1. Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder that affects 10-22% of the population. It is characterized by abdominal pain and changes in bowel habits without any underlying structural or biochemical abnormalities. 2. Management of IBS focuses on lifestyle modifications, diet changes, stress reduction techniques, and symptom-targeted medications. Dietary triggers like caffeine, alcohol, dairy, and fatty or gas-producing foods should be avoided. Bulk-forming fibers can help constipation, while antidiarrheals may relieve diarrhea. 3. Evaluation involves a careful history, physical exam, and initial labs as warranted. Colonoscopy is recommended if red flags are present. While there are no

1. Irritable bowel syndrome = IRS Functional disorders
See also : placebo effect
Further reading : http://www.diseasesdatabase.com/result.asp?glngUserCho
ice=1645&bytRel=26&blnBW=255&strBB=LR&blnClassSort=
http://emedicine.medscape.com/article/180389-overview 0
Tenesmus = Painful spasm of the anal sphincter
along with an urgent desire to defecate without the
significant production of feces; associated with irritable
bowel syndrome
http://www.gpnotebook.co.uk/simplepage.cfm?ID=-
181075954

2. 4. Risk Factors: Psychosocial
1. Anxiety
2. Major Depression
3. Somatization Disorder
4. Sexual abuse or physical abuse
5. Stressful life events
6. Substance Abuse
5. Types
1. Alternating Diarrhea and Constipation
2. Nervous Diarrhea
3. Predominant Constipation
4. Upper abdominal bloating and discomfort
6. Symptoms
1. ALTERED BOWEL HABITS
1. Diarrhea
2. Constipation
3. Scybalous stools
Irritable Bowel Syndrome
1. Epidemiology
1. Lifetime Prevalence: 10-22% 2. RECURRENT AND CHRONIC ABDOMINAL
2. Slightly more common in women PAIN
3. Prevalence for elderly same as for young 1. Upper abdominal discomfort after
4. MOST COMMON CONDITION SEEN BY eating
GASTROENTEROLOGISTS 2. Left Lower Quadrant Abdominal Pain
3. Right Lower Quadrant Abdominal Pain
4. ABDOMINAL PAIN RELIEVED
WITH DEFECATION
2. Pathophysiology
1. Organic gastrointestinal hypersensitivity
2. Provoked by psychosocial risk factors
3. Gaseousness
3. SEVERE GASTROENTERITIS EPISODE MAY BE
1. Excessive Flatulence or Eructation
ASSOCIATED
2. Normal patients experience about 13 farts
per day
3. Associated Conditions
1. Gastroesophageal Reflux Disease 4. Nausea or Vomiting
2. Dysphagia
3. Globus Hystericus
4. Fatigue
5. Non-cardiac Chest Pain
6. Urologic dysfunction
7. Gynecologic disease (e.g. Chronic Pelvic Pain)
8. Fibromyalgia
9. Chronic Fatigue Syndrome
10. Temperomandibular joint syndrome
11. Food Allergy
12. Low-fiber diet

3. 7. Diagnosis: Rome Criteria 9. Red Flags: Symptoms and signs
1. ABDOMINAL SYMPTOMS PERSISTENT OR suggestive of other diagnosis
RECURRENT FOR 3 MONTHS 1. Nighttime Diarrhea
1. Abdominal Pain or discomfort 2. Nocturnal stool Incontinence
2. Symptoms relieved with Defecation 3. Nocturnal awakening due to abdominal discomfort
3. Irregular pattern of Defecation (>25% of 4. Abdominal Pain that interferes with normal sleep
time) 5. Visible or occult blood in stool
1. Change in stool frequency 6. Weight loss
2. Change in stool consistency
7. Recurrent Fever
8. Family History of Colon Cancer
9. Family History of Inflammatory Bowel Disease
10. Elderly
2. TWO OR MORE BELOW (ONE QUARTER OF
DAYS)
1. Altered stool frequency
2. Altered stool consistency 11. LABORATORY ABNORMALITY
1. Constipation 1. Leukocytosis
2. Diarrhea 2. Anemia
3. Increased Erythrocyte Sedimentation
Rate (ESR)
3. ALTERED STOOL PASSAGE
1. Straining for normal
consistency stool
2. Urgency of Defecation
3. Incomplete evacuation
4. MUCUS IN STOOLS
5. ABDOMINAL BLOATING OR
DISTENTION
8. Diagnosis: Manning Criteria
1. Abdominal Pain
2. Loose stools
3. Increased stool frequency
4. ABDOMINAL PAIN RELIEVED
WITH DEFECATION
5. Abdominal distention
6. Mucus in stools
7. Sensation of incomplete evacuation

