(IBS)(IBS)IRRITABLE BOWEL IRRITABLE BOWEL

SYNDROMESYNDROME

By Wisam Gatea Hani

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CONTENTS Colon structure and function . Definition of irritable bowel syndrome . Epidemiology of IBS. Causes of IBS . What does the colon do in IBS? Symptoms of IBS . Types of IBS . Diagnosis of IBS . Treatment and drugs References 2

Colon structure and function

Colon is the part of the large intestine , the last portion of the human gastrointestinal tract is approximately 5 to 5.5 feet long with a diameter of about 2.5 inches, is located between the cecum and rectum.

It is divided into four sections, ascending, transverse

,descending and sigmoid colon

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Function

1 .The organ for storing waste products by elimination of toxic waste material in the

form of stool 2 .Reabsorbing water from wastes and

maintaining water balance in the body .

3 .Serves at the site for the growth of beneficial bacteria and other

microorganisms

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Irritable bowel syndrome

Irritable Bowel Syndrome is not a disease. It's a functional disorder, which means that the bowel simply does not work as it should.

(IBS) is a common disorder that affects the large intestine (colon).

(IBS) commonly causes cramping, abdominal pain, bloating, gas, diarrhea and constipation

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Epidemiology

Prevalence 3 - 22% world-wide Reason for 20 - 50% of gastroenterology visits .

26% prevalence among children with recurrent abdominal pain.

40% onset before age 35.50% onset age 35 – 50.

Female > Male (3:1)

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What does the colon do in IBS?

The contraction of the colon muscles and the movement of its contents is controlled by nerves,

hormones, and impulses in the colon muscles .These contractions move the contents inside the colon toward the rectum.

During this passage, water and nutrients are absorbed into the body , and what is left over is

stool .

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CONT.. A few times each day contractions push the

stool down the colon, resulting in a bowel movement .

However, if the muscles of the colon do not contract in the right way, the contents inside the colon do not move correctly.

-resulting in abdominal pain, cramps, constipation, a sense of incomplete

stool movement, or diarrhea 8

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Causes of IBS

1. Abnormal gastrointestinal (GI) tract movements.2. A change in the nervous system communication

between the GI and brain3. Sensory and motor disorders of the colon.4. Dietary allergies or food sensitivities.5. Neurotransmitter imbalance“(decreased

serotonin levels). 6. Stress

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PATHOPHYSIOLOGY  IBS pathophysiology is not clear Many theories have been put forward , but the

exact cause of IBS is still uncertain1. Alteration in GI motility : alteration in frequency

and irregularity of luminal contractions2. Visceral hypersensitivity : increased sensation

in response to stimuli3. Brain gut axis : alteration in communications

between enteric nervous system and CNS4. Post infectious :about 10% of IBS cases are

triggered by an acute gastroenteritis infection 5. Genetics 11

Who else gets IBS?

-People who have panic disorder or other psychological conditions .

People who have a family history of IBS.-

-People with other conditions including chronic fatigue syndrome, fibromyalgia, a condition that causes widespread muscle and soft tissue pain and tenderness, and temporo-mandibular (tm) disorder which causes pain and discomfort in the jaw muscles and joint.

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Symptoms of IBS

Most symptoms-:

1 -Pain, distension or abdominal discomfort and bloating

2 -Abnormal bowel habits with periods of constipation and/or diarrhea

Sensation of incomplete bowel movement-3

Mucus in the stool -4

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Types of IBS

IBS can be subdivided into: 1- Constipation-predominant :the person

tends to alternate constipation with normal stools. Symptoms of abdominal cramping or aching are commonly triggered by eating.

2- Diarrhea-predominant : the person tends to experience diarrhea first thing in the morning or after eating. The need to go to the toilet is typically urgent and cannot be delayed.

3- Alternating constipation and diarrhea(IBS-A)

or (IBS-M) mixed IBS14

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Diagnosis of IBS

Rome criteria-:

According to these criteria, you must have certain signs and symptoms before a doctor diagnoses irritable bowel syndrome.

