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Irritable Bowel Syndrome

IBS

Irritable bowel syndrome (irritable colon, spastic colon) is a common functional bowel disorder characterized by chronic abdominal pain, bloating and alteration of bowel habits.


Presentation

Patients with irritable bowel syndrome usually present with the following symptoms:

Colicky abdominal pain: Patients with irritable bowel syndrome suffer from acute episodes of sharp, colicky pain in the lower abdomen. This pain is often relieved by defecation.

Altered Bowel Habits: Both constipation and diarrhea can occur in the patients suffering from irritable bowel syndrome, however, one of them may predominate in a single patient. Those with constipation pass hard, infrequent stools. In contrast, those with diarrhea have low volume stools but with frequent defecation.

Abdominal distension: Bloating and gas causes abdominal distention in these patients. Abdominal distention typically worsens during the day.

Other symptoms: Patients of irritable bowel syndrome may have sexual dysfunction, urinary frequency, urgency and dysuria may be present. Other non-specific symptoms include nausea, vomiting and heart burn.

Pain
  • The influence of pain-sensitivity genes and the gut microbiome on IBS-pain SM behaviors and health outcomes also will be assessed.[ncbi.nlm.nih.gov]
  • Expert commentary: Pain is the main contributor to severity in IBS. Seeking pain alleviation is the most common reason that IBS sufferers consult with their physicians.[ncbi.nlm.nih.gov]
  • He also had nonradicular thoracic spine pain due to thoracic scoliosis. Both pains were affecting his ability to function as an attorney.[ncbi.nlm.nih.gov]
  • During severe illness, the patient had major psychosocial impairment, high life stress, a low visceral pain threshold, and activation of the midcingulate cortex (MCC), prefrontal area 6/44, and the somatosensory cortex, areas associated with pain intensity[ncbi.nlm.nih.gov]
  • Sixty two (62.5%) of the students with recurrent abdominal pain had IBS. IBS was more prevalent in the females compared to the males (p 0.000).[ncbi.nlm.nih.gov]
Chronic Fatigue Syndrome
  • Other examples of functional disorders include tension headaches and chronic fatigue syndrome (CFS). Contrary to popular belief, IBS isn’t a psychological condition. IBS has physical symptoms, but there is no known cause.[healthline.com]
  • fatigue syndrome, tempromandibular joint disorder, chronic pelvic pain, and dysmenorrhea [2] [1] .[physio-pedia.com]
  • The incidence of IBS is higher in individuals who have chronic fatigue syndrome, depression, fibromyalgia, and those individual who are under significant stress in their lives.[clinicaladvisor.com]
  • Infection with Giardia lamblia has been shown to lead to an increased prevalence of irritable bowel syndrome, as well as chronic fatigue syndrome.[emedicine.medscape.com]
Constipation
  • Prifinium bromide's efficacy in the treatment of abnormal bowel movements was most evident in patients with diarrhea and slightly less evident in patients with alternation of diarrhea and constipation, and in constipated patients.[ncbi.nlm.nih.gov]
  • The symptomatology worsened and constipation became frequent, and the patient experienced increased urinary frequency.[ncbi.nlm.nih.gov]
  • However, the drug was removed from the United States market because of its association with ischemic colitis and serious complications related to severe constipation.[ncbi.nlm.nih.gov]
  • Clinical study results in patients with Chronic Idiopathic Constipation (CIC) and Irritable Bowel Syndrome with Constipation (IBS-C) are also reviewed.[ncbi.nlm.nih.gov]
  • However, no positive results were detected in the diarrhea predominant IBS (IBS-D) and mixture of diarrhea and constipation IBS (IBS-M) subgroups.[ncbi.nlm.nih.gov]
Abdominal Pain
  • Sixty two (62.5%) of the students with recurrent abdominal pain had IBS. IBS was more prevalent in the females compared to the males (p 0.000).[ncbi.nlm.nih.gov]
  • […] acidophilus probiotic strains after 8 weeks, for decreasing abdominal pain.[ncbi.nlm.nih.gov]
  • Serum sTREM-1 level in D-IBS patients was significantly higher than that in HCs, which was also significantly correlated with abdominal pain scores.[ncbi.nlm.nih.gov]
  • The literature review included a PubMed search by each therapy, children, abdominal pain, and irritable bowel syndrome. Relevant articles to this review are discussed.[ncbi.nlm.nih.gov]
