Diarrhea Predominant Irritable Bowel Syndrome (IBS-D): Fact or fiction

Diarrhea Predominant Irritable Bowel Syndrome IBS (IBS-D) and functional diarrhea constitute 50% of cases treated by gastroenterology specialists and a significant proportion of those treated in a primary physicians practice. The size of the problem and the difficulty in successfully addressing these entities has frustrated patients and physicians alike. The presented data delineates work-up, final diagnoses and clinical outcomes in the largest single clinical retrospective study of 303 patients with an initial presentation of IBS-D and functional diarrhea. Results indicate that 298 (98%) patients were found to have a diagnosis different from the initial presentation of IBS-D, and 204 (68%) of the patients studied had conditions related to treatable bile acid abnormalities. After identifying these clinical diagnoses and instituting appropriate therapy, 98% of these patients had a favorable response, as measured by a decrease in the number of bowel movements to less than three per day and a significant change in the consistency of the stools. This finding is dramatically different from the poor response generally experienced from conventional therapy for IBS-D and functional chronic diarrhea. The data presented in this study substantiates the hypothesis that IBS-D and functional diarrhea do not exist as true clinical entities and explains the previous lack of satisfactory therapeutic response. Symptoms experienced by these patients were caused by a collection of different clinical conditions bunched up under this "umbrella" diagnosis of IBS-D. Once these separate entities were identified and appropriately addressed, the clinical response was quite impressive and encouraging. The implication of this hypothesis could be of vital importance because of the number of those suffering from these symptoms. (C) 2010 Elsevier Ltd. All rights reserved.