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