1. FUNCTIONAL DİSEASE FUNCTIONAL DİSEASE Cengiz Pata, MD Gastroenterology Department,Yeditepe University Istanbul

2. FGID (bowel & pain) Functional bowel disorders –C1: IBS –C2: Functional bloating –C3: Functional constipation –C4: Functional diarrhea –C5: Unspecified functional bowel disorder D: Functional abdominal pain syndrome Drossman DA. Gastroenterology 2006;130:1377-90.

3. IIRITABLE BOWEL SYNDROME Drossman et al. Gatsroenterology 1997;112:2120 A.Ş.K. ğrı işkinlik abızlık AŞK

13. Post-infection IBS İncresing bowel movements İncreasing rectal sensitvity İncreasing bowel passing increasing enterokromafine cell increasing enterokromafine cell İncreasing lenfocyte

17. Enteric nervous system (ENS)

18. Özet İBS birçok faktörlerden etkilenmektedir –viseral işlevler, duyular –duygu İBS semptomları beyin-barsak aksının disfonksiyonuyla ilişkilidir –afferent-efferent sinir sistemi 5-HT viseral işlev ve beyin-barsak iletişiminin regülasyonunda santral mediatördür Serotoninerjik işlevdeki bozukluklar katkıda bulunabilir.

20. diagnosis Exclude all organic diseases Roma II – at least ≥12 weeks abdominal pain and uncomfortance and changing bowel movements in last 12 mounths –At least both of them Changing of gaita sharphing Changing of gaita formation After defecation, feeling better

21. Bristol stool form scale FigureTypeDescription 1 Separate hard lump like nuts (difficult to pass) 2 Sausage shaped but lumpy 3 Like a sausage but with cracks on it surface 4 Like a sausage or snake, smooth and soft 5 Soft blobs with clear-cut edges (passed easily) 6 Fluffy pieces with raged edges, a mushy stool 7 Watery, no solid pieces, entirely liquid Heaton KW, Fast Facts of IBS 1999;27.

22. Alarm symptoms Anemia Family history fever Positive Fecal occult test Rectal bleeding >50 age new diagnosis Abdominal mass Continiusly diare or constipation Nocturinal symptoms

23. Sub-typing IBS by predominant stool pattern Subtype (absent use of antidiarrheals or laxatives) –IBS-C (IBS with constipation): hard or lumpy stools >25% and loose (mushy) or watery stools 25% and loose (mushy) or watery stools <25% of BMs –IBS-D (IBS with diarrhea): loose (mushy) or watery stools >25% and hard or lumpy stool 25% and hard or lumpy stool <25% of BMs –IBS-M (mixed IBS): hard or lump stools >25% and loose (mushy) or watery stools > 25% of BMs –IBS-U (unsubtyped IBS): insufficient abnormality of stool consistency to meet criteria for IBS-C, D, or M Stool form: Bristol scale Longstreth GF, et al. Gastroenterology 2006;130:1480-91.

25. Treatment of İBS anxiety explain Life No stress Diet Following patients – –İlaç Tedavisi Constipasyon: (Magnezyum, laktüloz), tageserodonstipasyon DiyareDiyare: loperamide, aluminum hydroxide, cholestyramine, alosetrone Abdominal pain: anticholinerjik, periferal kappa opioid agonisti (asimadoline ), tachykinin receptor antagonist Abdominal pain – –Second line Behavioral therapy Phiscoterapi, hipnoz Antidepresans (trisiklik, selektifveserotonin re-uptake inhibitoler Gastroenterolog

26. IBS pathophysiology and treatment

27. Alternative therapies Replaced colon flora: in controlled trial, efficacy, safety? Local action of antibiotics: effect in some, need rigorous test Probiotics:  flatulence in IBS Peppermint oil: no convincing data Chinese herb drug: significant in a trial –Mixture, true action? Need other trials to confirm Acupuncture: uncertain benefit Talley NJ. Am J Gastroenterol 2003;98:750-8.

28. Extra-colonic symptoms in IBS More physician visits: X 3 Undergoing more abdominal/GYN surgeries –More chronic pelvic pain GU/GYN dysfunctions –Dysmenorrhea, dyspareunia, impotence, urinary frequency, nocturia, incomplete bladder emptying Fibromylagia: 2/3 reported rheuma sx –Associated with IBS severity –63% chronic fatigue with IBS Others: headaches, back pain, HCVD? PU? Skin rash, insomnia, palpitation, loss of concentration, unpleasant taste Hasler WL, et al. Yamada T, Textbook of Gastroenterol 4th ed, 2003: 1817-42.