Melatonin: a novel treatment for IBS?

Can poor sleep affect gastrointestinal symptoms in IBS? More on the “bad dreams cause bad bowels” hypothesis with reference to new treatment options The issue of sleep in irritable bowel syndrome (IBS) is intriguing and relevant for several reasons. Firstly, complaints of poor sleep are extremely common in patients with IBS. In fact, self reported sleep disturbance can be regarded as one of the most important extraintestinal symptoms of IBS, which markedly affects quality of life and psychosocial well being.1 In spite of this, little is known about treatment options for this important extraintestinal symptom of IBS. Secondly, there is an overlap between IBS and fibromyalgia syndrome (FS),2 another pain syndrome which has also been linked to disturbed sleep physiology,3 as well as stress.4 If indeed a proportion of IBS patients share a common pathophysiological mechanism with FS, addressing the treatment of sleep related functions in patients with IBS would be a promising venue. Thirdly, hypervigilance has been discussed as one possible pathophysiological mechanism in IBS.5 In this context, sleep studies using electroencephalogram techniques may be useful to reveal disturbed brain activity consistent with the hypothesis of hypervigilance/altered arousal mechanisms in IBS. Finally, it has been suggested that reports of night time awakenings due to gastrointestinal symptoms, mainly abdominal or epigastric pain, may be used as a discriminatory factor between organic and functional disorder.6 A review of the existing literature confirms that a large percentage of IBS patients report sleep disturbances.7,8,9,10,11,12,13,14 Despite this overwhelming evidence of …