Lecture 6: Functional Bowel Disorders Flashcards
What am I describing?
- recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months with 2 or more of the following
1) improvement with defecation
2) onset associated with change of stool frequency
3) onset associated with change in stool form
Chronicity: Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis
Irritable Bowel Syndrome
-symptoms include abdominal discomfort, bloating, constipation, diarrhea
How do you diagnose functional dyspepsia?
Must Include: 1) One or more of A) Bothersome postprandial fullness B) Early satiation C) Epigastric pain D) Epigastric burning AND 2) NO evidence of structural disease that could explain the symptoms *criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis
How do you diagnose postprandial distress syndrome?
Must include one or both of the following:
1) Bothersome postprandial fullness, occurring after ordinary sized meals, at least several times a week
2) early satiation that prevent finishing a regular meal, at least several times a week
* criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis
Supportive Criteria:
1) upper abdominal bloating or postprandial nausea or excessive belching can be present
2) EPS can co-exist
How do you diagnose Epigastric Pain Syndrome?
Must include ALL of the following:
1) pain or burning localized to epigastrium of at least moderate severity at least 1x a week
2) intermittent pain
3) NOT generalized or localized to other abdominal or chest regions
4) NOT relieved by defecation or gas
5) NOT fulfilling criteria for gallbladder and sphincter of Oddi disorders
* criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis
Supportive criteria
1) pain may be of a burning quality but without retrosternal component
2) pain is commonly induced or relived by ingestion of a meal but may occur while fasting
3) postprandial distress syndrome may coexist
Who does IBS affect?
1) USA prevalence-10-20%
2) more frequently
- western world, white
- female
- young
- anxiety/depression
- history of abuse (sexual, physical, psychological)
3) EXCEPTIONS:
- gastroduodenal and esophageal functional disorders (M=F)
- frequency of fecal incontinence, chronic constipation, and dysphagia increases with age
How do you diagnose IBS?
1) History
- ID GI complains (nausea/vomiting, abdominal discomfort or pain location frequency onset duration radiation and course), stool frequency/consistency
2) Diagnostic Testing
- directed by history
Red Flags which need more evaluation for IBS
1) weight loss
2) hematochezia, melena
3) nocturnal symptoms
4) family history of IBD or colorectal cancer
5) age of onset>50 years
Physical exam findings suspicious for organic disease:
1) malnutrition
2) skin rashes
3) inflammatory arthropathy
4) abdominal mass
*lab/imaging abnormality
How do you treat IBS?
1) physician-patient relationship is the most important component of the placebo effect in IBS
2) NO CURE
What is the primary neurotransmitter regulating bowel activity?
- SEROTONIN!
1) Enterochromaffin cells secrete serotonin into the intestinal wall (regulates peristalsis in Enterochromaffin cells)
2) serotonin binds receptors on nerves to mediate motility, secretion, and sensation
3) SERT mediates serotonin uptake into enterocytes to inactivate it
How do you treat the psych disturbances of IBS?
TCA, SSRI/SNRI, cognitive behavioral treatment
How do you treat bloating in IBS?
1) probiotics
2) antibiotics
3) tegasterod
How do you treat diarrhea in IBS?
cholestyramine, loperamide, alosteron, antibiotics, probiotics
How do you treat abdominal pain/discomfort in IBS?
antispasmodics, TCA/SSRI, Alosteron, Tegaserod
How do you treat constipation in IBS?
Ispagula/psyllium, Methylcellulose, Lubiprostone, Osmotic Laxatives, Tegaserod
How do you treat dyspepsia in IBS?
PPI/H2 blocker
