Irritable Bowel Syndrome
Family Nurse Practitioner: GI Disorders
Pendergrass
Introduction
Common functional GI disorder
Idiopathic cause; no cure
Chronic condition w/ severe impact on qol
Abdominal pain/discomfort; altered bowel
habits
No specific tests; symptoms vary & can be
contradictory (constipation alt w/ diarrhea)
Most IBS treated at primary care level
2
Epidemiology
25-45 million people in US; roughly 10-15% of
population
3.5 million primary care visits yearly
Most common in young adults 18-34; 50% of
cases appear before age 35
10% has onset after age 60 (so must be
considered in elderly with abdominal pain,
diarrhea, constipation
More prominent in women (65%). Tends to run
in families
3
Common Comorbidities:
NonGI somatic disorders
Chronic pelvic pain
Fibromyalgia
Chronic fatigue
Dysmenorrhea
Cystitis
4
Common Comorbidities:
GI Disorders
Diverticulosis
Gastritis
GERD
PUD
IBD
Family history of IBD, colon ca and celiac
disease are risk factors
5
6
Comorbid Psychiatric Disorders
Comorbid Psychiatric disorders affect 50% of
IBS patients:
Anxiety
Depression
Higher level of lifetime & daily stress
44% experienced physical or sexual abuse in
childhood
7
Etiology
Not fully defined
Hypotheses range from purely psychosocial to
post-infectious alteration of GI tract
generally seen as a biopsychosocial disorder
8
Wide range of Factors that can have impact
on IBS symptoms
Psychological—stress, trauma, abuse
Dietary—artificial sweeteners, fructose, sorbitol
Medications—hydroxychloroquine, orlistat,
antidepressants, hyperlipidemia agents, narcotics
Neuromuscular disorders—Parkinson's disease,
multiple sclerosis, cerebral palsy
Pelvic floor dysfunction—post-gynecologic
surgery, cystocele, rectocele
Post-acne—isotretinoin, tetracycline, minocycline
Post-cholecystectomy
9
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 constipation
2.
Hypersensitive gut with enhanced visceral
perception and pain
3.
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 IBS
Stress may exacerbate symptoms & may
increase health care seeking behavior
Traumatic life events are correlated with IBS
Chronic stress may impair resolution of
symptoms
Bacterial infection has recently been
recognized as important cause of IBS
Campylobacter jejuni
,
Salmonella enteritidis
,
and
Shigella flexneri
11
Diagnosis
¾ remain undiagnosed
Accurate diagnosis is challenge
3 subtypes based on stool-habit alteration:
constipation-predominant
diarrhea-predominant
pain-predominant, also known as IBS with
alternating diarrhea-constipation.
