describe functional bowel disease
a functional GI disorder with symptoms attributable to the mid or lower GI tract
describe IBS
recurrent pain associated with abnormal defectation in the absence of structural abnormality - 10-15% affected, and only 10% will consult
% of IBS psychiatric
50%. Can be brought on for acute stress
describe seritonergic response
excess release in IBS-D, and deficiency in IBS-C.
5HT antag for D, and ag for C!
what controls intestinal motility and secretion
the enteric NS. The GI tract contains 95% of the body 5HT, from enterochromafin cells
criteria for diagnosis
ROME III –> recurrent abdo pain at least 3d/mth in the last 3 months associated with two or more of the following
i) improvement with defecation
ii) onset assoc w/ frequency change
iii) onset assoc w/ form appearance
average age of IBS presentaion
20-40
DDx of diarrhoea
- coeliac
- lactose
- thyrotoxicosis
- microscopic colitis
- bile acid malabsorption
- parasitic infection
typical IBS course
relapse remitting, with exacerbations following stressful life events
drugs for persistent diarrhoea
amitryptiline and imipramine (TCA)
rifaximin (Abx)
drugs for persistent constipation
prucalopride (v selective 5HT agonist)
linaclotide (guanylate cyclase C agonist)