Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS)

1. IRRITABLE BOWEL SYNDROME P. PAVITHRA M.Pharm I year

2. IRRITABLE BOWEL SYNDROME Irritable bowel syndrome(IBS) is not a disease. It is a functional gastro-intestinal disorder involving an abnormal condition of gut contractions (motility) and increased gut sensations (visceral hypersensitivity) IBS is a common disorder that affect large intestine.

3. IBS commonly causes cramping ,abdominal pain, bloating gas , diarrhea and constipation.

4. Epidemiology More frequent in women than men. 50% of patient present < 35 years old. Prevalence among the children with recurrent 20% abdominal pain . 25% of patients examined by a G.P. suffer from a gastro-intestinal disorder

5. Aetiology Abnormal GIT movement. A changes in the nervous system communication between the GI and brain. Sensory and motor disorders of the colon. Dietary allergies or food sensitivities. Neurotransmitter imbalance ( serotonin levels). Stress,Genetics

6. Pathophysiology Many theories have been put forward. But exact cause of IBS is still uncertain . Alteration in GI motility : alteration in frequency and irregularity luminal contraction . Visceral hypersensitivity : increased sensation in response to stimuli. Brain gut axis : alteration in communication between enteric nervous system and CNS.

7. Symptoms Pain , distension or abdominal discomfort and bloating. Abnormal bowel habits with period of constipation or diarrhea . Sensation of incomplete bowel movements. Mucus in the stool. Passing a stool three or four times a day .

8. Classification of IBS IBS with constipation (IBS-C) IBS with diarrhea (IBS –D) IBS mixed type (IBS-M)

9. Types of IBS IBS with constipation (IBS-C ) the person tends to alternate constipation with normal stools. More common in women. Symptoms - abdominal pain,bloating

10. 2. IBS with diarrhea (IBS –D) The person tends to experience diarrhea first thing in the morning or after eating. More common in Men They need to go to the toilet is typically urgent and cannot be delayed.

11. 3. IBS with alternating Constipation and Diarrhea (IBS-M): Passage of both hard and soft stools. Symptoms -Bowel habits often vary over time.

12. Diagnosis of IBS F lexible sigmoidoscopy Computerized tomography(CT) scan C olonoscopy L actose intolerance test

13. Flexible sigmoidoscopy This test examines the lower part of colon and rectum. It is a flexible tube( sigmoidoscope ) 60cm long and about the thickness of your little finger.It is gently inserted into anus.

14. computerized tomography(CT) scan CT scan produce cross sectional x-ray images of internal organs.

15. Colonoscopy In this diagnostic test ,small, flexible tube is used to determine the entire length of the colon.

16. Lactose intolerance test Lactose is an enzyme ,which need to digest the sugar found in the dairy products . If you don’t produce this enzyme you may have a problem including abdominal pain ,gas diarrhea . To find out this is the cause of your symptoms your doctor may order a breath test or exclude milk or milk products from your diet for several weeks.

17. Prevention Enough fiber in diet Stop smoking , avoid excessive amounts of caffeine Yoga, relaxation technique Regular exercise Reduce the stress

18. Treatment of IBS IBS-CONSTIPATION : a)5HT4 agonist : Tegaserod b)Bulking laxatives : Methyl cellulose , P syllium IBS- DIARROHEA : a) Antidiarrheal : L operamide , Diphenoxylate b) 5-HT3antagonist : A losetron FOR PAIN : a)Antispasmodics : Dicyclomine , Hyoscyamine TCAs: I mipramine ,Amitriptyline

19. 1.)Irritable Bowel Syndrome-constipation : Tegaserod Short term treatment for women with moderate /severe IBS with predominant constipation who have failed to fiber supplement and laxatives (reduces pain and bloating - bowel movement and hardness of stool )

20. Bulk laxatives

21. 2.)Irritable Bowel Syndrome- Diaarrhea : Antidiarrheal

22. LOPERAMIDE

23. Diphenoxylate:

24. 5-HT3 antagonist 5-HT3 antagonist used for diarrhea associated IBS . a) slow the intestinal transit urgency b) decreases the intestinal secretion c) decreases the water content of the stool d) diminish the colonic pain

25. Alosetron

26. Antispasmodics Drugs used to relieve the spasm of smooth muscles in the GIT . Dicyclomine and hyoscyamine Block muscarinic receptors in the enteric plexus and on smooth muscles

27. T ricyclic antidepressants