Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Irritable Bowel Syndrome: An Update in Pathophysiology and Management Monkez M Yousif
Irritable bowel syndrome is the commonest health problem in hospital outpatient clinics and in private health care facilities and represents a big challenge for patients and physicians. This presentation discusses a different aspect of the disease from pathophysiology, clinical presentation and management
This document discusses irritable bowel syndrome (IBS), defining it as a functional bowel disorder characterized by abdominal pain or discomfort along with changes in bowel habits without any detectable structural abnormality. The prevalence of IBS is 10-20% of the population, more common in females. Potential causes include altered gut motility, visceral hypersensitivity, gut-brain interaction disturbances, and environmental and psychological factors. Diagnosis is based on clinical criteria such as recurrent abdominal pain relieved by defecation and changes in stool frequency or form. Treatment focuses on lifestyle modifications, antispasmodics, antidepressants, and probiotics.
Irritable Bowel Syndrome Part 1 - Dr Vivek BaligaDr Vivek Baliga
In this presentation, Dr Vivek Baliga discusses the important aspects of irritable bowel syndrome - a common medical problem in clinical practice. For more articles, visit http://baligadiagnostics.com/author/drbvb/
Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by abdominal pain and altered bowel habits without any organic cause. It affects 3-22% of the population worldwide. While the exact cause is unclear, it is believed to involve altered gut motility, hypersensitivity, and psychosocial factors. Diagnosis is made based on symptoms according to the Rome criteria and excludes other conditions. Treatment involves dietary modifications, medications to target predominant symptoms such as fiber for constipation or alosetron for diarrhea, and treatment of accompanying psychiatric conditions like anxiety or depression.
This document discusses irritable bowel syndrome (IBS). It begins by defining IBS as a functional disorder of the large intestine that causes abdominal pain and changes in bowel movements. The document then outlines the pathophysiology, diagnosis, clinical presentation and epidemiology of IBS. It describes the different IBS subtypes and reviews non-pharmacological and pharmacological treatment options for managing symptoms of constipation, diarrhea and abdominal pain associated with IBS. The document concludes by summarizing several studies on probiotic therapy for improving IBS symptoms.
Irritable bowel syndrome - diagnosis, pathophysiology and pharmacologySIVASWAROOP YARASI
irritable bowel syndrome (IBS) is a common disorder that affects the large intestine. Signs and symptoms include cramping, abdominal pain, bloating, gas, and diarrhoea or constipation, or both. IBS is a chronic condition that you'll need to manage long term.
an over view of IBS in the general population, talks about aetiology pathology clinical features and diagnosis with special reference to the ROME criteria and the differences between ROME II and III.
Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain or discomfort associated with changes in bowel habits. IBS has no identifiable organic cause and is diagnosed based on symptom criteria. While IBS negatively impacts quality of life, it does not increase risk of serious disease or mortality. Potential contributing factors include abnormal gut motility, visceral hypersensitivity, disturbed pain processing, and psychiatric comorbidities like anxiety and depression. Differential diagnoses that require exclusion include inflammatory bowel disease, celiac disease, and colon cancer. All IBS patients should undergo basic blood tests and stool tests to rule out other conditions.
Irritable Bowel Syndrome: An Update in Pathophysiology and Management Monkez M Yousif
Irritable bowel syndrome is the commonest health problem in hospital outpatient clinics and in private health care facilities and represents a big challenge for patients and physicians. This presentation discusses a different aspect of the disease from pathophysiology, clinical presentation and management
This document discusses irritable bowel syndrome (IBS), defining it as a functional bowel disorder characterized by abdominal pain or discomfort along with changes in bowel habits without any detectable structural abnormality. The prevalence of IBS is 10-20% of the population, more common in females. Potential causes include altered gut motility, visceral hypersensitivity, gut-brain interaction disturbances, and environmental and psychological factors. Diagnosis is based on clinical criteria such as recurrent abdominal pain relieved by defecation and changes in stool frequency or form. Treatment focuses on lifestyle modifications, antispasmodics, antidepressants, and probiotics.
Irritable Bowel Syndrome Part 1 - Dr Vivek BaligaDr Vivek Baliga
In this presentation, Dr Vivek Baliga discusses the important aspects of irritable bowel syndrome - a common medical problem in clinical practice. For more articles, visit http://baligadiagnostics.com/author/drbvb/
Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by abdominal pain and altered bowel habits without any organic cause. It affects 3-22% of the population worldwide. While the exact cause is unclear, it is believed to involve altered gut motility, hypersensitivity, and psychosocial factors. Diagnosis is made based on symptoms according to the Rome criteria and excludes other conditions. Treatment involves dietary modifications, medications to target predominant symptoms such as fiber for constipation or alosetron for diarrhea, and treatment of accompanying psychiatric conditions like anxiety or depression.
This document discusses irritable bowel syndrome (IBS). It begins by defining IBS as a functional disorder of the large intestine that causes abdominal pain and changes in bowel movements. The document then outlines the pathophysiology, diagnosis, clinical presentation and epidemiology of IBS. It describes the different IBS subtypes and reviews non-pharmacological and pharmacological treatment options for managing symptoms of constipation, diarrhea and abdominal pain associated with IBS. The document concludes by summarizing several studies on probiotic therapy for improving IBS symptoms.
Irritable bowel syndrome - diagnosis, pathophysiology and pharmacologySIVASWAROOP YARASI
irritable bowel syndrome (IBS) is a common disorder that affects the large intestine. Signs and symptoms include cramping, abdominal pain, bloating, gas, and diarrhoea or constipation, or both. IBS is a chronic condition that you'll need to manage long term.
an over view of IBS in the general population, talks about aetiology pathology clinical features and diagnosis with special reference to the ROME criteria and the differences between ROME II and III.
Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain or discomfort associated with changes in bowel habits. IBS has no identifiable organic cause and is diagnosed based on symptom criteria. While IBS negatively impacts quality of life, it does not increase risk of serious disease or mortality. Potential contributing factors include abnormal gut motility, visceral hypersensitivity, disturbed pain processing, and psychiatric comorbidities like anxiety and depression. Differential diagnoses that require exclusion include inflammatory bowel disease, celiac disease, and colon cancer. All IBS patients should undergo basic blood tests and stool tests to rule out other conditions.
Irritable bowel syndrome is a common condition affecting the digestive system.
Symptoms of irritable bowel syndrome include stomach cramps, bloating, diarrhoea and constipation. These may come and go over time.
Making changes to your diet and lifestyle, like avoiding things that trigger your symptoms, can help ease irritable bowel syndrome.
Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder defined by abdominal pain associated with changes in bowel habits. IBS prevalence ranges from 3-20% worldwide and is more common in younger individuals and women. IBS has subtypes including constipation-predominant, diarrhea-predominant, and mixed-type based on stool consistency. The pathophysiology of IBS involves abnormal gut motility, visceral hypersensitivity, brain-gut axis dysregulation, and abnormal chemical signaling. Treatment focuses on diet, medication to relieve symptoms, and psychological therapies depending on the individual's dominant symptoms and severity.