  • The health education program improved quality of life and abdominal pain in middle school IBS students in Wenchuan quake-affected areas.[ncbi.nlm.nih.gov]
Diarrhea
  • Prifinium bromide's efficacy in the treatment of abnormal bowel movements was most evident in patients with diarrhea and slightly less evident in patients with alternation of diarrhea and constipation, and in constipated patients.[ncbi.nlm.nih.gov]
  • Stool examination Stool examination is performed to exclude infection or infestation as the cause of diarrhea.[symptoma.com]
  • Alosetron, a 5-hydroxytryptamine-3 (5-HT3) receptor antagonist, was an effective drug in treating women with diarrhea-predominant IBS.[ncbi.nlm.nih.gov]
  • However, no positive results were detected in the diarrhea predominant IBS (IBS-D) and mixture of diarrhea and constipation IBS (IBS-M) subgroups.[ncbi.nlm.nih.gov]
  • Many patients with IBS have a poor quality of life due to abdominal discomfort, diarrhea, constipation, and the presence of other diseases.[ncbi.nlm.nih.gov]
Flatulence
  • Blastocystis sp. was the predominant parasite in IBS patients; it had statistical significant association with both rural residence (OR   10) and flatulence (OR   8.2). There was a predominance of Blastocystis sp. ST3 (81%) followed by ST1 (19%).[ncbi.nlm.nih.gov]
  • Mean scores of gastrointestinal symptoms showed no statistically significant differences but suggested less flatulence after low-FODMAP bread consumption (P 0.063).[ncbi.nlm.nih.gov]
  • There are several natural causes of flatulence. Flatulence can also be caused by some health conditions related to the digestive system, or as a side effect of certain medicines." Bloating "Bloating is a common symptom in IBS.[home.bt.com]
  • Getty Images 1 of 14 11 common digestive conditions GETTY IBS: The condition can prevent people joining in sporting activities Bloating or swelling of the stomach Flatulence or excessive wind A feeling of not fully emptying bowels after going to the toilet[express.co.uk]
  • […] severe - pain may be relieved following a bowel movement Unusual bowel movements – intermittent diarrhoea, constipation, or an alternating combination of both Crampy urge to move bowels but inability to do so Bloating sensation Excessive belching and flatulence[irishhealth.com]
Recurrent Abdominal Pain
  • Sixty two (62.5%) of the students with recurrent abdominal pain had IBS. IBS was more prevalent in the females compared to the males (p 0.000).[ncbi.nlm.nih.gov]
  • Irritable bowel syndrome (IBS) is a functional gastrointestinal tract disorder characterized by recurrent abdominal pain or discomfort, where the onset is associated with either a change in form of stool or its frequency and is often improved with defecation[ncbi.nlm.nih.gov]
  • The role of this parasite as a pathogen is still controversial and it is suspected to be linked to Irritable Bowel Syndrome (IBS), a functional bowel disorder characterized by chronic or recurrent abdominal pain associated with altered intestinal habits[ncbi.nlm.nih.gov]
  • Irritable bowel syndrome (IBS) is a common functional bowel disease characterized by chronic or recurrent abdominal pain, bloating, constipation, and diarrhea.[ncbi.nlm.nih.gov]
  • Irritable bowel syndrome (IBS) is a common functional intestinal disease characterized by chronic or recurrent abdominal pain, abdominal distension, constipation and diarrhea.[ncbi.nlm.nih.gov]
Proximal Muscle Weakness
  • Both sisters subsequently developed proximal muscle weakness after pregnancy and started enzyme replacement therapy. Under treatment, gastrointestinal symptoms improved, but pain persisted.[ncbi.nlm.nih.gov]
Flushing
  • A person should also see a doctor if their symptoms get progressively worse, stools are pale, bulky, very offensive smelling and difficult to flush away (this may indicate a problem with absorbing fat), or if they are concerned about their symptoms.[mydr.com.au]
Dysmenorrhea
  • […] circadian rhythm, history of abuse, anxiety, and depression [2] [1] It has also been seen with many other pain syndromes and functional disorders such as fibromyalgia, chronic fatigue syndrome, tempromandibular joint disorder, chronic pelvic pain, and dysmenorrhea[physio-pedia.com]

Workup

The diagnosis of irritable bowel syndrome is difficult. It was once considered a diagnosis of exclusion; however, this belief is no longer valid. The diagnosis is based on history, general physical examination, laboratory investigations and radiographic studies [6].

