IBS & Chronic Constipation Flashcards
irritable bowel syndrome (IBS) - overview
*IBS is a SYNDROME - a pattern of GI sensory and motor symptoms
*diagnosis established by clinical history
*no definitive diagnostic signs, tests, or imaging
*a diagnosis of EXCLUSION
Rome IV criterion for IBS
*recurrent ABDOMINAL PAIN
*occurring at least 1 day/week in the past 3 months
*associated with 2+ of the following:
-related to defecation [alleviates/exacerbates]
-change in stool frequency
-change in the appearance [consistency] of the stool
“normal bowel movement”
a habitual pattern of stool frequency and consistency that is satisfactory
epidemiology of IBS
*USA prevalence ~10%
*peak incidence < 35 years old
*females 2x more likely than males
pathophysiology of IBS
*disorder of gut-brain axis, but not entirely understood
*dysregulated motor function (regulated by brain) and visceral hypersensitivity in the gut
*other contributing factors include genetics, immune system, psychosocial factors, diet, microbiome
clinical presentation of IBS
- chronic abdominal pain!!
-crampy, hypogastric or periumbilical
-intermittent; often post-prandial; NOT NOCTURNAL!
-pain relieved (totally/partially) by defecation - dysregulated GI motor function
-diarrhea, constipation, or alternating - associated symptoms
-bloating, abdominal distention, gassiness, flatulence, sense of incomplete rectal evacuation
clinical evaluation of IBS - HPI
-bristol stool chart to define consistency
-detailed hx of temporal patterns
-dietary hx (carbonated beverages, sugar alcohols)
diarrheal temporal patterns potentially consistent with IBS
*onset = “a long time ago” or “I’ve always had it”
*daily pattern = unpredictable
*weekly pattern = most weeks
*offending foods = none identified (maybe spicy, greasy)
*effects of stress = increased symptoms
clinical evaluation of IBS - personal & social history
-SYMPTOMS EXACERBATED BY STRESSORS
-hx of past sexual abuse
-stress level & stressors (marriage, personal relationships, work environment, finances, libido, sexual function, sleep)
clinical evaluation of IBS - associated conditions
*migraine
*fibromyalgia
*anxiety & panic disorders
*autonomic disorders - POTS
clinical evaluation of IBS - ABSENCE OF RED FLAGS
patient should NOT have any of the following if you are considering IBS:
-bloody stools
-iron deficiency anemia
-fever, systemic symptoms
-RECENT ONSET (esp in older patients)
-SIGNIFICANT WEIGHT LOSS (>10% in 6 months)
-NOCTURNAL DIARRHEA; steatorrhea
-ED visits for IV fluids; dehydration; hypokalemia
conditions that can mimic IBS-D
*post-infectious IBS (can last for years)
*small intestinal bacterial overgrowth (SIBO)
*specific malabsorption syndromes (lactose intolerance, fructose malabsorption, bile salt malabsorption)
*ingestion of sugar alcohols
*food intolerances and true food allergies
*early stages of celiac disease and IBD
*drug induced (metformin, antibiotics, NSAIDs)
dietary treatment of IBS
*provide reassurance and education
*specific dietary restrictions: carbonated beverages, fatty or spicy foods, sugar alcohols, lactose, fructose
*INCREASE DIETARY FIBERS: high fiber foods & fiber supplements
*low FODMAP diet (reduce intake of Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols)
*probiotics
drug treatments of IBS (overview)
*dicyclomine; hyoscyamine - M1 receptor antagonists
*L-menthol (kappa-opioid/5-HT3 receptor antagonist)
*loperamide; diphenoxylate - mu-opioid receptor agonists
*rifaximin - antibiotic
*amitriptyline - TCA
*SSRI antidepressants
primary causes of chronic constipation
*IBS-C (chronic constipation + pain)
*idiopathic
*colonic dysmotility (decreased colonic transit)
*pelvic floor dysfunction
