Biopsychosocial approach to the diagnosis of irritable bowel syndrome in the framework of functional disorders and the efficacy of therapy with the dual-acting antidepressant Duloxetine (clinical case)
https://doi.org/10.33667/2078-5631-2026-2-7-12
Abstract
Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder. According to the Rome IV criteria, IBS is defined as a condition characterized by abdominal pain associated with defecation and changes in stool form and frequency. The onset of the disease is typically acute and associated with stressful events, and subsequently leads to a significant decline in quality of life. This article provides a detailed case report of a patient who developed acute diarrhea and typical manifestations of functional gastrointestinal disorders. Treatment with the SSNRI antidepressant Duloxetine relieved the gastrointestinal symptoms and significantly improved quality of life.
About the Authors
G. M. Dyukova
A. S. Loginov Moscow Clinical Scientific Center
Russian Federation
Russian Federation
Dyukova Galina M., Dr Med Sci (habil.), professor, leading researcher at Dept of Neurology
Moscow
A. A. Makarova
A. S. Loginov Moscow Clinical Scientific Center
Russian Federation
Russian Federation
Makarova Alina A., junior researcher at Laboratory for Functional Diagnostics of Bowel Diseases, gastroenterologist at Dept of Bowel Pathology
Moscow
L. Kh. Indeykina
A. S. Loginov Moscow Clinical Scientific Center
Russian Federation
Russian Federation
Indeikina Liliya Kh., PhD Med Sci, head of Laboratory for Functional Diagnostics of Bowel Diseases, gastroenterologist at Dept of Bowel Pathology
Moscow
D. A. Degterev
A. S. Loginov Moscow Clinical Scientific Center
Russian Federation
Russian Federation
Degterev Daniil A., PhD Med Sci, head of Dept of Neurology
Moscow
A. I. Parfenov
A. S. Loginov Moscow Clinical Scientific Center
Russian Federation
Russian Federation
Parfenov Asfold I. , Dr Med Sci (habil.), professor, head of Intestinal Pathology Dept.
Moscow
References
1. Aaron LA, Buchwald DA. Review of the Evidence for Overlap among Unexplained Clinical Conditions Ann Intern Med. 2001; 134 (9 Part 2): 868–881.
2. ABC of Medically Unexplained Symptoms. January Ed. Christopher Burton.2013, BMJ Books. ISBN: 978-1-119-96725-5.
3. Agréus L, Svärdsudd K, Nyrén O, Tibblin G. Irritable bowel syndrome and dyspepsia in the general population: overlap and lack of stability over time. Gastroenterology 1995; 109: 671–680. [PMID: 7657095] 3, 11, 30–40.
4. Giovanni B, Stanghellini V. Biomarkers in IBS: when will they replace symptoms for diagnosis and management? Gut. 2009; 58: 1571–1575. PMID: 19923339. DOI: 10.1136/gut.2008.169672
5. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4: 561–571.
6. Bixquert-Jiménez M, Bixquert-Pla L. Antidepressant therapy in functional gastrointestinal disorders. Gastroenterol Hepatol. 2005 Oct; 28 (8): 485–92.
7. Brennan BP, Fogarty KV, Roberts JL, Reynolds KA, Pope HG Jr, Hudson JI. Duloxetine in the treatment of irritable bowel syndrome: an open-label pilot study. Hum Psychopharmacol. 2009 Jul; 24 (5): 423–8. DOI: 10.1002/hup.1038
8. Buono JL, Mathur K, Averitt AJ, Andrae DA.J Economic Burden of Irritable Bowel Syndrome with Diarrhea: Retrospective Analysis of a U.S. Commercially Insured Population.Manag Care Spec Pharm. 2017 Apr; 23 (4): 453–460. Epub 2016 Nov 21.
9. Canavan C, West J, Card T. The economic impact of the irritable bowel syndrome. Aliment Pharmacol Ther. 2014; 40: 1023–34.
10. Clouse RE, Lustman PJ, Geisman RA, Alpers DH. Antidepressant therapy in 138 patients with irritable bowel syndrome: a five-year clinical experience. Aliment Pharmacol Ther. 1994 Aug; 8 (4): 409–16.
11. Drossman D.A., Functional Gastrointestinal Symptoms. Beyond Tricyclics: New Ideas for Treating Patients With Painful and Refractory. Am J Gastroenterol. 2009; 104: 2897–2902. DOI: 10.1038/ajg.2009.341
12. Drossman D. A. Functional gastrointestinal disorders: History, pathophysiology, clinical features and Rome IV / Drossman D. A. Gastroenterology 2016; 150 (6):1262-1279.e2.
13. Drossman D.A. The Rome criteria process: diagnosis and legitimization of irritable bowel syndrome / Drossman D.A. The American journal of gastroenterology. 1999; 94 (10): 2803–2807.
14. Drossman DA, Chang, Chey, Kellow, Tack and Whitehead and Rome IV Committees. Rome IV-Functional GI Disorders. 2016.
15. El-Salhy Magdy, Gundersen Doris, Odd Helge Gilja, Jan Gunnar Hatlebakk, Hausken Trygve. Is irritable bowel syndrome an organic disorder? World J Gastroenterol. 2014 January 14; 20 (2): 384–400. bpgoffice@wjgnet.com DOI: 10.3748/wjg.v20.i2.384
16. Ford AC, NJ Talley, PS Schoenfeld, E M M Quigley,4 P Moayyedi. Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis. Gut. 2009; 58: 367–378. DOI: 10.1136/gut.2008.163162367
17. Jenkinson C, Layte R, Wright L, Coulter A. Manual and interpretation guide for the UK SF-36. Oxford: Health Services Research Unit, 1996.
