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This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.
A 28-year-old woman presents with a 7-month history of recurrent, crampy pain in the left lower abdominal quadrant, bloating with abdominal distention, and frequent, loose stools. She reports having had similar but milder symptoms since childhood. She spends long times in the bathroom because she is worried about uncontrollable discomfort and fecal soiling if she does not completely empty her bowels before
The Clinical Problem
Strategies and Evidence
Evaluation
Pharmacologic Treatment
Constipation
Diarrhea
Abdominal Pain
Cognitive–Behavioral Therapy
Areas of Uncertainty
Guidelines
Summary and Recommendations
Source Information
From the Center for Neurobiology of Stress, Division of Digestive Diseases, Departments of Medicine, Physiology, and Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles.
An audio version of this article is available at www.nejm.org.
Address reprint requests to Dr. Mayer at the University of California, Los Angeles, Peter Ueberroth Bldg., Ste. 2338 F, 10945 Leconte Ave., Los Angeles, CA 90095-6949, or at emayer@ucla.edu.
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