Irritable Bowel Syndrome (IBS)

2. IRRITABLE BOWEL SYNDROME
 Irritable bowel syndrome(IBS) is not a disease.
 It is a functional gastro-intestinal disorder
involving an abnormal condition of gut
contractions (motility) and increased gut sensations
(visceral hypersensitivity)
 IBS is a common disorder that affect large
intestine.

3.  IBS commonly causes cramping ,abdominal
pain, bloating gas , diarrhea and constipation.

4. Epidemiology
 More frequent in women than men.
 50% of patient present < 35 years old.
 Prevalence among the children with recurrent
20% abdominal pain.
 25% of patients examined by a G.P. suffer from
a gastro-intestinal disorder

6. Aetiology
 Abnormal GIT movement.
 A changes in the nervous system communication
between the GI and brain.
 Sensory and motor disorders of the colon.
 Dietary allergies or food sensitivities.
 Neurotransmitter imbalance ( serotonin levels).
 Stress,Genetics

7. Pathophysiology
 Many theories have been put forward. But exact
cause of IBS is still uncertain .
1. Alteration in GI motility : alteration in frequency
and irregularity luminal contraction .
2. Visceral hypersensitivity: increased sensation in
response to stimuli.
3. Brain gut axis: alteration in communication
between enteric nervous system and CNS.

9. Symptoms
 Pain , distension or abdominal discomfort and
bloating.
 Abnormal bowel habits with period of
constipation or diarrhea .
 Sensation of incomplete bowel movements.
 Mucus in the stool.
 Passing a stool three or four times a day .

10. Classification of IBS
 IBS with constipation (IBS-C)
 IBS with diarrhea (IBS –D)
 IBS mixed type (IBS-M)

11. Types of IBS
1. IBS with constipation (IBS-C)
• the person tends to alternate constipation with
normal stools. More common in women.
• Symptoms - abdominal pain,bloating

12. 2.IBS with diarrhea (IBS –D)
• The person tends to experience diarrhea first
thing in the morning or after eating. More
common in Men
• They need to go to the toilet is typically urgent
and cannot be delayed.

13. 3.IBS with alternating Constipation and Diarrhea (IBS-M):
 Passage of both hard and soft stools.
 Symptoms-Bowel habits often vary over time.

14. Diagnosis of IBS
 Flexible sigmoidoscopy
 Computerized tomography(CT) scan
Colonoscopy
Lactose intolerance test

15. 1) Flexible sigmoidoscopy
 This test examines the lower part of colon and
rectum. It is a flexible tube(sigmoidoscope) 60cm
long and about the thickness of your little finger.It is
gently inserted into anus.

16. 2) computerized tomography(CT) scan
 CT scan produce cross sectional x-ray images of
internal organs.

17. 3) Colonoscopy
 In this diagnostic test ,small, flexible tube is
used to determine the entire length of the colon.

18. 4) Lactose intolerance test
 Lactose is an enzyme ,which need to digest the
sugar found in the dairy products .
 If you don’t produce this enzyme you may
have a problem including abdominal pain ,gas
diarrhea .
 To find out this is the cause of your symptoms
your doctor may order a breath test or exclude
milk or milk products from your diet for several
weeks.

19. Prevention
 Enough fiber in diet
 Stop smoking ,avoid excessive amounts of
caffeine
 Yoga, relaxation technique
 Regular exercise
 Reduce the stress

21. Treatment of IBS
 IBS-CONSTIPATION :
a)5HT4 agonist :Tegaserod
b)Bulking laxatives: Methyl cellulose ,Psyllium
 IBS- DIARROHEA :
a) Antidiarrheal :Loperamide, Diphenoxylate
b) 5-HT3antagonist :Alosetron
 FOR PAIN :
a)Antispasmodics: Dicyclomine , Hyoscyamine
 TCAs: Imipramine ,Amitriptyline

22. 1.)Irritable Bowel Syndrome-constipation:
Tegaserod
 Short term treatment for women with
moderate /severe IBS with predominant
constipation who have failed to fiber
supplement and laxatives (reduces pain and
bloating - bowel movement and hardness
of stool )

23. Bulk laxatives
Eg: methyl cellulose
• absorbs the liquid in the intestine and swells
slowly distend the wall of intestine leads to
increases the propulsive movements and make
stools more soft .

24. 2.)Irritable Bowel Syndrome-Diaarrhea:
Antidiarrheal
Antidiarrheal agents may be used safely in the
patient with mild to moderate acute diarrhea.
Antidiarrheal are used to control chronic diarrhea
by such condition as irritable bowel syndrome
(IBS)or inflammatory bowel diseases (IBD).

25. LOPERAMIDE
Loperamide is phenylpiperidine
derivatives widely used to control
acute and chronic diarrhea.
Activates the presynaptic opioid
receptors in the enteric NS to inhibit
acetylcholine release and decreases
peristalsis.
side effects: drowsiness ,abdominal
cramps, dizziness, they should not be
used in children.

26. Diphenoxylate:
It is synthetic opioid ,chemically related
to pethidine, pharmacologically similar
to codeine.
It causes respiratory depression
,paralytic ileus and toxic mega colon in
children.

27. 5-HT3 antagonist
 5-HT3 antagonist used for diarrhea associated
IBS .
a) slow the intestinal transit urgency
b) decreases the intestinal secretion
c) decreases the water content of the stool
d) diminish the colonic pain

28. Alosetron
Alosetron is rapidly absorbed
and extensively metabolized.
Effectively relieving the pain,
normalizing the bowel frequency
and reducing the urgency.

29. Antispasmodics
 Drugs used to relieve the spasm of smooth
muscles in the GIT .
Dicyclomine and hyoscyamine
 Block muscarinic receptors in the enteric plexus
and on smooth muscles

30. Tricyclic antidepressants
It is used to treat functional bowel
disorder for 3 decades
Modulate the pain both centrally and
peripherally .