Wk 6

Question 1

3 key ssx of IBS

Answer 1

abd pain
change in frequency of stool
change in consistency of stool

Question 2

Rome II criteria

Answer 2

in the past yr, at least 12 weeks (not necessarily consecutive) of abd pain/discomfort w 2 out of the following 3:

1. relieved w defecaton
2. onset assoc w change in freq of stool
3. onset assoc w change in form of stool

Question 3

how does the menstrual cycle and post-menopausal status affect IBS symptoms?

Answer 3

• IBS most prevalent during menstruation years. More common in F than M
• sxs most severe: postovulatory/premenstrual (mb due to incr progesterone levels)
• abd bloating after menopause

Question 4

what stool tests may reveal infectious etiologies for IBS?

Answer 4

fecal WBCs, O&P, culture
(PI-IBS bugs: campylobacter, salmonella, shigella, e.coli, viruses, giardia)
CDT (cytolethal distending toxin) destroys pacemaker cells (interstitial cells of Cajal) of the MMC
Vinculin looks like CDT so our body make autoantibodies (anti-vinculin antibodies)

Question 5

what are the red flags in IBS?

Answer 5

symptom onset after age 50
severe, unrelenting diarrhea
nocturnal sx
unintentional WT loss
hematochezia
FHx of colorectal CA

Question 6

What non-invasive tests are used to determine the need for colonoscopy to rule out more serious diagnoses in patients with IBS-like sx?

Answer 6

hydrogen/methane breath testing to dx SIBO

blood tests: CBC, ESR, CV, KD, thyroid

Question 7

What are seven clinical indicators that increase the chances of SIBO being the etiology for IBS?

Answer 7

• pt develops IBS after acute gastroenteritis (PI IBS)
• after Abx tx, sxs dramatically improve
• after probiotics, sxs are worse
• eating more fiber incr constipation and other sxs
• when a “celiac pt” sxs do not improve after GF diet
• after taking opiates, pt develops IBS-C (C= constipation)
• pt has chronic low ferritin level w no apparent cause
• imaging reveals large gas bubble obscuring the pancreas
• small bowel follow-through imaging reveals areas of “flocculation”

Question 8

physiological mechanisms by which bacterial overgrowth is normally prevented?

Answer 8

• stomach acid, pancreatic enzymes, bile in the duodenum
• ph >3…overgrowth in ST and SI likely
• a well functioning ileocecal valve
• SI motility via MMC
• normal glycocalyx and microvillus of brush border

Question 9

what are the effects of H2 and CH4 on gastrointestinal motility?

Answer 9

methane: constipation alone, or alternating constipation and diarrhea. slow GI motility
hydrogen: diarrhea. usu IBS-D (diarrhea type). Increases GI motility

Question 10

which gas produced by SIBO is assoc w incr sx of fibromylagia?

Answer 10

hydrogen

Question 11

what is the likely mechanism by which SIBO leads to fat soluble vit def?

Answer 11

• damage to SI (digestive and absorptive function)
• bugs make glycosidase which damages glycoclyx or disaccharidases (deconjugation of bile–>fat malabs, steatorrhea, fat solube vit def)

Question 12

what are the four main categories of treatment for SIBO?

Answer 12

• diet (SCD, low-FODMAPS, elemental diet)
• herbal Abx (FC-Cidal w Dysbiocide OR Candibactin-AR w Candibactin-BR) (garlic, oregano, neem, berberine)
• antibiotics (Rifaximin for H2, Rifaximin + Neomycin for CH4)
• prokinetics (LDE, LDN, prucalopride, can add biofilm disruptor like NAC)

Question 13

what are the mechanisms of action and use of enteric coated menthos for IBS?

Answer 13

antibacterial effect
decreases pain, spasms
smooth muscle relaxant
side effect: GERD