me to be "advancing a position", just bringing relevant facts to the attention of the readers. —Preceding unsigned comment added by Pmadany (talk • contribs) 01:52, 25 November 2009 (UTC)

Actually, the figure is 30% according to PMID 17080246. There is a significant comorbidity, but they are still different illnesses. The Reyes example is a different situation - in that case it is influenza itself that you need to be careful about treating because it can lead to Reyes. --sciencewatcher (talk) 18:19, 25 November 2009 (UTC)

According to [4] "Up to 79% of IBS patients report ... (GERD) symptoms," and "... theory suggests ... IBS-like symptoms are part of the spectrum of GERD manifestation". Regardless of whether IBS and GERD are considered the same or different diseases, peppermint oil may exacerbate the symptoms of Gastroesophageal_Reflux_Disease (GERD), according to [5] and according to the Wiki entry for GERD. It seems quite reasonable to me to warn people that a commonly suggested treatment for IBS is known to worsen symptoms the patient is quite likely to have. (The analogy to Reye's still holds, since treating IBS could "lead" to GERD symptoms.) --Pmadany (talk) 03:55, 26 November 2009 (UTC)

The 30% figure seems more accurate since it is the average found in a systematic review, whereas your review just says 'up to'. And treating IBS does not lead to GERD - they are co-morbid. --sciencewatcher (talk) 16:10, 26 November 2009 (UTC)

Yoga as cure for IBS

I have IBS and I do 90 minutes yoga daily. It has tremendously improved my IBS symptoms and healed the stomach pain too. When I never did yoga, my IBS symptoms were horrible. There are many books too which specifically state that yoga benefits IBS patients. You can actually find 100's of google searches about this too. I do not understand why such an important thing is missing from this article. This should be mentioned under "alternative treatments" section. Accupuncture is mentioned as alterative treatment, but yoga is much more well documented than accupuncture. —Preceding unsigned comment added by 98.169.175.158 (talk) 07:37, 2 December 2009 (UTC)

I have added a mention of yoga for irritable bowel syndrome in the article with a citation.--Literaturegeek | T@1k? 11:44, 2 December 2009 (UTC)

Yoga might help you if the case for your IBS is mainly psychosomatic. In my case it's IBS-PI and I don't buy all the alternative healing methods crap. In fact the more alternative medicine is mentioned in the article the more people will think that IBS is only exisiting in the affected person's imagination. —Preceding unsigned comment added by 217.85.228.239 (talk) 08:15, 19 December 2009 (UTC)

Why on earth would they think that? Stress is a significant factor in many cases of IBS, so it's a no-brainer that yoga helps IBS because it reduces stress. How is that imaginary? --sciencewatcher (talk) 23:44, 19 December 2009 (UTC)

20-50% gastroenterology visits?

http://www.expresspharmaonline.com/20100115/market01.shtml

Why was this number deleted? —Preceding unsigned comment added by Hypernovic (talk • contribs) 22:25, 14 March 2010 (UTC)

Depression

I found a much more recent review article[6] which also cites the Ledochowski study. The interpretation is somewhat different:

"Fructose malabsorption has been associated with depression in young women with mood improvement following restriction of free fructose intake.68, 69 The mechanisms of these effects are poorly understood, but may involve low circulating levels of tryptophan, the precursor of serotonin.70 Such association is also consistent with the frequency of fatigue and lethargy in IBS."

"Other symptoms linked with fructose malabsorption, particularly mood and depression, have also been improved in patients following a ‘fructose-free’ diet. Thus, a 4-week exclusion diet in fructose malabsorbers has been shown to improve mood and depressive symptoms.69"

As far as I can see, major depression was not talked about by the Ledochowski study,[7] (source for the removed material), only an association with an increased Beck depression score. The Ledochowski study was also small (16 men, 34 women), with no blinding or controls. It only concludes, "Fructose malabsorption should be considered in patients with symptoms of depression and disturbances of tryptophan metabolism."

The material removed from the article was claiming much more than the Ledochowski study source. Ward20 (talk) 19:22, 10 April 2010 (UTC)

You need to be careful with studies like this because depression is highly susceptible to the placebo effect, and if there is no control then there is no way of knowing how much of the benefit is due to the placebo effect. Also the mechanism of fructose causing depression doesn't seem very plausible, so a lot of good evidence would be required before taking it seriously. --sciencewatcher (talk) 22:55, 10 April 2010 (UTC)

Agree. Editor Eloerc added more about fructose in the article then just the section that was removed [8]. Some material is obviously redundant and the rest should probably be examined for relevance and weight. Ward20 (talk) 23:20, 10 April 2010 (UTC)

Name change

Unsure why the name of this article was changed? Doc James (talk · contribs · email) 09:43, 11 April 2010 (UTC)

I explained on my talk page that I screwed up. There should be no redirect between these two articles, Irritable bowel syndrome and Irritable bowel disease. What I tried to do was remove the redirect and instead all I did was reverse the redirect. I tried to undo it but it didn't work. Would appreciate any help in removing the redirect completely. I've never done a redirect in all my time here so this would be a learning experience too. I read and read all I could about this but I guess I still didn't understand it. Sorry, --CrohnieGal^Talk 09:55, 11 April 2010 (UTC)

Well it looks like an editor found my error. This editor undid my move but there is still a problem with the IBD article being redirected to this article which it shouldn't be. Maybe the IBD article should be redirected to Inflammatory bowel disease or just left to stand on it's own? I don't know when the redirect was done and I don't know how to undo it. I still have it requested where you also commented. Thanks, --CrohnieGal^Talk 14:25, 11 April 2010 (UTC)

Is there even such a thing as 'irriable bowel disease'? I thought that was just people getting confused between IBS and IBD. Doing a quick search on google scholar seems to reveal that 'irritable bowel disease' is an occasionally used synonym for IBS, so I'd suggest either leaving the redirect so it points to IBS or just removing it entirely. It definitely shouldn't redirect to inflammatory bowel disease. --sciencewatcher (talk) 15:19, 11 April 2010 (UTC)

The initials IBD is commonly used for people with Inflammatory bowel disease like Crohn's disease or Ulcerative colitis. So it should redirect to that article or be deleted completely with anything in it that is salvagable put on the Inflammatory bowel disease article. I personally would like to see the redirect to there since a lot of people use the term IBD and it would take them to the correct article. IBD and IBS are not at all the same. Thanks, --CrohnieGal^Talk 15:50, 11 April 2010 (UTC)

