Irritable Bowel Syndrome Flashcards
How many people are affected by IBS?
10-20%
More common in North American women and Asian men
How many patients that have IBS seek medical care?
15% seek medical care
What is the brain-gut axis?
It is the connection between the brain and the gut.
Emotional instability can translate into GI instability via serotonin
What happens to the brain-gut axis in patients with IBS?
They seem to over react to various stimuli (stress, diet, certain activity)
What are some symptoms associated with IBS?
More than 6 months of duration
Symptoms:
Pain/spasms
Bloating/fullness
urgency
constipation <—–>diarrhea (cycle between the two)
Mucous in the stool, but no bleeding
What are the different types of IBS?
IBS-D (primarly diarrhea)
IBS-C (primarily constipation)
IBS-mixed (cycle between diarrhea and constipation, hard to treat with usual agents due to “bipolar” nature of condition)
What are some othe conditions that are similar to IBS?
Inflammatory Bowel Disease
Glucose intolerance
Drug-indiced
Lactose intolerance
Colorectal Cancer
What are some non-pharmacological treatment options in IBS?
Dietary fiber (it could be an irritant)
Reduce fatty foods
Avoid offending foods (FODMAPs)
What are FODMAP foods?
These are foods that IBS patients should avoid in their diet
Fermentable
Oligosaccharides
Disaccharides
Monosaccharides
AND
Polyols (sugar alcohols)
What is the mechanism of action for Beano/Lactaid?
They contain alpha-d-galactosidase which helps breakdown complex carbohydrates in food (beans, vegetables, and whole grains)
This reduced the burden on the GI tract
Not for IBS though
What are some pharmacogical agents used in IBS?
- Bulk-forming agents
- Smooth Muscle Relaxants
- Anti-diarrheals
- Laxatives
- Peppermint Oil
- Antidepressants
- Linaclotide
- Eluxadoline
- Probiotics
- Anti-cholinergics
What is the efficacy of bulk-forming agents in IBS?
Psyllium is now reccomended for IBS-C (2-4 tbsps per day with fluids)
PEG-3350 has less evidence
Bulk-forming agents may help with IBS-D
What is the efficacy of smooth muscle relaxants in IBS?
Create less spasm/better co-ordinations
Work best if used regularly
Try in IBS-D and IBS-C
ex. pinaverium (calcium channel antagonist) and trimebutine (opiate receptor agonist)
What is the efficacy of anti-diarrheals in IBS?
Used in IBS-D and some limited used in IBS-mixed (when stool is more watery)
Decrease in diarrhea, but not much help for pain
Can be used for years safely (chronic therapy is common in IBS-D)
ex. loperamide 2-4mg up to QID
What is a good strategy for controlling seemingly “uncontrollable” bowel movements in IBS with loperamide?
Take 2-4mg of loperamide approximately 45 min before leaving home
What is the safety of long-term use of loperamide?
Indefinite dosing with loperamide is safe as long as you avoid constipation (unlikely to develop dependence), but it is not preferred. Loperamide is a rescue drug, patients should be on agents that are intended for chronic use
Can loperamide be used safely in IBS-C?
No, loperamide will only worsen constipation by slowing down GI motility further
Only use loperamide in IBS-D and IBS-mixed when stool is watery
What are some good therapeutic options for IBS-C?
Prevention: Psyllium, Inulin, and docusate
Acute treatment: senna
What is the efficacy of peppermint oil in IBS?
It is mildly effective as a smooth muscle relaxer (broad spectrum works fine for both IBS-D, IBS-C, and IBS-mixed)
About 60% of patients benefit from the use of anti-spasmodics like peppermint oil
What is the efficacy of antidepressants in IBS?
TCAs are effective in reducing pain and diarrhea from IBS-D (slowing of GI motility)
SSRIs do not control IBS-D symptoms (can actually worsen diarrhea if patient has IBS-D)
What are some agents that take advantage of serotonin receptors in the GI tract to help treat IBS?
Alosetron: a 5 HT3 receptor antagonist (good for IBS-D)
Tegaserod: a 5-HT4 partial agonist (good for IBS-C)
Review slide 38 to examine therapeutic options for IBS-D and IBS-C?
What is the efficacy of linaclotide in IBS?
This agent is indicated for IBS-C
It acts locally (low side effects) and low oral bioavailability
Can cause diarrhea (preferable for patients with IBS-C
What is the efficacy of eluxadoline in IBS?
It is a mu-opioid receptor agonist
It is indicated for IBS-D (will slow down GI motility)
What is the efficacy of probiotics in IBS?
More than half (64%) of patients reported benefit over no benefit
It does not hurt to try, use agents that list IBS as an indication on the package
What is the efficacy of anti-cholinergics (Bentylol) in IBS?
Not first line for IBS-D
They are less effective and have more side effects
Not the preferred agent (not endorsed by pharmacists or other HCPs)
