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IBS

Gastroenterology

QuestionAnswer
IBS prognosis Once diagnosed 75% of pts remain symptomatic 5 yrs later, and 55% at 7 yrs
IBS Sx chronic abd pain & bloating relieved by defecation; changes in stool frequency or appearance
IBS dx criteria Manning; Kruis; Rome (I, II, III)
Considered a hallmark sx of IBS: Lowered rectal pain threshold
IBS & psych: 50% of pts seeking IBS med care also have depression/anxiety
IBS & post-infxn: often assoc with: Entamoeba, Salmonella and Campylobacter
Initial eval for IBS includes: PE; CBC, ESR; labs (FOBT, fecal leukocytes, O&P, cx), poss sigmoidoscopy
Current thought about IBS etiology: brain-gut dysregulation
IBS eval red flags (suggesting dz other than IBS) onset in pt >40; wt loss; nocturnal waking; FH ca/IBD; abnml exam; fever; pos FOBT; low HGB; high WBC; high ESR; abnml chems
Which tx have best evidence? antispasmodics (dicyclomine); anti-diarrheals (loperamide); SSRI/TCA (IBS-D not IBS-C); poss new probiotics (not lactobacillus); Amitiza
IBS tx having independent analgesis properties: antidepressants
Zelnorm & serotonin serotonin release in plasma reduced in IBS-C & increased in IBS-D
abd pain assoc w/bowel dysfn, often relieved by BM = IBS
IBS DDX dietary (lactose); celiac dz (wt loss); IBD, colon ca (wt loss, anemia)
Female with recurrent abdominal pain, alternating diarrhea, constipation; pain relieved with defecation = IBS. TCAs (nortriptyline) good if diarrhea predominant symptom
IBS & post-infection: often associated with: Entamoeba, Salmonella and Campylobacter
Serotonin 5 HT3 antagonist that relieves symptoms in diarrhea-predominant IBS: Alosetron
Serotonin 5 HT4 agonist that relieves symptoms in constipation-predominant IBS: Tegaserod
Created by: Abarnard
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