4. 10.Differential Diagnosis 11. Psychiatric illness
1. COLONIC ADENOCARCINOMA 1. Depression
2. Somatization
3. Anxiety Disorder or Panic Disorder
2. INFLAMMATORY BOWEL DISEASE
1. Ulcerative Colitis
2. Crohn's Disease 12. Medications
1. Laxatives
2. Constipating medications
3. Abdominal Angina (Ischemic colitis)
4. Pseudo-obstruction (Diabetes
Mellitus, Scleroderma)
5. Intermittent sigmoid volvulus
6. Toxic Megacolon or bacterial overgrowth
syndrome
7. Endocrine causes
1. Hypothyroidism
or Hyperthyroidism
2. Diabetes Mellitus
3. Addison's Disease
8. Malabsorption
1. Celiac Sprue (strongly consider
if Diarrhea with red flags)
2. Lactose Intolerance
3. Pancreatic insufficiency
9. Giardiasis
10. Endometriosis

5. 11.Evaluation 12.Labs: Initial, based on predominant
1. General symptom
1. Avoid a piecemeal work-up 1. CONSTIPATION DOMINANT
1. Perform a complete 1. Complete Blood Count (CBC)
evaluation the first time 2. Serum Electrolytes or Chemistry panel
2. Avoid over-investigation (chem8)
3. Thyroid Stimulating Hormone (TSH)
4. Flexible Sigmoidoscopy or Colonoscopy
2. IRRITABLE BOWEL IS NO LONGER
DIAGNOSIS OF EXCLUSION 2. DIARRHEA PREDOMINANT
1. Diagnostic criteria above 1. Stool Ova and Parasites
are sufficient to treat 2. Fecal Leukocytes
3. Complete Blood Count (CBC)
4. Serum Electrolytes or chemistry panel
3. INDICATIONS FOR FULL 5. Thyroid Stimulating Hormone (TSH)
EVALUATION AND 6. Erythrocyte Sedimentation Rate (ESR)
GASTROENTEROLOGY 7. Flexible Sigmoidoscopy or Colonoscopy
1. Red flags present (see
above) or 8. Celiac Sprue (Transglutaminase,
2. Onset over age 50 years endomysial Antibody)
1. Usually associated with red
flag signs or symptoms
2. CAREFUL HISTORY
1. History of Gastrointestinal Symptoms
2. Family History of gastrointestinal disease
3. Marital History 3. PAIN DOMINANT
4. Sexual Abuse (strong correlation) 1. Complete Blood Count (CBC)
3. REASONABLE EXAM 4. Reference
1. Thorough abdominal examination
2. Also focus on possible endocrine 1. Fass (2001) Arch Intern Med
causes 161:2081
4. LOOK FOR FOOD INTOLERANCE
1. Lactose Intolerance
2. Sorbitol
3. Wheat (Gluten Sensitive Enteropathy)

6. 13.Diagnostic studies 7. Avoid Artificial Sweeteners
(fructose)
1. Flexible Sigmoidoscopy 8. Avoid Fatty meals
1. More uncomfortable in Irritable 9. Corn, wheat and citrus may
Bowel Syndrome also exacerbate IBS
2. Consider additional studies as indicated 5. AVOID PROVOCATIVE OR ADDICTIVE
1. Upper GI Study
MEDICATIONS
2. Barium Enema
1. Stimulant Laxatives (except brief
use)
1. CORRECTOL
2. DULCOLAX
3. CASCARA
14.Management: General Measure
1. SEE THE PATIENT FREQUENTLY
1. Maintain a strong doctor-patient 2. SEDATIVES OR TRANQUILIZERS
relationship (BENZODIAZEPINES)
2. Offer frequent reassurance
3. Identify and treat emotional stressors
4. Answer patients questions in unhurried
environment
3. NARCOTICS
2. DO NOT DOWNPLAY SYMPTOMS AS
PSYCHIATRIC
1. Irritable Bowel is a real functional bowel
problem
2. Explain physiology and absence of
serious illness
3. REDUCE STRESSORS
1. Teach relaxation techniques
2. Teach coping mechanisms for chronic
illness
4. GENERAL DIET RECOMMENDATIONS
1. Get adequate fluid intake (>64
ounces/day)
2. Bulk agents (gradually increase)
1. METAMUCIL
2. CITRUCEL
3. High fiber-bran
3. Consider avoiding provocative
agents
1. Consider Elimination Diet
2. Avoid caffeine
3. Avoid Alcohol
4. Avoid Legumes and other
gas producing foods
5. Avoid Dairy products
(lactose)
6. Avoid carbonated
beverages (Sorbitol)

