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Irritable Bowel Syndrome (IBS)

Irritable Bowel Syndrome (IBS). Chapter 43. Description of IBS. Common chronic functional disorder Characterized by intermittent abdominal pain or discomfort and stool pattern irregularities Symptoms may occur for years More frequent diagnosis in women. Clinical Manifestations.

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Irritable Bowel Syndrome (IBS)

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  1. Irritable Bowel Syndrome (IBS) Chapter 43

  2. Description of IBS • Common chronic functional disorder • Characterized by intermittent abdominal pain or discomfort and stool pattern irregularities • Symptoms may occur for years • More frequent diagnosis in women

  3. Clinical Manifestations • GI symptoms • Abdominal pain • Diarrhea or constipation • Abdominal distention • Excessive flatulence • Bloating • Urgency • Sensation of incomplete evacuation

  4. Clinical Manifestations • Non-GI symptoms • Fatigue • Sleep disturbances

  5. Psychosocial Factors in IBS • Psychologic stressors associated with development and exacerbation of IBS • Common in patients with IBS • Anxiety, panic disorder • Depression • Posttraumatic stress disorder • Abuse history

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

  7. Case Study • D.V. is a 31-year-old woman who presents to your clinic with abdominal pain, discomfort, and bloating. • She has had intermittent abdominal pain for approximately 6 months. • She often misses work, where she is an administrative assistant, because of her GI symptoms, as well as fatigue. Stockbyte/Thinkstock

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

  9. Etiology and Pathophysiology • No organic cause is known • Patients often report history of GI infections and food intolerances • The role of food allergies is unclear • Other dietary factors such as fermentable saccharides and polyols may contribute to symptoms

  10. Differential Diagnoses • Malabsorption • Gluten intolerance • Lactose intolerance • Dietary factors • Infection • Colorectal cancer • Inflammatory bowel disease

  11. Differential Diagnoses • Endometriosis • Psychologic disorders • Gynecologic disorders • Peptic ulcer disease • Celiac disease

  12. Case Study • D.V. eats irregularly and often in a hurry. • She is anxious about her symptoms and worried that she may have colon cancer because her grandmother died of cancer. Stockbyte/Thinkstock

  13. Case Study • She has a very stressful lifestyle. • She denies any blood in stool or diarrhea. • There is no change in body weight, and appetite is good. Stockbyte/Thinkstock

  14. Diagnostic Studies • No specific physical findings • Diagnosis determined by • Symptoms • Ruling out other conditions

  15. Diagnostic Studies • Physical examination • Past health history • Psychosocial factors • Stress • Anxiety • Family history • Drug/diet history

  16. Diagnostic Studies • Impact on activities of daily living • Determine if and how IBS symptoms interfere with • School • Work • Recreational activities

  17. Diagnostic Studies • Symptom-based criteria for IBS have been standardized • Referred to as the Rome criteria III

  18. Collaborative Care • Treatment is directed at • Psychologic factors • Dietary factors • Medications that • Regulate output • Reduce pain/discomfort

  19. Collaborative Care • Patients do better with therapy if • They have a trusting relationship with the care provider • They have coping mechanisms • Symptoms are less severe/frequent

  20. Collaborative Care • Encourage patient to verbalize concerns • Suggest patient keep a diary to help identify factors that trigger IBS • Symptoms • Diet • Episodes of stress

  21. Case Study • D.V. states that abdominal pain and bloating are relieved by having a bowel movement. • She is often constipated, for which she takes laxatives. Stockbyte/Thinkstock

  22. Case Study • On examination, bowel sounds are present. • Vital signs and WBC count are normal. Stockbyte/Thinkstock

  23. Collaborative Care • Consider predominant symptom pattern • Diarrhea • Constipation • Pain

  24. Collaborative Care • Gradually increase fiber intake • Aim for a minimum of 20 g/day • Use a stool bulking agent • Monitor tolerance to increased fiber • Suggest gradual changes to avoid bloating and abdominal discomfort due to gas

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

  26. Nutritional Therapy • Eliminate fructose and sorbitol • Yogurt may be better tolerated than milk products • Probiotics may be used • Alterations in intestinal bacteria are believed to exacerbate symptoms

  27. Case Study • What problems do D.V.’s history and symptoms suggest? • What important teaching topics should you discuss with her? Stockbyte/Thinkstock

  28. Drug Therapy • Loperamide (Imodium) • Used to treat incidences of diarrhea • Synthetic opioid • Decreases intestinal transit

  29. Drug Therapy • Alosetron (Lotronex) • Serotonergic antagonist • Used to treat severe pain and diarrhea • Available only in a restricted access program for women who have not responded to other IBS therapies, because of serious side effects: • Severe constipation • Ischemic colitis

  30. Drug Therapy • Lubiprostone (Amitiza) • Approved for the treatment of women with IBS-related constipation • Linaclotide (Linzess) • Approved for the treatment of men and women with IBS-related constipation

  31. Drug Therapy • Antidepressants • Low doses of tricyclic antidepressants seem to provide benefit • Possibly work by decreasing peripheral nerve sensitivity

  32. Psychologic Therapies • Cognitive-behavioral therapy • Stress management techniques • Acupuncture • Hypnosis

  33. Nonpharmacologic Treatments • Teaching and reassurance • Relaxation • Stress management techniques • Complementary and alternative therapies

  34. Irritable Bowel Syndrome • No single therapy has been found to be effective for all patients with IBS

  35. Case Study • What nutritional recommendation could you make to D.V.? • How should you address her concerns about cancer? Stockbyte/Thinkstock

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