IBS is a *functional bowel disorder*, which means... - ✔✔Nothing will be "wrong" with the patient's GI
tract, so early mortality is not expected
IBS is a diagnosis of exclusion and there is no true reason found for the cause
Symptoms of IBS - ✔✔Recurrent abdominal pain at least one day per week in the last three months,
associated with two or more of the following criteria:
- Related to defecation
- Change in stool frequency
- Chain in stool appearance
Proposed Pathophysiology of IBS - ✔✔Somatovisceral and motor dysfunction of the intestine along with
visceral hypersensitivity, caused by genetics, motility factors, inflammation, colonic infections/bacterial
overgrowth, mechanical irritation to local nerves, stress/psychological factors
Serotonin and IBS - ✔✔IBS-D patients have increased postprandial levels of 5-HT as compared to healthy
adults
Frequent doctor visits, more medication uses, missed work, higher direct cost than patients without
Signs and symptoms found in other diseases, but not directly related to IBS: - ✔✔Anemia
Rectal bleeding
Weight loss
Nocturnal symptoms
Family history of colorectal cancer, IBD, or celiac sprue
Diagnostic Criteria for IBS - ✔✔Rome Criteria
, Bristol Stool Subtype
Manning Criteria (not used often)
IBS with predominant constipation - ✔✔Patient reports that abnormal bowel movements are usually
constipation
IBS with predominant diarrhea - ✔✔Patient reports that abnormal bowel movements are usually
diarrhea
IBS with mixed bowel habits - ✔✔Patient reports that abnormal bowel movements are usually both
constipation and diarrhea
IBS unclassified - ✔✔Patients who meet diagnostic criteria for IBS but cannot be accurately categorized
into one of the other three subtypes
Clinical Presentation of IBS - ✔✔Lower abdominal pain
Abdominal bloating and distension
Diarrhea or constipation symptoms
Depression and anxiety
Urinary symptoms
Fatigue
Dyspareunia
Available Tx for IBS Based on Predominant Symptom: Bloating/distension - ✔✔Diet
Probiotics
*Rifaximin*
Available Tx for IBS Based on Predominant Symptom: Abdominal pain/discomfort - ✔✔Antispasmodics
SNRI/*TCA*
Rifaximin (-D)
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