10 irritable bowel syndrome v01

by Dr TRẦN NGỌC ÁNH Hà Nội Medical University Objectives 1.Recognize the typical clinical presentation for IBS 2.Describe an appropriate diagnostic plan and ROME III 3.Prescribe an appropriate therapeutic regimens IBS- Dr Trần Ngọc Ánh GENERAL CONSIDERATIONS  IBS- a functional bowel disorder : abdominal pain, discomfort, altered bowel habits, absence of detectable structural abnormalities  IBS-other functional disordes: fibromyalgia, headech, backache, genitourinary symptoms IBS- Dr Trần Ngọc Ánh GENERAL CONSIDERATIONS  Diagnosis: Clinical presentation  10-20% adult, adolescents: symptoms of IBS  W/M:2-3; 80% Severe in women IBS- Dr Trần Ngọc Ánh IBS- Dr Trần Ngọc Ánh PATHOPHYSIOLOGY IBS- Dr Trần Ngọc Ánh IBS Genetics Abnormal GUT motility Visceral hypersensitivity PATHOPHYSIOLOGY IBS- Dr Trần Ngọc Ánh PATHOPHYSIOLOGY Psychosocial factor  Heightened pain sensitivity to visceral stimulation of the brain gut axis  Fibromyalgia (49% have IBS)  Chronic fatigues syndrome (51%)  Chronic pelvic pain (50%)  JMTs (64%) Post infections causes: luminal irritation small bowel bacteries over growth, gas, food allergy IBS- Dr Trần Ngọc Ánh CLINICAL FEATURES 1.Abdominal pain -Localition: 25% hypogastrium, 20% rightside, 20% left side, 10% epigastric -Episodic and crampy -Exacerbated by eating or emotional stress Improved by passage of flatus or stools Worsening during the premenstrual and menstrual phases IBS- Dr Trần Ngọc Ánh CLINICAL FEATURES 2.Altered Bowel Habit -Most consistent clinical feature -Constipation alternaty with diarrhea, usually with onve of these symptoms predominantly -Constipations: episodic, continous and increasingly intractable to laxative . Interrupted with brief periods of diarrhea -Diarrhea Smll volumes of loose stools (<200mL). Not bleeding. Maybe: passage of large amount mucus IBS- Dr Trần Ngọc Ánh [...]... contrast barium enema • Colonoscopy • Sedimentation rate • Leucocyte or blood in stool • Stool volume >200ml • OTHER DIAGNOSTIC IBS- Dr Trần Ngọc Ánh APPROACH TO THE PATIENT  Diagnostic criteria for irritable bowel syndrome ROME Recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months asscociated with 2 or 3 mor of the following Improvement with defecation Onset Onset asscociated... radiography, Gastroscopy, Ultrasonography IBS- Dr Trần Ngọc Ánh APPROACH TO THE PATIENT  Careful history, physical examination, establish the diagnosis Recurrence of lowel abdominal pain with altered bowel habits over a period of time without progressive deterioration  Exclude -Disorder for the first time in old age -Persistent diarhea after a 48 h -Nocturnal diarrhea, steatose IBS- Dr Trần Ngọc Ánh... severe, women) Constipation Psylium husk Methylcellulose Calcium polycarbophil Lactulose syrup 70% sorbitol Polyethylen glycol Lubiprostone Magnesium hydroxide 3-4g bid with meals 2g bid with meals 1g qd 10- 20g bid 15ml bid 17g/250ml water qd 24mg bid 30-60mL qd Abdominal pain Smooth muscle hydroxid Tricyclic antidepressant Selective serotonin reuptake inhibitors Qd to qid Start 25-50mg hs Begin small... amitriptyline  Citalopram (SSRI) ↓se/drug interactions  Fluoextine (SSRI) Fewer withdrawal effects  Paroxetine (SSRI) Greatest anticholinergic effects of SSRI  Buspirone (Azapirone): antianxiety, Bowel relaxation  IBS-D; Tricyclic antidepressant  IBS –C:Tricylic agent, the selective serotonin reuptake inhibitor-SSRP, paroxetic IBS- Dr Trần Ngọc Ánh TREATEMENT 6.Antiflatulant therapy Eat slowly, . DIAGNOSTIC IBS- Dr Trần Ngọc Ánh APPROACH TO THE PATIENT  Diagnostic criteria for irritable bowel syndrome ROME IBS- Dr Trần Ngọc Ánh Recurrent abdominal pain or discomfort at least. Fibromyalgia (49% have IBS)  Chronic fatigues syndrome (51%)  Chronic pelvic pain (50%)  JMTs (64%) Post infections causes: luminal irritation small bowel bacteries over growth, gas, food allergy. IBS- Dr Trần Ngọc Ánh GENERAL CONSIDERATIONS  IBS- a functional bowel disorder : abdominal pain, discomfort, altered bowel habits, absence of detectable structural abnormalities  IBS-other