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: 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
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.
IRRITABLE BOWEL SYNDROME
The term irritable bowel syndrome is used to describe a functional gastrointestinal disorder characterized by a variable combination of chronic and recurrent intestinal symptoms not explained by structural or biochemical abnormalities.
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
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.
IRRITABLE BOWEL SYNDROME
The term irritable bowel syndrome is used to describe a functional gastrointestinal disorder characterized by a variable combination of chronic and recurrent intestinal symptoms not explained by structural or biochemical abnormalities.
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.
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.
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 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 group of symptoms, including pain discomfort in your abdomen combined with changes in your bowel movement patterns.
For More detail visit this link:
http://goo.gl/RaZhvc
IBS(Irritable Bowel Syndrome) Management Update-2021Pritom Das
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.
Small intestinal bacterial overgrowth (SIBO)fathi neana
Like all healthy ecosystems, Richness of microbiota species characterizes the GI microbiome in healthy individuals. Conversely, a loss in species diversity (Dysbiosis) is a common finding in several disease states. The types of Dysbiosis are: 1- Loss of beneficial bacteria. 2- Overgrowth of potentially pathogenic bacteria. 3- Loss of overall bacterial diversity. 4- Overgrown in an area they’re not supposed to be in like the small intestine (SIBO).
The overgrowth of microbes in the small intestine results in: 1- fermentation of food in the small intestine, producing hydrogen and other gases. 2- They can also degrade the thin mucus layer and come in contact with the gut barrier, causing inflammation and intestinal permeability (Leaky gut). 3- This can lead to a variety of unpleasant symptoms and consequences like food allergies , sensitivities and chronic inflammatory processes. 4- SIBO leads to both maldigestion and malabsorption as the bacteria interfere with normal enzymatic and metabolic activity of the small intestine. 5- Additionally, these bacteria are associated with increased serum endotoxin and bacterial compounds stimulating production of (pro)inflammatory cytokines. 6- Iron is typically absorbed in the duodenum and the jejunum and SIBO can interfere with this absorption resulting in microcytic anemia. 7- Vitamin B12 is absorbed in the ileum and patients with SIBO often have B12 malabsorbtion which leads to megaloblastic anemia and B12 deficiency.
The best treatment for SIBO, like other forms of bacterial imbalance – or DYSBIOSIS is rehabilitating our microbiome.”
This is the latest update on irritable bowel syndrome and gastroesophageal reflux by Associate Professor Reuben Wong from gutCARE. This is presented during the latest GP symposium
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.
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.
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 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 group of symptoms, including pain discomfort in your abdomen combined with changes in your bowel movement patterns.
For More detail visit this link:
http://goo.gl/RaZhvc
IBS(Irritable Bowel Syndrome) Management Update-2021Pritom Das
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.
Small intestinal bacterial overgrowth (SIBO)fathi neana
Like all healthy ecosystems, Richness of microbiota species characterizes the GI microbiome in healthy individuals. Conversely, a loss in species diversity (Dysbiosis) is a common finding in several disease states. The types of Dysbiosis are: 1- Loss of beneficial bacteria. 2- Overgrowth of potentially pathogenic bacteria. 3- Loss of overall bacterial diversity. 4- Overgrown in an area they’re not supposed to be in like the small intestine (SIBO).
The overgrowth of microbes in the small intestine results in: 1- fermentation of food in the small intestine, producing hydrogen and other gases. 2- They can also degrade the thin mucus layer and come in contact with the gut barrier, causing inflammation and intestinal permeability (Leaky gut). 3- This can lead to a variety of unpleasant symptoms and consequences like food allergies , sensitivities and chronic inflammatory processes. 4- SIBO leads to both maldigestion and malabsorption as the bacteria interfere with normal enzymatic and metabolic activity of the small intestine. 5- Additionally, these bacteria are associated with increased serum endotoxin and bacterial compounds stimulating production of (pro)inflammatory cytokines. 6- Iron is typically absorbed in the duodenum and the jejunum and SIBO can interfere with this absorption resulting in microcytic anemia. 7- Vitamin B12 is absorbed in the ileum and patients with SIBO often have B12 malabsorbtion which leads to megaloblastic anemia and B12 deficiency.
