L17: IBS Flashcards
Def of IBS
Epidemeology of IBS
- More common in Females
- Peak: 30 - 40 years.
Pathophysiology of IBS
Most accepted pathophysiology of IBS
Visceral hypersensitivity: increased sensitivity to abdominal distension
Types of IBS
CP of IBS
Rome IV Criteria for IBS
Symptoms of IBS
Altered bowel habits.
Abdominal pain.
Abdominal distention
Altered Bowel Habits in IBS
- Constipation
- Diarrhea
- Postprandial urgency
Constipation in IBS
characterized by pellet-like stools associated with straining, sense of incomplete evacuation, and passage of mucus
Diarrhea in IBS
described as frequent, loose stools that may be associated with urgency (stool volume is normal)
Post-Prandial Urgency in IBS
is common, as is alternation between constipation and diarrhea.
Characteristically, one feature predominates in a single patient, but significant variability exists among patients.
..
Characters of abdominal Pain in IBS
- Frequently is diffuse without radiation.
- Acute episodes of sharp pain are often superimposed on a more constant dull ache.
Site of of abdominal Pain in IBS
Common sites of pain include the lower abdomen, specifically the left lower quadrant.
What Increases abdominal Pain in IBS?
Meals may precipitate pain
What Decreases abdominal Pain in IBS?
Defecation commonly improves pain.
Dx of IBS
Red flags in IBS
⇒ Older age
⇒ Weight loss
⇒ Rectal bleeding
⇒ Vomiting
⇒ Fever
Additional Symptoms in IBS
Excess mucus
Dyspepsia & heart burn
Urinary urgency
Comorbid fibromyalgia
Stress related
Investigations in IBS
TTT of IBS
- General Measures
- Symptoms-Guided TTT
- Probiotics & Antibiotics
General measures in TTT of IBS
Reassurance, explanation, support, aim for realistic goals
Relaxation therapy, biofeedback, stress reduction, exercise
Low FODMAP diet for pain, bloating gas.
TTT of Pain in IBS
- Antispasmodic medication before meals (e.g. hyoscine, low level evidence)
- Increase dietary fiber (bran or psyllium)
- Tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRI)
TTT of IBS with diarrhea (IBS-D)
Loperamide (Imodium)
Diphenoxylate (Lomotil)
Cholestyramine
TTT of IBS with constipation (IBS-C)
Increase fiber in diet
Linaclotide
Laxatives (help more with the constipation than the pain)
Probiotics & antibiotics in IBS
Rifaximin: Nonabsorbable antibiotics, decreasing bloating
Probiotics: for bloating and flatulence.
Fecal transplantation
Done
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