Presentation IBS & GERD

Advanced Pathophysiology
N570/5270

Irritable Bowel Syndrome
Gastro Esophageal Reflux Disease

IBSIrritable Bowel Syndrome
Chaluza Kapaale RN, BSN

Spastic colon, Irritable colon, Mucous colitis
Affects 10% to 15% of North American population
Not structural
Characterized by abdominal pain and cramping with alterations in bowel movements
More common in women ranging from teens to age 40
IBS typically co-exists with anxiety and depression
IRRITABLE BOWEL SYNDROME

The cause of IBS is not known but suggestions about the cause based on possible explanations of symptoms have been made.
What Causes IBS??

Usually accompanied by distention of the rectum and other areas of the intestine. May be caused by disturbances in the brain gut-axis, serotonin, action of mast cells and T-lymphocytes, changes in autonomic and central nervous system function increasing perception of visceral pain.
Visceral hypersensitivity or hyperalgesia

low grade inflammation and abnormal immune responses in intestinal tissue caused by intestinal infection have been linked to some IBS symptoms.
Post infectious IBS

Overgrowth of bowel flora is often associated with IBS symptoms. Methane gas has been suggested to slow colonic transit times.
Intestinal flora overpopulation

: Allergic reactions to consumed food increase mucosal hypersensitivity and IBS symptoms.
Foods such as chocolate, wheat, milk and alcohol are usually the culprits for these reactions.
Food allergy and food intolerance

Influence brain – gut interactions, including neuro endocrine and pain modulation activities encouraging IBS symptoms.
Psychosocial factors:

Those with diarrhea have fast colonic transit times and those with constipation have slower colon transit times. Changes most likely caused by visceral hypersensitivity or malfunction of the brain-gut axis and the role of serotonin in the enteric nervous system.
Abnormal motility and secretion

As the name implies IBS affects the bowel.
Lower abdominal pain, diarrhea, constipation, or both diarrhea and constipation, gas, bloating and nausea.
Fecal urgency and incomplete evacuation.
Symptoms are usually relived by defecation.
Does not cause permanent damage to bowel and does not lead to adverse complications such as cancer.
TARGET SYSTEM

IBS is often a life long condition that is usually disabling.
It affects life styles more than actual physical body systems by interfering with work, travel, socializing and other activities of daily living.
The main effect on the body is alterations in nutrition.
Typically does not affect sleep patterns
WHOLE BODY

Based on signs and symptoms after ruling out structural and biochemical causes. Blood tests to rule out anemia and stool cultures to rule out infection.
Celiac disease, colon cancer and inflammatory bowel disease are some causes of symptoms that must be ruled out.
Sigmoidoscopy and colonoscopy as needed may be used.
Diagnosis

3 months of continuous or recurring symptoms of abdominal pain or irritation that
May be relieved with a bowel movement,
May be coupled with a change in frequency, or
May be related to a change in the consistency of stools.
ROME III

Two or more of the following are present at least 25 percent (one quarter) of the time:
A change in stool frequency (more than 3 bowel movement per day or fewer than 3 bowel movements per week)
Noticeable difference in stool form (hard, loose and watery stools or poorly formed stools)
Passage of mucous in stools
Bloating or feeling of abdominal distention
Altered stool passage (e.g. sensations of incomplete evacuation, straining, or urgency)
ROME III

There is no cure, treatment addresses symptoms which vary among individuals.
Life style changes like avoiding foods and drinks that stimulate the intestine such as caffeine, soda or tea.
Smaller meals are better
Avoid wheat, chocolate, milk products and alcohol
Increase dietary fiber
Treatment

GERDGastro Esophageal Reflux Disease
Chaluza Kapaale RN,BSN

GERD is a more serious form of a common condition referred to as Gastro esophageal Reflux (GER)
GER occurs when the lower esophageal sphincter becomes incompetent. The failure of the sphincter to perform its function causes regurgitation of stomach contents into the esophagus.
The contents of the stomach include acidic digestive juices and food.
GERD

The acid in the refluxed contents causes the burning sensation in the chest and throat referred to as heart burn or acid indigestion.
GER that is frequent and occurs more than twice a week is considered GERD
Risk factors include obesity and
GERD

The primary symptom is recurrent heart burn.
Heart burn is described as a burning sensation in the lower part of the mid chest, behind the breast bone and mid abdomen.
It is possible to have GERD without heart burn
Dry cough, asthma symptoms and trouble swallowing.
Symptoms

The cause is undetermined in some people
The lower esophageal Sphincter relaxes randomly
Anatomical abnormalities include hiatal hernia
The diaphragm helps the lower esophageal sphincter in its function
Duodenal ulcers and pyloric strictures that delay gastric emptying
What Causes GERD??

The presence of a hiatal hernia creates optimal conditions for GERD however it is possible to have a hiatal hernia and no symptoms of GERD.
Other factors that facilitate the occurrence of GERD include obesity, pregnancy and smoking.
Food types such as chocolate, citrus fruits, fatty fried foods etc. potentiate reflux symptoms.
What Causes GERD??

Most people treat reflux with OTC medications without realizing the severity of their condition
It is recommended to seek help if one has been using OTC antacids or other reflux medications for more than 2 weeks
Treatment

Lifestyle Changes
Smoking secession
Small frequent meals
Loose fitting clothes
Avoid laying down for up to 3 hours after a meal
Avoid food and beverages that exacerbate symptoms
Weight loss
Treatment

Medications
Antacids (Neutralize the acid in stomach)
Foaming agents (Cover the stomach contents with foam to prevent reflux)
H2 blockers ( Decrease acid production)
Proton pump inhibitors ( Decrease acid production)
Prokinetics ( strengthen the LES and make the stomach empty faster)
Treatment

Surgery
Fundoplication
Vagotomy
Tests for unresolved symptoms
Barium Swallow Radiograph
Upper endoscopy
pH monitoring
Treatment

Esophagitis
Esophageal Strictures
Barrett’s Esophagus, occurs in 10% of GERD patients and 40 times more likely to develop into esophageal cancer
Esophageal cancer
Target System

Barrett’s Esophagus

Reflux Esophagitis

Esophageal Stricture

Unrelieved GERD can lead to asthma exacerbation, chronic cough and pulmonary fibrosis
If complications progress to esophageal cancer there is a high possibility of metastasis.
Alterations in nutritional intake.
Whole Body

IBS is characterized by
Constipation
Diarrhea
Gas
All the above
Questions

IBS is associated with
Diverticulum in the colon
Ulcerations in the colon
Colorectal cancer
Non structural complications
Questions

Rome III is primarily used to?
Classify stages of IBS
Diagnose GERD
Diagnose IBS
None of the above
Questions

Resection of the vagus nerve by vagotomy reduces symptoms GERD by
Increasing acid production
Promoting gastric emptying
Reducing acid production
Reducing gastric emptying
Questions

Which complication of GERD most often leads to cancer?
Barrett's esophagus
Esophageal strictures
Esophageal varices
esophagitis
Questions

McCance k., Huether S., Brashers V., Rote N., (2010). Pathophysiology- The Biological Basis for Disease in Adults and Children (745-765). Missouri:MosbyElsevier.
National Digestive Diseases Information Clearinghouse.Gastro Esophageal Disease.Retrieved March 20, 2011: http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/
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Presentation IBS & GERD

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