The best treatment for SIBO, like other forms of bacterial imbalance – or DYSBIOSIS is rehabilitating our microbiome.”
This is the latest update on irritable bowel syndrome and gastroesophageal reflux by Associate Professor Reuben Wong from gutCARE. This is presented during the latest GP symposium
Hello , everyone I am Ms Shivani Choudhary pursuing Masters of pharmacology from Oriental college of Pharmacy affiliated to University of Mumbai. I have made this slide under guidance of Mr Nilesh Babre.
This is a presentation regarding the epidemiology, pathophysiology,clinical features,symtoms,diagnosis,treatment and management options for the disease -irritable bowel disease.
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3. Outline
At the end of the presentation we’ll be able to:
Recall the pathophysiology, diagnosis, clinical presentation, epidemiology of IBS
learn Non-Pharmacological and pharmacological treatment modalities.
25-Apr-21
3
4. Definition Of IBS
• Irritable Bowel Syndrome is not a disease. It’s a functional
disorder, which means that the bowel simply does not works as it
should.
• It is the most common disorder diagnosed by gastroenterologists
and one of the most common seen by primary care physicians.
• IBS is a common disorder that affects the large intestine (colon).
• IBS commonly causes cramping, abdominal pain, bloating,
gas, diarrhea and constipation or both.
25-Apr-21
4
5. Definition (Cont’d)
• According to the Rome IV criteria, Irritable bowel syndrome is
defined as recurrent abdominal pain on average, at least one day
per week in the last three months with two or more of the
following:
1. Related to defecation
2. Associated with a change in frequency of stool
3. Associated with a change in form (appearance) of stool
25-Apr-21
5
6. Epidemiology
• Prevalence: 3-22% worldwide,10-15% USA/Europe and 5% Asian
countries.
• Incidence: 1-2% per year
• Spent related to IBS: 8 billion dollars/year
• Onset before age 35: 40%
• Onset age 35-50: 50%
• Female > Male: 3:1
25-Apr-21
6
8. Pathophysiology
• IBS pathophysiology is not clear.
• Many theories have been put forward, but the exact cause of IBS is still
uncertain.
1) Alteration in GI motility: alteration in frequency and regularity of luminal contractions.
2) Visceral hypersensitivity: increased sensation in response to stimuli.
3) Brain gut axis: alteration in communications between enteric nervous systemic and CNS.
4) Post infectious: about 10% of IBS cases are triggered by an acute gastroenteritis infection.
5) Genetics
6) Inflammation: Cytokines,lymphocytes & mast cell are identified in IBS patients.
7) Serotonin receptors (95% found in GIT):
Type 3: increase motility → IBS-D
Type 4: decrease motility → IBS-C
8
19. 1-Abdominal pain
Antispasmodics
• Used when needed
• Decrease fecal urgency
• Short term relieve for abdominal pain
Caution incase of IBS-C : Antispasmodics will
worsen constipation due to anticholinergic effect.
25-Apr-21
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20. Antispasmodics Agents
Spasmine
•Mebeverine,200 mg capsule
•Taken 20 min before a meal max 3 doses/day
•Relax muscles of the gut
•SE: heart burn,indigestion,constipation insomnia
•CI:paralytic ileus, constipation
Debutine
•Trimebutine,200mg tablet
•Taken before meal, 1 tab 3x/day
•SE: Anticholinergics(dry mouth,N,Fatigue,C,dizziness)
Buscopan
•Hyoscine butylbromide,10mg tablet
•Taken 1 tab 3x/day or increase to 2 tab 4x/day
•Decreases contractions of the muscles of stomach,bowel,and bladder
•SE: anticholinergics
•CI: Myasthenia Gravis, paralytic ileus
25-Apr-21
20
21. Used in low dose if
persistent pain (10-25
mg/day)
TCAs used for 3-5 days
Side effects:
anticholinergic,
sedation, QT
prolongation,
constipation, weight
gain
Antidepressants
Caution incase of IBS-C, and in patients with heart problems
25-Apr-21
21
Antidepressants have analgesic properties
independent of their mood improving effects.
