Irritable Bowel Syndrome: Pathophysiology, Symptoms, and Management
❏
Important
❏
Original content
❏
Only in girls slides
❏
Only in boys slides
❏
Doctor’s notes
Family & Community
Medicine
Irritable Bowel Syndrome
OBJECTIVES:
-↑ Numbers of lymphocytes have been
reported in the colon and small
intestine in patients with IBS.
-↑ In lymphocyte infiltration in the
myenteric plexus in 9 patients and
neuron degeneration in 6 patients.
-These cells release mediators (nitric
oxide, histamine and proteases)
capable of stimulating the ENS, leading
to abnormal motor and visceral
responses within the intestine.
Pathophysiology:
*It remains uncertain, yet it is viewed as a disorder
resulting from an interaction among a number of factors.*
Motor abnormalities of the GI tract are
detectable in some patients with IBS
Abnormalities observed include:
- Increased frequency and irregularity of
luminal contractions.
- Prolonged transit time in constipation-
predominant IBS.
-If the Motility is slow → Constipation
(Mainly on the left side. Overcome by high
fiber intake/laxatives).
-If the Motility is Fast → Diarrhea.
Gastrointestinal Motility
Visceral Hypersensitivity
Intestinal Inflammation
Is a frequent finding in IBS patients.
Perception in the gastrointestinal (GI)
tract results from stimulation of various
receptors in the gut wall.
These receptors transmit signals via
afferent neural pathways to the dorsal
horn of the spinal cord and ultimately to
the brain.
*increased sensation in response to stimuli*
1
2
3
Irritable Bowel Syndrome (IBS):
is a gastrointestinal disorder characterized by chronic abdominal pain and altered
bowel habits in the absence of any organic cause.
*
It is the most commonly diagnosed gastrointestinal condition
*
It is unclear whether heightened sensitivity of the intestines to normal sensations is mediated by the local GI nervous system,
by central modulation from the brain, or by some combination of the two.
Distention:
Various studies have shown that in patients with IBS, awareness and pain caused by balloon distention in the
intestine are experienced at lower balloon volumes compared with controls.
Bloating
: About half of patients with IBS (
mainly those with constipation
) have a measurable increase in abdominal girth
associated with bloating (
sensation of abdominal fullness
).
Psychosocial factors may influence
the expression of IBS.
- Change in gut microbiota:
emerging
data suggest that the fecal microbiota in
individuals with IBS differ from healthy
controls and varies with the predominant
symptom.
-Bacterial Overgrowth.
Alteration in
Fecal Microflora
Food Hypersensitivity
Psychological Dysfunction
Some food helps aggravate/worsen
the case, so most patients use a
gluten-free diet which helped them
out a lot, remain not understood.
4
5
6
Postinfectious: E.coli
7
-
Younger patients and women are more likely to be diagnosed with IBS.
-
2:1 female predominance in North America though.
-
In china males are more common to have IBS.
Clinical feature
:
Signs & Symptoms
Chronic abdominal
pain
Altered bowel
habits
Diarrhea
Constipation
Other gastrointestinal
symptoms
GERD,
dysphagia, early satiety, intermittent
dyspepsia, nausea, and non-cardiac chest
pain.
mnemonics:
*
C
amila
A
te
D
onuts with
C
ranberries*
Diagnostic Criteria (Rome IV)
Recurrent abdominal pain on average at least 1 day/week in the last 3 months, associated with two or more of the following criteria:
Related to defecation.
Associated with a change in frequency
of stool.
Associated with a change in form
(appearance) of stool.
1
2
3
Criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis.
Diagnostic Criteria (Rome III)
Recurrent abdominal pain on average at least 3 day/month in the last 3 months, associated with two or more of the following criteria:
Improvement with defecation.
Associated with a change in frequency
of stool.
Associated with a change in form
(appearance) of stool.
1
2
3
MOST recent & Important criteria than rome III
IBS Subtypes
Unsubtyped IBS
Insufficient abnormality of
stool consistency to meet
the above subtypes.
Mixed IBS
Hard or lumpy stools ≥25%
Loose or watery stools
≥25% of bowel movements.
IBS with diarrhea
Loose or watery stools
≥25% Hard or lumpy stools
<25% of bowel movements.