Yes, IBD should definitely redirect to inflammatory bowel disease. However 'irritable bowel disease' should redirect to IBS, which I see it does. So I think everything is ok now. --sciencewatcher (talk) 17:33, 11 April 2010 (UTC)

Yes agree with sciencewatcher. Doc James (talk · contribs · email) 18:16, 11 April 2010 (UTC)

The problem with have the article Irritable bowel disease being redirected here is that it is incorrect. IBD stands for Inflammatory bowel disease which can be seen at that article. IBD and IBS are always confused as being the same thing which it is not. The main thing I can think of is that IBS never causes bleeding whereas IBD can. I think the redirect to this article should be removed and a redirect put to the Inflammatory bowel disease. Thanks, --CrohnieGal^Talk 16:48, 12 April 2010 (UTC)

Maybe a disambig page would be best which lists both and properly distinguishes them? Doc James (talk · contribs · email) 16:53, 12 April 2010 (UTC)

Crohnie, 'Irritable bowel disease' is not the same as 'Inflammatory bowel disease'. Just because they have the same first letters does not mean they are the same thing. 'Irritable bowel disease' is another term for IBS, although it seems to be infrequently used. If you redirected 'irritable bowel disease' to 'inflammatory bowel disease' that would be incorrect. I don't see the problem with IBD getting confused with IBS - as long as the IBD page lists 'inflammatory bowel disease' (which it does) and not 'irritable bowel disease' there should not be any confusion.

The only potential issue I can think of is people typing in 'irritable bowel disease' when they actually mean 'inflammatory bowel disease'. If that is an issue then maybe we should use Jmh649's suggestion to clearly distinguish between the two. --sciencewatcher (talk) 18:20, 12 April 2010 (UTC)

I agree with what Jmh649 and Sciencewatcher suggest. Thanks for all the input. I will not be doing anything since I do have a strong POV about this. I shouldn't be the one to make any changes like this. I'm sure you all understand. Thanks again, --CrohnieGal^Talk 18:50, 12 April 2010 (UTC)

Suppose I should have posted earlier here - per a discusson at WT:MED, I added disambiguation hat notes on 13th April.[9] David Ruben ^Talk 20:36, 25 April 2010 (UTC)

Thank you, yes that takes care of things nicely and puts my concerns to rest. Thanks again, --CrohnieGal^Talk 10:28, 26 April 2010 (UTC)

Fibromyalgia is not a psychiatric disease

This is biased information. Current thought on fibromyalgia is that it is an illness of central sensitization, an illness of the central nervous system.

Well there is some debate about that. The general consensus is that it probably is psychiatric, although it isn't classified as a psychiatric illness at present. However if you look at the reference for that statement in the article it actually lumps fibromyalgia in with 'nonpsychiatric conditions', so I think someone needs to take a closer look at that sentence and fix it. --sciencewatcher (talk) 15:18, 29 April 2010 (UTC)

Actually, on re-reading the article it does NOT say that fibromyalgia is psychiatric, but it isn't entirely clear. I'll just tweak it to make it more clear. --sciencewatcher (talk) 18:55, 29 April 2010 (UTC)

SarMarTay Suggestions 5-4-10 (Citations 1-26)

SarMarTay (talk) 16:47, 4 May 2010 (UTC)

In addition to these citation suggestions, I made minor text edits.

Irritable Bowel Syndrome:

1-(brief description of the disease) is a reliable source. This textbook can also be used:

Gastroenterology: an illustrated colour text By Graham P. Butcher

2-(bowel movement may relieve symptoms) is a primary literature article that should be replaced with a secondary source. Suggest deleting and replacing with [10]

For the second use of citation 2, the phrase "psychological interventions" is not supported by this source, so a separate source is required OR the wording can be changed to "...including dietary adjustments and medication." A secondary source that discusses psychological abnormalities and IBS is this textbook:

Gastroenterology: an illustrated colour text By Graham P. Butcher

3-(fructose malabsorption) is a primary literature article in German that should be replaced (See ref 4 comment).

4-(parasitic infections) is a dead link. I suggest deleting cites 3 and 4 and using a general reference such as a textbook or review for the entire sentence "Several conditions may present as IBS including celiac disease, Fructose malabsorption, mild infections, parasitic infections like giardiasis, several inflammatory bowel diseases, functional chronic constipation, and chronic functional abdominal pain." Citation 20 will work here, but "fructose" and "like giardiasis" should be removed.

5-(brain/body, gut flora or immune system) is a primary literature article that is not appropriate in this context (does not support the statement).

6-(brain/body, gut flora or immune system) is a primary literature review of IBS and gut flora and is relevent as of 2007. Citations for brain/body and immune system roles in IBS must be included here, too.

7-11-(IBS does not lead to other complications) are primary literature reviews that do not support the statement. I suggest replacing with a single secondary source such as[11].

12-15-(increased medical costs and absenteeism) are primary literature reviews that all basically come to similar conclusions. I suggest deleting all of these and replacing them with a single reference. I suggest citation 19 (The Burden of Illness of Irritable Bowel Syndrome: Current Challenges and Hope for the Future by DARRELL HULISZ, RPh, PharmD). Absenteeism is also in [12].

16-19-(prevalence and societal costs of IBS) are primary literature reviews that should also be deleted and replaced with citation 19.

Classification:

20-(types of IBS) is an appropriate primary literature review.

Symptoms:

21-23-(symptoms) are appropriate primary literature reviews [13] can also be added here.

Causes:

24-(infection increases IBS) is an appropriate primary literature review. However, the wording of the sentence "Post-infection, further risk factors are young age, prolonged fever, anxiety, and depression." is unclear. Are these additional factors that may lead to IBS, or are these symptoms due to IBS?

25-26-(brain/gut) are primary literature articles that are directly referred to in the text, so they should remain in the article.

SarMarTay (talk) 16:47, 4 May 2010 (UTC)

SarMarTay Suggestions 5-5-10 (Citations 27-42)

SarMarTay (talk) 16:31, 5 May 2010 (UTC)

-One or more citations are required for the "Immune reaction" section, preferably from secondary sources. This 2007 primary literature review discusses increased cytokine production in colons of IBS patients and will fit well here:

Role of infection in irritable bowel syndrome.[14]

27-28-(protozoa infection rates) are graphs that are not referred to in the text. 28 is a primary source and should be deleted. 27 (a review) can be cited later in the wiki after "Two of the protozoa investigated have a high prevalence in industrialized countries and infect the bowel, but little is known about them as they are recently emerged pathogens."

