Chronic and debilitating functional gastrointestinal disorder
IBS
What does IBS have an absence of?
Red flag symptoms
What is IBS usually relieved by?
Defecation
What are the 4 red flag symptoms?
- Loss of appetite
- Rectal bleeding
- Fistulas
- Strictures
What are the 3 main mechanisms associated with IBS?
- Altered gut reactivity
- Hypersensitive gut with enhanced visceral perception of pain
- Dysregulation of the brain-gut axis
Serotonin levels are ______ in constipation
Reduced
Serotonin levels are _______ in Diarrhea
Increased
True or False: IBS is a severely under-diagnosed syndrome
True
Patients experience a reduction in what aspect of life?
Work productivity
What is needed to diagnose IBS?
Recurrent abdominal pain at least 2 DAYS per week on average over 3 months
For IBS diagnosis, what things need to be associated with it?
- Pain related to defecation
- Change in frequency of stool
- Change in form of stool
What must you rule out to diagnose IBS? 3
- Drug induced diarrhea
- Constipation
- GI upset
What are the 8 red flag symptoms that aren’t associated with IBS?
- 50 years or older without colon Ca screening
- Recent change in bowel habit
- Evidence of GI bleed
- Nocturnal pain or passage of stool
- Unintentional weight loss
- Iron deficiency anemia
- Family history of colon cancer or IBD
- Potential drug induced
What 5 things can cause drug induced diarrhea?
- Antibiotics
- Caffeine
- Colchicine
- Sorbitol containing products
- Laxatives
What 4 things can cause drug induced constipation?
- Anticholinergic agents
- Aluminum antacids
- Opioid analgesics
- Anti-diarrheal agents
What 5 drugs can cause drug induced abdominal discomfort?
- Iron
- Corticosteroids
- Antibiotics
- Bisphosphonates
- NSAIDs
What are 4 non pharmacological managements for IBS?
- Dietary manipulation
- Fiber
- Peppermint oil
- Psychological therapies
What diet shows the most evidence to help with IBS?
FODMAP
What 2 things are recommended as part of initial management for IBS?
- Dietary fiber
- Psyllium
What can insoluble fiber cause?
Bloating
What is insoluable fiber not recommended for?
IBS-D
What is the MOA for peppermint oil?
Relaxes smooth muscle and attenuation of visceral hypersensitivity and pain sensation
What formulation of peppermint oil is the best?
Coated capsule
