Irritable Bowel Syndrome Ben Thomas, D.O. Specialty Medicine Care- Gastroenterology Beavercreek, OH

Which of the following is NOT included in the new Rome IV criteria? improvement with defecation associated with change in stool frequency associated with change in stool form symptoms at least 1 day per week in the last 3 months 10

Which dietary modifications have NOT been shown to improve irritable bowel syndrome symptoms? FODMAP diet Gluten Free diet Elemental Diet Elimination Diet 10

Most common gastrointestinal disorder accounts for almost 30% of GI consultations Alterations in GI motility fecal flora and bacterial overgrowth Visceral hypersensitivity Food Sensitivities

Motility increased frequency and irregularity of intestinal contractions prolonged transit time exaggerated response to CCK and meals

Visceral Hypersensitivity increased sensation in response to stimulus distention- awareness and pain increased with lower volumes in balloon distention tests bloating- awareness increase in abdominal girth

Alterations in Fecal Flora fecal microbiota vary from normal individuals Bacterial Overgrowth abnormal breath hydrogen levels, methane levels

Food sensitivities food allergy testing impaired absorption of carbohydrates fructose intolerance gluten sensitivity

Psychosocial Dysfunction increased stressful event over controls

Clinical Presentation Chronic Abdominal Pain anorexia, malnutrition, weight loss awakens from sleep Altered Bowel Habits mornings and after meals abdominal cramps and urgency mucus discharge

Rome IV Criteria Recurrent abdominal pain, on average, at least one day per week in the last 3 months with two or more: related to defecation associated with change in stool frequency associated with change in stool form

Labs Celiac disease TTG IgA IBD serologies Prometheus Labs ASCA IgA, IgG, P-ANCA Inflammatory Markers CRP fecal calprotectin

IBSChek

Endoscopy EGD small bowel biopsies Colonoscopy terminal ileum/random biopsies

Treatment

Pain Relief Antispasmodics OTC medications IBGard

IBS-D Anti-diarrheal medications Imodium Lomotil rifaximin (Xifaxan) eluxodoline (Viberzi) bile acid sequestrants

IBS-C Water/fiber Laxatives Amitiza Linzess

Gas and Bloating Simethicone (Gas-X) Beano FODMAP diet

Dietary Modifications exclusion of gas producing foods traditional IBS diet FODMAP diet lactose avoidance gluten avoidance

Dietary Modifications exclusion of gas producing foods traditional IBS diet FODMAP diet lactose avoidance gluten avoidance

Sensitization TCAs SSRIs Alternative therapies

Multidisciplinary IBS programs in the Region Allegheny Health Network Functional Bowel Center (Pittsburgh) Center for Functional Bowel Disorders- Cleveland Clinic

“Chronic health problems are so often due to lifestyle, and we don’t have pills for those”

Leaky Gut?? bloating, gas, cramps, food sensitivities, aches and pains unsolved mystery treatment nutrition

Sphincter of Oddi Dysfunction Post-cholecystectomy with biliary pain, elevated liver enzymes, and biliary ductal dilation Type I, II, III Treatment Indiana University ERCP program

Cyclic Vomiting Syndrome Diagnosis criteria Treatment Marijuana and CVS legalization

Which of the following is NOT included in the new Rome IV criteria? improvement with defecation associated with change in stool frequency associated with change in stool form symptoms at least 1 day per week in the last 3 months 10

Which dietary modifications have NOT been shown to improve irritable bowel syndrome symptoms? FODMAP diet Gluten Free diet Elemental Diet Elimination Diet 10