Transcript [19] Changes in bowel movement-IBS.ppt

Changes in bowel movement-IBS
Mohammed Alwahibi
Khalid Alsadhan
Walid Alkhamis
Content
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Changes in bowel movement:
Abnormal changes in the frequency, consistency and the color of the stool
Irritable bowel syndrome (IBS) is a chronic, relapsing and often life-long
disorder. Symptoms may include disordered defaecation (constipation or
diarrhoea or both) and abdominal distension, usually referred to as bloating.
People with IBS present to primary care with a wide range of symptoms, some
of which they may be reluctant to disclose without sensitive questioning.
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Abdominal pain, bloating and
bowel habits changes (diarrhea
or constipation)
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Altered GI motility includes distinct aberrations in small
and large bowel motility.
Psychopathology is the 2nd aspect. Associations between
psychiatric disturbances and irritable bowel syndrome
pathogenesis are not clearly defined.
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Gender differences:
Affects up to 20% of adults (70% of them are women).
Age:
Young
Psychopathology:
High prevalence of psychiatric disorders (anxiety and
depression were the most common).
Only 25% of persons with this condition seek medical care.
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Irritable bowel syndrome in secondary school
male students in AlJouf Province, north of Saudi
Arabia (2011 Nov)
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The primary aim should be to establish the person's
symptom profile, with abdominal pain or discomfort
being a key symptom.
It is also necessary to establish the quantity and
quality of the pain or discomfort, and to identify its
site (which can be anywhere in the abdomen)
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Healthcare professionals should consider assessment
for IBS if the person
reports having had any of the following symptoms for
at least 6 months:
1-Abdominal pain or discomfort
2-Bloating
3-Change in bowel habit.
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A diagnosis of IBS should be considered only if the person has abdominal pain
or discomfort that is either relieved by defaecation or associated with altered
bowel frequency or stool form. This should be accompanied by at least two of
the following four symptoms:
altered stool passage
abdominal bloating
symptoms worse by eating
passage of mucus
Other features such as lethargy, nausea, backache and bladder
symptoms are common in people with IBS
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In people who meet the IBS diagnostic criteria, the following
tests should be undertaken to exclude other diagnoses:
1)
full blood count (FBC)
2)
erythrocyte sedimentation rate (ESR) or plasma viscosity
3)
c-reactive protein (CRP)
4)
antibody testing for coeliac disease - endomysial antibodies [EMA] or
tissue
5)
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transglutaminase [TTG].
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Dietary and lifestyle advice
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
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Healthcare professionals should assess the physical
activity levels of people with IBS and for the People
with low activity levels should be given brief advice
and counselling to encourage them to increase their
activity levels.
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Diet and nutrition should be assessed for people with IBS and
the following general advice given:
* Have regular meals and take time to eat.
* Avoid missing meals or leaving long gaps between eating.
* Drink at least 8 cups of fluid per day, especially water or
other non-caffeinated drinks, for example herbal teas.
* Restrict tea and coffee to 3 cups per day.
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Pharmacological therapy
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).
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- Antispasmodic (Dicyclomine hydrochloride) agents should
be taken as required, alongside dietary and lifestyle advice.
- Laxatives (Methylcellulose) should be considered for the
treatment of constipation in people with IBS, but people
should be discouraged from taking lactulose.
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# Consider linaclotide (Linzess) for people with IBS only if:
- optimal or maximum tolerated doses of previous laxatives
from different classes have not helped
- they have had constipation for at least 12 months.
- Follow up people taking linaclotide after 3 months.
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- Loperamide (Imodium) should be the first choice of
antimotility agent for diarrhoea in people with IBS
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- Consider tricyclic antidepressants (TCAs) (Imipramine) as
second-line treatment for people with IBS if laxatives,
loperamide or antispasmodics have not helped. Start
treatment at a low dose (5–10 mg equivalent of
amitriptyline), taken once at night, and review regularly.
Increase the dose if needed, but not usually beyond 30 mg.
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- Consider selective serotonin reuptake inhibitors (SSRIs) for
people with IBS only if TCAs are ineffective.
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Psychotherapy
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o Cognitive behavioral therapy (perceptions of illness), was
reportedly to be effective.
o A review of psychological treatments for IBS reported
positive responses to psychotherapy
o Psychotherapy is considered useful for those who have
relatively severe or refractory symptoms
o Small studies have shown that tricyclic compounds in low
doses relieve unexplained abdominal pain.
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Psychological interventions
Referral for psychological interventions (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).
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Patient education remains the cornerstone of successful
treatment of irritable bowel syndrome. Teach the patient
to acknowledge stressors and to develop avoidance
techniques. Many patients successfully manage their
symptoms with attention to dietary triggers.
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if they have any of the following 'red flag' indicators and
should be referred to secondary care for further investigation if
any are present:
- unintentional and unexplained weight loss
- rectal bleeding
- a family history of bowel or ovarian cancer
- anaemia
- abdominal masses
- rectal masses
- inflammatory markers for inflammatory bowel disease
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Lactose intolerance is a common disorder and is due to the
inability to digest lactose into its constituents, glucose and
galactose, secondary to low levels of lactase enzyme in the
brush border of the duodenum.
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loose
stools
borborygmi
nausea
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abdominal
bloating
flatulence
A diagnosis or even the suggestion of lactose
intolerance leads many people to avoid milk
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Rome III criteria is a diagnostic criteria for IBS
red flag Symptoms include unintentional and unexplained
weight loss, rectal bleeding, family history, anaemia,
abdominal masses, rectal masses, inflammatory markers
for inflammatory bowel disease
Treatment of IBS include Dietary and lifestyle advice,
antispasmodic, Laxatives, Loperamide, TCAs, SSRIs
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Irritable bowel syndrome in adults: diagnosis and
management of irritable bowel syndrome in primary care
NICE clinical guideline
http://www.medscape.org/viewarticle/439588
http://emedicine.medscape.com/article/187249-differential
http://emedicine.medscape.com/article/180389-medication#7
http://www.ncbi.nlm.nih.gov/pubmed/22125990
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