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26 Cards in this Set
- Front
- Back
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functional disorder |
- diagnosisis made after ruling out all other possible organic causes of the patient’ssymptoms |
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diagnostic criteria |
- Manning: algorithm - Rome criteria - ACG task force - H breath test; if not present, used FODMAP restrictive diet which re-challenge |
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Rome III criteria |
- Recurrent abdominal pain or discomfort three days per month in the lastthree months association with two or more of the following: - Improvementwith defecation - Onsetassociated with change in frequency of stool - Onsetassociated with a change in form of stool |
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ACG criteria |
- Abdominalpain or discomfort that occurs in association with altered bowel habits over aperiod of at least 3 months. |
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classifications |
IBS - constipation IBS - diarrhea IBS - mixed |
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pathophys of IBS |
- Complex and not well-understood - Abnormal motility plays major role in symptoms- Abnormalities in brain-gut communication - Increased sensitivity to stimulation of the gastrointestinal tract - Small intestinal bacterial overgrowth - Increased permeability of the mucosa |
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possible etiological factors of IBS |
- communication between body systems: nervous system regulation - GI fxn and environment: altered motility and visceral reflexes, mucosal immune activation, altered gut flora - GI symptoms: food sensitivity/intolerance, exccessive gas, constipation |
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serotonin |
- Synthesizedfrom tryptophan - >95%found in GI tract – remaining 5% in brain - activateboth excitatory and inhibitory neurons - causes therelease of acetylcholine, causing smooth muscle contraction, and the inhibitoryneurons that release nitric oxide, which results in relaxation of smooth muscle - Stimulatesvagal and enteric nerves – initiating peristalsis and affecting gimotility |
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altered serotonin in IBS |
- Decreasedpostprandial serotonin in IBS-C - Increasedpostprandial serotonin in IBS-D - Alteredrelease; altered receptors; altered synthesis, altered transport |
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serotonin receptors |
- Serotoninreceptors for gut motor functions:5-HT1, 2, 3, 4 and 7 subtypes - Intestinalmucosa has high capacity to remove serotonin that is produced in the gut |
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SERT transport |
- serotonin transporter - decreased expression in IBS due to genetics - meta analysis says diff shapes of transporter isn't associated |
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altered sensation in IBS |
- cerebral imaging - Relationshipto post-infectious IBS and the subsequent inflammation - pharmaceutical interventions |
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other possible factors |
- SI bacterial overgrowth; antibiotics decreased sx - food allergy; adverse reaction - diet - stress |
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food allergy |
- Slowonset food allergy mediated by t lymphocytes, mast cells which mediate anongoing inflammation - butshould be considered if an individual has positive history of other allergicconditions |
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dietary triggers |
- lactose - fructose - caffeine - fat - carbonated drinks - sorbitol - size of meals |
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treatment for IBS |
•Nutritiontherapy•Probiotics•Fiber•Laxatives•Bulkingagents•Psychologicaltherapies•Herbaltherapies•acupuncture •Antidiarrheals•Antibiotics•Antispasmodics•5HT3 receptor antagonists•5HT4 receptor agonists•SelectiveC-2 chloride channel activators•antidepressants |
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5ht4 agonists |
- Renzapride, cisapride, tegaserod - delay GI transit - reduces colonic tone - blunts gastro colic reflex - decrease visceral sensation |
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5-HT3 receptor antagonist |
- Alosetron; used for treatment of severe diarrhea - serotonin antagonist - Strictlimited marketing program - Severeconstipation and ischemic colitis have documented |
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Selective C-2 chloride channel activators |
- Worksto promote chloride secretion into the intestine (could initiate diarrhea) - Lubiprostone; only drug world wide; Alsoused to treat chronic constipation |
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antidepressants |
- Improvementin abdominal pain - Overallimprovement in global symptoms - TricyclicAntidepressants – e.g. desipramine - SSRI (Selective serotonin reuptake inhibitors) – e.g. fluoxetine |
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herbal therapies |
- peppermint oil: affect smooth muscle, Ca channel blocker which reduces pain and contractions - Capsaicin: enterically coated red pepper powder, Desensitizing of nerve fiber activity (decrease in visceralhypersensitivity) |
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Nutrition therapy |
- Low FODMAP - lactose free - traditional exclusion diet |
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fiber in IBS |
- foundno evidence that fiber reduces abdominal pain - insolublefiber (corn, wheat bran) was found to actually make symptoms worse - ACG recommendation: onlypsyllium canbe given a conditional recommendation |
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FODMAPs |
- FermentableOligo-,Di-and Mono-saccharidesandPolyols - FODMAPSincrease osmotic load – provides substrate for fermentation, diarrhea, gas, abdominal pain - Honey, agave, certain fruits and veg, sugar alcohols, inulin, beans, nuts, seeds, wheat/rye - reductionofhigh-FODMAP foods from the diet alleviates gut distension and rapid waterosmosis intothe gastrointestinal tract, minimizing many symptoms associated with IBS |
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low FODMAP diet |
- Extensive two phase processElimination phase – 6-8 week avoiding allhigh FODMAP foods. - Reintroduction phase – high FODMAP foodsor categories re-introduced one at a time with documentation of any symptomsthat occur after consumption of that food. If sx.re-occur, assumed that this food is a trigger and should beavoided. - Good candidates: IBS, IBD with GI issues, celiac with GI issues, pt with consistent/sporadic intake of high FODMAPs |
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