7. 3. DICYCLOMINE (Bentyl) 10-20
mg, 15 min before meal
4. HYOSCYAMINE (Levsin) 0.125 to
15.Management: Symptom specific 0.25 mg before meal
medications
1. DIARRHEA
1. Consider eliminating lactose, caffeine
from diet 4. CONSTIPATION
2. CHOLESTYRAMINE 4 grams qhs to 6 1. Use gastro-colic response
times daily
3. LOPERAMIDE (Imodium) 2-4 mg qid prn
1. Wake-up, eat breakfast
1. Before meals and anticipate stool in AM
2. As needed in stressful social
situations
4. ONDANSETRON (Serotonin antagonist)
1. Reduces rapid transit
5. ALOSETRON (LOTRONEX) 2. FIRST LINE: BULK AGENTS (E.G.
1. Risk of Constipation and FIBER, PSYLLIUM, BRAN)
ischemic colitis 1. Titrate to 20-30 grams per day
1. Iatrogenic deaths have 2. Risk of bloating initially
occured
2. Black box warning:
Signed informed
consent needed
2. FDA approved only for women 3. SECOND LINE (USE AT BEDTIME
with IBS with Diarrhea FOR AM STOOL)
3. Dose: 1 mg daily (may advance
1. Osmotic agents
to bid)
1. LACTULOSE 1-2
6. PEPPERMINT
teaspoons at bedtime
1. Pittler (1998) Am J 2. POLYETHYLENE
Gastroenterol 93:1131 GLYCOL solution 8
ounces at bedtime
3. MILK OF
MAGNESIA 1-2
tablespoons at
2. COMORBID MOOD DISORDERS bedtime
1. Major Depression 4. MIRALAX
1. SSRI MEDICATIONS OR
OTHER ANTIDEPRESSANTS
2. Anxiety
1. BUSPAR
2. AMITRIPTYLINE (ELAVIL) 2. Consider Stimulant
Laxatives if osmotic agents
fail
1. Senna or Cascara
3. PAIN DOMINANT SYMPTOMS 2. Bisacodyl
1. CHRONIC PAIN
1. AMITRIPTYLINE (Elavil) 25
mg qhs
2. DESIPRAMINE (Norpramin)
50 mg tid 4. THIRD LINE (PRESCRIPTION
3. Tegaserod (Zelnorm) AGENTS)
1. Nyhlin (2004) Scand
1. Amitiza (LUBIPROSTONE)
J Gastroenterol
39:119 5. RESTRICTED USE AGENT
4. SSRI medications may be (EMERGENCY USE ONLY DUE TO
effective as adjunct RISK)
1. Tabas (2004) Am J 1. TEGASEROD (Zelnorm): 5-
Gastroenterol 99:914 HT4 agonist
1. Dose: 6 mg bid 30
minutes before meals
2. POST-PRANDIAL PAIN:
ANTICHOLINERGIC
1. Avoid chronic use 6. OTHER AGENTS POTENTIALLY
2. Trial for 2 weeks and stop if no USEFUL
effect 1. Guar-Gum