18. Kaplan AJ, Michael D Franzen, Pv Nickell, Danielle Ransom, Paul J. Lebovitz An Open Label Trial of Duloxetine in Patients with Irritable Bowel Syndrome and Comorbid Generalized Anxiety Disorder. Int J Psychiatry Clin Pract. 2014 Jan; 18 (1): 11–5. DOI: 10.3109/13651501
19. Labus JS, Bolus R, Chang L, Wiklund I, Naesdal J, Mayer EA, Naliboff BD. The visceral sensitivity index: development and validation of a gastrointestinal symptom-specific anxiety scale. Aliment Pharmacol Ther. 2004; 8: 89–97.
20. Longstreth GF, Hawkey CJ, Mayer EA, Jones RH, Naesdal J, Wilson IK, Peacock RA, Wiklund IK. Characteristics of patients with irritable bowel syndrome recruited from three sources: implications for clinical trials. Aliment Pharmacol Ther. 2001; 15: 959–964. PMID: 11421870.
21. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006; 130: 1480–1491. PMID: 16678561 DOI: 10.1053/j.gastro.2005.11.061
22. Mayer E.A., Labus J.S., Kirsten T., Cole S.W., Pierre B. Towards a systems view of IBS. Nat. Rev. Gastroenterol. Hepatol. advance online publication 25 August 2015. DOI: 10.1038/nrgastro.2015.121
23. Oblizajek N.R., Sangeetha Gandhi, Mayank Sharma et al. Anorectal pressures measured with high-resolution manometry in healthy people – Normal values and asymptomatic pelvic floor dysfunction. Journal of the Neurogastroenterology and Motility. 2019; 31 (8): e13597. DOI: 10.1111/nmo.13597
24. Owens DM Nelson DK Talley NJ. The irritable bowel syndrome: long-term prognosis and the physician-patient interaction. Ann Intern Med. Ann Intern Med. 1995 Sep 15; 123 (6): 471. PMID: 76394521995 Jan 15; 122 (2): 107–12. DOI: 10.7326/0003-4819-122-2-199501150-00005
25. Spiegel BM. The burden of IBS: looking at metrics. Curr Gastroenterol Rep. 2009; 11: 265–269. PMID: 19615301.
26. Spiller R, Aziz Q, Creed F, Emmanuel A, Houghton L, Hungin P, Jones R, Kumar D, Rubin G, Trudgill N, Whorwell P. Guidelines on the irritable bowel syndrome: mechanisms and practical management. Gut. 2007; 56: 1770–1798. PMID:17488783 DOI: 10.1136/gut.2007.119446
27. Spiller RC. Potential biomarkers. Gastroenterol Clin North Am. 2011; 40: 121–139. PMID: 21333904 DOI: 10.1016/j.gtc.2011.01.001
28. Tanaka Yukari, Motoyori Kanazawa, Shin Fukudo, and Douglas A Drossman. Biopsychosocial Model of Irritable Bowel Syndrome. J Neurogastroenterol Motil. 2011 Apr; 17 (2): 131–139.
29. Thabane M, Marshall JK. Post-infectious irritable bowel syndrome. World J Gastroenterol 2009; 15 (29): 3591–3596.
30. Thompson WG, Heaton KW. Functional bowel disorders in apparently healthy people. Gastroenterology. 1980; 79: 283–288. PMID: 7399231.
31. Wang LH, Fang XC, Pan GZ. Bacillary dysentery as a causative factor of irritable bowel syndrome and its pathogenesis.Gut. 2004; 53: 1096–1101.
32. Wessely S, Nimnuan C, Sharpe M. Functional somatic syndromes: one or many? The Lancet. 1999 Sept 11; 354: 936–939.
33. Dyukova G.M., Golubev V.L. Functional Neurological Disorders, Diagnosis and Therapy. Moscow: Medpress-Inform, 2022. 754 p. (In Russ.).
34. Dyukova G.M., Golubev V.L., Pogromov A.P., Mnatsakanyan M.G. Functional disorders: modern ideas about the systematics of clinical manifestations and pathogenesis. (Literature review). SS Korsakov Journal of Neurology and Psychiatry 2016; 116 (12): 115–120. (In Russ.).
35. Ivashkin V.T., Maev I.V., Shelygin Yu.A., Baranskaya E.K., Belous S.S., Belousova E.A., Beniashvili A.G., Vasiliev S.V., Veselov A.V. et al. Diagnosis and treatment of irritable bowel syndrome (Clinical guidelines of the Russian Gastroenterological Association and the Association of Proctologists of Russia). Russian Journal of Gastroenterology, Hepatology, Proctology. 2021; 31 (5): 74–95. (In Russ.).
36. Pogromov A. P., Dyukova G. M., Leonova M. L. Psychovegetative aspects of functional gastric dyspepsia and irritable bowel syndrome, efficacy of duloxetine therapy. Russian Journal of Hepatology, Gastroenterology and Coloproctology. 2012; 3: 26–32. (In Russ.).
37. Khanin Y.L. A Short Guide to the Application of the Reactive and Personal Anxiety Scale Spielberger. Leningrad, 1976. 40 p. (In Russ.).
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For citations:
Dyukova G.M., Makarova A.A., Indeykina L.Kh., Degterev D.A., Parfenov A.I. Biopsychosocial approach to the diagnosis of irritable bowel syndrome in the framework of functional disorders and the efficacy of therapy with the dual-acting antidepressant Duloxetine (clinical case). Medical alphabet. 2026;(2):7-12. (In Russ.) https://doi.org/10.33667/2078-5631-2026-2-7-12
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