Overview of Irritable Bowel Syndrome

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Overview of Irritable Bowel Syndrome

  1. 1. Overview of Irritable Bowel Syndrome Arnold Wald, MD Professor of Medicine Department of Gastroenterology, Hepatology, and Nutrition University of Pittsburgh Medical Center Pittsburgh, Pennsylvania
  2. 2. Irritable Bowel Syndrome <ul><li>Chronic or recurrent GI symptoms </li></ul><ul><ul><li>Lower abdominal pain/discomfort </li></ul></ul><ul><ul><li>Altered bowel habits </li></ul></ul><ul><ul><li>Bloating </li></ul></ul><ul><li>Not explained by structural or biochemical abnormalities </li></ul>
  3. 3. IBS Clinical Subgroups <ul><li>Constipation predominant </li></ul><ul><li>Diarrhea predominant </li></ul><ul><li>Alternating constipation/diarrhea </li></ul>
  4. 4. IBS Clinical Subgroups <ul><li>Constipation predominant </li></ul><ul><li>Diarrhea predominant </li></ul><ul><li>Alternating constipation/diarrhea </li></ul>
  5. 5. Rome II Criteria for IBS <ul><li>At least 12 weeks or more, which need not be </li></ul><ul><li>consecutive, in the preceding 12 months, of </li></ul><ul><li>abdominal discomfort or pain that has 2 out </li></ul><ul><li>of 3 features: </li></ul><ul><li>Relieved by defecation </li></ul><ul><li>Onset associated with a change in frequency of stool </li></ul><ul><li>Onset associated with a change in form (appearance) of stool </li></ul>Gut . 1999.
  6. 6. Epidemiology of IBS in US (15% to 20% of Population) Specialists 5% 25% to 50% of referrals to GIs are IBS Nonconsulters 80% Primary care 15%
  7. 7. Prevalence of Disorders in US <ul><li>IBS: 15% - 20% </li></ul><ul><li>Dyspepsia: 8% </li></ul><ul><li>GE reflux: 7% </li></ul><ul><li>Asthma: 4% </li></ul><ul><li>Diabetes: 3% </li></ul>
  8. 8. IBS Symptoms Reduce Patient Well Being Reduced sense of well being Abdominal pain Altered bowel habits Cramps Bloating Constipation Diarrhea Urgency
  9. 9. Medical Costs Associated With IBS <ul><li>Estimated $8 billion annually in direct costs </li></ul><ul><li>Increased physician visits for both GI and non-GI complaints </li></ul><ul><li>IBS patients incur 74% more health care costs than do non-IBS sufferers </li></ul>Drossman, et al. Dig Dis Sci . 1993;38(9):1569-1580. Talley, et al. Gastroenterology . 1995;109(6):1736-1741.
  10. 10. Impact of IBS on Work <ul><li>Missed work: 30% (1.7 days) </li></ul><ul><li>Reduced days: 46% (3 days) </li></ul><ul><li>Turned down promotion: 16% </li></ul><ul><li>Changed job, health reasons: 9% </li></ul><ul><li>Changed work schedule: 8% </li></ul>Hahn BA, et al. Digestion . 1999;60(1):77-81.
  11. 11. Pathophysiology of IBS: A Biopsychosocial Disorder <ul><li>Biological </li></ul><ul><ul><li>Altered GI motor activity </li></ul></ul><ul><ul><li>Altered visceral sensation </li></ul></ul><ul><li>Psychosocial </li></ul><ul><ul><li>Behavioral </li></ul></ul><ul><ul><li>Cognitive </li></ul></ul><ul><ul><li>Emotional </li></ul></ul>
  12. 12. Multiple Medications Are Used to Treat IBS <ul><li>Anticholinergics </li></ul><ul><li>Tricyclic antidepressants </li></ul><ul><li>SSRIs </li></ul><ul><li>Antidiarrheals </li></ul><ul><li>Bulking agents </li></ul><ul><li>Laxatives </li></ul><ul><li>Alosetron* </li></ul>*Data support efficacy for diarrhea-predominant IBS.
  13. 13. New Treatment Paradigm for C-IBS IO 5-HT 4 agonists Altered motility Altered sensation

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