By necessity, any abbreviated version of the guideline published in its entirety elsewhere (1) is forced to bundle the most important practical recommendations. For this reason, several aspects were dealt with only briefly. On this background we wish to respond to the criticisms raised as follows:
By contrast to what Dr Albers suggests, the guideline includes among the essential basic diagnostic tools, especially for irritable bowel syndrome, a comprehensive medical history of the patient; we discussed the eminent importance of the history in a prominent position in our article.
The particularities of psychological mechanisms were reflected in a main chapter, which was compiled in collaboration with many representatives from the respective medical specialties and medical specialty societies. The same applies for stress and extraintestinal symptoms.
The pivotal key mechanisms of the syndrome, however, are biochemical and cellular malfunctions at the level of the mucosal integrity and the enteric nervous system. This was elucidated by a multitude of high quality studies and demonstrated in a convincing and reproducible manner.
The “normal” interaction between gut and psyche plays an important part in irritable bowel syndrome: it may worsen symptoms, but it may also be used to alleviate symptoms. The guideline made a point of emphasizing both. This can be done, for example, by means of psychotherapy and/or low-dose antidepressants, with the latter aiming primarily to achieve pharmaceutical modulation of the enteric neurons and not the central nervous system. However, studies have yielded contradictory results with regard to therapeutic successes, which have thus far not been as compelling as our correspondent stated.
By contrast, hypotheses that classify irritable bowel syndrome as a purely psychological disorder („autonomy of the amygdala“) or phobia („arachnophobia“) must be refuted, as they are entirely lacking any sound scientific basis. The psychosomatic “model” for gastric ulcers, which was employed for decades before Helicobacter pylori was discovered, was based on a similar misconception.
Footnotes
Conflict of interest statement
Professor Layer has received honoraria for acting as an adviser from Abbott, Solvay, Shire, and Norgine. He has received travel and hotel expenses from Shire and Norgine. He has also received honoraria for speaking from Falk, Movetis/Shire, Abbott/Solvay, Axcan, Boehringer, and Novartis. He has received honoraria for commissioned clinical studies from Axcan and Solvay.
Dr. Andresen has received honoraria for acting as an adviser and for speaking, as well as travel and hotel expenses and delegate fees for continuing medical educational events and conferences from Norgine, Falk, Axcan, Abbott/Solvay, and Shire/Movetis.
References
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