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25 Cards in this Set
- Front
- Back
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IBS epidemiology
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5-10% population
F>M more common under 50 yo |
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IBS definition
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abdominal pain
constipation and/or diarrhea bloating/distention functional bowel disorder - cant see abnormality on physical findings |
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IBS dx
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abdominal pain at least 3 days per month in last 12 weeks
improvement with defacation, change in stool frequency, change in stool form onset >6 months prior to diagnosis types: IBS constipation predominance IBS diarrhea predominance |
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IBS pathophysiology
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(1) neuromusuclar dyfunction
(2)abnormal brain-GI tract interactions (3)immune activations (4)genetic influence (5)psychological distress (6)intestinal flora disturbances |
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path of IBS
neuromuscular dysfunction |
Abnormal colonic motility
Visceral hypersensitivity Diarrhea – stronger, more frequent muscle contraction Feces move through colon too quickly Constipation – less frequent contractions or too strong and block passage Visceral hypersensitivity – pain out of proportion to motility changes Discomfort during normal events Pain in areas other than bowels – more diffuse |
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path of IBS
abnormal brain GI tract interactions |
Signals from enteric nervous system inside digestive tract
Neuronal control – enteric and sympathetic/parasympathetic Serotonin – potential target for mediator Released by mucosal ECL cells with pain stimulus Activates peristalsis – increased/decreased transit Activates pathways that mediate pain |
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path of IBS
immune activations |
Salmonella, shigella, campylobacter, e.coli, c. jejuni proceed IBS
T cell activation in IBS Particular T cell mediated |
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path of IBS
genetic influence |
Increased frequency in adults with afflicted family member
Twin studies |
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path of IBS
psychological distress |
Exacerbates GI symptoms
Affects illness experience and behavior |
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path of BIS
intestinal flora disturbances |
Colon normal has large amount of bacteria
When bacteria grows into small intestine, can have symptoms similar to IBS Bloating, diarrhea, gas, pain, etc. Challenges to theory – lot of patients are on PPIs Must studies include patients on PPIs which are known to increase bacterial overgrowth |
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Tx of IBS (non medical)
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Treat according to predominant symptom
Mild: Eliminate food/drink and medications that make symptoms worse Moderate: symptom diary Keep track of foods, drinks, stressors Keep track of timing of symptoms Behavioral tx Relaxation therapy Hypnosis Biofeedback CBT |
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Medications for IBS stool
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diarrhea - bulking agents
constipation - laxatives lubiprostone antidiarrheals operamide diphenoxylate with atropine severe IBS - antidepressants to reduce pain |
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Lubiprostone
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approved for chronic functional constipation in IBS
increases intestinal fluid secretion by stimulating CL channel does not change electrolyte concentrations in serum |
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operamide
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Antidiarrheal
slows transit time through colon increasing resorption of intestinal water |
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diphenoxylate with atropine
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antidiarrheal
reduces transit time, reduces intestinal muscle spams anticholinergic activity |
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Tx of pain and bloating
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antispasmodics for pain
inhibit smooth muscle contraction (1)alosetron (2) tegaserod maleate antidepressants reduce pain threshold (1)tricyclic (2)SSRI - improved quality of life, symptom frequency, and abdominal pain |
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Alosetron
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5TH3 antagonist
reduces viscreal pain and slows colonic transit approved for women can cause ischemic colitis and constipation |
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tegaseord maleate
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5HT4 agonist
stimulate intestinal motility via cholinergic transmission augment peristaltic reflex enhances secretion, reduces visceral hypersensitivity |
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tricyclics in IBS
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reduce pain threshold
alter GI transit |
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SSRIs in IBS
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improved quality of life, symptom frequency, and abdominal pain
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antibiotics and IBS
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for small bowel overgrowth
rifaxamin, metronidzaole, quinolones dx with hydrogen breath test |
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rifaxamin
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for small bowel overgrowth
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metronidazole
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for small bowel overgrowth
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quinolones
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for small bowel overgrowth
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probiotics for IBS
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bifidobacterium infantisi improved pain/discomfort, bloating/distention bowel difficulty
no other probiotic improves IBS symptoms |