Tricyclic antidepressants (TCAs), via their
anticholinergic properties, also slow intestinal
transit time, which may provide benefit in
Diarrhea-predominant IBS
26. DIET
IBS-C IBS-D
• Sources of fiber include whole-grain bread
and cereals, fruits, vegetables, and beans.
(gradually)
• Dried plums, prune juice, ground flaxseed
and water as well.
• Stay away from coffee , carbonated
drinks, alcohol and processed foods
such as chips, cookies, and white bread and
rice.
• Avoid chocolate, fried foods,
alcohol, caffeine, carbonated
drinks, the artificial
sweetener sorbitol, and
fructose.
• Be careful with fiber.
• Drink plenty of water every day.
26
27. OTC DRUG
IBS-C IBS-D
FIBERS:
1. Wheat bran
2. Corn fiber
3. Calcium polycarbophil (Fibercon)
4. Psyllium (Fiberall, Metamucil, Perdiem, and
others).
LAXATIVES:
1. Bulk forming: psyllium, Ca carbophil and
methylcellulose (Best)
2. Peg based laxatives: include lactulose and
polyethylene glycol.
3. Stimulants: Bisacodyl (Correctol, Dulcolax),
sennosides (Ex-Lax, Senokot), castor oil, and
the plant cascara .
1. Bismuth subsalicylate (Kaopectate, Pepto-
Bismol).
2. Loperamide (Imodium).
3. Simethicone (Gas-X, Mylicon)
25-Apr-21
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31. Drug MOA Adm-counseling SE CI
LINACLOTIDE
(linzess)
oligo-peptide agonist
of guanylate cyclase
2C
145-290mcq qd taken
on an empty stomach
30 mins before 1st
meal for 12 weeks
DIARRHEA
flatulence
In patient prone to
water or electrolytes
disturbances
LUBIPROSTONE
(amitiza)
Chloride channel
activator.
Adults with CIC:
Take 24mcg bid po
with food
Adult women with
IBS:
Take 8 mcg BID po
with food.
Both for up to 52
weeks.
NAUSEA
DIARRHEA
DYSPNEA
BOWEL OBS
Fecal incontinence
Decreased appetite
rash
Mechanical GI
obstruction.
Severe Diarrhea
PRUCALOPRIDE
(reslor)
5-HT4 receptor
agonist
Taken as 2-4 mg/d NAUSEA
VOMIT
HA
IRRITABILITY
FATIGUE
Severe renal
impairment.
Dialysis patient.
Colonic obstruction.
Inflammatory bowel
disease.
25-Apr-21
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33. Drug MOA Adm-counseling SE CI
Loperamide
(immodium)
ANTIDIARRHEAL Take 2 mg 45 mins
before a meal
N,V,Dry mouth
Abdominal pain
infectious diarrhea.
torsades de pointes.
paralysis of the
intestines.
liver problems.
bloody diarrhea.
Eluxadoline
(viberzi)
ANTIDIARRHEAL Take 100 mf PO BID
with food.
N,V,C,URTI
Nasopharyngitis
Pancreatitis
Without gallbladder
Biliary duct obs.
Alcohol Abuse.
Cholestyramine
Colestipol
Coleselvam
Bile acid sequestrants taken 2 to 16
grams/day given once
or in divided doses.
Bloating, flatulence.
Abd discomfort.
Constipation
hypertrigylceridemia
(>250 mg/dL)
Alosteron
(lotronex)
Serotonin 3
antogonist
0.5 mg bid for 4
weeks.
Best for females with
severe ibd symp
Constipation
Nausea
Ischemic colitis
Constipation
Intestinal obs
Ischemic colitis
Impaired intestinal
circulation
IBD
Hepatic impair
Fluvoxamine
25-Apr-21
33
34. • Improvement in the IBS Symptom Severity Score and Rescue Medication Use.
• Increase in Bowel Movement Frequency in Participants with IBS-C.
• Decrease in the Bowel Movement Frequency in Participants with IBS-D.
• No Significant Changes in the Bowel Movement Frequency in Participants with IBS-M.
• Improvements in Mental Health Measures in Participants Given Probiotics.
• Improvement within 4-8 weeks.
https://pubmed.ncbi.nlm.nih.gov/32326347/
25-Apr-21
34