The findings in history and general physical examination often indicate iron deficiency anemia. Weight loss is also a common feature. A family history of certain gastrointestinal disorders including celiac disease, inflammatory bowel disease and colorectal carcinoma is often present.

The following investigations are necessary to establish the diagnosis with certainty.

Blood studies

Blood studies include:

Stool examination

Stool examination is performed to exclude infection or infestation as the cause of diarrhea.

History-specific examinations

History-specific examinations in irritable bowel syndrome include:

  • Hydrogen breath test
    This test excludes bacterial overgrowth in patients presenting with diarrhea and the complaints of lactose and fructose intolerance.
  • Tissue transglutaminase antibody test
  • Thyroid function test
  • Erythrocyte sedimentation rate
  • C-reactive protein

History specific imaging studies

These studies include:

  • Barium studies of the upper gastrointestinal tract are performed to detect any obstruction or inflammatory condition (such as Crohn’s disease)
  • Abdominal CT scan is also required to look for tumors, obstruction and pancreatic diseases.

History specific procedures
History specific procedures include:

  • Anal manometry (to detect rectal distention)
  • Flexible sigmoidoscopy (to evaluate the presence of distal obstruction)
  • Colonoscopy (to look for polyps or carcinoma in the colon) [7]
Colitis
  • […] espástica , colitis mucosa , colitis nerviosa , colon espástico , enfermedad funcional del intestino , espasmo colónico , Síndrome del intestino irritable , colitis membranosa , Colitis Mucosa , Colon Irritable , Síndrome del Colon Irritable Japanese[fpnotebook.com]
  • Irritable bowel syndrome Synonyms Spastic colon, nervous colon, mucous colitis, spastic bowel Irritable bowel syndrome at Curlie (based on DMOZ ) UNC Center for Functional GI & Motility Disorders[en.wikipedia.org]
  • However, the drug was removed from the United States market because of its association with ischemic colitis and serious complications related to severe constipation.[ncbi.nlm.nih.gov]
  • Sometimes the symptoms are called mucous colitis or spastic colitis, but those names are technically incorrect. Colitis is an inflammation of the colon, whereas IBS does not cause inflammation.[healthline.com]
  • Trypsin, elastase, and cathepsin S, which are activated in the colonic mucosa of patients with IBS and in experimental animals with colitis, caused persistent PAR2-dependent hyperexcitability of nociceptors, sensitization of colonic afferent neurons to[ncbi.nlm.nih.gov]

Treatment

The management of irritable bowel syndrome includes dietary measures and psychological support.

Dietary measurements

The dietary measures that are recommended in the patients suffering from irritable bowel syndrome are listed below.

  • Fiber supplementation is essential to improve symptoms of constipation and diarrhea
  • Polycarbophil compounds (Fibercon) are highly recommended
  • Adequate water intake is necessary
  • Caffeine avoidance is recommended to limit anxiety
  • Legumes should be avoided to limit bloating
  • Lactose and/or fructose intake should be restricted
  • Gluten free diet is also beneficial [8]

Drugs

A number of other drugs have a beneficial role in the management of irritable bowel syndrome. These drugs are:

  • Alosetron (a nerve receptor antagonist specifically used for irritable bowel syndrome) [9][10]
  • Anti-cholinergics (such as dicyclomine and hyoscyamine)
    Anti-diarrheals (such as loperamide)
  • Tricyclic anti-depressants (such as imipramine and amitriptyline)
  • Anti-biotics (such as rifaximin)

Prognosis

The life expectancy in the patients suffering from this disease is the same as that in healthy population. Female patients may have an increased risk of ectopic pregnancies and miscarriages; however, there is no association with stillbirth.

The quality of life is also affected. Work absenteeism is more common in such patients due to severe abdominal pain and altered bowel habits.

Etiology

There is no specific cause for the development of irritable bowel syndrome.

Enteric infection may lead to the development of irritable bowel syndrome in the majority of the cases. A study demonstrated the prevalence of irritable bowel syndrome in patients suffering from enteritis caused by Giardia lamblia to be as high as 46.1% as opposed to only 14% in the controls [1]. 

Since irritable bowel syndrome is more common in families, genetic factors may also play a predisposing role. Other predisposing factors include inflammatory processes like food intolerance, lack of dietary fibers in the diet and alterations in the gut microbiota [2] [3]. Anxiety, excessive worry and sexual or physical abuse are also contributing factors.

