Clinical Presentation of Irritable Bowel Syndrome

Question 1

What is Irritable Bowel Syndrome (IBS)?

Answer 1

• chronic abdominal pain and altered bowel habits in the absence of any organic cause.

Question 2

What is the most commonly diagnosed GI condition?

Answer 2

IBS

*affects men and women (young and old), but usually middle aged WOMEN.

Question 3

How does the Rome III diagnostic criteria define IBS?

Answer 3

recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months, associated with 2 or more of the following:

• improvement with defecation
• onset associated with a change in frequency of stool.
• onset associated with a change in form (appearance) of stool.

Question 4

*** Is mucus in the stool uncommon in IBS?

Answer 4

NO it is very common.

Question 5

What is the most common cause of work related absence?

Answer 5

common cold
#2 is IBS.

Question 6

What are the 4 subtypes of IBS?

Answer 6

• IBS-C
• IBS-D
• IBS-M
• IBS-U

Question 7

What is IBS-C?

Answer 7

• hard or lumpy stools greater than 25% of bowel movements (BMs).
• loose or watery stools less than 25% of BMs
• bristol stool form scale 1-2

Question 8

What is IBS-D?

Answer 8

• loose or watery stools greater than 25% of BMs
• hard or lumpy stools less than 25% of BMs
• bristol stool form scale 6-7

Question 9

What is IBS-M?

Answer 9

• both stool forms (diarrhea and constipation) greater than 25% of BMs

Question 10

What is IBS-U?

Answer 10

both stool forms less than 25% of BMs

Question 11

Is IBS considered a multi-symptomatic disorder?

Answer 11

YES

• abdominal pain/discomfort (must have at least this).
• trapped wind
• diarrhea
• bloating
• constipation

Question 12

What comorbidities are associated with IBS?

Answer 12

• headache
• poor sleep
• fatigue
• fibromyalgia
• depression, anxiety

Question 13

What are some other symptoms common in IBS patients?

Answer 13

GERD, dysphagia, early satiety, dyspepsia, nausea, non-cardiac chest pain, impaired sexual function, dysmenorrhea, dyspareunia, increased urinary frequency, fibromyalgia

Question 14

What is the pathophysiology of IBS?

Answer 14

we don’t know.

- likely hereditary and environmental factors

Question 15

What was the effect of rectosigmoidal balloon distention on pain in IBS patients vs. control?

Answer 15

• IBS patients reported significantly more pain than control pts.

Question 16

Is visceral hyperalgesia specific for IBS?

Answer 16

NO it occurs in other patients with chronic pain syndromes (esophageal chest pain, angina pectoris with normal coronary arteries, fibromyalgia)

Question 17

Was IBS found in about 1/3 of patients after acute bacterial infection (infections enteritis)?

Answer 17

YES especially after antibiotic use.

Question 18

Could alteration in fecal microflora (bacterial overgrowth) or food sensitivities be possible causes for IBS?

Answer 18

yes maybe

Question 19

Are patients with IBS more likely to have a history of physical or sexual abuse?

Answer 19

YES corticotropin releasing factor (CRF) has been shown to increased abdominal pain and colonic motility in iBS patients to a higher degree than controls.

Question 20

Does a typical IBS patient usually lose or gain weight?

Answer 20

GAINS weight.

Question 21

Does IBS cause you to wake from sleep?

Answer 21

NO!

Question 22

Does IBS cause GI/rectal bleeding?

Answer 22

NO!

Question 23

If the pts symptoms point to IBS and there are no alarm symptoms, should you run diagnostic tests?

Answer 23

NO, just treat them!

Question 24

What treatments have been used to treat IBS symptoms?

Answer 24

• prescription medications, OTC laxatives, OTC antidarrheals, herbals…
• fewer than 1/3 reported satisfaction

Question 25

How do we treat IBS?

Answer 25

no known cure, but treatment is to relieve symptoms.

Question 26

What is the MOST IMPORTANT component of IBS treatment?

Answer 26

establishing a strong therapeutic physician-patient relationship. - show empathy, acknowledge pain - listen actively - reassure - educate - be confident * positive placebo effects are significant

Question 27

What dietary restrictions may be used for IBS?

Answer 27

- exclusion of gas-producing foods: beans, onions, celery, carrots, raisins, bananas, apricots, prunes, brussel sprouts, pretzels, and bagels. * low FODMAP diet (Fermentable Oligo-, Di-, and Mono-saccharides And Polyols).

Question 28

Is fiber proven to help IBS?

Answer 28

No but it is easy for pts to try and if it helps, great!

Question 29

Will physical activity help IBS?

Answer 29

YES

Question 30

*** What do we do for IBS-D?

Answer 30

- antispasmodic agents (most frequently used agents in IBS). - hyposcyamine, dicyclomine, peppermint oil (smooth muscle relaxants with anticholinergic properties). - 5-HT3 antagonists (Alosetron) and may help the abdominal pain. - RIFAXIMIN= oral antibiotic, minimal systemic absorption, inhibits bacterial RNA synthesis by binding to bacterial DNA-dependent RNA polymerase. EXTREMELY SAFE bc it stays in the GI tract and does not get absorbed systemically. - antidepressants (TCA's and SSRI's)= analgesic properties with facilitation of endogenous endorphin release. Use caution with a constipated patient bc they can slow intestinal transit via anticholinergic properties. More for resistant IBS patients.

Question 31

Will imodium help the diarrhea in IBS?

Answer 31

YES but will do nothing for the bloating and abdominal pain.

Question 32

**** How do you treat constipation predominant IBS (IBS-C)?

Answer 32

- consider PEG (polyethylene glycol) - osmotic laxative (may worsen abdominal bloating and cramping, but improves constipation). Monitor serum electrolytes. - C-2 chloride channel activator (lubiprostone)= enhances chloride-rich intestinal fluid secretion. EXTREMELY SAFE and can use indefinitely :) - Guanylate cyclase agonists (linaclotide)= stimulates intestinal fluid secretion and transit. - Rifaximin - Probiotics (no data that they work). - psychosocial therapies (hypnosis...)

Question 33

If you have a loop in your colon, are you more or less likely to have IBS?

Answer 33

5x MORE likely!