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Copyright ©2014 Baishideng Publishing Group Inc.
World J Gastroenterol. Jun 14, 2014; 20(22): 6759-6773
Published online Jun 14, 2014. doi: 10.3748/wjg.v20.i22.6759
Table 1 Summary of diagnostic criteria used to define irritable bowel syndrome
Diagnostic criteriaSymptoms, signs, and laboratory investigations included in criteria
Manning (1978)IBS is defined as the symptoms given below with no duration of symptoms described. The number of symptoms that need to be present to diagnose IBS is not reported in the paper, but a threshold of three positive is the most commonly used:
Abdominal pain relieved by defecation
More frequent stools with onset of pain
Looser stools with onset of pain
Mucus per rectum
Feeling of incomplete emptying
Patient-reported visible abdominal distension
Kruis (1984)IBS is defined by a logistic regression model that describes the probability of IBS. Symptoms need to be present for more than two years.
Symptoms:
Abdominal pain, flatulence, or bowel irregularity
Description of character and severity of abdominal pain
Alternating constipation and diarrhea
Signs that exclude IBS (each determined by the physician):
Abnormal physical findings and/or history pathognomonic for any diagnosis other than IBS
Erythrocyte sedimentation rate > 20 mm/2 h
Leukocytosis > 10000/cc
Anemia (Hemoglobin < 12 for women or < 14 for men)
Impression by the physician that the patient has rectal bleeding
Rome I (1990)Abdominal pain or discomfort relieved with defecation, or associated with a change in stool frequency or consistency,
PLUS two or more of the following on at least 25% of occasions or days for 3 mo:
Altered stool frequency
Altered stool form
Altered stool passage
Passage of mucus
Bloating or distension
Rome II (1999)Abdominal discomfort or pain that has two of three features for 12 wk (need not be consecutive) in the last one year:
Relieved with defecation
Onset associated with a change in frequency of stool
Onset associated with a change in form of stool
Rome III (2006)Recurrent abdominal pain or discomfort three days per month in the last 3 mo associated with two or more of:
Improvement with defecation
Onset associated with a change in frequency of stool
Onset associated with a change in form of stool
Table 2 Emerging therapies for irritable bowel syndrome
AgentMechanism of actionTargeted disorderClinical status
Peripheral acting agents
CrofelemerCFTR inhibitorIBS-DPhase 2b complete
Linaclotide (MD-1100)Guanylatecyclase-c agonistIBS-CApproved by US FDA in 2012, 30th August
Arverapamil (AGI-003)Calcium channel blockerIBS-DPhase 3
VerapamilKappa opioid agonistIBSPhase 2b complete
MitemcinalMotilin receptor agonistIBS-CPhase 2
Peripheral and central acting agents
Ramosetron5-HT 3 antagonistIBS-DPhase 3
TD-51085-HT 4 agonistIBS-CPhase 2
DDP-7735-HT 3 agonistIBS-CPhase 2
BMS-562086Corticotropin-releasing hormone antagonistIBS-DPhase 2
GW876008(319) Corticotropin-releasing hormone antagonistIBSPhase 2
DDP-2255-HT 3 antagonist and NE reuptake inhibitionIBS-DPhase 2
GTP-010Glucagon-like peptideIBS painPhase 2
AGN-203818Alpha receptor agonistIBS painPhase 2
SolabegronBeta-3 receptor agonistIBSPhase 2
Espindolol (AGI-011)Beta receptor antagonistIBS (all subtypes)Phase 2
Dextofisopam2,3 benzodiazepine receptorsIBS-D and IBS-MPhase 3