This document provides an overview of irritable bowel syndrome (IBS), including its definition, prevalence, demographics, pathophysiology, clinical features, diagnosis, differential diagnosis, severity assessment, management, and prognosis. Some key points are:
- IBS is a functional bowel disorder characterized by abdominal pain associated with changes in bowel habits. It predominantly affects those aged 15-65 and is more common in women.
- The pathophysiology involves altered gut motility, visceral hypersensitivity, abnormal gas handling, low-grade inflammation, food sensitivities, abnormal gut microbiota, and central nervous system dysregulation.
- Diagnosis is based on symptoms meeting certain criteria and exclusion of organic diseases. Management focuses on
- IBS is a functional disorder of the colon that causes abdominal pain, bloating, and changes in bowel habits like diarrhea and constipation. It is more common in women and is diagnosed based on symptoms.
- The colon's contractions can be abnormal in IBS, affecting how contents move through the colon. Common causes include changes in the nervous system, diet, stress, and imbalances in neurotransmitters like serotonin.
- Symptoms include abdominal pain or discomfort and changes in bowel movements. Treatment focuses on lifestyle changes, medications to relieve symptoms, probiotics, and stress management. IBS does not lead to other diseases or harm the intestines.
IBS is a functional bowel disorder characterized by abdominal pain and altered bowel habits. It affects 5-10% of people in North America, predominantly women aged 20-39. The causes involve genetics, gut motility issues, hypersensitivity, and the brain-gut axis. Treatment focuses on symptom relief through diet, exercise, fiber, probiotics, antispasmodics, antidepressants, and 5-HT agonists/antagonists. Managing IBS can be challenging due to recurrent, resistant symptoms.
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits in the absence of any underlying organic cause. IBS affects 1-2% of the population annually and 10-20% of people overall. The main symptoms include changes in bowel movement frequency and consistency, abdominal pain, and bloating. IBS is diagnosed after ruling out other potential causes through medical history, examination, and basic blood tests and scans. Treatment involves lifestyle modifications like diet changes, stress management, exercise, as well as medications to relieve symptoms and psychological therapies for refractory cases. Patient education is key to successful long-term management of IBS.
This document summarizes recent advances in the diagnosis and treatment of gastroesophageal reflux disease (GERD). It discusses definitions, pathophysiology, epidemiology, clinical presentation, diagnostic tests including 24-hour pH monitoring and endoscopy, and treatment options including lifestyle modifications, medications like PPIs, and surgical procedures. Key recent advances mentioned include new diagnostic markers, multichannel intraluminal impedance pH monitoring, narrow-band imaging, and endoscopic assessment of mucosal impedance. Surgical treatments discussed are laparoscopic anti-reflux surgery and the Linx device, and recent studies comparing partial versus complete fundoplication and surgical versus medical therapy.
gutCARE IBS Talk on 20/5/2020.
In this talk, we update Singapore local epidemiology about increasing trend of IBS locally since 1998. There is also challenges in diagnosing IBS confidently in primary care due to patient presentation and symptoms.
We also update audience about latest diagnostic criteria for IBS.
New treatment for IBS, relationship between Small intestine bacterial overgrowth and IBS and the role of hydrogen breath testing in managing IBS.
We hope you enjoy the slides.
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation. Severe constipation includes obstipation (failure to pass stools or gas) and fecal impaction, which can progress to bowel obstruction and become life-threatening.
Constipation is a symptom with many causes. These causes are of two types: obstructed defecation and colonic slow transit (or hypo mobility). About 50 percent of people evaluated for constipation at tertiary referral hospitals have obstructed defecation. This type of constipation has mechanical and functional causes. Causes of colonic slow transit constipation include diet, hormonal disorders such as hypothyroidism, side effects of medications, and rarely heavy metal toxicity. Because constipation is a symptom, not a disease, effective treatment of constipation may require first determining the cause. Treatments include changes in dietary habits, laxatives, enemas, biofeedback, and in particular situations surgery may be required.
Constipation is common; in the general population rates of constipation varies from 2–30 percent. In elderly people living in care homes the rate of constipation is 50–75 percent.[4] In the United States expenditures on medications for constipation are greater than US$250 million per year.
The definition of constipation includes the following:
infrequent bowel movements (typically three times or fewer per week)
difficulty during defecation (straining during more than 25% of bowel movements or a subjective sensation of hard stools; straining in this context is a strong effort to push out stool often by holding one's breath and by pushing the respective muscles in the abdominal area hard), or
the sensation of incomplete bowel evacuation.
The Rome III criteria are widely used to diagnose chronic constipation, and are helpful in separating cases of chronic functional constipation from less-serious instances.
Another definition states that less than three bowel movements per week and straining on more than 75% of occasions represents constipation in clinical surveys.
This document provides information on irritable bowel syndrome (IBS), including its definition, epidemiology, etiology, clinical features, diagnosis, investigations, treatment, and prognosis. IBS is a functional bowel disorder characterized by abdominal pain or discomfort and altered bowel movements in the absence of structural abnormalities. It has a prevalence of 1-20% worldwide and is more common in women. The cause is uncertain but may involve GI motor abnormalities, visceral hypersensitivity, brain-gut axis dysregulation, and abnormal psychology. Diagnosis is based on symptoms and ruling out other diseases. Treatment involves diet modification, pharmacotherapy including antispasmodics, antidepressants, and probiotics, as well as psychological therapies like CBT.
This document provides information on Gastroesophageal Reflux Disease (GERD). It defines GERD as abnormal reflux of gastric contents into the esophagus causing troublesome symptoms or complications, with more than 2 heartburn episodes per week. Approximately 20% of adults experience frequent GERD symptoms. The document discusses the pathogenesis, risk factors, diagnosis and diagnostic tests, and treatment options for GERD including pharmacologic therapies, surgery, and endoscopic treatments. It provides details on classifications of esophagitis, guidelines for endoscopy and pH monitoring in GERD diagnosis and management.
This document discusses irritable bowel syndrome (IBS). It provides a brief history of IBS, discussing early descriptions of the condition from the 18th-19th centuries. It also covers the diagnosis of IBS, including the Rome criteria used to positively diagnose IBS based on symptoms. The pathophysiology of IBS is explored, noting enhanced perception, altered motility, and visceral hypersensitivity as factors. Quality of life impacts for patients with IBS are compared to other conditions like depression. Finally, treatment approaches are summarized, including patient education, dietary intervention, pharmacotherapy, psychotherapy, and hypnotherapy.
Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder characterized by abdominal pain and changes in bowel habits. The main symptoms are cramping, abdominal pain, bloating, gas, diarrhea and constipation. IBS has three subtypes based on predominant stool pattern: IBS with constipation, IBS with diarrhea, or IBS with mixed bowel habits. While the exact cause is uncertain, IBS involves abnormalities in gut motility and visceral sensitivity. Treatment involves lifestyle changes and medications to manage symptoms based on IBS subtype.
