1. IBS
Irritable bowel syndrome,
a functional bowel disorder

2. IBS
Common in OPD ~20%
Common in young/middle-aged
A positive clinical diagnosis

3. Pathophysiology
 Symptoms of IBS are not pathological
 Factors that affect symptoms are-
 Altered gut reactivity- motility or secretion-
in response to luminal/environmental stimuli
 Hypersensitive gut,
with enhanced visceral perception/pain
 Dysregulation of brain-gut axis,
associated with greater stress reactivity

4. Symptoms
 Chronic abdominal pain/discomfort
 Bloating or distension of abdomen- ‘gas’
 Altered bowel habits- constipation or diarrhea
 Feeling of incomplete evacuation
 Symptoms relieved by bowel movements
 Associated gastro-esophageal reflux, ill-
defined bodyaches, depression/anxiety
 No organic cause

5. Rome II diagnostic criteria
 At least 3 days/month x last 3 months
of abdominal pain/discomfort relieved
with defecation, with change in frequency or
form of stool
 Cumulative symptoms-
 Abnormal stool frequency- <3/week or >3/day
 Abnormal stool form- hard or loose
 Abnormal stool passage- urgency, straining, tenesmus
 Passage of mucus
 Bloating or abdominal distension

6. Warning symptoms/signs
 Old age
 Blood in stool
 Persistent, severe pain
 Fever
 Vomiting
 Dehydration
 Weight loss
 Pallor or anemia
 Abnormal abdominal examination/LNE
 Acute presentation

7. Investigations
Only if required, based on
presence of warning
symptoms/signs

8. Treatment
 Based on nature & severity of
symptoms and functional impairment
 Education & reassurance
 Fiber in diet & exercise
 Pain- antispasmodics
 Constipation- Tegaserod- 5-HT4 agonist (withdrawn),
laxatives-Lactulose
 Diarrhea- Alosetron- 5-HT3 antagonist, Loperamide
 Psychotherapy
 Co-morbid psychiatric illness- TCA or SSRI