Epidemiology

Irritable bowel syndrome affects both men and women and occurs most commonly in individuals between 30 and 50 years of age. In Western countries, female-to-male ratio is 2:1. According to the epidemiological data from the United States, around 5 to 9% of men and 14 to 24% of women are affected.

The global incidence of irritable bowel syndrome is estimated to be 1-2% annually while the prevalence is around 10 to 15%. Prevalence is similar in white and black population but lower in Hispanics.

Sex distribution
Age distribution

Pathophysiology

The pathogenesis of irritable bowel syndrome includes several components which are further explained below:

Altered gastrointestinal motility: The electrical activity of the bowel is disturbed which causes altered gastrointestinal motility of both the small and large gut.

Visceral hyperalgesia: There is hypersensitivity of the small and large gut is increased, particularly with rapid distention. This is more common in women and in the patients in whom this disease is predominantly characterized by diarrhea.

Psychopathology: There is no well-known association between psychopathic disturbances and the pathogenesis of irritable bowel syndrome. Yet, patients under medical care are highly prone to the development of depression, panic and anxiety. These patients usually present with history of suicidal attempts [4].

Microscopic inflammation: Inflammation of both the colon and the small bowel have been demonstrated in the patients suffering from irritable bowel syndrome [5]. The number of lymphocytes and enteroendocrine cells in the bowel is also increased. The latter secrete serotonin, the action of which causes diarrhea.

Prevention

Irritable bowel syndrome can be prevented by ensuring proper hygiene. The use of high fiber diet is also helpful.

Summary

Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder that is characterized by abdominal pain, altered bowel habits (diarrhea, constipation or both) without any underlying obvious pathologic change in the small and large gut. The disease is not life threatening condition but it can disrupt the quality of life.

Patient Information

Irritable bowel syndrome is a disorder in which the motility of the large gut and small gut are disturbed. The patients usually develop abdominal discomfort and altered bowel habits. The disease runs in families usually affecting the younger age group.

References

Article

  1. Wensaas KA, Langeland N, Hanevik K, Morch K, Eide GE, Rortveit G. Irritable bowel syndrome and chronic fatigue 3 years after acute giardiasis: historic cohort study. Gut. Feb 2012;61(2):214-219.
  2. Shepherd SJ, Parker FC, Muir JG, Gibson PR. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. Jul 2008;6(7):765-771.
  3. Kassinen A, Krogius-Kurikka L, Makivuokko H, et al. The fecal microbiota of irritable bowel syndrome patients differs significantly from that of healthy subjects. Gastroenterology. Jul 2007;133(1):24-33.
  4. Miller V, Hopkins L, Whorwell PJ. Suicidal ideation in patients with irritable bowel syndrome. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. Dec 2004;2(12):1064-1068.
  5. Bercik P, Verdu EF, Collins SM. Is irritable bowel syndrome a low-grade inflammatory bowel disease? Gastroenterology clinics of North America. Jun 2005;34(2):235-245, vi-vii.
  6. Spiegel BM, Farid M, Esrailian E, Talley J, Chang L. Is irritable bowel syndrome a diagnosis of exclusion?: a survey of primary care providers, gastroenterologists, and IBS experts. The American journal of gastroenterology. Apr 2010;105(4):848-858.
    American College of Gastroenterology Task Force on Irritable Bowel S,
  7. Brandt LJ, Chey WD, et al. An evidence-based position statement on the management of irritable bowel syndrome. The American journal of gastroenterology. Jan 2009;104 Suppl 1:S1-35.
  8. Biesiekierski J, Newnham, ED, Irving, PM, Barrett, JS, Haines, M, Doecke, JD, et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease. The American journal of gastroenterology. 2011;106(3):508-514.
  9. Thumshirn M, Coulie B, Camilleri M, Zinsmeister AR, Burton DD, Van Dyke C. Effects of alosetron on gastrointestinal transit time and rectal sensation in patients with irritable bowel syndrome. Alimentary pharmacology & therapeutics. Jul 2000;14(7):869-878.
  10. Bardhan KD, Bodemar G, Geldof H, et al. A double-blind, randomized, placebo-controlled dose-ranging study to evaluate the efficacy of alosetron in the treatment of irritable bowel syndrome. Alimentary pharmacology & therapeutics. Jan 2000;14(1):23-34.

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Last updated: 2018-06-21 22:32