This document provides an overview of inflammatory bowel disease (IBD), focusing on Crohn's disease and ulcerative colitis. It discusses the anatomical distribution and prevalence of Crohn's, potential risk factors, pathogenesis involving immune dysregulation and tumor necrosis factor, and clinical presentations including abdominal pain, fistulas, and perianal disease. Diagnostic tests like bloodwork, imaging, and endoscopy are outlined. The document also reviews complications, medical treatments including aminosalicylates, corticosteroids, immunosuppressants, antibiotics, and biologicals. Surgical treatment and management of IBD are briefly discussed, as well as prognosis. Ulcerative colitis forms, features, and experience with IBD patients
Irritable bowel syndrome (IBS) is characterized by chronic abdominal pain or discomfort associated with changes in bowel habits. Common symptoms include abdominal discomfort relieved with defecation, changes in stool frequency or form. Treatment depends on whether constipation or diarrhea predominates, and may include increased fiber, bulk forming laxatives, antispasmodics, or anti-inflammatory drugs. While the cause is unknown, theories include altered stress responses, low-grade inflammation, and changes in gut microbiota. Diet modifications and lifestyle changes can help manage symptoms.
GERD is a common condition where stomach acid refluxes into the esophagus. It is classified into NERD (non-erosive reflux disease) and ERD (erosive reflux disease). Complications include esophagitis, peptic stricture, and Barrett's esophagus which increases cancer risk. Diagnosis involves symptom response to PPI trial or pH monitoring. Treatment begins with lifestyle changes and uses PPIs. New drugs under development target the proton pump or motility in novel ways. Surgery is an option for refractory or complicated cases.
This document discusses peptic ulcer disease (PUD), including its causes, types, symptoms, diagnosis, and treatment. PUD is characterized by erosion of the GI mucosa from stomach acid and pepsin. It commonly affects the lower esophagus, stomach, and duodenum. The two main types are gastric and duodenal ulcers. Symptoms include abdominal pain, nausea, and vomiting. Diagnosis involves endoscopy and tests for H. pylori bacteria. Treatment focuses on reducing stomach acid with PPIs or H2 blockers, eradicating H. pylori, and protecting the mucosa. Complications can include bleeding, perforation, and obstruction if not properly treated.
This document provides information about irritable bowel syndrome (IBS), including its pathophysiology, diagnosis, signs and symptoms, and treatment. IBS is classified as a functional disorder caused by altered gastrointestinal function rather than structural issues. It is related to visceral hypersensitivity and abnormal bowel motility. Diagnosis involves reviewing symptoms and ruling out other conditions through tests. Signs include abdominal pain, changes in bowel habits, bloating and gas. Treatment focuses on dietary changes like reducing trigger foods, stress management techniques, fiber intake, and medications in some cases.
This document discusses irritable bowel syndrome (IBS) and summarizes a case study of a 32-year-old female patient, Ms. Lee, experiencing IBS symptoms. It covers the evolving diagnostic criteria for IBS, potential treatments including lifestyle modifications, medications, probiotics, and the relationship between small intestinal bacterial overgrowth (SIBO) and IBS. Hydrogen breath testing is presented as a non-invasive way to diagnose SIBO, though it has limitations. The antibiotic rifaximin is introduced as a treatment option for patients who test positive for SIBO.
Irritable bowel syndrome is a common condition affecting the digestive system.
Symptoms of irritable bowel syndrome include stomach cramps, bloating, diarrhoea and constipation. These may come and go over time.
Making changes to your diet and lifestyle, like avoiding things that trigger your symptoms, can help ease irritable bowel syndrome.
Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder defined by abdominal pain associated with changes in bowel habits. IBS prevalence ranges from 3-20% worldwide and is more common in younger individuals and women. IBS has subtypes including constipation-predominant, diarrhea-predominant, and mixed-type based on stool consistency. The pathophysiology of IBS involves abnormal gut motility, visceral hypersensitivity, brain-gut axis dysregulation, and abnormal chemical signaling. Treatment focuses on diet, medication to relieve symptoms, and psychological therapies depending on the individual's dominant symptoms and severity.
This document provides an overview of irritable bowel syndrome (IBS), including its definition, prevalence, demographics, pathophysiology, clinical features, diagnosis, differential diagnosis, severity assessment, management, and prognosis. Some key points are:
- IBS is a functional bowel disorder characterized by abdominal pain associated with changes in bowel habits. It predominantly affects those aged 15-65 and is more common in women.
- The pathophysiology involves altered gut motility, visceral hypersensitivity, abnormal gas handling, low-grade inflammation, food sensitivities, abnormal gut microbiota, and central nervous system dysregulation.
- Diagnosis is based on symptoms meeting certain criteria and exclusion of organic diseases. Management focuses on
- IBS is a functional disorder of the colon that causes abdominal pain, bloating, and changes in bowel habits like diarrhea and constipation. It is more common in women and is diagnosed based on symptoms.
- The colon's contractions can be abnormal in IBS, affecting how contents move through the colon. Common causes include changes in the nervous system, diet, stress, and imbalances in neurotransmitters like serotonin.
- Symptoms include abdominal pain or discomfort and changes in bowel movements. Treatment focuses on lifestyle changes, medications to relieve symptoms, probiotics, and stress management. IBS does not lead to other diseases or harm the intestines.
IBS is a functional bowel disorder characterized by abdominal pain and altered bowel habits. It affects 5-10% of people in North America, predominantly women aged 20-39. The causes involve genetics, gut motility issues, hypersensitivity, and the brain-gut axis. Treatment focuses on symptom relief through diet, exercise, fiber, probiotics, antispasmodics, antidepressants, and 5-HT agonists/antagonists. Managing IBS can be challenging due to recurrent, resistant symptoms.
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits in the absence of any underlying organic cause. IBS affects 1-2% of the population annually and 10-20% of people overall. The main symptoms include changes in bowel movement frequency and consistency, abdominal pain, and bloating. IBS is diagnosed after ruling out other potential causes through medical history, examination, and basic blood tests and scans. Treatment involves lifestyle modifications like diet changes, stress management, exercise, as well as medications to relieve symptoms and psychological therapies for refractory cases. Patient education is key to successful long-term management of IBS.
This document summarizes recent advances in the diagnosis and treatment of gastroesophageal reflux disease (GERD). It discusses definitions, pathophysiology, epidemiology, clinical presentation, diagnostic tests including 24-hour pH monitoring and endoscopy, and treatment options including lifestyle modifications, medications like PPIs, and surgical procedures. Key recent advances mentioned include new diagnostic markers, multichannel intraluminal impedance pH monitoring, narrow-band imaging, and endoscopic assessment of mucosal impedance. Surgical treatments discussed are laparoscopic anti-reflux surgery and the Linx device, and recent studies comparing partial versus complete fundoplication and surgical versus medical therapy.
gutCARE IBS Talk on 20/5/2020.
