Ibd

1. Irritable bowel syndrome
‫سندروم‬
‫امعا‬
‫تخریش‬
‫پذیر‬
The art of medicine consists of amusing the
patient while nature cures the disease

2. Irritable bowel syndrome
Synonyms:
Functional bowel disease
Spastic bowel syndrome
Classification:
oIBS-C
oIBS-D
oIBS-M

3. Epidemiology of IBs
• 10-20% of adults
• 2-3times higher in women
• Common age:30-50yr
• More common in whites then blacks
• Decreased incidence by increasing age

4. Pathophysiology of IBS
1. Visceral hypersensivity
2. Brain gut dysregulation
3. Immune&inflammatory
mediators
4. Post infection

5. Pathophysiology…Visceral hypersensivity
• Inflation of balloon
• Myoelectric
• Afferent pathway of visceral innervation is
affected
• Normal somatic

6. Pathophysiology
…Brain Gut
dysregulation
• Functional imaging studies:regional
brain activity
• Emotional stress
• Antipsychotic drugs relieve
symptoms

7. Pathophysiology…role of
immune&inflammatory mediators
oProinflammatory cytokines…IL-6, IL-8
oACTH level scaled up after infusion of cortisol releasing hormone
oEnterochromaffin cells are increased
oSerotonin level elevation post prandialy
Post infective IBS

8. Clinical manifestations of IBS
I. Abdominal Pain
II. Altered bowel habits
III. Gas and flatulence
IV.Upper GI symptoms

9. Abdominal pain in IBS
oExacerbated by eating or emotional
stress
oHighly variable in intensity and location
oMild enough to be ignored or it may
interfere with daily activities

10. Altered bowel habits & GAS and flatulence in
IBS
• Constipation alternating with diarrhea
• Episodic, but eventually it becomes continuous and
increasingly intractable to treatment with laxatives
• Abdominal distention and increased belching or flatulence
• Normal amount of intestinal gas
• Impaired transit and tolerance of intestinal gas loads

11. Upper GI symptoms in IBS
• 25 and 50% of patients dyspepsia, heartburn,
nausea, and vomiting
• Normal nocturnal motor pattern
• high incidence of abnormalities in the small
bowel during the diurnal (waking) period

12. Diagnosis of IBS
Diagnosis is stablished by clinical symptoms and exclusion of other organic disease

13. Diagnosis of IBS
CBC
Sigmoidoscopy
Contrast barium
enema or colonoscopy
Esophagogastroduode
noscopy
Hydrogen breath test

14. Differential diagnosis of IBS
EPIGASTRIC PAIN: PUD, Gastric and pancreatic CA,Intestinal Ischemia
HYPOGASTRIUM PAIN:IBD,Colonic cancer,Diverticular disease of colon
POST PRANDIAL PAIN:Gastric paresis,Partial intestinal obstruction
DIARRHEA:Lactase deficiency,Malabsorption,Hyperthyroidism,IBD
CONSTIPATION:Hypothyroidism,Hypoparathyroidism,Anticholinergic,Anti
hypertensive drugs

15. TREATMENT of IBS
oReassurance
oDietary changes
oMedicalTreatment

16. Dietary changes
 Hydrogen breath test for excluding lactose intolerance

17. MedicalTreatment of IBS
1)Antispasmodic Drugs
2)Antidiarrheal agent
3)Anticonstipation agent
4)Psychotropic agent
5)Serotonin receptor Antagonist
6)Serotoning Receptor Agonist
7) Nonabsorbable Antibiotics
8)Probiotics

18. Medical treatment of IBS
1. Antispasmodic drug
oHyoscyamine 0.25mg-0.125mg BID
oDicyclomine 10-20mg QID
oMethscopalamine 2.5-5mg daily before meal
2.Antidiarrhea agent
oLoperamide 2mg-4mg QID
oOpiates

19. Medical treatment of IBS
3.Anticonstipation agent
oLubiprostone 8mcg BID
oLinaclotid 290mcg OD
oAvoid Osmotic
laxatives such as Milk of
magnesia,Lactulose

20. Medical treatment of IBS
4.Psychotropic Agent
TCA:10-150mg OD
oImipiramine
oDesipramine
oNortryptyline
SSRI:
oParoxetine 10-20mg daily
oFluoxetine 20-40mg daily
oEscitalopram 5-20mg daily

21. Medical treatment of IBS
5-Selective serotonin receptor r antagonist
• Alosetron 1mg OD or BID
6-Selective serotonin receptor agonist
• Tegaserod 6mg BID

22. Medical treatment of IBS
7-Nonabsorbable Antibiotics
• Rifaximin 550mgTID
8-Probiotics
• Bifidobacterium infantis BID