1. IRRITABLE BOWEL SYNDROME

2. IRRITABLE BOWEL SYNDROME
Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain or discomfort and altered bowel habits in the absence of detectable structural abnormalities
6/27/2018
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3. IRRITABLE BOWEL SYNDROME
Approximately 20% of the general population fulfil diagnostic criteria for IBS but only 10% of these consult their doctors because of gastrointestinal symptoms.
Female predominent
6/27/2018
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4. IRRITABLE BOWEL SYNDROME
Etiology
The pathogenesis of IBS is poorly understood
psychosocial factors
anxiety
depression
somatisation and neurosis
altered gastrointestinal motility
no consistent evidence of abnormal motility
6/27/2018
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5. IRRITABLE BOWEL SYNDROME
altered visceral sensation
a consequence of altered central nervous system processing of visceral sensation.
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6. IRRITABLE BOWEL SYNDROME
luminal factors
following an episode of gastroenteritis
intolerant of specific dietary components, particularly lactose and wheat
gut microflora
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7. IRRITABLE BOWEL SYNDROME
Clinical features
Colicky abdominal pain
Altered bowel habit
Abdominal distension
Rectal mucus
Feeling of incomplete defecation
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8. IRRITABLE BOWEL SYNDROME
Abdominal Pain
Abdominal pain episodic and crampy(lower)
may be mild enough to be ignored or it may interfere with daily activities.
Pain is often exacerbated by eating or emotional stress and improved by passage of flatus or stools
Sleep deprivation is also unusual
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9. IRRITABLE BOWEL SYNDROME
Altered Bowel Habits
The most common pattern is constipation alternating with diarrhea, usually with one of these symptoms predominating.
Stools are usually hard with narrowed caliber
Diarrhea resulting from IBS usually consists of small volumes of loose stools
Nocturnal diarrhea does not occur
Diarrhea may be aggravated by emotional stress or eating.
Stool may be accompanied by passage of large amounts of mucus
6/27/2018
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10. IRRITABLE BOWEL SYNDROME
Gas and Flatulence
abdominal distention
increased belching
flatulence,
Most IBS patients have impaired transit and tolerance of intestinal gas loads.
6/27/2018
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11. IRRITABLE BOWEL SYNDROME
The diagnosis
is clinical with excluding secondary disease if needed
Features supporting a diagnosis of IBS
Symptoms > 6 months without progressive deterioration,
absence of other systemic symptoms such as fever and weight loss
small-volume stool without any evidence of blood.
Frequent consultations for non-GI problems
Previous medically unexplained symptoms
Stress worsens symptoms
6/27/2018
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12. IRRITABLE BOWEL SYNDROME
Diagnostic Criteria (Rome)
Recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months associated with two or more of the following:    
 1. Improvement with defecation  
2. Onset associated with a change in frequency of stool 
 3. Onset associated with a change in form (appearance) of stool
6/27/2018
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13. IRRITABLE BOWEL SYNDROME
Investigation
minimal for typical symptom
if we need:
Full blood count
GSE
lower GI endoscopy
(sigmoidoscopy, Colonoscopy)
alarm features.
Diarrhoea-predominant
6/27/2018
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14. IRRITABLE BOWEL SYNDROME
Alarm features
Age > 50 years; male gender
Weight loss
Nocturnal symptoms
Family history of colon cancer
Anaemia
Rectal bleeding
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15. IRRITABLE BOWEL SYNDROME
Management
Diagnosis
Reassure the patient and
Dietary alteration
wheat-free diet
lactose exclusion
Treatment of the predominant symptoms
Therapy with tricyclic antidepressant
5-HT4 agonists
Psychological interventions
6/27/2018
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16. IRRITABLE BOWEL SYNDROME
6/27/2018
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17. IRRITABLE BOWEL SYNDROME
Prognosis
Most patients have a relapsing and remitting course. Exacerbations often follow stressful life events, occupational dissatisfaction and difficulties with interpersonal relationships
6/27/2018
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