29-(Rifaximin) is a primary literature article that should be replaced with a secondary source. I am unable to find a non-primary source to support this section. Perhaps this should be moved to the Research or Treatment sections of this wiki.

30-(overgrowth of intestinal flora) is a primary literature article that should be replaced with a secondary source. I suggest using this 2009 primary literature review:

Small intestinal bacterial overgrowth in irritable bowel syndrome: systematic review and meta-analysis. [15]

6-(protozoa and IBS) is an acceptable primary literature review.

31-32-(increase in protozoa infection in IBS patients) are primary literature articles that should be replaced with a secondary source. The following review discusses this topic with regards to Blastocystis, but it is not from a mainstream journal (a textbook or mainstream review cite is desired):

Blastocystis hominis and bowel diseases[16]

33-(blastocystis symptoms) is a primary literature article that should be replaced in this context with a secondary source. This CDC website will work:

http://www.cdc.gov/ncidod/dpd/parasites/blastocystishominis/factsht_blastocystis_hominis.htm

34-(blastocystis symptoms contested by some physicians) is a primary literature article that should be replaced with a secondary source. The CDC website will also work here:

http://www.cdc.gov/ncidod/dpd/parasites/blastocystishominis/factsht_blastocystis_hominis.htm

35-(London infection rates) is a primary literature article that is appropriate because it is directly cited. It is currently a dead link.

31-(Pakistan infection rates) is a primary literature article that is appropriate here because it is directly cited.

32-(Italy infection rates) is a primary literature article that is appropriate here because it is directly cited.

36-(fail to identify blast infection) is a primary literature article that should be replaced with a secondary source. I suggest:

http://www.cdc.gov/ncidod/dpd/parasites/blastocystishominis/factsht_blastocystis_hominis.htm#should

34,37-39-(blast may not respond to treatment) are primary literature articles that should be replaced by a single secondary source. Again, the CDC site is sufficient:

http://www.cdc.gov/ncidod/dpd/parasites/blastocystishominis/factsht_blastocystis_hominis.htm#should

-I suggest citing D. fragilis infection symptoms with:

http://www.cdc.gov/ncidod/dpd/parasites/dientamoeba/factsht_dientamoeba.htm#symptoms

27-(See above) is an appropriate primary literature review.

40-(fragilis resolves with antibiotics) is a primary literature article that should be replaced with a secondary source. I suggest using:

http://www.cdc.gov/ncidod/dpd/parasites/dientamoeba/factsht_dientamoeba.htm#medication

Later, 40 is used to cite "Researchers have noted that methods used clinically may fail to detect some Dientamoeba fragilis infections." I suggest using:

http://www.cdc.gov/ncidod/dpd/parasites/dientamoeba/factsht_dientamoeba.htm#diagnosis

41-(fragilis causes IBS-like symptoms and can be treated) is a primary literature article that is directly cited, so it is appropriate. This is currently a dead link.

42-(fragilis found in non-IBS patients) is a primary literature article that should be deleted. I don't think a source is necessary here.

SarMarTay (talk) 16:31, 5 May 2010 (UTC)

SarMarTay Suggestions 5-5-10 (Citations 43-59)

SarMarTay (talk) 18:39, 5 May 2010 (UTC)

Diagnosis:

43-(IBS is a diagnosis of exclusion, suggested screening) is an appropriate primary literature review. This information can also be found in the textbook:

Gastroenterology: an illustrated colour text By Graham P. Butcher

44-(compared criteria for diagnosis) is an appropriate primary literature review.

45-(assessment of IBS diagnosis) is an acceptable primary literature review.

46-(patients with hidden constipation) is a primary literature article that is directly referenced in the text and should remain. The rest of this paragraph is a summary of this paper, so I suggest citing 46 again at the end of the paragraph. There is no link for this citation.

47-51-(misdiagnosis as IBS when really other conditions) are primary literature articles that should be replaced with a single secondary reference. Cite 20 can be used except it does not specifically reference heliobacter pylori (a bacteria), though it does have bacteria listed.

52-(IBS Celiacs recommendation) is an appropriate primary literature opinion article.

53-(medications may cause IBS-like symptoms) is a primary literature article that should be replaced with a secondary source. I suggest using citation 20.

23-(%of comorbidity) is an appropriate primary literature review.

54-(comorbidities) is a primary literature article that is directly cited in the text so it is appropriate. However, I suggest changing the wording of the sentence to "Irritable Bowel Syndrome is associated with headache, fibromyalgia, chronic fatigue syndrome and depression." This statement can be supported by a number of sources, including citation 20 and

Gastroenterology: an illustrated colour text By Graham P. Butcher (textbook)

7-10-(IBS and IBD) are acceptable primary literature reviews.

11-(specific IBS/IBD study) is a primary research article that is acceptable b/c it is directly referenced in the text.

55-57-(IBS and unnecessary abdominal surgery) are primary literature articles that are acceptable b/c they are directly mentioned in the article. However, there are a number of secondary sources that describe increased abdominal surgeries in IBS patients, including citation 19.

58-(migraine, endometriosis, IBS link) is a primary literature article that is appropriate because it is directly cited in the text.

59-(link to other chronic disorders) is a mayo clinic link to a small description of Interstitial cystitis. The wiki description was copied and pasted from this website. This section should be deleted, reworded and the mayo clinic link can be used as a citation:

[17]

SarMarTay (talk) 18:39, 5 May 2010 (UTC)

SarMarTay Suggestions 5-5-10 (Citations 60-92)

SarMarTay (talk) 00:27, 6 May 2010 (UTC)

Management:

60-(overview of treatment success) is an appropriate primary literature review.

61-(restrictive diets) is an appropriate primary literature review.

62-(lactose-free diet) is a primary literature article that should be replaced with a secondary source. I recommend:

[18]

63-(fructose malabsorption) is a website that is currently a dead link.

64-65-(IgG diet) is a primary literature article that is acceptable b/c it is directly referenced in the text. The link to 65 is the same link as 64. I think 65 should be deleted anyway because the statement does not need a reference.

