Irritable Bowel Syndrome is a functional bowel disorder characterised by chronic abdominal pain associated with change in bowel habits

1. Irritable Bowel Syndrome
Jyothsna Ravilla.
RAGHAVENDRA INSTITUTE OF PHARMACEUTICAL
EDUCATION AND RESEARCH (RIPER)- AUTONOMOUS

2. Contents:
▪ Definition
▪ Etiology
▪ Signs and symptoms
▪ Bristol stool chart (IBS subtyping)
▪ Diagnosis
▪ Neuroimmune interactions ( mechanism)
▪ IBS management
▪ Pharmacological treatment
▪ Conclusion

3. Definition:
Irritable bowel syndrome is a functional bowel disorder characterized
by intermittent and chronic abdominal pain associated with change in
bowel habits.

4. ETIOLOGY:

5. Signs and Symptoms:
▪ Abdominal pain associated with defecation
“cramping” pain, variable intensity and location. Pain
can be exacerbated by meals and stressors.
▪ Change in stool frequency and consistency (Diarrhea/
constipation)
– Diarrhea: morning or after eating preceded by
lower abdominal pain and sense of urgency.
– Constipation: Pellet shaped, sensation of
tenesmus ( a feeling of being unable to empty the
large bowel of stool, even if there is nothing left to
expel.

6. other symptoms include:
1.Upper GI symptoms –
gastro-oesophageal reflux, dysphagia, early satiety, intermittent dyspepsia,
nausea and non-cardiac chest pain, flatulence or belching, passage of mucous,
bloating and abdominal distension.
2. Extra intestinal symptoms -
dysmenorrhea, dyspareunia
3. Hypertension, asthma and fibromyalgia
▪ symptoms can be altered by stress, social and cultural factors.
▪ fibromyalgia, chronic fatigue syndrome, GERD, anxiety, somatization
worsen IBS.

7. Bristol stool chart and IBS subtyping:
▪ The higher the number the more
water content the stool has.
IBS types:
IBS-C: primarily constipation(1
and 2)
IBS-D: primarily diarrhoea (6 and
7)
IBS-M: the abnormal bowel
movements are both constipation
and diarrhoea.

8. Diagnosis:
▪ A set of criteria, based on history of
symptoms which help us to make us
the diagnosis of IBS.
▪ Based on history:
patients bowel movements, bowel habit journal, frequency and consistency of the stool and
abdominal pain.

9. Other features supportive of diagnosis:
▪ IBS is a diagnosis of Exclusion
▪ Rule out RED FLAG symptoms:
– Onset after age 50, anaemia, fever,
melena/ haematochezia, nocturnal
defecation, unexplained weight loss,
laboratory abnormalities
– Rule out similar conditions like
gastrointestinal infections, IBD,
lactose intolerance, coeliac disease,
diet induced diarrhoea, obstruction
malignancy.

10. Diagnostic Algorithm:

11. Neuroimmune interaction: (mechanism)

13. IBS management:
▪ Increase in fibre 30 g/day.
▪ Low FODMAP diet (fermentable, oligosaccharides,
disaccharides, monosaccharides and polyols).
▪ Avoid lactose, gluten, excess caffeine.
▪ Increase in physical activity
▪ Stress reduction.
▪ Psychological therapies
▪ Gut-focused hypnotherapy

14. IBS
treatment:

16. Conclusion:
▪ A thorough patient history can help to identify potential dietary and lifestyle triggers that
can be modified as the first stage of IBS management. If symptoms are not effectively
managed by these measures, pharmacological treatments can be considered, along with
psychological therapies. The optimal choice of management strategy will ultimately
depend on the predominant symptoms, patient preferences and a thorough understanding of
the patient agenda in terms of their treatment expectations.
▪ IBS are more common in women than in men
▪ IBS occurs at any age.