In this talk, we update Singapore local epidemiology about increasing trend of IBS locally since 1998. There is also challenges in diagnosing IBS confidently in primary care due to patient presentation and symptoms.
We also update audience about latest diagnostic criteria for IBS.
New treatment for IBS, relationship between Small intestine bacterial overgrowth and IBS and the role of hydrogen breath testing in managing IBS.
We hope you enjoy the slides.
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation. Severe constipation includes obstipation (failure to pass stools or gas) and fecal impaction, which can progress to bowel obstruction and become life-threatening.
Constipation is a symptom with many causes. These causes are of two types: obstructed defecation and colonic slow transit (or hypo mobility). About 50 percent of people evaluated for constipation at tertiary referral hospitals have obstructed defecation. This type of constipation has mechanical and functional causes. Causes of colonic slow transit constipation include diet, hormonal disorders such as hypothyroidism, side effects of medications, and rarely heavy metal toxicity. Because constipation is a symptom, not a disease, effective treatment of constipation may require first determining the cause. Treatments include changes in dietary habits, laxatives, enemas, biofeedback, and in particular situations surgery may be required.
Constipation is common; in the general population rates of constipation varies from 2–30 percent. In elderly people living in care homes the rate of constipation is 50–75 percent.[4] In the United States expenditures on medications for constipation are greater than US$250 million per year.
The definition of constipation includes the following:
infrequent bowel movements (typically three times or fewer per week)
difficulty during defecation (straining during more than 25% of bowel movements or a subjective sensation of hard stools; straining in this context is a strong effort to push out stool often by holding one's breath and by pushing the respective muscles in the abdominal area hard), or
the sensation of incomplete bowel evacuation.
The Rome III criteria are widely used to diagnose chronic constipation, and are helpful in separating cases of chronic functional constipation from less-serious instances.
Another definition states that less than three bowel movements per week and straining on more than 75% of occasions represents constipation in clinical surveys.
This document provides information on irritable bowel syndrome (IBS), including its definition, epidemiology, etiology, clinical features, diagnosis, investigations, treatment, and prognosis. IBS is a functional bowel disorder characterized by abdominal pain or discomfort and altered bowel movements in the absence of structural abnormalities. It has a prevalence of 1-20% worldwide and is more common in women. The cause is uncertain but may involve GI motor abnormalities, visceral hypersensitivity, brain-gut axis dysregulation, and abnormal psychology. Diagnosis is based on symptoms and ruling out other diseases. Treatment involves diet modification, pharmacotherapy including antispasmodics, antidepressants, and probiotics, as well as psychological therapies like CBT.
This document provides information on Gastroesophageal Reflux Disease (GERD). It defines GERD as abnormal reflux of gastric contents into the esophagus causing troublesome symptoms or complications, with more than 2 heartburn episodes per week. Approximately 20% of adults experience frequent GERD symptoms. The document discusses the pathogenesis, risk factors, diagnosis and diagnostic tests, and treatment options for GERD including pharmacologic therapies, surgery, and endoscopic treatments. It provides details on classifications of esophagitis, guidelines for endoscopy and pH monitoring in GERD diagnosis and management.
This document discusses irritable bowel syndrome (IBS). It provides a brief history of IBS, discussing early descriptions of the condition from the 18th-19th centuries. It also covers the diagnosis of IBS, including the Rome criteria used to positively diagnose IBS based on symptoms. The pathophysiology of IBS is explored, noting enhanced perception, altered motility, and visceral hypersensitivity as factors. Quality of life impacts for patients with IBS are compared to other conditions like depression. Finally, treatment approaches are summarized, including patient education, dietary intervention, pharmacotherapy, psychotherapy, and hypnotherapy.
Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder characterized by abdominal pain and changes in bowel habits. The main symptoms are cramping, abdominal pain, bloating, gas, diarrhea and constipation. IBS has three subtypes based on predominant stool pattern: IBS with constipation, IBS with diarrhea, or IBS with mixed bowel habits. While the exact cause is uncertain, IBS involves abnormalities in gut motility and visceral sensitivity. Treatment involves lifestyle changes and medications to manage symptoms based on IBS subtype.
This document provides an overview of inflammatory bowel disease (IBD), focusing on Crohn's disease and ulcerative colitis. It discusses the anatomical distribution and prevalence of Crohn's, potential risk factors, pathogenesis involving immune dysregulation and tumor necrosis factor, and clinical presentations including abdominal pain, fistulas, and perianal disease. Diagnostic tests like bloodwork, imaging, and endoscopy are outlined. The document also reviews complications, medical treatments including aminosalicylates, corticosteroids, immunosuppressants, antibiotics, and biologicals. Surgical treatment and management of IBD are briefly discussed, as well as prognosis. Ulcerative colitis forms, features, and experience with IBD patients
Irritable bowel syndrome (IBS) is characterized by chronic abdominal pain or discomfort associated with changes in bowel habits. Common symptoms include abdominal discomfort relieved with defecation, changes in stool frequency or form. Treatment depends on whether constipation or diarrhea predominates, and may include increased fiber, bulk forming laxatives, antispasmodics, or anti-inflammatory drugs. While the cause is unknown, theories include altered stress responses, low-grade inflammation, and changes in gut microbiota. Diet modifications and lifestyle changes can help manage symptoms.
GERD is a common condition where stomach acid refluxes into the esophagus. It is classified into NERD (non-erosive reflux disease) and ERD (erosive reflux disease). Complications include esophagitis, peptic stricture, and Barrett's esophagus which increases cancer risk. Diagnosis involves symptom response to PPI trial or pH monitoring. Treatment begins with lifestyle changes and uses PPIs. New drugs under development target the proton pump or motility in novel ways. Surgery is an option for refractory or complicated cases.
This document discusses peptic ulcer disease (PUD), including its causes, types, symptoms, diagnosis, and treatment. PUD is characterized by erosion of the GI mucosa from stomach acid and pepsin. It commonly affects the lower esophagus, stomach, and duodenum. The two main types are gastric and duodenal ulcers. Symptoms include abdominal pain, nausea, and vomiting. Diagnosis involves endoscopy and tests for H. pylori bacteria. Treatment focuses on reducing stomach acid with PPIs or H2 blockers, eradicating H. pylori, and protecting the mucosa. Complications can include bleeding, perforation, and obstruction if not properly treated.
This document provides information about irritable bowel syndrome (IBS), including its pathophysiology, diagnosis, signs and symptoms, and treatment. IBS is classified as a functional disorder caused by altered gastrointestinal function rather than structural issues. It is related to visceral hypersensitivity and abnormal bowel motility. Diagnosis involves reviewing symptoms and ruling out other conditions through tests. Signs include abdominal pain, changes in bowel habits, bloating and gas. Treatment focuses on dietary changes like reducing trigger foods, stress management techniques, fiber intake, and medications in some cases.