66-(gastrocolic response) is a primary literature article that should be replaced with a secondary source. I am unable to find a secondary source at this time.

67-75-(fiber data) are primary literature sources that are acceptable because they are directly referenced in the wiki text. I would also suggest including one or more general citations regarding fiber, including:

http://digestive.niddk.nih.gov/ddiseases/pubs/ibs/#help

76-79-(medication overview) are acceptable primary literature reviews.

80-(laxatives) is a primary literature article that should be replaced with a secondary source.

-The Lubiprostone section appears to have been copied from answers.com

-The Antispasmotics section appears to have been copied from cureirritablebowel.com

-The Tegaserod section appears to have been copied from mayoclinic.com —Preceding unsigned comment added by SarMarTay (talk • contribs) 02:49, 6 May 2010 (UTC)

81-(Zelnorm effectiveness) is a primary literature article that is appropriate because it is referenced in the wiki, though a secondary source is desired. I suggest:

Updates on treatment of irritable bowel syndrome.[19]

Also, this section describes the history of Zelnorm approval, which is not necessarily appropriate for this article. I suggest describing Zelnorm's effectiveness in one sentence with a link to a Zelnorm wiki that discusses the history of the medication. The suggested citation also hits on Zelnorm approval.

82-85-(SSRI effectiveness) are primary literature articles that should be replaced with a secondary source. I suggest:

Role of serotonin in gastrointestinal motility and irritable bowel syndrome.[20]

86-(antidepressant effectiveness) is a pay-only website and should be replaced with a secondary citation that is accessible to the general public. I suggest citation 87 or:

[21]

87-88-(antidepressant effectiveness) 87 is a review and acceptable (mentioned above). 88 is acceptable because it is a primary research article that is referenced in the text.

89-90-(rafiximin) 89 is a primary literature article that is acceptable because it is referenced in the wiki text. 90 is an acceptable review about gut flora in IBS patients.

91-(domperidone) is a primary literature article that should be replaced with a secondary source. There is no link to citation 91. I am unable to find a secondary reference.

92-(opiods) is a dead link to a textbook.

SarMarTay (talk) 00:27, 6 May 2010 (UTC)

Ref numbers

It is not always clear which version of the article SarMarTay's ref numbers pertain to, as some were added during the time period for the above comments. The starting point would have been this rev, bit it is possible that the subsequent changes to the article impacted the number/ref mapping. Please use caution.LeadSongDog come howl 17:11, 12 May 2010 (UTC)

SarMarTay Suggestions 5-5-10 (Citations 93-115)

SarMarTay (talk) 01:16, 6 May 2010 (UTC)

-Cites 93-95 (phsycological treatments) are primary literature sources that should be replaced with a single secondary source. Citation 67 will work or many textbooks discuss psycological treatments, including:

Gastroenterology: an illustrated colour text By Graham P. Butcher

96-(questionnaire on IBS) is an acceptable primary research article because it is referenced in the wiki text.

97 and 100-(probiotics) are acceptable primary research reviews.

98-(probiotics) is a primary research article and the data is discussed in citation 97.

99-(probiotics) is a press release and should be deleted. A citation is not required because the information is discussed in citation 97.

101-(probiotics) is a dead link to Mayo Clinic.

102-(peppermint oil) is a primary source that should be replaced with a secondary source. I suggest using the citation 60 review. Or, this information is discussed on websites and textboooks.

The section concerning peppermint oil usage to treat IBS suggests that all IBS sufferers should use peppermint oil. This statement is medical advice and should be deleted.

103-(iberogast) is a primary source that should be replaced with a secondary source.

-Cite 104 (acupuncture) is a primary research article that is acceptable because it is directly referenced in the wiki text. However, a secondary article is desired.

-Graph with % population with IBS is not cited in the text. It should be cited OR removed.

-Cites 105-110 (% population with IBS) and table are direct references from primary data and are sufficient as citations.

History:

-Cite 111 (first IBS symptoms reported) is a direct reference from primary literature and is sufficient.

Economics:

-Cites 112-113 (monetary costs of IBS) are direct references from primary literature and are sufficient.

Research:

-Cite 114 (fructose diet) is a direct reference and is sufficient in the Research section.

-Cite 115 (IgG diet) is a direct reference and is sufficient in the Research section.

SarMarTay (talk) 01:16, 6 May 2010 (UTC)

Can you condense and/or shorten some of this. It's gotten to the point where too long; didn't read gets applied. Also, you just need to sign at the end of your post not in the beginning nor in the subject line. Thanks in advance, --CrohnieGal^Talk 10:26, 6 May 2010 (UTC)

Agreed. If you want to help fix the references in the article, that is great - just go ahead and do it. No need to post a whole load of references here for us to look through. --sciencewatcher (talk) 14:26, 6 May 2010 (UTC)

I am concerned that reviews and meta-analysis's have been wrongly labeled as primary sources as well as other issues with this analysis of sources which I have addressed on the SarMarTays talk page. I reviewed some of the changes and flagging and saw lots of inappropriate flaggings and decided to boldly revert. Hopefully SarMar will understand my bold revert.--Literaturegeek | T@1k? 15:16, 8 May 2010 (UTC)

(outdent), I think I see one problem, SarMar is interpreting review articles as being primary sources because they are reviewing primary sources, presumably SarMar mistakenly thinks a secondary source is one that only reviews reviews or something. A secondary source comments and reviews or analyses primary source. As a result of this misinterpretation even a meta-analysis by Cochrane Review was labeled a primary source! Primary sources are not forbidden on wikipedia just simply used more cautiously and secondary sources given preference.--Literaturegeek | T@1k? 15:20, 8 May 2010 (UTC)

SarMarTay: You can easily see if something is a review by clicking on the "MeSH Terms" in pubmed and it will say "Review". --sciencewatcher (talk) 16:16, 8 May 2010 (UTC)

I think you'll find it's a bit more complicated than that. What Wikipedia declares to be a secondary source for our purposes is not always what an academic or professional would consider a secondary source. For that matter, what Wikipedia declares to be a secondary source depends on the context: The same article from a newspaper would considered a secondary source for the purpose of notability, but a primary source for the purpose of WP:NPOV. WhatamIdoing (talk) 04:41, 18 May 2010 (UTC)

I understand that, but for medical info in medical articles a secondary source is a high quality review. I'm just saying how you figure out the 'review' bit. Deciding if it is 'high quality' is another issue altogether. --sciencewatcher (talk) 14:45, 18 May 2010 (UTC)

Google Project

Hi guys,

Let me provide a little (possibly useful) context: Google's private foundation is supporting expansions of the Swahili Wikipedia, Spanish Wikipedia, and Arabic Wikipedia. (See this announcement.) Forty medicine- or health-related articles have been identified as targets, including this one. Basically, Google is having these articles reviewed and professionally translated -- and we want the translators looking at good, accurate, globally relevant articles.

