Week 9 Part 2 Flashcards
What does itis generally mean?
Inflammation of the colon
What is IBS?
Clinical diagnosis based on typical symptoms - ABC of symptoms
1950
It was called nervous colitis
Definition has changed considerably over the years
1960
Mucous colitis
Absence of objective biomarker
Symptom based diagnosis
1970
Spastic colon
1980
Irritable bowel syndrome
systematised by multi-national Rome comittee - 4th iteration
What is the Manning criteria?
Abdominal pain was in someway associated with bowel movements
Pain relieved by defaecation
What did Rome criteria suggest?
Recurrent abdominal pain on weekly basis
Change in frequency/form of stool
What is the red flag symptoms?
Rectal bleeding
Weight loss
Recent antibiotic use
Nocturnal symptoms
What are the criteria based diagnosis of IBS?
Symptoms present for more than 6 months
Frequent consultation for non-gastrointestinal symptoms
Previous medical unexplained symptoms
Patient reports that stress aggravates symptoms
What are alarm feature in IBS?
Age > 50 years Short history of symptoms Documented weight loss Nocturnal symptoms Male sex Family history of colon cancer Anaemia Recital bleeding Recent antibiotic use
What does IBS cover?
A lot of different symptoms
IBS mixed
Float back and forth between diarrhoea and constipation
IBS with constipation
> 25% hard stools
<25% loose stools
IBS mixed
Both hard and loose stools
IBS with diarrhoea
> 25% loose stools
< 25% hard stools
Epidemiology of IBS in US and Europe
10-15%
Similar to South America
Epidemiology in China of IBS?
23%
1 in 4 people to have IBS
Gender difference in terms of IBS
3 females to 1 male in the UK/North America
Reflects the degree of cultural differences between groups
What is the main predictor of IBS?
Abdominal pain
How much percentage does IBS count for in all GP consultation?
3%
What does predictors do?
Move patients from primary care to secondary care
What are patients worried about?
Abdominal pain
Changes in bowel habits
cancer
What makes IBS symptoms worse?
Stress
What does predictors do?
Move patients from primary care to secondary care
What are patients worried about?
Abdominal pain
Changes in bowel habits
cancer
What makes IBS symptoms worse?
Stress
Why is IBS a common disorder?
4 new patients of IBS every year
What is presenteeism?
Working while sick - not doing anything productive
Productivity loss
Poor health
Exhaustion and work place epidemics
What is the cost of patients in the US?
Over 5000 dollars per annum
What does SFI36 measure ?
Instrument used for evaluating health-related QoL
What are the different aspects it measures?
Physical functioning Physical limitation Bodily pain Well being Emotional General health
IBS
Costs a lot
Significant reduction in people’s quality of life
What is the prevalence of IBS?
10-20%
What are different components of abdominal pain?
Psychosocial abnormalities
Motility abnormalities
Sensory abnormalities
CNS processing abnormalities
What is the Brain Gut Axis?
Bi-directional communication system from gut to CNS
What is the Enteric Nervous System?
Little Brian
What is the Enteric Nervous System?
Little Brain
Brain in the GIT
What is ENS composed of?
2 neuronal plexus
Sub-mucosal and mucosal plexi
What does the 2 neuronal plexus control?
Motility
Secretion
Neurohormonal activation within the gut
What are the 2 pathways that information goes back up to the brain?
Spinal pathways
Vagal pathways
What is spinal pathways?
Roles in perception of the internal state
Pain and inhibition of digestive function
What is vagal pathway?
Physiological sensation
Hunger, satiety etc
Reflex control
Behaviour
What are 3 main pathways of ascending?
Spinomesencephalic
Spinoreticular
Spinothalamic
Geography of pain
Posterior Insula
Thalamus
Primary sensory area
Emotional/affective component of pain
Pain makes us feel
Amygdala, anterior Insula, ACC
Pain forms memories
Descending pathway
Largely mediated in ACC via periaacquctal grey in the medulla
3 separate pathsways after their neurotransmitters - Opiodergic, Noradrenergic and Serotonergic
What does CNS exert influence on?
Motility
Secretion
Immune function
What is the Brain gut axis vital for?
Regulation of food intake
Digestion
Sensation
Control of motility
What happens if there is any disruption at any level of brain gut axis?
Profound changes in perception in the internal state
What is visceral hypersensitivity?
Changes in gut motility
Why do patients with IBS get chronic abdominal pain?
Disturbance of brain gut axis at any level
Change from level of gut wall, spinal dorsal horn, spinal cord to anywhere in the CNS
What is TRPV1 sensitive to?
Capsaicin
What does all IBS patients have?
Elevated TRPV1 fibres in the rectum
What is post-infectious IBS?
When IBS occurs after what appears to be a bout of gastroenteritis
Post infectious IBS has been described following what infections?
Campylobacter
Salmonella
Shigella
What are the risk factors for PI-IBS?
The duration and severity of initial illness
Features in the infected person such as psychological factors m, gender and age
The capability of bacteria to produce a toxin
What are the physiological mechanisms in IBS?
Central nervous system Stress responsive systems Psychological factors Genetic factors Microbiota
In IBS what is there a considerable overlap with?
Psychological disorders
What are the functional neuroimaging techniques ?
Cortical evoked potentials (CEP)
Magnetoencephalograpy (MEG)
Position Emission Tomography
Functional Magnetic Resonance Imaging
Central Structural Abnormalities in IBS
Thinning in the anterior mid-cingulate and insular cortex in IBS
What did meta-analysis of central structures show greater engagement with?
Emotional arousal
Endogenous pain modulation
What are the major components of stress responsive system?
ANS
HPA axis
Link external environment with internal milieu
What can psychological factors do?
Aggravate or induce symptoms
What do IBS patients with history of abuse have?
Lower sensory thresholds
Lower defaecatory urge thresholds
Greater tendency to report pain
What are the 3 phyla within human gut?
Firmicutes
Bacteroidetes
Actinobacteria
