Irritable Bowel Syndrome
Irritable bowel syndrome or ibs as an abbreviation is the topic for this video irritable bowel syndrome is essentially a medical condition that involves abdominal pain and it alternates between diarrhea and constipation and irritable bowel syndrome is essentially a diagnosis of exclusion and what that means is that this will be given to the patient as a diagnosis
After many other medical conditions are ruled out through testing the etiology or cause of ibs can be broken up into psychosocial and physiological factors psychosocial includes anxiety depression and a history of sexual or physical abuse physiological factors include altered motility in particular of course of the intestinal tract something called visceral hyper
Algea and this term means a heightened perception of pain another physiological factor that can cause ibs is colonic transit being either slow or fast if it’s slow that will lead to constipation and if it’s fast it will lead to diarrhea let’s discuss the symptoms now ibs usually presents in a person’s teenage years or in their twenties and it can be triggered by
Certain foods or stress and the main issues involved are abdominal pain or discomfort constipation and diarrhea and also abdominal bloating is another common symptom and there is a very specific criteria that is used to diagnose ibs and it is known as the rome criteria so here is that rome criteria and it involves the following recurrent abdominal pain on average
At least one day per week in the last three months associated with two or more of the following criteria relation to defecation associated with a change in frequency of the stool either more often as in diarrhea or less often as in constipation and associated with a change in form or appearance of the stool and this criteria needs to be fulfilled for the last
Three months with symptom onset at least six months before diagnosis treatment of ibs involves patient education letting the patient know about this medical condition with a brochure or a pamphlet is very helpful diet modification can help especially if certain foods have been identified as triggers interestingly fiber and does not help much in ibs so now let’s
Get into the medications the first type of medication that’s commonly used is something called an antispasmodic and the two most common are dicyclomine and hyoscyamine the following medications involve ibs but in particular if it is ibs constipation predominant or diarrhea predominant if it’s constipation predominant the medication of choice is lubiprostone
And diarrhea predominant the two medications most commonly used are dyfan oxalate and a very popular medication known as loperamide two more remedies i would like to share that are important peppermint oil has been shown to be beneficial in patients with ibs because it relaxes the smooth muscle of the intestine and this can help relieve pain and cramping the
Next category of medications that can be tried if the previous medications have not worked is a group of medications known as tcas which stands for tri cyclic antidepressants and examples of those are deci priming nortriptyline and amy trip to lean so now let’s take a look at a few clinical vignettes a 40 year old businessman has recently been diagnosed with
Irritable bowel syndrome after extensive testing by his gastroenterologist his predominant symptoms are diarrhea and pain which one of the following has been shown to be helpful in controlled trials as i mentioned in the video that daily use of peppermint oil has been shown to relieve symptoms in patients with ibs because it relaxes the smooth muscle and can
Help relieve pain and cramping a 22-year old college student comes to your office to discuss her several year history of abdominal pain and constipation it has gotten worse since she returned to school this fall she describes crampy pain and bloating that eases after defecation her bowel movements are firm and difficult to pass and occur about every three days
On average her symptoms have not included vomiting weight loss blood in the stool or melina her menses are regular and she is an otherwise healthy young woman family history is negative for any gi or gu diseases on exam you find her abdomen to be soft and without masses with no tenderness to palpation which one of the following would be most appropriate at this
Time so let’s go through these answer choices fiber interestingly does not help much with ibs lubiprostone is definitely the drug of choice for constipation predominant ibs which is what she has so let’s keep that one choices c d and e are actually imaging studies and they’re costly and if you look here her symptoms have not included any vomiting a weight loss
Or blood or melina and her physical exam was on markable so at this time a trial of lubiprostone would be most appropriate a 34 year old female with ongoing untreated depression consults you for newly diagnosed diarrhea predominant irritable bowel syndrome she presents with worsening abdominal discomfort her abdominal discomfort is not severe but it is constant
She has tried dicyclomine without relief and is interested in trying a different approach the patient has had negative testing for inflammatory bowel disease and celiac disease along with normal blood tests she asks about specific dietary modifications or medications that may be helpful for her abdominal discomfort which one of the following interventions would
You recommend the first choice is a tricyclic antidepressant that is used to treat ibs now if you notice in the vignette she also suffers from depression so this would probably be the most appropriate choice but let’s go through the other ones hyoscyamine is one of those antispasmodic drugs and she has already been on one called dicyclomine so since she has not
Had any relief with one antispasmodic drug starting her on another one probably is not the best choice lubiprostone is definitely a great medication but it’s for constipation predominant ibs and the last one which is fiber has not been beneficial in the treatment of irritable bowel syndrome so the answer for this question is a
Transcribed from video
Irritable Bowel Syndrome By CanadaQBank