The comments above represent one of the first reviews by an outside expert (an expert in medical writing, not an expert in Wikipedia's ways!). Other articles will be reviewed soon. You are not required to do anything at all, but I know all the regular editors on this page, and SarMarTay is fortunate to have been assigned an article with such a great, hard-working group. I hope that you will help identify and implement the best of the suggestions. Even small improvements are very much appreciated and will be very helpful to the other Wikipedias. Think of this as a great opportunity to pick a couple of the comments above that you think are most important, and to improve this article. This is such an important subject for our readers, and I'd really love to see it reach Good Article status.

As a suggestion for managing this long list, another page has been using templates from the {{done}} and {{notdone}} family to keep track of what needs doing, what is finished, what is confusing, and what suggestions have been rejected.

If you're curious, here's the rest of the target list. If you are interested in helping with the overall project, please consider adding Wikipedia:WikiProject Medicine/Google Project to your watchlist, improving any articles on the list, and/or contributing advice at the talk page. All editors are welcome. Also, if you have opinions about what does or doesn't work for you, please leave a note at the project's talk page. Thanks, WhatamIdoing (talk) 04:33, 18 May 2010 (UTC)

Yes, this is a good idea and hopefully people will take some of SarMayTay's suggestions and improve the article. This article is important because IBS is "one of the most common disorders seen by doctors" and "the most common condition seen by gastroenterologists" (according to a quick google search, although we don't have that info in the article anywhere). --sciencewatcher (talk) 15:05, 18 May 2010 (UTC)

Missing medication

I was surprised that the medication section did not include Pinaverium Bromide, marketed as dicetel. it is a colon muscle relaxant that I take, and is quite effective in my case. —Preceding unsigned comment added by 96.49.152.4 (talk) 06:36, 24 May 2010 (UTC)

Differential diagnosis

Most of the text under Differential diagnosis belongs under the main heading Diagnosis. I've added the main diseases eliminated in a thorough differential diagnosis. Anthony (talk) 18:08, 24 October 2010 (UTC)

PoV in alt med section

I mean: "Due to often unsatisfactory results from medical treatments for IBS". So treatment is apparently ineffective... Then "up to 50 percent of people turn to complementary alternative medicine." Is there are reason to include the percentage other to increase the perceived validity of AM ?

Then it continues: "Probiotics -can be- beneficial in the treatment of IBS" . Finally "There is good evidence of a beneficial effect of these capsules " . Good evidence? does not sound scientific at all, does it? —Preceding unsigned comment added by 190.103.73.109 (talk) 00:50, 15 December 2010 (UTC)

Looking through the first reference, it completely supports the first sentence of this section. Not only that, but it appears to be a pretty good review and it also matches my own perception of IBS. Also, the review states 'Peppermint oil and probiotics are supported by enough evidence to recommend their use' - so 'good evidence' is correct and scientific. I'm certainly not a fan of quackery (check my edits), but I don't see any problem with this section. --sciencewatcher (talk) 15:40, 15 December 2010 (UTC)

PLEASE HELP ME..

I'm at present 20 years old(male). I'm from south India. I have been suffering from alternating Diarrhea and Constipation over 2-3 years. I had undergone a colonoscopy last year and found to have ulcers in my intestine.He also told me to undergo certain tests. But due to lack of money I avoided them. Doctor asked me to avoid wheat products and to use his prescription for 3 months. I followed his advice and avoided the wheat products completely. From then onwards I still have the same problem but with severe. So I thought that it may take time to cure. But the problem continued over with small periods of mild attacks. Since I'm a college student I'm facing serious problems of lack of attendance during those mild attacks. From last three days this problem became very severe. The main thing is that I usually face this problem in the morning session only. The rest of the day is very cool for me. I can't understand the problem. Please help me in finding out my problem and aiding me in my diet. Please tell what food should I take to get relief from these problems. —Preceding unsigned comment added by 202.133.61.84 (talk) 15:09, 18 December 2010 (UTC)

I'm sorry but we can't give medical advice plus you should ask for medical advise on the net. Go back to your doctor and talk about this. Sorry,--CrohnieGal^Talk 15:16, 18 December 2010 (UTC)

SSRIs

There appears to be a contradiction of sorts in the Management: Medication section with regard to SSRIs. Under the Tricyclic antidepressants subheader it asserts that there is "little evidence of effectiveness of other antidepressant classes such as the SSRIs", but under the Serotonin agonists section, it states that "Selective serotonin reuptake inhibitor anti-depressants (SSRIs), because of their serotonergic effect, would seem to help IBS, especially patients who are constipation predominant. Initial crossover studies and randomized controlled trials support this role." The phrasing "would seem to help" suggests that perhaps there isn't sufficient evidence to say so with more confidence, but if there are studies that support this, isn't that some evidence? Perhaps this could be clarified? — Preceding unsigned comment added by Lzzzl (talk • contribs) 05:44, 18 March 2011 (UTC)

Those 2 reviews used in the first paragraph don't seem to be the most authoritative. The French one only has 1 citation, and the other one is written by a 2nd-year medical student and only has 27 citations. --sciencewatcher (talk) 14:54, 18 March 2011 (UTC)

Opening sentence

The opening sentence should not be "Irritable bowel syndrome is a diagnosis of exclusion". This is only a fancy way of saying what IBS is not. "Diagnosis of exclusion" probably belongs in the lead somewhere, probably in the second paragraph, but the opening should say what IBS is. 86.41.46.205 (talk) 08:20, 10 August 2011 (UTC)

Just a placeholder for "we don't have a clue"?

