IBS-Jenkins Flashcards
***Who is most likely to be diagnosed with IBS?
Young women (20-40)
***Is there a genetic predisposition to IBS?
YES!
What are the pathophysiology considerations of IBS? (9)
- Alterations in GI motility –> “spastic bowel” or prolonged transit time
- Visceral hypersensitivity (triggered by bowel distention or bloating)
- Inflammation (lymphocytes, mast cells and pro inflammatory cytokines)
- post-infectious (bacterial or parasitic)
- Alterations in fecal flora (why we use probiotics sometimes)
- Bacterial overgrowth (abnormal breath hydrogen levels after a dose of carbs)
- Food sensitivity (allergy (IgG), carb malabsorption, gluten sensitivity)
- Genetic predisposition
- Psychosocial Dysfunction (IV administration of CRF can increase abd pain and colonic motility)
***What are the subtypes of IBS? When do IBS pts get pain?
- IBS with constipation (hard stool >25%)
- IBS with diarrhea (loose stool >25%)
- Mixed IBS (hard stool >25% and loose stool >25%)
- Unsubtyped IBS (insufficient abnormality of stool)
***post-prandial pain (NOT normally in the middle of the night–> infection)
Is IBS a diagnosis of exclusion?
Sometimes?
Constipation dominant IBS can be diagnosed based on symptoms–> NOT dx of exclusion
-diarrhea predominant need to do tests to exclude other things (Celiac and Crohn’s)
What are some other symptoms associated with IBS?
- GI: BLOATING, dysphagia, GERD, early satiety, dyspepsia, nausea, non-cardiac chest pain
- Fibromyalgia symptoms
- impaired sexual function
- dysmenorrhea
- urinary frequency
***How is IBS diagnosed?
- symptom criteria (no tests)
- Manning or Rome Criteria
What is Manning Criteria for IBS?
- Pain relieved with defecation
- More frequent stools at the onset of pain
- Looser stools at the onset of pain
- Visible abdominal distention
- Passage of mucus
- Sensation of incomplete evacuation
***What is the Rome Criteria for IBS?
- Recurrent abdominal pain or discomfortat 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
- (symptom onset must also be at least 6 months prior to diagnosis)
***What are “alarm” symptoms? Are they associated with IBS?
- Alarm symptoms include: Rectal bleeding, Nocturnal abdominal pain, Weight loss, Anemia, elevated inflammatory markers, or electrolyte disturbances
- these are NOT associated with IBS
- do imaging or colonoscopy
What tests should be ordered if constipation-predominant IBS is the likely diagnosis? If a pt is > 50 yo, what needs to be ruled out?
- Radiography – plain film of abdomen to see retained stool
- Flexible sigmoidoscopy or colonoscopy – if a structural lesion is suspected
- Colonoscopy preferred for >50 y/o to rule out colon cancer
What are potential tests used to rule out other diagnoses in diarrhea-predominant IBS?
- Stool cultures – if Giardia exposure
- Celiac disease screening – Serum IgA antibody to tissue transglutaminase
- 24-hr stool collection – if osmotic or secretory diarrhea, or malabsorption
- Colonoscopy or Flexible Sigmoidoscopy – endoscopic evaluation
- IBD workup – lab and imaging studies
***What are the key points in making an IBS diagnosis?
- Good history and rule out “red flags”
- Provide reassurance and close follow-up
- Rome III criteria have high specificity for IBS diagnosis
- Psychological component: anxiety, depression, and abuse
***What can we advise pts with IBS to do to feel better?
- Start a diary to keep track of each meal, each activity, and how felt–> figure out what makes symptoms better or worse.
- Exercise for 20-60 minutes, 3-5 days a week.
- Get counseling to discuss how to cope with stresses in life.
- Eat more fiber* (can supplement with psyllium or methyl cellulose)
- stop eating foods that make IBS worse (lactose, foods that cause gas)
What medications can be used to ease the symptoms of IBS?
- anti-cholinergic meds (Dicyclomine and Hyoscyamine) –> block the stimulation of the GI tract, take preventively
- anti-depressants (TCAs) –> pain relief in IBS at low doses
- anti-anxiety (Diazepam, Lorazepam, Clonazepam) –> ONLY take for a short time
- anti-diarrheals (Loperamide or Diphenoxylate with atropine) –> slow movement through the GI tract (use only as needed)*
- antibiotics can be helpful in some
- peppermint oil (although may worsen heartburn
- acidophilus (probiotics) –> not proven benefit
