The burden of illness of irritable bowel syndrome: current challenges and hope for the future.

OBJECTIVES: To review unmet medical needs associated with irritable bowel syndrome (IBS), to discuss factors that contribute to these unmet needs, and to provide an overview of advancements in IBS diagnosis and treatment options that may influence treatment strategies.
SUMMARY: IBS is characterized by a multiple symptom complex of abdominal pain or discomfort and altered bowel habits (i.e., constipation, diarrhea, or both in alternation) and is associated with a large unmet medical need. IBS symptoms are chronic and bothersome, and they have a profound negative impact on patients. quality of life (i.e., affecting sleep, personal relationships, travel, diet, and sexual functioning). IBS imposes a substantial economic burden in direct medical costs and in indirect social costs such as absenteeism from work and school and lost productivity, along with the less-measurable costs of a decreased quality of life. The annual cost of IBS treatment in the United States has been estimated to be between $1.7 billion and $10 billion in direct medical costs (excluding prescription and over-the-counter [OTC] drug costs) and $20 billion for indirect costs. The goals of IBS therapy are to provide global relief of the multiple symptoms of IBS and to relieve single IBS symptoms. Although traditional IBS therapies (e.g., laxatives, antidepressants, antispasmodics, and bulking agents) are useful for some patients in relieving single IBS symptoms, patients generally are dissatisfied with their overall efficacy and tolerability. These agents have not been proven in randomized, controlled clinical trials to be more effective than placebo in providing global relief of the multiple symptoms of IBS. Over the past 2 decades, numerous advancements in the diagnosis and management of IBS have provided hope for the future, including research strides in our understanding of the underlying pathophysiology of IBS; new diagnostic and management recommendations based on a stepwise, symptom-based approach; and the development of novel pharmacologic agents.
CONCLUSION: IBS imposes a high socioeconomic burden on its sufferers and on society. Research strides in the underlying pathophysiology of this disorder have enhanced our understanding of IBS, but many questions remain to be answered. Development of evidence-based guidelines on the stepwise, symptom-based approach to IBS diagnosis and the continuing efforts to develop unique pharmacologic classes targeted at the multiple symptoms of this disorder are steps in the right direction. Though cost-effectiveness data on specific pharmacologic classes are not yet available, these ongoing efforts may help promote timely IBS diagnosis and patient satisfaction with care, optimally decreasing the use of health care resources. Copyright 2004 Academy of Managed Care Pharmacy