The most important are abdominal pain and discomfort lasting at least 12 weeks, though the weeks don't have to occur consecutively.

You also need to have at least two

of the following: 16

1 -A change in the frequency or consistency of your stool .

- for example you may change from having one normal formed stool every day to three or more loose stools daily, or you may have only one hard stool every three to four days.

2 -Straining, urgency or a feeling that you can't empty your bowels completely.

Mucus in your stool . -3Bloating or abdominal distension. -4

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Additional tests

1 -Flexible sigmoidoscopy-: This test examines the lower part of the colon (sigmoid) with

a flexible, lighted tube (sigmoidoscope).

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2- Computerized tomography (CT) scan :- CT scans produce cross-sectional X-ray images of

internal organs

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3- Colonoscopy :- In some cases, your doctor may perform this

diagnostic test, in which a small, flexible tube is used to examine the entire length of the colon.

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4- Lactose intolerance tests :- -Lactase is an enzyme you need to digest the sugar

found in dairy products . -If you don't produce this enzyme, you may have

problems including abdominal pain, gas and diarrhea.

-To find out if this is the cause of your symptoms, your doctor may order a breath test

or ask you to exclude milk and milk products from your

diet for several weeks.21

TREATMENT STRATEGIES Treatment involves a mix of drug , diet ,and

psychosocial interventions .

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A-DIETARY MODIFICATION

Avoid food that trigger symptoms (such as gases forming foods as lentils , legumes , and beans )

Low FODMAP diet ( Fermentable Oligo Di Mono-saccharides And Polyols) :- are short chain carbohydrates that are poorly absorbed in small intestine .

Fiber supplementation :- may improve symptoms of constipation and diarrhea

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B- PHARMACOLOGICAL THERAPIES

1- Antispasmodics :- dicyclomine, hyoscine N-butylbromide, clidinium ,peppermint oil, mebeverine ,and pinaverium2- Tricyclic antidepressants : - imipramine , amitriptyline , nortriptyline 3- selective serotonin reuptake inhibitors (SSRIS):- fluoxetine, sertraline , paroxetine , citalopram , escitalopram4- probiotics :- improvement in global symptoms , bloating and flatulence

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Drugs for IBS-C :- Laxatives :- psyllium Chloride channel activators:- lubiprostone Serotonin agonists:- tegaserod , mosapride Guanylate cyclase -C agonists :- linaclotide Drugs for IBS-D:-o Antibiotics :- Rifaximino Antimotility agents :- loperamide ,

diphenoxylate o Serotonin antagonists :- alosetron ,

cilansetron25

GERD: GASTROESOPHAGEAL REFLUX DISEASE

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References1 -Anonymous (2010), Irritable bowel syndrome (English). Medical Subject

Headings. U.S. National Library of Medicine.2 -Article:Amanda Chan Date: 06 January 2011 Time: 10:11 AM ET

3-March 9, 2011 | Author: Kristie Brehant | Posted in Disease and Illness http://mdhba.com/disease-and-illness/ibs-help/

4 -http://www.naturalnews.com/IBS.htmlFriday, October 08, 2010 by: Tony Isaacs

5 -Alan Jensen EzineArticles.com Expert AuthorJoined December 13, 2010

6 ©-2010 State Government of Victoria 7 -Irritable bowel syndrome. The National Digestive Diseases Information

Clearinghouse. http://digestive.niddk.nih.gov/ddiseases/pubs/ibs/. Accessed June 2, 2009.

8-Clinical Therapeutics, Volume 30, Issue 5, May 2008, 8Pages 884-901-8Roja Rahimi, Shekoufeh Nikfar, Mohammad Abdollah

9-Gastrointestinal Endoscopy, Volume 70, Issue 5, November 2009, Pages 942-946S. Bennett Hooks III, Travis J. Rutland, Jack A. Di Palma

10 -Pharma Guide By DAHSHAN HASSAN DAHSHAN