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3 key ssx of IBS

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


Rome II criteria

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


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

-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


what stool tests may reveal infectious etiologies for IBS?

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)


what are the red flags in IBS?

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


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

hydrogen/methane breath testing to dx SIBO
blood tests: CBC, ESR, CV, KD, thyroid


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

-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"


physiological mechanisms by which bacterial overgrowth is normally prevented?

-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


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

methane: constipation alone, or alternating constipation and diarrhea. slow GI motility

hydrogen: diarrhea. usu IBS-D (diarrhea type). Increases GI motility


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



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

-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)


what are the four main categories of treatment for SIBO?

-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)


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

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