Patients with moderately painful symptoms have more frequent or severe pain that is at times disabling. There may be symptom-related psychological distress, associated with greater physiological gut reactivity (e.g., worse with eating or stress, relieved by defecation or vomiting) and a greater number of health-care visits. Treatments involve gut-acting pharmacological agents (e.g., anticholinergics, antidiarrheals, or the newer 5-HT receptor-acting agents, etc.), and the psychosocial distress tends to improve concurrent with relief of the GI symptoms. If the symptoms are more persistent, low-dose tricyclic antidepressants and/or psychological treatments can be considered.
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