8. 1. Parisi (2002) Dig Dis Sci
47:1696
2. Peppermint
1. Pittler (1998) Am J
Gastroenterol 93:1131
3. LOXIGLUMIDE
(CHOLECYSTOKININ-A
RECEPTOR ANTAGONIST)
5. EXCESSIVE FLATUS (GAS)
1. SIMETHICONE 40 to 125 mg up to qid
2. BETA-GALACTOSIDASE (Beano)
16.Resources
1. International Foundation for Functional GI
Disorders
1. http://www.iffgd.org
2. American College of Gastroenterology
1. http://www.ACG.GI.org
3. Mind-Body Digestive Center
1. http://www.mindbodydigestive.com
17.References
1. Camilleri (2000) Gastroenterology 120:652
2. Camilleri (1999) Am J Med 107(5A):27F
3. Chang (2006) Curr Treat Options Gastroenterol
9(4):314
4. Drossman (1999) Am J Med 107(5A):41S
5. Hammer (1999) Am J Med 107(5A):5S
6. Heymann-Monnikes (2000) Am J Gastroenterol
95:981
7. Holten (2003) Am Fam Physician 67(10):2157
8. Jailwala (2000) Ann Intern Med 133:136
9. Mertz (2003) N Engl J Med 349:2136
10. Naliboff (1999) Curr Rev Pain 3:144
11. Ringel (2001) Annu Rev Med 52:319
12. Viera (2002) Am Fam Physician 66:1867

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Irritable Bowel
Overview Search Term: Irritable Bowel (disease: Irritable bowel syndrome)
Overview Print page
RESEARCH
A disorder with chronic or recurrent colonic symptoms without a clearcut etiology. This condition is
Data Correlations characterized by chronic or recurrent ABDOMINAL PAIN, bloating, MUCUS in FECES, and an erratic
disturbance of DEFECATION.
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Individual Studies
Ulcerative colitis Jejunum from diarrhea-IBS patients and
healthy individuals
Homo sapiens | RNA Expression
IBS: Patients who have undergone a diagnostic Homo sapiens | RNA Expression
program for gastrointestinal symptoms and where Comparison of gene expression profile of
the diagnosis irritable bowel syndrome was diarrhea-irritable bowel syndrome patients and
reached. healthy volunteers.
Authors: Seidelin JB, Hansen M, Kirkeby LT Authors: Martinez C, Santos J
et al. Organization: Institut de Recerca HUVH
Organization: University of Copenhagen Digestive disea…
Department of M…
View All Individual Studies
Literature | 6,617 results View All Clinical Trials | 347 trials
View All
Postinfectious irritable bowel
syndrome. A Study to Evaluate the Safety,
Authors: Robin Spiller, Klara Garsed Tolerability and Pharmacodynamics of
Gastroenterology 2009 May DDP733 for IBS-c
conditions: Irritable Bowel Syndrome With
Lactobacillus acidophilus modulates Constipation ; Irritable Bowel Syndrome
intestinal pain and induces opioid and interventions: DDP733
cannabinoid receptors.
Authors: Christel Rousseaux, Xavier
Acupuncture for Irritable Bowel
Thuru, Agathe Gelot, Nicolas Barnich,
Christel Neut, Laurent Dubuquoy, Syndrome
Caroline Dubuquoy, Emilie Merour, Karen conditions: Irritable Bowel Syndrome
Geboes, Mathias Chamaillard,… interventions: Acupuncture
Nature medicine 2007 Jan
Associated Researchers News | 5 stories View All
Thought leaders and organizations working
on research involving Irritable Bowel. Irritable Bowel Syndrome Can Have Genetic
Causes
Authors View All Medical News Today.
Nicholas J Talley Peter J Whorwell
It's Worth The Risk To Get Relief, IBS Patients
Lesley A Houghton Eamonn M M Say In New Study
Quigley Medical News Today. - May 06, 2009
Michael Camilleri