IBS with constipation
Hard or lumpy stools ≥25%
Loose or watery stools
<25% of bowel movements.
3
2
4
1
Diagnostic Approach
Patients are identified as having a symptom
complex compatible with IBS based upon the
Rome III criteria.
Routine laboratory studies (CBC, chemistries)
are normal in IBS.
NO RED FLAGS SYMPTOMS (Age >40):
-
Rectal bleeding.
-
Nocturnal or progressive abdominal
pain.
-
Weight loss.
(>10% in 6 months)
-
Anemia.
Management
IBS is a
chronic condition
with
no known cure
.
The focus of treatment should be on
relief of
symptoms
and in
addressing the patient's
concerns
.
-
Therapeutic relationship.
-
Patient education.
-
Dietary modification.
-
Psychosocial therapies.
-
Antidepressants
(eg. SSRI).
-
Symptomatic relief of pain.
*We don’t worry about
Rome criteria*
*Managed by fibers/laxatives*
*Managed by Imodium(loperamide) *
Answers: 1) B, 2) D, 3)C, 4) D
QUIZ!
●
Which one of the following is the most commonly
diagnosed gastrointestinal condition:
A)
IBD.
B)
IBS.
C)
Colitis.
D)
Pancreatitis.
●
Which CRITERIA is the recent criteria that is used
in diagnosis of IBS:
A)
Rome criteria I.
B)
Rome criteria II.
C)
Rome criteria III.
D)
Rome criteria IV.
●
Increased numbers of which one of the following cells
have been reported in the colon and small intestine in
patients with IBS:
A)
Macrophages.
B)
Monocytes.
C)
Lymphocytes.
D)
Neutrophils.
●
Which one of the following used to manage the
symptoms for a patient with IBS:
A)
Dietary modification.
B)
Antidepressant medications.
C)
Psychosocial therapies.
D)
All of the above.
1
2
3
4
THIS WORK IS DONE BY:
Abdulrahman Bedaiwi
&
Jude Al-Otaibi
Give us your feedback!
Irritable Bowel Syndrome (IBS) is a common gastrointestinal condition with uncertain pathophysiology involving factors like motility, hypersensitivity, inflammation, and gut microflora. Symptoms include abdominal pain, altered bowel habits, and bloating. Diagnosis is based on Rome IV criteria, and management strategies include dietary changes, psychological support, and addressing food sensitivities.
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Presentation Transcript
Family & Community Medicine Irritable Bowel Syndrome Editing file Important Original content Only in girls slides Only in boys slides Doctor s notes
OBJECTIVES: 01 Understand the hypothesis & explain the pathophysiology of IBS . 02 Common sign & symptoms . 03 Rome IV criteria of diagnosis . 04 IBS management .
Irritable Bowel Syndrome (IBS): deretla dna niap lanimodba cinorhc yb deziretcarahc redrosid lanitsetniortsag a si .esuac cinagro yna fo ecnesba eht ni stibah lewob * It is the most commonly diagnosed gastrointestinal condition* Pathophysiology: *It remains uncertain, yet it is viewed as a disorder resulting from an interaction among a number of factors*. 2 1 3 Gastrointestinal Motility Visceral Hypersensitivity *increased sensation in response to stimuli* Intestinal Inflammation - Numbers of lymphocytes have been reported in the colon and small intestine in patients with IBS . - In lymphocyte infiltration in the myenteric plexus in 9 patients and neuron degeneration in 6 patients . -These cells release mediators (nitric oxide, histamine and proteases) capable of stimulating the ENS, leading to abnormal motor and visceral responses within the intestine. Motor abnormalities of the GI tract are detectable in some patients with IBS edulcni devresbo seitilamronbA : Is a frequent finding in IBS patients. Perception in the gastrointestinal (GI) tract results from stimulation of various receptors in the gut wall . -Increased frequency and irregularity of luminal contractions . -Prolonged transit time in constipation- predominant IBS. These receptors transmit signals via afferent neural pathways to the dorsal horn of the spinal cord and ultimately to the brain. -If the Motility is slow Constipation (Mainly on the left side. Overcome by high fiber intake/laxatives). -If the Motility is Fast Diarrhea. 1 1
