1. Focus on Irritable Bowel Syndrome (IBS)
(Relates to Chapter 43, “Nursing Management: Lower Gastrointestinal Problems,” in the textbook)

2. IBS Description
Common problem affecting 10% to 15% of Western populations
2 to 2.5 times as many women as men seek health care services
Characterized by intermittent and recurrent abdominal pain and stool pattern irregularities

3. IBS Etiology and Pathophysiology
Pain/discomfort from visceral hypersensitivity
Stool or gas in GI tract stimulates visceral afferent fibers
Neurochemicals involved in bowel symptoms
Serotonin

4. IBS Etiology and Pathophysiology
Altered motility
Altered intestinal and colonic motility
Altered response to stress
May be due to alterations in the enteric nervous system and/or autonomic nervous system

5. IBS Clinical Manifestations
Symptoms
Diarrhea
Constipation
Alternating diarrhea/constipation
Abdominal distention
Excessive flatulence

6. IBS Clinical Manifestations
Symptoms (cont’d)
Bloating
Continual defecation urge, urgency
Sensation of incomplete evacuation

7. IBS Psychosocial Factors in IBS
Common in patients with IBS
Anxiety, panic disorder
Depression
Post-traumatic stress disorder
Abuse history

8. IBS Psychosocial Factors in IBS
Stress can exacerbate stress symptoms
May influence health care seeking behavior

9. IBS Problems Not Associated with IBS
Anemia
Fever
Persistent diarrhea
Rectal bleeding
Severe constipation
Weight loss

10. IBS Differential Diagnoses
Malabsorption (gluten intolerance)
Dietary factors
Infection
Colorectal cancer
Inflammatory bowel disease

11. IBS Differential Diagnoses
Psychologic disorders
Gynecologic disorders
Peptic ulcer disease
Celiac disease

12. IBS Diagnostic Studies
No specific findings
Diagnosis made based on symptoms and ruling out other conditions
Physical examination
Past health history
Psychosocial factors
Family history
Drug/diet history

13. IBS Diagnostic Studies
Standardized symptom-based criteria (Rome II criteria)
Abdominal discomfort/pain for at least 12 weeks (not necessarily consecutive) within 12 months with at least two of following characteristics
Relieved with defecation
Onset associated with change in stool frequency
Onset associated with change in stool appearance

14. IBS Collaborative Care
Patients do better with therapy if
They have a trusting relationship with care provider
Coping mechanisms
Symptoms are less severe/frequent

15. IBS Collaborative Care
Based on dominant symptoms and their severity and on psychosocial factors
Medical management
Diet
Psychologic or behavioral options

16. IBS Collaborative Care
Consider predominant symptom pattern
Diarrhea
Constipation
Pain

17. IBS Collaborative Care
Diet modification
Fiber therapy (20 g/day)
Antispasmodics
Antidiarrheals
Laxatives
Serotonergic agents
Antidepressants

18. IBS Nonpharmacologic Treatments
Education and reassurance
Relaxation
Stress management techniques
Alternative therapies

19. IBS Nutritional Therapy
Eliminate gas-producing foods
Brown beans
Brussels sprouts, cabbage, cauliflower, raw onions
Grapes, plums, raisins

20. IBS Nutritional Therapy
Eliminate fructose, sorbitol
Determine if lactose intolerant

21. IBS Drug Therapy: Antispasmodics
Anticholinergics
Dicyclomine (Bentyl)
Reduce colonic motility after meals
Take before meals
Side effects
Dry mouth, urinary retention, tachycardia

22. IBS Drug Therapy: Antidiarrheals
Loperamide (Imodium)
Decrease intestinal transit
Enhances intestinal water absorption and sphincter tone

23. IBS Drug Therapy: Antidepressants
Symptomatic treatment: Pain
Reserved for patients with severe or refractory pain

24. IBS Drug Therapy: Serotonin Agonist
5-HT3 receptor blockers
↓ Urgency, pain, and diarrhea in diarrhea-prominent women
Alosetron (Lotronex)
FDA approved for women only
Must be monitored due to potential side effects

25. IBS Drug Therapy: Serotonin Agonist
Tegaserod (Zelnorm)
Used in women with constipation- predominant IBS
Current widespread use suspended by FDA
May be released for use again with close monitoring