IRRITABLE BOWEL SYNDROME
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Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain or discomfort and altered bowel habits in the absence of detectable structural abnormalities
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* IRRITABLE BOWEL SYNDROMEApproximately 20% of the general population fulfil diagnostic criteria for IBS but only 10% of these consult their doctors because of gastrointestinal symptoms. Female predominent
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* IRRITABLE BOWEL SYNDROMEEtiology The pathogenesis of IBS is poorly understood psychosocial factors anxiety depression somatisation and neurosis altered gastrointestinal motility no consistent evidence of abnormal motility
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* IRRITABLE BOWEL SYNDROMEaltered visceral sensation a consequence of altered central nervous system processing of visceral sensation.
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* IRRITABLE BOWEL SYNDROME
luminal factors following an episode of gastroenteritis intolerant of specific dietary components, particularly lactose and wheat gut microflora
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* IRRITABLE BOWEL SYNDROMEClinical features Colicky abdominal pain Altered bowel habit Abdominal distension Rectal mucus Feeling of incomplete defecation
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* IRRITABLE BOWEL SYNDROMEAbdominal Pain Abdominal pain episodic and crampy(lower) may be mild enough to be ignored or it may interfere with daily activities. Pain is often exacerbated by eating or emotional stress and improved by passage of flatus or stools Sleep deprivation is also unusual
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* IRRITABLE BOWEL SYNDROMEAltered Bowel Habits The most common pattern is constipation alternating with diarrhea, usually with one of these symptoms predominating. Stools are usually hard with narrowed caliber Diarrhea resulting from IBS usually consists of small volumes of loose stools Nocturnal diarrhea does not occur Diarrhea may be aggravated by emotional stress or eating. Stool may be accompanied by passage of large amounts of mucus
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* IRRITABLE BOWEL SYNDROMEGas and Flatulence abdominal distention increased belching flatulence,
Most IBS patients have impaired transit and tolerance of intestinal gas loads.
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* IRRITABLE BOWEL SYNDROME
The diagnosis is clinical with excluding secondary disease if needed Features supporting a diagnosis of IBS Symptoms > 6 months without progressive deterioration, absence of other systemic symptoms such as fever and weight loss small-volume stool without any evidence of blood. Frequent consultations for non-GI problems Previous medically unexplained symptoms Stress worsens symptoms
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* IRRITABLE BOWEL SYNDROMEInvestigation minimal for typical symptom if we need: Full blood count GSE lower GI endoscopy (sigmoidoscopy, Colonoscopy) alarm features. Diarrhoea-predominant
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* IRRITABLE BOWEL SYNDROMEAlarm features Age > 50 years; male gender Weight loss Nocturnal symptoms Family history of colon cancer Anaemia Rectal bleeding
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* IRRITABLE BOWEL SYNDROMEManagement Diagnosis Reassure the patient and Dietary alteration wheat-free diet lactose exclusion Treatment of the predominant symptoms Therapy with tricyclic antidepressant 5-HT4 agonists Psychological interventions
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* IRRITABLE BOWEL SYNDROMEPrognosis Most patients have a relapsing and remitting course. Exacerbations often follow stressful life events, occupational dissatisfaction and difficulties with interpersonal relationships