This document discusses irritable bowel syndrome (IBS) and summarizes a case study of a 32-year-old female patient, Ms. Lee, experiencing IBS symptoms. It covers the evolving diagnostic criteria for IBS, potential treatments including lifestyle modifications, medications, probiotics, and the relationship between small intestinal bacterial overgrowth (SIBO) and IBS. Hydrogen breath testing is presented as a non-invasive way to diagnose SIBO, though it has limitations. The antibiotic rifaximin is introduced as a treatment option for patients who test positive for SIBO.
1. Irritable bowel syndrome (IBS) is a common chronic condition characterized by abdominal pain and altered bowel habits that affects 10-15% of the population.
2. IBS is diagnosed based on fulfilling the Rome III criteria through symptom assessment alone in the absence of red flags. Testing is generally not required but celiac serology may be considered in some cases.
3. Treatment involves diet modification, medication based on stool pattern (e.g. linaclotide for IBS-C, loperamide for IBS-D), and psychological therapies if needed. Further testing is pursued only if red flags are present.
This document summarizes guidelines for the diagnosis and management of irritable bowel syndrome (IBS). It defines IBS and its subtypes based on the Rome IV criteria. It recommends diagnosing IBS based on symptoms in the absence of alarm features or abnormal test results. Limited testing like fecal calprotectin can help distinguish IBS from inflammatory bowel disease. Treatment involves dietary changes, probiotics, antispasmodics, antidepressants, and targeted therapies depending on IBS subtype and predominant symptoms. For refractory cases, a multidisciplinary approach including psychological support may help manage persistent symptoms.
This document summarizes common mistakes made in managing irritable bowel syndrome (IBS) patients. It discusses 11 potential mistakes, including failing to test for bile acid malabsorption, not recognizing somatization, and not clearly explaining the likelihood of IBS being the diagnosis early in evaluation. It emphasizes the importance of considering IBS as a heterogeneous condition requiring an individualized approach, and avoiding unnecessary or potentially harmful tests and treatments.
1) The document outlines a 6-step approach to evaluating patients with gas-related symptoms, including clarifying the predominant symptom, timing relative to meals, dietary factors, associated GI symptoms, medications/supplements, and risk factors.
2) Potential causes are discussed depending on symptom onset, such as gastric issues for soon after eating and small bowel issues for over 1 hour later.
3) Treatment focuses on identifying and
Irritable Bowel Syndrome (IBS) is a functional bowel disorder that affects around 20% of the population. It is characterized by abdominal pain associated with changes in bowel habits and is more common in young females. IBS has no identifiable organic cause but involves low-grade inflammation, altered gut motility and microbiota, visceral hypersensitivity, and psychological factors like stress and anxiety. Treatment focuses on diet modification, fiber supplementation, antispasmodics, antidepressants, and psychological therapies depending on symptoms of diarrhea, constipation or pain.
GIT irritable bowel syndrome (IBS) for 5th year 2011Shaikhani.
IBS is a common gastrointestinal disorder affecting 7% of the population. Women are more likely to be affected than men, most commonly between ages 20-40. The pathophysiology is not fully understood but may involve abnormal gut motility, visceral hypersensitivity, and immune system activation. IBS places a high economic burden due to direct and indirect healthcare costs. Diagnosis is based on Rome criteria and absence of alarm symptoms. Treatment depends on symptoms but may include antispasmodics, antidepressants, antibiotics, probiotics, and laxatives or anti-diarrheals.
This document provides information on irritable bowel syndrome (IBS), including its definition, diagnostic criteria, subtypes, differential diagnosis, evaluation, and management approaches. Some key points:
- IBS is a common functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits. It affects 10-15% of the population.
- Diagnosis is based on fulfilling the Rome symptom criteria, with subtyping based on predominant stool pattern. Additional testing is usually not needed in absence of alarm features.
- Treatment involves reassurance, dietary modifications, antispasmodics, laxatives/antidiarrheals based on subtype, and tricyclic antidepressants/SSRIs for refractory cases.
Are there digestive diseases whose incidence increases during “Ramadan”?
- At the time of the Ramadan fast, the modification of feeding after the iftar meal favours foods rich in lipids and glucids which will directly act on the relaxation of the lower sphincter of the esophagus accompanied by an increase in the gastric secretion of acid at the origin of the pains at the oesogastric level and by a deceleration of digestion.
- Food changes in terms of quality and quantity (significant and late consumption of food, just before sleep) support the occurrence of RGO.
- The appearance of dyspeptic symptoms relates to poor feeding at the moment of breaking the fast
- Frequent and excessive association with too fatty, too sweet, too spicy food
- Obstructed/isolated abdominal discomfort or generally associated with warning signs such as nausea or abdominal meteorism, dyspepsia
Are there digestive diseases which increase during the Ramadan?
- Constipation can cause disorders such as indigestion with feeling of distension, but it can sometimes be more serious with the appearance of hemorrhoids or anal fissures.
- Gastro-œsophagal reflux (RGO) is a disease which affects the valve between the esophagus (conduit which helps swallowing) and the stomach which involves an inverse reflux of the contents of the stomach into the esophagus.
The most frequent symptoms:
- Distension and flatulence
- Rumblings
- Imperative need to go to stool;
- Feelings of incomplete evacuation of stools.
- Mucus in stools.
These symptoms generally occur
after meals (iftar, sohour.)
April is IBS Awareness Month. This presentation provides education on IBS symptoms, potential causes, medications and laboratory testing to determine if IBS is the issue.
This document discusses gastritis, irritable bowel syndrome (IBS), their epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, management, and nursing care. It provides details on the types and causes of gastritis and IBS. It notes that the prevalence of H. pylori infection and IBS increases with age. Management involves lifestyle changes, medications, dietary modifications, and treatment of underlying infections or conditions. Nursing focuses on education, dietary guidance, monitoring for complications, and addressing patient anxiety.
1. Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain or discomfort and altered bowel habits without detectable structural abnormalities.
2. IBS is caused by abnormalities in gastrointestinal motility, visceral hypersensitivity, central neural processing, the gut microbiome, and serotonin signaling.
3. Treatment involves managing symptoms through diet, stress reduction, antispasmodics, antidepressants, and antibiotics in some cases. Thorough evaluation is needed to rule out other causes for symptoms.
Why Does My Stomach Ache? - Dennis Han, MD, Gastroenterologist - Morristown &...Summit Health
Do you have stomach issues which are bothering you and you can't figure out why? Learn about conditions that could be causing abdominal pain or discomfort at this virtual program. Our expert will discuss different conditions such as: Irritable Bowel Syndrome; Inflammatory Bowel Disease; Celiac Disease and other conditions that require a gluten-free diet; and GERD (Reflux). He will explain the differences between these various conditions, how they are diagnosed, and treatment options available. Hosted by Morristown & Morris Township Public Library.
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder defined by abdominal pain and changes in bowel habits. The causes are unclear but may involve stress, infection, or brain-gut interactions. Symptoms include abdominal pain, gas, bloating, and diarrhea or constipation. Diagnosis is based on symptoms, and tests rule out other conditions. Treatment focuses on lifestyle changes like diet, exercise, and stress relief. Medications may help control symptoms but no single treatment works for everyone with this common disorder.