5 Alteration in Fecal Microflora 4 6 Food Hypersensitivity Psychological Dysfunction -Change in gut microbiota: emerging data suggest that the fecal microbiota in individuals with IBS differ from healthy controls and varies with the predominant symptom. Psychosocial factors may influence the expression of IBS. 7 Some food helps aggravate/worsen the case, so most patients use a gluten-free diet which helped them out a lot, remain not understood. Postinfectious: E.coli -Bacterial Overgrowth. Distention: eht ni noitnetsid noollab yb desuac niap dna ssenerawa ,SBI htiw stneitap ni taht nwohs evah seiduts suoiraV slortnoc htiw derapmoc semulov noollab rewol ta decneirepxe era enitsetni . Bloating( SBI htiw stneitap fo flah tuobA :mainly those with constipation htrig lanimodba ni esaercni elbarusaem a evah ) ( gnitaolb htiw detaicossasensation of abdominal fullness ) . It is unclear whether heightened sensitivity of the intestines to normal sensations is mediated by the local GI nervous system, by central modulation from the brain, or by some combination of the two. 1 2
Clinical feature: - Younger patients and women are more likely to be diagnosed with IBS. - 2:1female predominance in North America though. - In china males are more common to have IBS . Signs & Symptoms mnemonics: *Camila Ate Donuts with Cranberries* Chronic abdominal pain Altered bowel habits Diarrhea Other gastrointestinal symptoms Constipation GERD, dysphagia, early satiety, intermittent dyspepsia, nausea, and non-cardiac chest pain . 1 3
Diagnostic Criteria (Rome III) Recurrent abdominal pain on average at least 3 day/month in the last 3 months, associated with two or more of the following criteria: 2 1 3 Associated with a change in frequency of stool . Associated with a change in form (appearance) of stool. Improvement with defecation . Diagnostic Criteria (Rome IV) MOST recent & Important criteria than rome III Recurrent abdominal pain on average at least 1 day/week in the last 3 months, associated with two or more of the following criteria: 2 Criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis. 1 3 Associated with a change in frequency of stool . Associated with a change in form (appearance) of stool. Related to defecation . 1 4
IBS Subtypes *Managed by fibers/laxatives* *Managed by Imodium(loperamide)* IBS with constipation Hard or lumpy stools Loose or watery stools <25%of bowel movements . IBS with diarrhea Loose or watery stools 25% Hard or lumpy stools <25%of bowel movements . Mixed IBS Unsubtyped IBS Insufficient abnormality of stool consistency to meet the above subtypes . 25% Hard or lumpy stools Loose or watery stools 25% of bowel movements . 25% 1 2 3 4 Diagnostic Approach Management Patients are identified as having a symptom complex compatible with IBS based upon the Rome III criteria . Routine laboratory studies (CBC, chemistries) are normal in IBS. IBS is a chronic condition with no known cure. The focus of treatment should be on relief of symptoms ni dna addressing the patient's concerns. - - - - - - Therapeutic relationship . Patient education . Dietary modification . Psychosocial therapies . Antidepressants (eg. SSRI). Symptomatic relief of pain . NO RED FLAGS SYMPTOMS (Age > 40 - Rectal bleeding . - Nocturnal or progressive abdominal pain . - Weight loss. (>10%in 6 months) - Anemia. ) : *We don t worry about Rome criteria* 1 5
QUIZ! 1 3 Increased numbers of which one of the following cells have been reported in the colon and small intestine in patients with IBS: Macrophages. Monocytes. Lymphocytes. Neutrophils. Which one of the following is the most commonly diagnosed gastrointestinal condition: IBD. IBS. Colitis. Pancreatitis. A) B) C) D) A) B) C) D) 2 4 Which CRITERIA is the recent criteria that is used in diagnosis of IBS : Rome criteria I. Rome criteria II. Rome criteria III. Rome criteria IV. Which one of the following used to manage the symptoms for a patient with IBS: Dietary modification. Antidepressant medications. Psychosocial therapies. All of the above. A) B) C) D) A) B) C) D) Answers: D ) ,C) 4 ,D ) 3 ,B ) 2 1
THIS WORK IS DONE BY: Abdulrahman Bedaiwi ibiatO lA eduJ - & Give us your feedback!