10. Clinical Trials Sponsors View All
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Medicine (NCCAM) Irene Gabashvili
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Sigmoid Volvulus
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Search
Sigmoid volvulus occurs when the last part of the large bowel
just before the rectum (the sigmoid shaped sigmoid colon)
Treatment for
twists on its self.
Anorexia
It is by far the most common type of volvulus, accounting for Leading Rehab in
75 to 90 % of all volvulus. South Africa.
Professional
Sigmoid volvulus accounts for up to 8 % of all cases of Residential Care.
intestinal obstruction. It is commoner in the elderly, patients MontroseManor.co.za/Anorexi
with chronic illnesses, those in long term institutions like
nursing homes, and patients with mental illness. Free Swine Flu
Report
The use of anti-psychotic medications which often have anti- What You Need to
cholinergic constipatory effect has been blamed for the Know Before You Get
increased incidence of sigmoid volvulus in the later sets of a Swine Flu Shot.
patients. www.AlSearsMD.com
It can also been seen in children under the age of ten. Men are Deep Vein
more often affected than women. Thrombosis
A resource for
Common to all patients with this condition is chronic physicians and
constipation, which leads to a long redundant sigmoid colon patients about
with narrowing of the mesentery (the part where blood vessels thrombosis!
pass in to reach the gut). www.Thrombosisadviser.com
Osteoarthritis pain
Volvulus of the sigmoid colon is commoner in Africans, Asians,
relief
and South Americans. This has been attributed to their
Answers to your
consumption of high roughage diet. This in it self offers
questions about
protection against many bowel disorders including constipation.
Osteoarthritis, joint
There is a common type of sigmoid volvulus almost restricted pain & more!
yourtotalhealth.ivillage.com
to those of African descent called ileo-sigmoid knoting, and
affects even young adults. 1 Tip of a flat belly :
Cut down 1 Kilo of
In parts of the world with round worm infestation, a heavy load
your belly every day
of worm has been associated with sigmoid volvulus in young
by using this 1 weird
persons.
old tip.
Everyotherdaydiet.com
This is also true in South American Countries like Brazil where
acquired Mega colon diseases of the large bowel lead to sigmoid
volvulus.
How to Recognise Volvulus of the Sigmoid Colon
Volvulus affecting the sigmoid colon will cause a cramping left lower abdominal pain, with associated
distension, complete failure to open the bowel (obstipation), and there may be nausea.
Vomiting is usually a very late sign. Fever may occur, especially if the blood supply
to that part of the gut is affected, and there is perforation of the bowel.
Diagnosed with
Leukaemia?
Tests Available University researched
guide for patients and
Doctors may wish to do a combination of the following investigations to confirm
families. Order Here
the presence of a sigmoid volvulus: www.ipp-shr.cqu.edu.au/book
X-RAY 1 Tip of a Flat Belly

12. :
A normal plain abdominal x-ray will demonstrate a huge air filled distended bowel
Cut down 3 lbs of
like the shape of an inverted U, with the convexity of the U facing the right upper
your belly every week
abdominal quadrant. This shape has been described as the kidney bean shape,
by using this 1 weird
coffee bean shape, bent inner tube shape, ace of spades or ‘Omega loop Sign’. You
tip.
can see an example down in the resource section.
FatBurningFurnace.com
BARIUM ENEMA
Cerebral Palsy
With a water soluble barium enema, the dilatation in the sigmoid colon can be Therapy
demonstrated to be due to a twist, as it will show an area of complete obstruction Cerebral Palsy
with some twisting in the so called bird beak or bird of prey sign. treatment for children
and adults
Colonoscopy could be done in rare cases, which would help to confirm diagnosis, as www.CP-Hotline.com
well as treating the obstruction.
Treatment of
Osteoporosis
Treatment Many helpful
information and tips
Once the diagnosis of sigmoid volvulus is confirmed, treatment must be immediate, for affected women.
as delay means more likelihood of bowel wall death and gangrene. Find out more
www.osteoporosis-disease.eu
Up to 80% of people with this condition die from gangrene if intervention is
delayed. Fast Kidney Stone
Relief
There are two approaches to treatment. The first step is to free the acute All Natural, Safe &
obstruction, and then to fix the redundant part of the bowel in a bid to reduce or Effective Disintegrates
defer re-occurrence. Stone Within Days
www.kidneysite.com
In the UK, a rigid sigmoidoscope is often passed into the sigmoid colon through the
anus under direct vision.
Once the junction between the rectum and sigmoid is negotiated and passed, it could open up the
obstruction, letting off the trapped wind in the twisted bowel.
This is followed by spontaneous unwinding of the obstruction, with massive explosion of faeces to the
exterior. A flatus tube is then left in place.
The patient may need fluid replacement, and resuscitation if severely dehydrated, if signs of infection have
set in.
If there is evidence suggestive of perforation, then the abdomen is opened and dealt with.
In up to 90% of patients with sigmoid volvulus, the condition reoccurs after untwisting, without a definitive
operation. For this reason, any one with a sigmoid volvulus would need to be operated during the same
admission if fit enough, to fix down the excessive bowel length.
Prevention
Prevention of volvulus is basically a matter of preventing chronic constipation.
A diet too high in high fibre diet would lead to elongation of the bowel, and large redundant sigmoid or
mega colon.
Other causes of mega colon include diabetes mellitus, celiac sprue, low potassium levels in the blood for a
long time, and excessive use of laxatives.
Please see more resources on sigmoid volvulus below:
Additional Resources for Gastric Volvulus
Great Books on Volvulus
Picture of Sigmoid Volvulus
Gastric Volvulus
Intestinal Volvulus
Caecal Volvulus
Transverse Volvulus

