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Management
of irritable bowel syndrome (IBS)
WORKSHOP
Dimitris Karanasios
Content
• Knowledge about pathogenesis and
diagnosing IBS
• Strategies for achieving symptoms control
• Patients’ involvement in IBS selfmanagement
PATHOGENESIS – GUIDELINES
• Pathogenesis of IBS
• Guidelines for IBS management
(NICE, American Gastrenterology Society,
ECPCG)
A 43-year-old woman attends your
practice
She complains about pain and discomfort in the abdomen as well
as a change in the frequency of her stools. Defecation improved for
the last three years but now “it’s not tolerable” as she says.
• History:
– Smoking for 20 years (2p/d)
– Does not consume alcohol
– A history of major depression on her mother’s side
• Physical examination:
– BP 126/84 mmHg
– Weight 68 kg, Height 170 cm, WC 74 cm
– No abdominal or rectal masses, bowels sound normal
• Additional examinations:
– Abdominal x-rays, abdomen ultrasound (2 months ago) both normal
INDIVIDUAL EXERCISE
 Establish the patient’s bowel habit.
 Assess the patient’s risk for malignancy, paying
attention to possible ‘’red flags.’’
 Think of other conditions that could be excluded.
 Establish the diagnosis if possible.
 Use: IBS guidelines (NICE, American
Gastrenterology Society, ECPCG),
Rome III diagnostic criteria, Bristol Stool Chart
EXAMINATIONS
• The patient’s condition and common
problems
• Necessary additional examinations when
IBS criteria are met
• Aimless additional examinations
IBS EXAMINATIONS
(Roma III criteria)
RECOMMENDED
NOT RECOMMENDED
1. Full blood count (FBC)
1. Ultrasound
2. Erythrocyte sedimentation rate
(ESR) or plasma viscosity
2. Rigid/flexible sigmoidoscopy
3. C-reactive protein (CRP)
3. Colonoscopy; Barium enema
4. Antibody testing for coeliac disease
(endomysial antibodies [EMA]
or tissue transglutaminase [TTG])
4. Hydrogen breath test (for lactose
intolerance and bacterial
overgrowth)
5. Thyroid function test (TSH)
6. Faecal ova and parasite test
7. Faecal occult blood test
GROUP WORK (3 GROUPS)
PREPARE A PROGRAM FOR :
 Giving information that explains the importance
of self-help in effectively managing the patient’s
IBS (information on general lifestyle, physical
activity, diet and symptom-targeted medication)
 Pharmacological therapies (antispasmodic
or/and laxatives, tricyclics, SSRIs)
 Behavioural and alternative therapies
PRESENTATION
OF THE
PROGRAMS
AND
DISCUSSION
SUMMARY
The self-management of IBS
•
•
•
•
”People with IBS should be given information
that explains the importance of self-help in
effectively managing their IBS.
This should include information on :
general lifestyle
physical activity
diet and
symptom-targeted medication.”
Diagnosis and management of irritable bowel syndrome in
primary care. National Institute for Health and Clinical
Excellence (NICE) 2008
Pharmacological treatment of IBS
”Decisions about pharmacological management should
be based on the nature and severity of symptoms. The
recommendations made below assume that the choice
of single or combination medication is determined by the
predominant symptom(s).’’
•
•
•
•
Antispasmodic agents
Laxatives
Tricyclic antidepressants
Selective serotonin reuptake inhibitors (SSRIs)
Diagnosis and management of irritable bowel syndrome in
primary care. National Institute for Health and Clinical
Excellence (NICE) 2008
Behavioural and alternative
therapies in IBS
Psychological interventions
• Referral for cognitive behavioural therapy [CBT], hypnotherapy
and/or psychological therapy should be considered for people with
IBS who do not respond to pharmacological treatments after 12
months and who develop a continuing symptom profile (described
as refractory IBS).
Complementary and alternative medicine
• The use of acupuncture should not be encouraged for the treatment
of IBS.
• The use of reflexology should not be encouraged for the treatment
of IBS.
Diagnosis and management of irritable bowel syndrome in primary care.
National Institute for Health and Clinical Excellence (NICE) 2008
The Rome III Diagnostic Criteria*
A SYSTEM FOR DIAGNOSING FUNCTIONAL
GASTROINTESTINAL DISORDERS BASED ON SYMPTOMS
FOR IBS:
Recurrent abdominal pain or discomfort** at least 3 days per month
over the last 3 months associated with 2 or more of the following:
• Improvement with defecation
• Onset associated with a change in frequency of stool
• Onset associated with a change in form (appearance) of stool
* Criteria fulfilled for the last 3 months with symptom onset at least
6 months prior to diagnosis.
** "Discomfort" means an uncomfortable sensation not described as
pain.