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

2. 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

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

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

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

7. 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

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

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

10. Psychosocial Dysfunction
increased stressful event over controls

11. 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

12. 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

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

15. IBSChek

16. Endoscopy EGD small bowel biopsies Colonoscopy
terminal ileum/random biopsies

17. Treatment

18. Pain Relief
Antispasmodics
OTC medications
IBGard

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

20. IBS-C
Water/fiber
Laxatives
Amitiza
Linzess

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

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

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

26. Sensitization
TCAs
SSRIs
Alternative therapies

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

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

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

30. 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

31. Cyclic Vomiting Syndrome
Diagnosis criteria
Treatment
Marijuana and CVS
legalization

32. 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

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