Clinical Presentation of Irritable Bowel Syndrome Flashcards
What is Irritable Bowel Syndrome (IBS)?
- chronic abdominal pain and altered bowel habits in the absence of any organic cause.
What is the most commonly diagnosed GI condition?
IBS
*affects men and women (young and old), but usually middle aged WOMEN.
How does the Rome III diagnostic criteria define IBS?
recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months, associated with 2 or more of the following:
- improvement with defecation
- onset associated with a change in frequency of stool.
- onset associated with a change in form (appearance) of stool.
*** Is mucus in the stool uncommon in IBS?
NO it is very common.
What is the most common cause of work related absence?
common cold #2 is IBS.
What are the 4 subtypes of IBS?
- IBS-C
- IBS-D
- IBS-M
- IBS-U
What is IBS-C?
- hard or lumpy stools greater than 25% of bowel movements (BMs).
- loose or watery stools less than 25% of BMs
- bristol stool form scale 1-2
What is IBS-D?
- loose or watery stools greater than 25% of BMs
- hard or lumpy stools less than 25% of BMs
- bristol stool form scale 6-7
What is IBS-M?
- both stool forms (diarrhea and constipation) greater than 25% of BMs
What is IBS-U?
both stool forms less than 25% of BMs
Is IBS considered a multi-symptomatic disorder?
YES
- abdominal pain/discomfort (must have at least this).
- trapped wind
- diarrhea
- bloating
- constipation
What comorbidities are associated with IBS?
- headache
- poor sleep
- fatigue
- fibromyalgia
- depression, anxiety
What are some other symptoms common in IBS patients?
GERD, dysphagia, early satiety, dyspepsia, nausea, non-cardiac chest pain, impaired sexual function, dysmenorrhea, dyspareunia, increased urinary frequency, fibromyalgia
What is the pathophysiology of IBS?
we don’t know.
- likely hereditary and environmental factors
What was the effect of rectosigmoidal balloon distention on pain in IBS patients vs. control?
- IBS patients reported significantly more pain than control pts.
Is visceral hyperalgesia specific for IBS?
NO it occurs in other patients with chronic pain syndromes (esophageal chest pain, angina pectoris with normal coronary arteries, fibromyalgia)
Was IBS found in about 1/3 of patients after acute bacterial infection (infections enteritis)?
YES especially after antibiotic use.
Could alteration in fecal microflora (bacterial overgrowth) or food sensitivities be possible causes for IBS?
yes maybe
Are patients with IBS more likely to have a history of physical or sexual abuse?
YES corticotropin releasing factor (CRF) has been shown to increased abdominal pain and colonic motility in iBS patients to a higher degree than controls.
Does a typical IBS patient usually lose or gain weight?
GAINS weight.
Does IBS cause you to wake from sleep?
NO!
Does IBS cause GI/rectal bleeding?
NO!
If the pts symptoms point to IBS and there are no alarm symptoms, should you run diagnostic tests?
NO, just treat them!
What treatments have been used to treat IBS symptoms?
- prescription medications, OTC laxatives, OTC antidarrheals, herbals…
- fewer than 1/3 reported satisfaction
How do we treat IBS?
no known cure, but treatment is to relieve symptoms.
What is the MOST IMPORTANT component of IBS treatment?
establishing a strong therapeutic physician-patient relationship.
- show empathy, acknowledge pain
- listen actively
- reassure
- educate
- be confident
- positive placebo effects are significant
What dietary restrictions may be used for IBS?
- exclusion of gas-producing foods: beans, onions, celery, carrots, raisins, bananas, apricots, prunes, brussel sprouts, pretzels, and bagels.
- low FODMAP diet (Fermentable Oligo-, Di-, and Mono-saccharides And Polyols).
Is fiber proven to help IBS?
No but it is easy for pts to try and if it helps, great!
Will physical activity help IBS?
YES
*** What do we do for IBS-D?
- antispasmodic agents (most frequently used agents in IBS).
- hyposcyamine, dicyclomine, peppermint oil (smooth muscle relaxants with anticholinergic properties).
- 5-HT3 antagonists (Alosetron) and may help the abdominal pain.
- RIFAXIMIN= oral antibiotic, minimal systemic absorption, inhibits bacterial RNA synthesis by binding to bacterial DNA-dependent RNA polymerase. EXTREMELY SAFE bc it stays in the GI tract and does not get absorbed systemically.
- antidepressants (TCA’s and SSRI’s)= analgesic properties with facilitation of endogenous endorphin release. Use caution with a constipated patient bc they can slow intestinal transit via anticholinergic properties.
More for resistant IBS patients.
Will imodium help the diarrhea in IBS?
YES but will do nothing for the bloating and abdominal pain.
** How do you treat constipation predominant IBS (IBS-C)?
- consider PEG (polyethylene glycol)
- osmotic laxative (may worsen abdominal bloating and cramping, but improves constipation). Monitor serum electrolytes.
- C-2 chloride channel activator (lubiprostone)= enhances chloride-rich intestinal fluid secretion. EXTREMELY SAFE and can use indefinitely :)
- Guanylate cyclase agonists (linaclotide)= stimulates intestinal fluid secretion and transit.
- Rifaximin
- Probiotics (no data that they work).
- psychosocial therapies (hypnosis…)
If you have a loop in your colon, are you more or less likely to have IBS?
5x MORE likely!
