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Correspondence to Sanjay Prakash; [email protected]
Background
Restless legs syndrome (RLS) and irritable bowel syndrome (IBS) are both very high in the general population. The pooled global prevalence of IBS is about 10%, and it is the most common reason for referral to gastroenterologists.1 2 The prevalence of RLS is 5%–15% in the general population and is considered the most common movement disorder.3 There are a number of comorbidities for both RLS and IBS. A few recent studies have demonstrated a high prevalence of RLS in patients with IBS.4 However, the inter-relations between the two have not been discovered in the literature. Herein, we describe two patients of RLS with IBS. The symptom complex of both RLS and IBS responded to dopamine or dopamine agonists.
Case presentation
Case 1
A 37-year-old man had a history of variable abdominal discomfort since his childhood. The symptoms included abdominal cramping, bloating, abdominal distension and excessive flatulence. These symptoms were associated with increased bowel movements (five to six times daily), faecal urgency and a feeling of incomplete evacuation. These symptoms were predominantly in the morning, and he was often awakened from sleep by abdominal cramps. Abdominal symptoms have woken him up many times even at 02:00 to 03:00. Bowel movements used to relieve his abdominal problems, and there have been typically minimal or no symptoms after the morning hours. The gastrointestinal symptoms were initially infrequent with a frequency of two to three attacks in a week. However, the frequency gradually increased, and the patient noted these symptoms almost daily for the last several years. He denied any nausea, vomiting, haematemesis and bleeding per rectum. The patient consulted several physicians and gastroenterologists over 20 years. He had been subjected to a number of investigations by gastroenterologists and, all were normal. The investigations included complete blood count, erythrocyte sedimentation rate, blood glucose, kidney function tests, liver function tests, thyroid profiles, stool studies, ultrasound of the gallbladder, abdominal and pelvic CT scan and upper and lower gastrointestinal endoscopy. A diagnosis of IBS was first made about 20 years ago by a general physician and later confirmed by several gastroenterologists. The patient received an array of management regimes over the course of his illness, including psychopharmacological treatments, and lifestyle and food...