The Search for Biomarkers and Endophenotypes in Functional Gastrointestinal Disorders
Center for Neurobiology of Stress, Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California.Gastroenterology (Impact Factor: 13.93). 03/2011; 140(5):1377-9. DOI: 10.1053/j.gastro.2011.03.023
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ABSTRACT: There are a number of reasons to establish the accurate diagnosis of irritable bowel syndrome (IBS): to relieve patient uncertainty; to avoid adverse effects of unnecessary medications or treatments; to avoid unnecessary diagnostic procedures and surgeries; to conserve limited healthcare resources; and, of course, to initiate the most appropriate treatment. However, making the diagnosis of IBS remains difficult because it is clinically heterogeneous, no biological marker to detect it exists, many other diseases share the same clinical manifestations and it is often difficult for both physicians and patients to accept the uncertainty of a symptom-based diagnosis. Different diagnostic criteria have been developed during the last 4 decades but none have proved to be an ideal method of accurately diagnosing IBS. Just as importantly, physicians are frequently unaware of published guidelines or consciously ignore these diagnostic criteria. Most clinicians still believe IBS is a diagnosis of exclusion and not a positive diagnosis based on history, physical examination, use of published diagnostic criteria such as the Rome III criteria, and the absence of alarm features. In the sections to follow we will address the inherent difficulties of diagnosing IBS, highlight the importance of symptom-based diagnoses to help reign in soaring healthcare costs, and discuss future strategies that may enable a more cost-efficient diagnosis of IBS.Neurogastroenterology and Motility 09/2012; 24(9):791-801. DOI:10.1111/j.1365-2982.2012.01992.x · 3.42 Impact Factor
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ABSTRACT: Functional somatic syndromes are common and disabling conditions that all include chronic pain, and which may be related to central nervous system sensitisation. Here, we address the concept of central sensitisation as a physiological basis for the functional somatic syndromes. A narrative review of the current literature on central sensitisation and physiological studies in the functional somatic syndromes. Central sensitisation may be a common neurophysiological process that is able to explain non-painful as well as painful symptoms in these disorders. Furthermore, central sensitisation may represent an endophenotypic vulnerability to the development of these syndromes that potentially explains why they cluster together. Further research is needed to verify these findings, including prospective studies and the standardisation of combined methods of investigation in the study of central sensitisation in functional somatic syndromes. In turn, this may lead to new explanatory mechanisms and treatments being evaluated. Our conclusions add to the debate over the nomenclature of these syndromes but importantly also provide an explanation for our patients. Copyright © 2015 Elsevier Inc. All rights reserved.Journal of Psychosomatic Research 01/2015; 78(3). DOI:10.1016/j.jpsychores.2015.01.003 · 2.84 Impact Factor
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