This document provides guidance on managing chronic diarrhea. It defines chronic diarrhea as loose or watery stools occurring at least 3 times per day for 4 or more weeks. Most cases of chronic diarrhea in developed countries are non-infectious. A key distinction is between functional causes like IBS and organic causes. Symptoms, stool characteristics, medical history and dietary factors can help focus the differential diagnosis. Testing is recommended if alarm features are present or initial workup is inconclusive. Empiric treatments like loperamide, bile acid sequestrants or dietary changes may help symptomatic management when a cause cannot be identified.
Similar to IBS(Irritable Bowel Syndrome) Management Update-2021 (20)
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
The document provides guidance on assessing a patient's musculoskeletal system and rheumatological symptoms. It describes:
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Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
This document discusses iron deficiency anemia, including its morphological classification, red blood cell indices, causes, pathogenesis, physical findings, and management. It notes that iron deficiency anemia results in microcytic hypochromic anemia with a low MCV and MCHC. The progression involves depletion of iron stores, decreased ferritin and iron, and increased TIBC, eventually resulting in microcytic hypochromic anemia seen on peripheral smear. Common physical findings include angular stomatitis, glossitis, koilonychia, and atrophic gastritis. Treatment involves iron supplementation orally or intravenously, with blood transfusion for severe anemia.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
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Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
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Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
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1. Define an electrocardiogram (ECG) and electrocardiography
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3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
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Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
1. UPDATES IN MANAGEMENT OF IBS
Presenter: Dr. Pritom Das
Registrar, Medicine, DAMCH
Organized By:
Society of Medicine,
Faridpur
Powered By:
Renata
Pharmaceuticals
Ltd.
2. UPDATES IN MANAGEMENT OF IBS
Section 1
Definition
Epidemiology
Pathophysiology
Diagnosis
Investigations
Section 2
Ways of
intervention
Lifestyle changes
and Dietary
approaches
1st and 2nd line
drugs
Approach to
refractory case
Section 3
Prognosis
Follow-up
Take-home
messages
Quiz
3. GUIDELINES REVIEWED
• World Gastroenterology Organisation Global Guidelines - Irritable
Bowel Syndrome: a Global Perspective [WGO]
• American College of Gastroenterologists Clinical Guideline:
Management of Irritable Bowel Syndrome [ACG]
• British Society of Gastroenterology guidelines on the management of
irritable bowel syndrome [BSG]
• NICE Irritable bowel syndrome in adults: diagnosis and management
• Canadian Association of Gastroenterology Clinical Practice Guideline
for the Management of Irritable Bowel Syndrome
4. DEFINITION
World Gastroenterology Organization defines Irritable
Bowel Syndrome as
“a functional bowel disorder in which
abdominal pain or discomfort is
associated with defecation and/or a
change in bowel habit.”
5. EPIDEMIOLOGY
• Irritable bowel syndrome (IBS) remains one of the most common
gastrointestinal disorders seen by clinicians in both primary and
secondary care.
• The prevalence of IBS in the global population is estimated at 11% and
in Asians ranges from 4% to 9% depending on the criteria used.
• The prevalence of IBS in women is about twice as high as in men and
make up 80% of the population with severe IBS.
• However, there is no sex predilection in South Asia, South America,
and Africa.
• Half of patients report their first symptoms before the age of 35.
6. ETIOLOGY - A DISORDER OF GUT-BRAIN
INTERACTION
• In the multifactorial pathogenesis of IBS a key role is played by
disorders of gut-brain interactions (DGBI).
• The intestinal microbiota is an essential element of these
interactions, and its dysregulation directly affects the other
pathogenic mechanisms of IBS.
• Genetics, and epigenetic changes, infection and early adverse
life events may predispose an individual to developing IBS, and
chronic stress, psychological symptoms, negative beliefs about
symptoms and illness and maladaptive coping mechanisms can
increase the frequency and severity of symptoms.
7. ETIOLOGY - A DISORDER OF GUT-BRAIN
INTERACTION
• IBS is a disorder of altered bidirectional communication between
the gut and brain (via the gut-brain axis), and has a biopsychosocial
aetiology.
• Major Components of this complex pathophysiology includes-
Central nervous system and autonomic nervous system
modulation
Altered visceral perception
Transit and motility
Immune regulation, inflammation and epithelial permeability
The microbiome
8. ETIOLOGY
• Activation of the immune system of the intestinal mucosa
associated with dysbiosis, diet, stress and endogenous factors
results in increased permeability of the intestinal barrier and the
induction of motor-sensory functions of the gastrointestinal tract.
• In patients with IBS there are qualitative and quantitative changes
in the composition of the gut microbiota, which has significant
therapeutic implications. SIBO plays a special role in the
pathogenesis of intestinal symptoms.
• Disturbed motor activity of the gastrointestinal tract and visceral
hypersensitivity are typical but not completely specific features of
IBS.
9. ETIOLOGY
• Central nervous system disorders occurring in patients with IBS
may cause increased reactivity to stress stimuli and influence the
severity of symptoms.
• Dietary factors, with particular emphasis on poorly absorbed,
easily fermentable oligo-, di-, monosaccharides and polyols
(FODMAPs), may influence the occurrence and severity of IBS
symptoms.
• Psychosocial factors and coexisting psychiatric disorders have a
significant impact on the course and results of IBS treatment.
13. FOLLOWING CHANGES ARE NOTABLE IN ROME IV AS
COMPARED TO ROME III
„
„ Term abdominal discomfort has been deleted considering the
dubious nature of the term and also that it is not present in every
language.
„
„ Abdominal pain to be present on at least 1 day/week based on
scientific evidence
„
„ Bloating and distention are recognized as common symptoms
„
„ Improvement with defecation has been replaced with related to
defecation as it has been found that many patients report increase in
pain with defecation
„
„ Rome IV also mentions about the location of pain, which can be
present anywhere in the abdomen in contrast to the older criteria which
considered lower abdominal pain as consistent with IBS
14. NICE ABC MNEMONIC FOR DIAGNOSIS
• The diagnosis of IBS should be considered if the patient has had the
following for at least 6 months:
• Abdominal pain, and/or
• Bloating, and/or
• Change in bowel habit
“Although the Rome IV criteria are the gold standard to define IBS for research purposes,
they are probably overly restrictive for use, even in secondary care, and a pragmatic
definition in line with that used in the NICE guideline, and outlined above, should be
preferred.” [BSG]
15.
16. CLASSIFICATION
• IBS is categorized into four main subtypes based on
the predominant bowel habit:
1. IBS with constipation (IBC-C);
2. IBS with diarrhea (IBS-D);
3. IBS with mixed symptomology (IBSM);
4. Unclassified IBS
18. NON-GASTROINTESTINAL FEATURES OF IBS
• IBS patients suffer from a number of non-intestinal symptoms, which
may be more intrusive than the classical features. IBS coexists with
chronic fatigue syndrome, fibromyalgia and temporomandibular joint
dysfunction.
