10 irritable bowel syndrome v01

by
Dr TRẦN NGỌC ÁNH
Hà Nội Medical University
Objectives
1.Recognize the typical
clinical presentation for
IBS
2.Describe an appropriate
diagnostic plan and ROME
III
3.Prescribe an appropriate
therapeutic regimens
IBS- Dr Trần Ngọc Ánh
GENERAL CONSIDERATIONS
 IBS- a functional bowel disorder : abdominal pain,
discomfort, altered bowel habits, absence of detectable
structural abnormalities
 IBS-other functional disordes: fibromyalgia, headech,
backache, genitourinary symptoms

IBS- Dr Trần Ngọc Ánh
GENERAL CONSIDERATIONS
 Diagnosis: Clinical presentation
 10-20% adult, adolescents: symptoms of IBS
 W/M:2-3; 80% Severe in women


IBS- Dr Trần Ngọc Ánh
IBS- Dr Trần Ngọc Ánh
PATHOPHYSIOLOGY
IBS- Dr Trần Ngọc Ánh

IBS
Genetics
Abnormal GUT
motility
Visceral
hypersensitivity
PATHOPHYSIOLOGY
IBS- Dr Trần Ngọc Ánh
PATHOPHYSIOLOGY
Psychosocial factor
 Heightened pain sensitivity to visceral
stimulation of the brain gut axis
 Fibromyalgia (49% have IBS)
 Chronic fatigues syndrome (51%)
 Chronic pelvic pain (50%)
 JMTs (64%)
Post infections causes: luminal irritation small
bowel bacteries over growth, gas, food allergy
IBS- Dr Trần Ngọc Ánh
CLINICAL FEATURES
1.Abdominal pain
-Localition: 25% hypogastrium, 20% rightside, 20%
left side, 10% epigastric
-Episodic and crampy
-Exacerbated by eating or emotional stress
Improved by passage of flatus or stools
Worsening during the premenstrual and menstrual
phases
IBS- Dr Trần Ngọc Ánh
CLINICAL FEATURES

2.Altered Bowel Habit
-Most consistent clinical feature
-Constipation alternaty with diarrhea, usually with
onve of these symptoms predominantly
-Constipations: episodic, continous and
increasingly intractable to laxative . Interrupted
with brief periods of diarrhea
-Diarrhea
Smll volumes of loose stools (<200mL). Not
bleeding. Maybe: passage of large amount mucus
IBS- Dr Trần Ngọc Ánh
CLINICAL FEATURES
Aggraved by emotional stress or eating
Malabsortion or weight loss: not occur
3,Gas and Flatulence
-Abdominal distension, increased belching or
flatulence (Increased gas)-Quantitative
measurement reveal: no more than a normal
amount of intestinal gas
-Impaired transit and tolerance of intestinal gas
loads
-Reflux gas from the distal to the more proximal
intestine belching
IBS- Dr Trần Ngọc Ánh
CLINICAL FEATURES
4,Upper Gastrointestinla symptoms
 -Dyspepsia, heartburn, nausea, vomiting: 31.7%
Dyspepsia have IBS (7.9% Non dyspepsia have IBS)
 IBS 55.6% have dyspepsia
IBS- Dr Trần Ngọc Ánh

CLINICAL FEATURES
Typ of IBS
Typ of IBS
IBS- Dr Trần Ngọc Ánh
75% change subtyps, 29% swith between IBS-C, IBS-D over 1 years
IBS alternating 39%
IBS diarhea 27%
IBS-
constipationm34%
IBS- Dr Trần Ngọc Ánh
CLINICAL FEATURES
IBS- Dr Trần Ngọc Ánh
Spectrum of severity in IBS
Clinical

features

Mild

Moderate

Severe

Prevalence

70%

25%

55

Correlation

with
Physiology

+++

++

+

Symptoms

0

+

+++

Psychosocial

difficulties

0

+

+++

Health
care
issues

+


++

+++

IBS- Dr Trần Ngọc Ánh
LABORATORY FINDINGS
 Complete blood count
 Sigmoidoscopy
 Stool specimens
 Air contrast barium enema
 Colonoscopy
 Exclude lactase deficiency
 Hydrogen breath test
 Evaluation after 3 weeks lactase free diet
 Exclude celiac sprue (Serology test)
 GI radiography, Gastroscopy, Ultrasonography
IBS- Dr Trần Ngọc Ánh
APPROACH TO THE PATIENT
 Careful history, physical examination, establish
the diagnosis
Recurrence of lowel abdominal pain with altered
bowel habits over a period of time without
progressive deterioration

 Exclude
-Disorder for the first time in old age
-Persistent diarhea after a 48 h
-Nocturnal diarrhea, steatose
IBS- Dr Trần Ngọc Ánh
APPROACH TO THE PATIENT
Young patients
• Complete blood
count
• Sigmoidoscopy
• Stool specimens
>40 years
• Air contrast barium
enema
• Colonoscopy
If patient have
• Sedimentation rate
• Leucocyte or blood
in stool
• Stool volume
>200ml
• OTHER
DIAGNOSTIC
IBS- Dr Trần Ngọc Ánh
APPROACH TO THE PATIENT
 Diagnostic criteria for irritable bowel syndrome
ROME

IBS- Dr Trần Ngọc Ánh
Recurrent abdominal pain or discomfort at least 3 days

per month in the last 3 months asscociated with 2 or 3
mor of the following
Improvement
with
defecation
Onset
asscociated
with a change
in frequency of
stool
Onset
asscociated
with a change
in form
(appearance of
stool)
TREATMENT
DIETARY
ALTERATIONS
STOOL BULKING
AGENTS
ANTISPASMODIC ANTIDIARRHEAL
ANTIDEPRESSANT
DRUG
ANTIFLATULENCE
THERAPY
SEROTONIN
RECEPTION
AGONIST,
ANTAGONISTS

CHLORIDE
CHANNEL
ACTIVATION
IBS- Dr Trần Ngọc Ánh
TREATEMENT
1.Patient counseling and dietary alterations
-Chronic and benign
-Avoid obvious food precipatant
-A meticulous dietary history may reveal substances
(Coffe, disaccharides, legumes, carbbage) aggravate
symptoms
-Excessive fructose, artificiel sweteners (sorbitol,
manitol) may cause diarrhea, bloating, crampy, or
flatulence
IBS- Dr Trần Ngọc Ánh
TREATEMENT
Good food for IBS
IBS-D: low fiber
exclusion diet
IBS-C: Low fiber plus
or minus laxtive
IBS-C no bloating:
high fiber diet plus or
minus laxative
IBS- Dr Trần Ngọc Ánh
TREATEMENT
Avoid food in IBS
-Alcohol,
caffein related drink

Non citrus drink,
herbalte
-Avoid all: milk
butter, yoghurt →soya
subtitutes
IBS- Dr Trần Ngọc Ánh
TREATEMENT
Avoid food in IBS:
Processed meats, burges,
sausages

IBS- Dr Trần Ngọc Ánh