Irritable Bowel Syndrome
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| Epidemiology of IBS | F:M = 3-4:1, presents in the 30's or 40's. Onset Rare after 50. Prevalence similar between races
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| Signs and Sx of IBS | chronic abdominal pain and bloating relieved by defecation. Changes in stool frequency of appearance in stool. Number of comorbid conditions
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| Constipation is having a BM less than ___ times a week | 3 times a week
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| IBS subdivisions | C, D, M
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| Diagnostic Evaluation of IBS | CBC, Chemistry panel, and serum albumin. Do stool if increased likelihood of infection(occult blood, leukocytes, O & P, Culture). ESR, Thyroid fxn, sigmoidoscopy, colonoscopy or barium are not recommended without alarm symptoms
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| ESR measures | unspecific marker for inflammation
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| How does diarrhea affect potassium | lowers it
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| Diagnoses that may mimic IBS | Infection, IBD, Dietary factors (eg lactose intolerace), malabsorption (post gastrectomy), Endometriosis, Endocrine tumors, AIDS, Psychologic
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| Too much methane in your breath indicates | bacterial overgrowth
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| high fat meals and IBS | People with IBS have been shown to have exaggerated motility with high fat meals
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| Post meal feelings in IBS | pain, cramps, diarrhea
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| What did PET and functional MRI studies show in IBS patients? | PET and fMRI studies showed differences in the intensity of brain activation in regions like the anterior cingulate cortex, thalamus after rectal balloon distension and that IBS patients have heightened pain sensation.
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| Pyschologial factors | 50% of IBS patients who seek medical care are depressed or anxious.The presence or absence of a history of childhood abuse is correlated in the severity of symptoms in patients with IBS.
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| Previous episode of ______ is associated with IBS | Infectious enteritis
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| Tx of IBS | Dietary Modification, abx, bulking agents, antispasmodics, laxatives, anti-diarrheals, antidepressants, psychotherapy/Hypnosis, Probiotics, Zelnorm
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| Bacterial overgrowth hypothesis in IBS | Hypothesis that with dysregulated motor function stasis can lead to small bowel bacterial overgrowth.Treated with antibiotics (preferably those not absorbed by the gut
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| Evidence regarding fiber | not a lot of concrete proof. There have been 13 RCT looking at bulking agents. One meta-analysis suggests fiber may be effective in improving global IBS symptoms.Overall, bulking agents appear similar to placebo. Also, no data to support laxatives
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| Rescue therapy for IBS | Antispasmodics
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| Which encapsulated probiotic has been found to be superior to placebo by 20% in a recent trial? | Bifidobacterium infantis 35624
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| Major regulator of the peristaltic reflex and sensory relays in the gut through 5HT3 and 5HT4 receptors. | Zelnorm. Only medication with high quality data for treatment of IBS approved by the FDA at the time of its withdrawal from the market mid-2007 (CV risks)
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| locally acting selective chloride-channel activator that enhances chloride-rich fluid secretion into the intestinal lumen | Lubisprostone
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| Mild IBS tx | Patient Education, reassurance, dietary recommendation
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| Moderate IBS tx | Monitor Sx, Pharmacotherapy targeted to specific sx, psychological tx
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| Severe IBS tx | Ongoing relationship with physician, antidepressant therapy, referral to mental health professional
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| only FDA approved medication with data supporting benefit withdrawn. | Tegaserod (effective in constipation-predominant IBS)
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| Theory with most backing right now | Brain-Gut theory
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| Common location of IBS pain | Left Lower Quadrant
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| Alosetron | a serotonin 5HT3 agonist that has been shown to help relieve sx in patients with diarrhea-predominant IBS
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| Key to IBS | not explicable by the presence of structural or biochemical properties
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| Symptoms should be present for at least __ months before diagnosis can be considered | 3 months
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| Visceral Hypersensitivity | Patients often have a lower visceral pain threshold, reporting abdominal pain at lower volumes of colonic gas insufflation or colonic ballon inflation than controls
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| Patients 50 and over | In all patients 50 and over who have not had a previous evaluation, barium enema or colonoscopy should be considered to exclude malignancy
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| Alarm symptoms that patients should be aware of b/c they suggest a diagnosis other than IBS | acute onset of sx, nocturnal diarrhea, hematochezia, weight loss, and fever
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| Low rectal pain threshold is considered a | hallmark of IBS
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