Isn't this "IBS" just a (pseudo-scientific) placeholder for "we don't have a clue"? The same goes for "functional symptom" (in which case, even if the source of disease is of psychological origin, there is still some gland (or what-have-you) acting up). --90.157.252.17 (talk) 06:39, 14 September 2011 (UTC)

If you read my insert about the FODMAP diet (below), it would your statement is no longer true (i would have agreed even a week ago). Everything that is now known was once a puzzle. Looks like IBS is being solved. — Preceding unsigned comment added by 90.193.233.44 (talk) 23:42, 1 December 2011 (UTC)

FODMAP diet

The Fodmap diet is especially beneficial for IBS sufferers. This contradicts some of the article. The relatively recent diet is based on molecular groups of natural compounds found in food, which ferment in the gut producing the gases and bowel movement symptoms. Will someone please add the fodmap diet to the article. here are some references:

http://fodmap.com/ http://foodhospital.channel4.com/conditions/irritable-bowel-syndrome/low-fodmap-diet

general supporting article: http://ibs.about.com/od/ibsfood/a/The-Fodmap-Diet-For-IBS.htm 90.193.233.44 (talk) 23:39, 1 December 2011 (UTC)

Thanks for your suggestion. The FODMAP diet does look interesting. The last link you provide gives a caution, however:

"Currently, all of the published work on the FODMAP theory for IBS is being done by a related group of researchers. Further studies must be conducted, at a variety of sites, to further test the theory's assumptions and to evaluate the effect of a low FODMAP diet in reducing IBS symptoms."

That suggests that while we might make brief mention of FODMAP, we need to also add the caution that these studies are from an interrelated group of researchers and there have not yet been studies to confirm these findings. Go ahead and add something along those lines, if you wish. Note that a citation from a reliable source is needed. If you would like help with that, please contact me on my talk page. Sunray (talk) 21:17, 4 December 2011 (UTC)

Not a reliable source, but go to any forum of IBS patients, they will tell you that low FODMAP diet reduces their symptoms. tepi (talk) 23:09, 25 August 2012 (UTC)

Link to SIBO?

What about all the papers suggesting most IBS cases are caused by Small intestinal bacterial overgrowth?Tepi (talk) 18:17, 17 August 2012 (UTC)

It looks like we already cover that in the article. --sciencewatcher (talk) 19:56, 17 August 2012 (UTC)

Yes, I see know there were 2 sentences in active infections section. I am currently updating the SIBO page, so I used some of these refs to expand this section. I definitely think it should have more detail, as it looks like there is more evidence behind the SIBO-IBS theory than any other explanation.Tepi (talk) 13:24, 18 August 2012 (UTC)

From what do you base that conclusion? When I do a quick search on google scholar for "etiology irritable bowel syndrome", the highest cited papers still go with the stress/infections/psychiatric as the main theories. A review on SIBO says the evidence is conflicting, and I see we say this in the article. SIBO could just be another symptom rather than a cause. You need to be careful that you're not giving excessive WP:WEIGHT to these theories, which I suspect you might be. --sciencewatcher (talk) 15:30, 18 August 2012 (UTC)

My opinion, (I will not put in the article) is that the bio-psychosocial model of IBS represents an old medical paradigm, and these new approaches represent new enlightened medicine. Comparison can be made with the history of the attitudes towards petpic ulcer disease. Initially, lack of understanding lead to psychosocial causation being widely accepted, however later, the massively important role of H pylori became apparent. I think i gave an unbiased summary of the possible link to SIBO, including the arguments against:

"There is a lack of consensus however, regarding the suggested link between IBS and SIBO. Other authors concluded that the abnormal breath results so common in IBS patients do not suggest SIBO, and state that "abnormal fermentation timing and dynamics of the breath test findings support a role for abnormal intestinal bacterial distribution in IBS." [30] There is general consensus that breath tests are abnormal in IBS, however the disagreement lies in whether this is representative of SIBO.[31] More research is needed to clarifiy this possible link."

And in the SIBO article itself:

"In recent years, several proposed links between SIBO and other disorders have been made. However, the usual methodology of these studies involves the use of breath testing as an indirect investigation for SIBO. Breath testing has been critizised by some authors for being an imperfect test for SIBO, with multiple known false positives.[24]" Tepi (talk) 16:46, 18 August 2012 (UTC)

Your opinion isn't borne out by the opinion of the scholarly research, which still places the bio-psychosocial model high on the list of possible causes, along with infections, so that is what we should be reflecting in the article. Also you seem to be misinformed about peptic ulcer - stress is still thought of as a major cause, along with H.Pylori. You seem to be part of the new American-led crusade to eradicate psychosomatic illness and go back to some sort of weird, unscientific mind-body dualism. That's just my opinion :) --sciencewatcher (talk) 20:03, 18 August 2012 (UTC)

Rollback my added refs, nice. Maybe read some of the ref'd papers? All research pertaining to IBS should be mentioned in the article. As to excessive weight, I fail to see how the few sentences within such a a long article constitutes excessive weight.Tepi (talk) 17:36, 20 August 2012 (UTC)

reason: resolve question of excessive weight pleaseTepi (talk) 17:38, 20 August 2012 (UTC)

As stated in the edit summary, your refs were primary sources. We primarily use secondary sources (ideally reviews) - see WP:MEDRS. Regarding weight: your edits took up over 90% of the 'causes' section, which seemed excessive. Even at the moment the 'active infections' section seems a bit excessive in terms of weight, and it has a lot of primary sources. --sciencewatcher (talk) 20:27, 20 August 2012 (UTC)

Agree with above that the changes led to undue weight to the speculation of the cause to one particular cause and sourced to non MEDRS. I also agree that the current Causes section needs re-writing using secondary sources. Yobol (talk) 20:32, 20 August 2012 (UTC)

There are secondary sources in this section, including a report from the Rome foundation, a very respected international research organization into functional GI disorders. There is no excessive weight here, and it is being used as a cover for people who hold biased points of view and do not wish certain researches to be included in the article. tepi (talk) 18:25, 25 August 2012 (UTC)

Active infections

There is research to support IBS being caused by an as-yet undiscovered active infection. Studies have shown that the nonabsorbed antibiotic rifaximin can provide sustained relief for some IBS patients. Some researchers see this as evidence that IBS is related to an undiscovered agent.