13. Recipe for Great Healthy Meals
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14. Abdominal angina
From Wikipedia, the free encyclopedia
Abdominal angina is postprandial abdominal pain that occurs in Abdominal angina (bowelgina)
individuals with insufficient blood flow to meet mesenteric visceral
demands.[1] The term angina is used in reference to angina pectoris, a ICD-10 K55.
similar symptom due to obstruction of the coronary artery. The American ICD-9 557.1
Heritage Stedman's Medical Dictionary defines abdominal angina as
"Intermittent abdominal pain, frequently occurring at a fixed time after
eating, caused by inadequacy of the mesenteric circulation. Also called intestinal angina."
Contents
 1 Pathophysiology
 2 Frequency
 3 Clinical
 4 Treatment
 5 See also
 6 References
Pathophysiology
The pathophysiology is similar to that seen in angina pectoris and intermittent claudication. The most common cause of
abdominal angina is atherosclerotic vascular disease, where the occlusive process commonly involves the ostia and the
proximal few centimeters of the mesenteric vessels. It can be associated with:
 carcinoid[2]
 aortic coarctation[3]
 antiphospholipid syndrome[4]
Frequency
 Internationally: Extremely rare. True incidence is unknown
 Race: No data available
 Sex: Females outnumber males by approximately 3 to 1
 Age: Mean age of affected individuals is slightly older than 60 years
Clinical
 Hallmark of condition: Disabling midepigastric or central abdominal pain within 10–15 minutes after eating.
 Physical examination: The abdomen typically is scaphoid and soft, even during an episode of pain. Patients present with
stigmata of weight loss and signs of peripheral vascular disease, particularly aortoiliac occlusive disease, may be present.
 Causes: Smoking is an associated risk factor. In most series, approximately 75-80% of patients smoke.
Treatment
Stents have been used in the treatment of abdominal angina.[5][6]
See also

15.  Abdominal pain
 Ischemic colitis
References
1. ^ Kapadia S, Parakh R, Grover T, Agarwal S (2005). "Side-to-side aorto-mesenteric anastomosis for management of abdominal
angina". Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology 24 (6): 256–7. PMID
16424623.
2. ^ deVries H, Wijffels RT, Willemse PH, et al. (2005). "Abdominal angina in patients with a midgut carcinoid, a sign of severe
pathology". World journal of surgery 29 (9): 1139–42. doi:10.1007/s00268-005-7825-x. PMID 16086212.
3. ^ Ingu A, Morikawa M, Fuse S, Abe T (2003). "Acute occlusion of a simple aortic coarctation presenting as abdominal angina".
Pediatric cardiology 24 (5): 488–9. doi:10.1007/s00246-002-0381-3. PMID 14627320.
4. ^ Choi BG, Jeon HS, Lee SO, Yoo WH, Lee ST, Ahn DS (2002). "Primary antiphospholipid syndrome presenting with abdominal
angina and splenic infarction". Rheumatol. Int. 22 (3): 119–21. doi:10.1007/s00296-002-0196-9. PMID 12111088.
5. ^ Senechal Q, Massoni JM, Laurian C, Pernes JM (2001). "Transient relief of abdominal angina by Wallstent placement into an
occluded superior mesenteric artery". The Journal of cardiovascular surgery 42 (1): 101–5. PMID 11292915.
6. ^ Busquet J (1997). "Intravascular stenting in the superior mesenteric artery for chronic abdominal angina". Journal of endovascular
surgery : the official journal of the International Society for Endovascular Surgery 4 (4): 380–4. PMID 9418203.
Retrieved from "http://en.wikipedia.org/wiki/Abdominal_angina"
Categories: Pain
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