Gynaecological
symptoms
• Painful periods
(dysmenorrhoea)
• Pain following
sexual
intercourse
(dyspareunia)
Urinary symptoms
• Frequency
• Urgency
• Passing urine at
night (nocturia)
• Incomplete emptying
of bladder
Other symptoms
• Joint hypermobility
• Back pain
• Headaches
• Bad breath,
unpleasant taste in the
mouth
• Poor sleeping
• Fatigue
19. INVESTIGATIONS
• Clinicians should make a positive diagnosis of IBS based on symptoms, in
the absence of alarm symptoms or signs, and abnormalities on simple
blood and stool tests
• In people who meet the IBS diagnostic criteria, the following tests should be
undertaken to exclude other diagnoses:
FBC
ESR or CRP
patients <45 years of age with diarrhoea, a faecal calprotectin to
exclude IBD
antibody testing for coeliac disease
20. INVESTIGATIONS
• All guidelines suggest serologic testing be performed to rule out
celiac disease (CD) in patients with IBS and diarrhea symptoms.
• There is no role for colonoscopy in IBS, other than in those with
alarm symptoms or signs, or those with symptoms suggestive of IBS
with diarrhoea who have atypical features and/or relevant risk
factors that increase the likelihood of them having microscopic colitis.
24. EXERCISE, DIET AND DIETARY
MANIPULATION
• All guidelines suggest Exercise helps overall symptom improvement in
IBS patients, particularly for constipation, with beneficial effects still apparent
at 5 years in one trial.
• A low FODMAP diet helps with overall symptom improvement in IBS
patients.
• Guidelines suggest against a gluten-free or exclusion diet.
• Poorly fermentable, soluble fiber such as psyllium (ispaghula) remains an
evidence- based treatment for IBS. Insoluble fiber may exacerbate in and
bloating in IBS, and has no evidence for efficacy. Osmotic laxatives shouldn’t
be used.
• Soluble fiber should be commenced at a low dose (3–4 g/day) and built up
gradually to avoid bloating
25. DIET AND DIETARY MANIPULATION
•First-line dietary advice should be offered to all patients
with IBS.
• Which includes - adopting healthy eating patterns, such as
regular meals, maintaining adequate nutrition, limiting alcohol
and caffeine intake, adjusting fiber intake, and reducing
consumption of fatty and spicy foods.
26. WHAT STEPS CAN I TAKE IF I HAVE IBS?
• eat three regular meals a
day
• try not to skip any meals
or eat late at night
(smaller meal sizes may
ease symptoms)
• reduce intake of
caffeine-containing
drinks e.g. no more than
two mugs (three cups) a
day
• reduce intake of soft
drinks
• drink at least eight cups
of fluid per day,
especially water or other
non-caffeinated drinks,
for example herbal teas
• cut down on rich or fatty
foods
• reduce your intake of
manufactured foods and
cook from fresh
ingredients where
possible
• limit fresh fruit to three
portions per day.
27. HELPFUL TIPS
If symptoms include
bloating and wind
If symptoms include constipation If symptoms include diarrhoea
• Limit intake of
gas producing
foods e.g. beans
pulses,
cauliflower, and
also sugar-free
mints/chewing
gum.
• You may find it
helpful to eat
• Try to gradually increase
your fibre intake – any
sudden increase may
make symptoms worse.
Rich sources include
wholegrains, oats,
vegetables, fruit and
linseeds. They help to
soften stools and make it
easier to pass.
• Replace lost fluids by drinking
plenty.
• Limit caffeine intake from tea,
coffee and soft drinks to three
drinks per day.
• Try reducing intake of high-
food
• Avoid sugar-free sweets, mints,
gum and drinks containing
sorbitol, mannitol and xylitol.
•Take time to relax – relaxation tapes, yoga, aromatherapy or massage may help
•Take regular exercise such as walking, cycling, swimming
•Take time to eat meals – chew your food well
•Keep a food and symptom diary whilst you are making changes so you can see what has helped
28. WHAT IS A LOW FODMAP DIET?
• The catchy acronym stands for fermentable oligosaccharides,
disaccharides, monosaccharides and polyols, which are more commonly
known as carbohydrates.
• These can be further divided into five groups called fructans, galacto-
oligosaccharides, lactose, excess fructose and polyols.
• These sugars are poorly absorbed and pass through the small intestine
and enter the colon, where they are fermented by bacteria.
• Gas is then produced, which stretches the sensitive bowel causing
bloating, wind and pain.
• This can also cause water to move into and out of the colon, causing
diarrhoea, constipation or a combination of both.
30. INTERVENTIONS THAT MODIFY THE MICROBIOTA:
PREBIOTICS, SYNBIOTICS, PROBIOTICS AND
ANTIBIOTICS
• Prebiotics are food or dietary supplements that result in specific
changes in the composition and/or activity of the GI microbiota.
• Probiotics have been defined as “live microorganisms that, when
administered in adequate amounts, confer a health benefit on
the host”.
• Synbiotics, which are also food or dietary supplements, are a
mixture of probiotics and prebiotics that act synergistically to
promote the growth and survival of beneficial organisms.
31. INTERVENTIONS THAT MODIFY THE MICROBIOTA:
PREBIOTICS, SYNBIOTICS, PROBIOTICS AND
ANTIBIOTICS
• Guidelines suggest against the use of prebiotics and synbiotics for
overall symptom improvement in IBS patients.
• All Guidelines suggest probiotics, taken as a group, to improve
global symptoms, as well as bloating and flatulence in IBS patients.
• It is reasonable to advise patients wishing to try probiotics to take
them for up to 12 weeks, and to discontinue them if there is no
improvement in symptoms. [BSG]
• ACG suggest the non-absorbable antibiotic rifaximin for reduction in
global IBS symptoms, as well as bloating in non-constipated IBS
patients.
32. DRUGS USED FIRST LINE FOR IBS -
ANTISPASMODICS AND PEPPERMINT OIL
• All guidelines suggest Certain antispasmodics [antimuscarinics
and smooth muscle relaxants- (trimebutine- TRITIN, otilonium, hyoscine,
cimetropium, pinaverium, dicyclomine and mebeverine, alverine citrate- ALRIN]
as an effective treatment for global symptoms and
abdominal pain in IBS. Dry mouth, visual disturbance and
dizziness are common side effects.
• All guidelines suggest Peppermint oil as an effective
treatment for global symptoms and abdominal pain in IBS.
Gastro-oesophageal reflux is a common side effect. The risk
of adverse events is no greater with peppermint oil than
with a placebo.
33. DRUGS USED FIRST LINE FOR IBS –
RECOMMENDATION AGAINST CONTINUOUS
LOPERAMIDE USE
• All guidelines recommend against continuous
Loperamide(synthetic μ-opioid agonist) except for diarrhea
in IBS. It is no more effective than a placebo in reducing
pain, bloating, and global symptoms of IBS, but it is an
effective agent for the treatment of diarrhea.