Proposed link to small intestinal bacterial overgrowth

Main article: Small intestinal bacterial overgrowth

Other researchers offer small intestinal bacterial overgrowth (SIBO) as an etiological factor in IBS. SIBO is an overgrowth of intestinal flora, possibly explaining why antibiotics are effective in reducing symptoms. A new study, which has connected cultures of bacteria from the small intestine to a significantly increased occurrence of IBS, may have confirmed this theory.

Some studies reported up to 80% of patients with IBS have abnormal breath test results, which may indicate SIBO. Subsequent studies demonstrated statistically significant reduction in IBS symptoms following therapy for SIBO.

Fibromyalgia is a poorly understood pain condition. Patients with Fibromyalgia often suffer from IBS in addition. One study found that patients who had both IBS and Fibromyalgia also had abnormal breath test results, which could be suggestive of SIBO.

The research that appears to link IBS and SIBO generally involves the use of breath testing, which has been critizised by some authors for being an imperfect and unvalidated test for SIBO, with multiple known false positives. As such, there is a lack of consensus regarding this topic. Other authors concluded that the abnormal breath results so common in IBS patients do not suggest SIBO, and state that "abnormal fermentation timing and dynamics of the breath test findings support a role for abnormal intestinal bacterial distribution in IBS." There is general consensus that breath tests are abnormal in IBS, however the disagreement lies in whether this is representative of SIBO.

A recent Rome foundation review of intestinal microbiota in functional bowel disorders, stated that both SIBO and altered intestinal microbiota (dysbiosis) are implicated in subgroups of patients with funcitonal bowel disorders. Furthermore, there have been both quantitative and qualitative changes in gut microbiota, demonstrated in IBS by more robust methods than breath testing alone. However the review also critisied the lactulose hydrogen breath test, stating that in IBS patients, it is more of a measure of colonic transit rather than the levels of bacteria in the small intestine. It has been shown that when a lower diagnostic threshold for SIBO is used ( >10³ cfu/ml rather than >10⁵ cfu/ml jejunal culture), IBS patients have greater prevalence of SIBO than the general population. The review concluded that "available molecular studies are not adequately designed to establish whether SIBO is involved in IBS but have significant potential". Simren, M.; Barbara, G.; Flint, H. J.; Spiegel, B. M. R.; Spiller, R. C.; Vanner, S.; Verdu, E. F.; Whorwell, P. J.; Zoetendal, E. G.; Rome Foundation, C. (2012). "Intestinal microbiota in functional bowel disorders: A Rome foundation report". Gut. 62 (1): 159–176. doi:10.1136/gutjnl-2012-302167. PMC 3551212. PMID 22730468.

References #1, #2, #3, #5, #7 are primary studies and do not deserve weight here. #6 is a popular press book, and while likely meets minimum criteria for reliability, the multitude of other available high quality sources like peer-reviewed review and position papers should probably be used before this. The problem with putting so much emphasis on SIBO here is that there is not definitive cause (reviews note numerous other possible causes); to expand in detail this one cause without expanding in detail the other possible causes gives our readers the wrong impression about the prominence of this one possible factor. Yobol (talk) 22:47, 25 August 2012 (UTC)

Is there not such a concept as expanding parts of an article at a time? (like most editors do) Or must all its concepts be expanded at identical rates to avoid accusation of excessive weight? Another reason for placing more emphasis on something could be that of all these possibilities, it seems to have most evidence. Weighting according to evidence. Demonstrating abnormalities of gut microbiota and its distribution in IBS patients for me offers hugely more convincing evidence than a more intangible bio-psychosocial model. As it stands, I will rework the whole section in a sandbox with as much secondary source as possible, I'm sure there is some since I did not look very hard. tepi (talk) 23:01, 25 August 2012 (UTC)

I would also list ref #4 as reliable. The book contains hundreds of referenced papers.tepi (talk) 23:04, 25 August 2012 (UTC)

Whether or not you or I find something "convincing" is of no importance here, but what the reliable sources find important. You cannot inflate the importance of one particular cause because you personally think it is more important. The relative weight we give to each possible cause should come from reliable secondary sources that discuss all possible causes in context of each other. Yobol (talk) 23:09, 25 August 2012 (UTC)

I did not inflate its importance, I wrote with neutrality giving the arguments against the proposed link. Restricting the edits of those who may only have researched part of a topic is folly. With huge topic like IBS, the greater the variation in specialties that contribute, the better the overall quality of the article. It is unreasonable to expect an article to grow its various aspects at identical rates. Not relevant to this this discussion, but is SIBO an active infection, or a dysbiosis? tepi (talk) 23:16, 25 August 2012 (UTC)

I'm not asking for the entire article to be re-written, but if you want to update a section, it is best to do so in a neutral fashion. Overweighting a particular theory out of prominence to its respective weight in the medical literature breaks one of our core policies. Asking people to edit so that they do not break this policy is not too much to ask. Yobol (talk) 23:19, 25 August 2012 (UTC)

I was talking about reworking only the active infections section, and not anytime soon unfortunately. What is actually going on here is a accusation of excessive weight because "proposed link to SIBO" was expanded without expanding the other proposed links in this section. My comment is that there is is no reason to restrict the edits of part of article because the other parts were not expanded.tepi (talk) 23:33, 25 August 2012 (UTC)

Tepi, I think it would be beneficial for you to also inflate the biopsychosocial section as well. Given that you say it is 'intangible' makes me think you haven't really done your homework. Really, there is very convincing evidence showing how stress causes diarrhea, pain and immune dysfunction (SIBO could very definitely be a result of stress). Some of these things - for example, stress causing diarrhea - you can easily demonstrate in the lab. Now whether this is the ENTIRE cause of IBS or if there are other causes of IBS, we don't really know. Perhaps there are multiple different illnesses being lumped together as IBS. The same can be said for CFS.

As a first step I would recommend reading through the most-cited, highest quality reviews that are available on the subject. The article should reflect the weight of theories given in those reviews. Also see WP:RECENT. While we can include recent advances, we shouldn't give them undue weight. Wikipedia is an encyclopedia, not a journal. We generally wait until research has a high number of citations before giving it weight in the article - this is all explained in WP:MEDRS. --sciencewatcher (talk) 23:32, 25 August 2012 (UTC)

Correct me, but you are asking editors to rework whole sections rather than only their chosen area of interest. It does not matter if the individual editors have opinions about their chosen area of research, as long as their edits are neutral and well written. With such a large article, it becomes harder and harder to rework whole sections at a time. It starts to grow here and there with small edits. I will update this thread with the proposed edit, but it will not be anytime soon. Enjoy your dark ages article in the mean timetepi (talk) 23:47, 25 August 2012 (UTC)

I think we should entirely delete the current Causes section and rewrite it based on the Thabane and similar reviews. As for SIBO, you will need to rewrite based on reviews (i.e. Ford and Rome) and give it appropriate weight. --sciencewatcher (talk) 03:39, 26 August 2012 (UTC)

Link with miscarriages.

