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Irritable Bowel SyndromeFamily Nurse Practitioner: GI Disorders Pendergrass
IntroductionCommon functional GI disorderIdiopathic cause; no cureChronic condition w/ severe impact on qolAbdominal pain/discomfort; altered bowel habitsNo specific tests; symptoms vary & can be contradictory (constipation alt w/ diarrhea)Most IBS treated at primary care level2
Epidemiology25-45 million people in US; roughly 10-15% of population3.5 million primary care visits yearlyMost common in young adults 18-34; 50% of cases appear before age 3510% has onset after age 60 (so must be considered in elderly with abdominal pain, diarrhea, constipationMore prominent in women (65%). Tends to run in families3
Common Comorbidities: NonGI somatic disordersChronic pelvic painFibromyalgiaChronic fatigueDysmenorrheaCystitis4
Common Comorbidities:GI DisordersDiverticulosisGastritisGERDPUDIBDFamily history of IBD, colon ca and celiac disease are risk factors5
Comorbid Psychiatric DisordersComorbid Psychiatric disorders affect 50% of IBS patients: AnxietyDepressionHigher level of lifetime & daily stress44% experienced physical or sexual abuse in childhood7
EtiologyNot fully definedHypotheses range from purely psychosocial to post-infectious alteration of GI tractgenerally seen as a biopsychosocial disorder 8
Wide range of Factors that can have impact on IBS symptomsPsychological—stress, trauma, abuseDietary—artificial sweeteners, fructose, sorbitolMedications—hydroxychloroquine, orlistat, antidepressants, hyperlipidemia agents, narcoticsNeuromuscular disorders—Parkinson's disease, multiple sclerosis, cerebral palsyPelvic floor dysfunction—post-gynecologic surgery, cystocele, rectocelePost-acne—isotretinoin, tetracycline, minocyclinePost-cholecystectomy9
At least 3 interrelated factors IBS is not characterized by any specific physiologic mechanism. 1.Altered gut reactivity in response to luminal or provocative environmental stimuli, resulting in symptoms of diarrhea and/or constipation2.Hypersensitive gut with enhanced visceral perception and pain3.Dysregulation of the brain-gut axis, possibly associated with greater stress-reactivity and altered perception and/or modulation of visceral afferent signals.10
Psychosocial issues play important role in development of IBSStress may exacerbate symptoms & may increase health care seeking behaviorTraumatic life events are correlated with IBSChronic stress may impair resolution of symptomsBacterial infection has recently been recognized as important cause of IBSCampylobacter jejuni, Salmonella enteritidis, and Shigella flexneri11
Diagnosis¾ remain undiagnosedAccurate diagnosis is challenge3 subtypes based on stool-habit alteration:constipation-predominant diarrhea-predominant pain-predominant, also known as IBS with alternating diarrhea-constipation.