• Abdominal pain, bloating, nausea and constipation are
common, and may limit tolerability. Titrating the dose
carefully may avoid this.
34. DRUGS USED FIRST LINE FOR IBS
GUT-BRAIN NEUROMODULATORS
• Dysfunction within the bidirectional gut-brain axis is considered to play an
important role in the genesis and maintenance of symptoms in IBS.
• Although IBS is often considered a functional gastrointestinal disorder, it
has been re-termed as disorders of gut-brain interaction.
• Patients with IBS often have comorbid anxiety and depression, and these
are also risk factors for the subsequent development of IBS in healthy
people.
• This, together with their peripheral effects on gastrointestinal function, is
part of the rationale for the use of gut-brain neuromodulators, such as
TCAs and SSRIs.
35. GUT BRAIN MODULATORS
TCA AND SSRI
• TCAs and SSRIs impact on bowel function, with TCAs improving diarrhea
by slowing GI transit, and SSRIs ameliorating constipation by accelerating
GI transit.
• Tricyclic antidepressants used as gut-brain neuromodulators are an
effective second-line drug for global symptoms and abdominal pain in
IBS. [BSG]
• They should be commenced at a low dose (eg, 10 mg amitriptyline once a
day) and titrated slowly to a maximum of 30–50 mg once a day. [BSG]
• TCAs are associated with significant adverse effects in treating IBS-D and
should be avoided in IBS-C; clinicians should expect one adverse effect for
every three patients who benefit from therapy [WGO]
36. GUT BRAIN MODULATORS
TCA AND SSRI
• SSRIs may be considered in resistant IBS-C, although it is not
currently recommended that SSRIs should be routinely prescribed for
IBS in patients without comorbid psychiatric conditions. [WGO]
• Selective serotonin reuptake inhibitors used as gut-brain
neuromodulators may be an effective second-line drug for global
symptoms in IBS. [BSG/ ACG]
• Whether all IBS sufferers, or only certain sub-populations, respond to
anti-depressants is also unclear, and therapy with these agents may
be limited by patient acceptance and adverse events.
37. DRUGS USED SECOND LINE FOR THE
TREATMENT OF IBS-D
• Who do not experience symptom improvement with antidiarrhoeals
• 5-Hydroxytryptamine 3 receptor antagonists are efficacious second-
line drugs for IBS with diarrhoea in secondary care. [Ondansetron
titrated from a dose of 4 mg once a day to a maximum of 8 mg tds]
Constipation is the most common side effect. (EMEREN/EMESET)
• The non-absorbable antibiotic rifaximin is an efficacious second-line
drug for IBS with diarrhoea in secondary care.
• Other options- Eluxadoline, a mixed opioid receptor drug;
contraindicated in patients with cholecystectomy, pancreatitis or
severe liver impairment
38. DRUGS USED SECOND LINE FOR THE
TREATMENT OF IBS-C
• Who do not experience symptom improvement with laxatives
• Lubiprostone, a chloride channel activator, is an efficacious second-
line drug for IBS with constipation in secondary care. (LAXANA)
• This secretagogue is less likely to cause diarrhoea than others.
However, patients should be warned that nausea is a frequent side
effect
• Other options: Linaclotide and Plecanatide (guanylate cyclase-C
agonist), Tenapanor (sodium-hydrogen exchange inhibitor), Tegaserod
(5-Hydroxytryptamine 4 receptor agonist) – not available in the market
yet
39. PSYCHOLOGICAL THERAPIES
• All guidelines suggest IBS-specific cognitive behavioural therapy as an
efficacious treatment for global symptoms in IBS.
• Psychological therapies should be considered when symptoms have not
improved after 12 months of drug treatment. [BSG]
• General nonpharmacological recommendations
• Discuss the patient’s anxieties. This reduces complaints; aim to eliminate
unnecessary worries.
• Aim to reduce avoidance behavior. Patients may avoid activities that they fear
are causing the symptoms, but avoidance behavior has a negative influence on
the prognosis.
• Discuss and aim to resolve stressful factors.
40. NOVEL APPROACHES FOR THE FUTURE
• Fecal Microbiota Transplant (FMT)
• Mast Cell Stabilizer and Other Anti-
inflammatory Drugs
• Ghrelin Receptor Agonists: Relamorelin
• 5-HT3 Antagonists: Ramosteron
• Drugs Acting on Bile Acids
• Modulating the Central Pain Mechanism -
IBStim Device: The Cranial Nerve Stimulator
IBStim device
41. BSG Treatment algorithm for IBS
*Review efficacy after 3 months of
treatment and discontinue if no
response
TCAs should be first choice,
starting at a dose of 10 mg at night,
and titrating slowly (eg, by 10
mg/week) according to response and
tolerability. Continue for at least 6
months if the patient reports
recommended strongly when
symptoms are refractory to
drug treatment for 12
months
SUMMARY OF SECTION 2
43. PROGNOSIS
• For most patients with IBS, symptoms are likely to
persist, but not worsen. Symptoms will deteriorate in
a smaller proportion, and some patients will recover
completely.
• Factors that may negatively affect the prognosis
include:
• Avoidance behavior related to IBS symptoms
• Anxiety about certain medical conditions
• Impaired function as a result of symptoms
• A long history of IBS symptoms
• Chronic ongoing life stress
44. FOLLOW-UP
In mild cases, there is generally no medical need for follow-up consultations in the
long term, unless:
• Symptoms persist, with considerable inconvenience or dysfunction.
• The patient is seriously worried about the condition.
• Persistent diarrhea > 2 weeks.
• Constipation persists and does not respond to therapy.
• Warning signs for possibly serious gastrointestinal disease developing
• One should beware of eating disorders developing:
— The tendency for eating disorders to develop is more common in female IBS
patients.
45. TAKE HOME MESSAGES
1) IBS is a very common illness that can hamper productivity and
reduce the quality of life.
2) Previously thought to be a functional disorder, now it’s more
commonly recognized as complex result of intestinal dysbiosis
causing altered gut-brain interaction.
3) Usually a clinical diagnosis and intervention needs to be managed
with empathy and sharing as much information as possible with the
patient.
4) Dietary and lifestyle modifications, soluble fibers, antispasmodics
and probiotics are universally proven to improve global symptoms.
5) Antidepressant and anti-diarrheal drugs need to be used judiciously
keeping respective side effects in mind.
6) Any refractory case should be managed with psychotherapy and
needs long-term follow up.
46. QUIZ
• Suspected IBS patients will need colonoscopy to
confirm the diagnosis. (T/F)
• Previous gastroenteritis can be a risk factor for IBS.
(T/F)
• Probiotics have no role managing IBS. (T/F)
• Psychotherapy is usually offered as a first-line
treatment. (T/F)
• TCAs should be offered in IBS patients with Diarrhea as
predominant symptom. (T/F)