Recent studies have cited that patiets with IBS are 20% more likely to have miscarriages. I don't know the reliability of the articles, but it's not mentioned anywhere in THIS article. --95.33.129.145 (talk) 19:12, 14 December 2012 (UTC)

IBS isn't necessarily a single disease

The article keeps talking about "the cause" of IBS, "no cure for IBS", "the exact cause is unknown", and similar language, but it's a syndrome, not a disease. It's a collection of symptoms that often occur together, meaning "we tested you for a bunch of stuff and you don't have any of that, so we don't know what's causing it yet", right?

It could have multiple causes, no? IBS-D could be caused by one thing, and IBS-C caused by a different thing. The psychosomatic explanation could be correct for some people, while the SIBO explanation could be correct for others, and the FODMAP explanation for others, no? The third paragraph lists several known causes of IBS, but then says "the cause is unknown". That seems contradictory.

I think the language in some places in the article is misleading and should be reworded. — Preceding unsigned comment added by Justanothervisitor (talk • contribs) 21:44, 25 December 2012 (UTC)

Agree, but there's no point trying to improve this article in any serious way, too many angry mastadons here. lesion (talk) 22:09, 25 December 2012 (UTC)

That's ridiculous. The OP is completely correct. Feel free to update the article, all improvements are welcome. --sciencewatcher (talk) 23:45, 25 December 2012 (UTC)

L-GLUTAMINE as IBS remedy

L-Glutamine is said to help manage IBS symptoms. I have been suffering with IBS for years and just recently I tried using L-Glutamine powder daily mixed with water. It has indeed almost cured IBS. There are several links on the net about this too

<http://www.livestrong.com/article/431680-irritable-bowel-syndrome-l-glutamine/>

There is a separate article on L-glutamine in wikipedia and that too mentions that it helps intestinal function. Also a brief definition of l-glutamine would be helpful. It is an amino acid produced in the body naturally. — Preceding unsigned comment added by 98.169.160.118 (talk) 09:31, 26 December 2012 (UTC)

Unfortunately, those "links on the net" are limited to anecdotal stories similar to yours, and a couple of hysterical advocate portals. If I can find a legitimate peer-reviewed published study (or if you can), I'll be happy to add a cautious sentence or two. There have been so many "promising" treatments for IBS in the past, none of which has panned out, that we have to be careful, and objective, and encyclopedic. DoctorJoeE ^{talk to me!} 15:50, 26 December 2012 (UTC)

Right now there is an ongoing medical study whose results will be announced next year.

<http://www.clinicaltrials.gov/ct2/show/NCT01414244>

Please keep up with the status of this study and when the results are announced, you can add a section. — Preceding unsigned comment added by 98.169.166.83 (talk) 01:12, 30 December 2012 (UTC)

Dietary approach

Br Med Bull doi:10.1093/bmb/ldu039 JFW | T@lk 16:42, 5 March 2015 (UTC)

SIBO

Regarding the revert by WholeNewJourney: I didn't remove your edit, I just moved it from the Stress section to the SIBO section, as it seemed more appropriate there. I'm not sure what that has got to do with NPOV. --sciencewatcher (talk) 03:32, 25 March 2015 (UTC)

Although the reference focuses on SIBO the quoted or summarised text from the source is not talking about SIBO but rather IBS as a whole so adding it to the SIBO section is inappropriate. Furthermore you are consciously removing fibromyalgia from your revert of my added text which leaves only one POV that the brain-gut axis works in one direction rather in than in both directions which is what the evidence and literature shows.--WholeNewJourney (talk) 16:53, 29 March 2015 (UTC)

As I understand it, the summarised text is talking about how SIBO might be causing the IBS symptoms, hence putting it in the SIBO section seems appropriate. It was primarily talking about IBS, but they said that the same mechanism has been proposed for fibromyalgia. I didn't think it was useful to add the bit about fibro, as this article is about IBS and it didn't really seem relevant. I'm slightly baffled as to why you think that is introducing a POV about the brain gut axis only working one way.

If you're concerned about the discussion of CFS and fibro in the preceeding section, perhaps we can remove that and just say anxiety. --sciencewatcher (talk) 13:49, 30 March 2015 (UTC)

I don't mind a role for stress/anxiety being mentioned associated with fibromyalgia and CFS and IBS etc, it is a valid theory. I agree stress is one of several important risk factors for developing IBS (post-infectious, antibiotic usage, and genetics being others). I just felt that the role of the immune system and an abnormal reaction to the commensal flora and fibromyalgia and CFS symptoms should also be mentioned. If the immune system in a subgroup of IBS affected individuals thinks the commensal bacteria is an infection and is attacking it it is not surprising if patients complain of fatigue and fibromyalgia as those symptoms are typical of someone who is ill. Of course that is just my opinion but there are sources that are saying pretty much this point.

How about we just add it to the newly created mechanism (pathophysiology) section as it is quite technical as it talks about proinflammatory cytokines etc. Perhaps that is the best place for it?--WholeNewJourney (talk) 19:55, 2 April 2015 (UTC)

Recent research is showing that SIBO is unlikely to be causal (see for example the Spiegel (2011) ref in the SIBO therapy section). We should perhaps expand that in the SIBO pathophysiology section. I'm not really sure it's a good idea to be speculating about SIBO causing IBS and fibro when the evidence is showing that SIBO is likely a symptom rather than a cause. --sciencewatcher (talk) 21:40, 2 April 2015 (UTC)

Yeah, there are several areas of controversy associated with SIBO. The sentences from the source that I was quoting don't mention SIBO so I was just going to mention IBS and an abnormal immune system interaction with bacteria possibly causing fibromyalgia and not mention anything about SIBO. What do you think?--WholeNewJourney (talk) 23:20, 2 April 2015 (UTC)