Ibs

1. Irritable bowel syndrome RAGHAV GARG MBBS 2011

2. what is Irritable bowel syndrome irritable bowel syndrome can be defined ,as an idiopathic clinical entity characterized by chronic(more than 3months)abdominal pain or discomfort that occurs in association with altered bowel habits Most are due to disorders of intestinal motility.

3. SYMPTOMS These symptoms may be continuous or intermittent. Consensus definition of irritable bowel syndrome is abdominal discomfort or pain that has two of the following three features ; 1.Relieved with defecation. 2.Onset associated with a change in frequency of stool 3.onset associated with a change in form of stool .

4. Other symptoms supporting the diagnosis include abnormal stool frequency ; abnormal stool form (lumpy or hard;loose or watery ); abnormal stool passage (straining, urgency,or feeling of abdominal distention

5. Signs Examination often unremarkable Generalized abdominal tenderness

6. PATHO -PHYSIOLOGY OF IBS SUGGETSED THEORIES 1.Altered responses of general stress circuits. 2.The alternation of autonomic and neuroendocrine systems in response to visceral stimulation . 3. Serotonin release 4.low grade inflammation 5. IBS secondary to GIT infections

7. 6.Increased lactobacilli, coliform in IBS 7. Genetic factors

8. treatment

9. Constipation 1.bulk purgatives Ispaghulla and pysllium Methyl cellulose 2. Anthraquinones tegaserod Diarrhoea 1.Bulking agent 2.Antisecretory Sulfasalazine Mesalazine

10. TREATMENT FOOD INTOLERANCE  TRY EXCLUSION DIET CONSTIPATION INCREASE FIBER UPTAKE BULK PURGATIVES ISPAGHULA AND PSYLLIUM NATURAL COLLOIDAL MUCILAGE FORMS GELATINOUS MASS BY ABSORBING WATER 3-12 g OF HUSK IS MIXED WITH WATER OR MILK TAKEN DAILY ACT IN 1- 3 DAYS

11. METHYLCELLULOSE SEMISYNTHETIC COLLOIDAL HYDROPHILIC DERIVATIVE OF CELLULOSE 4-6 g/day They have non fermentable fiber better than lactulose which ferments 3 . ANTHRAQUINONES TEGASEROD NEW SELECTIVE 5 – HT4 RECEPTOR PARTIAL AGONIST WITH NO ACTION ON OTHER RECEPTORS IT ENHANCES RELEASE OF Ach AND calcitonin GENE RELATED PEPTIDE WHICH PROMOTE PERISTALTIC REFLEX AND COLONIC SECRETION elimination t1 /2 of absorbed drug 11 hr

12. STIMULANT PURGATIVES (PHENOLPHTHALEIN AND BISACODYL) ARE CONTRAINDICATED

13. DIARRHOEA Bulking agent as absorbants ispaghula and other bulk forming colloid are useful in both constipation and diarrhoea . They modify the consistency and frequency of stools by absorbing water

14. ANTISECRETORY SULFASALAZINE compound of 5-aminosalicylic acid with sulfapyridine linked through azo bond. 5-ASA  it inhibits COX and LOX ,decreased PG and LT, they play minor role in the therapeutic effect. Inhibition of cytokine, PAF, TNF and nuclear transcription factor Migration of inflammatory cells into bowel wall is interfered and mucosal secretion is reduced

15. DOSE -3-4 g/day induces remission over a few weeks but relapses are common after stoppage Maintenance therapy with 1.5-2 g/day postpone relapse Adverse effects Rashes ,fever, joint pain, hemolysis

16. MESALAZINE formulated as delayed release preparation by coating of 5-ASA with acrylic polymer This helps in effective delivery of the drug DOSE - 2.4 gm prevents relapses adverse effects are less than sulfasalazine

17. OTHER FORMS – 5 ASA enemas Olsalazine Balsalazine Other drugs helpful Corticosteroids Immunosuppressants Antispasmodic  in colic and bloating

18. Antimotility drug ( opoid drugs  codiene , diphenoxylate , loperamide ) Contraindicated as they increase the intraluminal pressure

19. THANK YOU