IBS women.

1. Kurdistan Board GEH/GIT SurgeryKurdistan Board GEH/GIT Surgery
Weekly J ClubWeekly J Club
Supervised by:Supervised by:
Dr. Mohamed AlshekhaniDr. Mohamed Alshekhani

2. Introduction:Introduction:
 A common GI disorder characterized by abdominal pain &A common GI disorder characterized by abdominal pain &
discomfort associated with altered bowel function ;diarrhea,discomfort associated with altered bowel function ;diarrhea,
constipation, or mixed.constipation, or mixed.
 It is a chronic disorder with a female predominance ranging fromIt is a chronic disorder with a female predominance ranging from
2-4:1 in the west, but in Asia equal.2-4:1 in the west, but in Asia equal.
 Worldwide the prevalence varies from 7-21%.Worldwide the prevalence varies from 7-21%.
 Females have more constipation & abd pain & males moreFemales have more constipation & abd pain & males more
diarrhea.diarrhea.
 Several pathophysiologies: increased visceral sensation,Several pathophysiologies: increased visceral sensation,
alterations in intestinal motility /permeability, autonomic nervousalterations in intestinal motility /permeability, autonomic nervous
system dysregulation, activation of GI immune function, brain-gutsystem dysregulation, activation of GI immune function, brain-gut
dysregulation,alterations in the gut microbiome, sex hormones &dysregulation,alterations in the gut microbiome, sex hormones &
psychosocial factorspsychosocial factors
 Many of the comorbidities with IBS have a female predominance;Many of the comorbidities with IBS have a female predominance;
fibromyalgia, chronic pelvic pain, migraine ,chronic fatiguefibromyalgia, chronic pelvic pain, migraine ,chronic fatigue

3. Introduction:Introduction:
 Between 12- 23% of menstruating women have endometriosis.Between 12- 23% of menstruating women have endometriosis.
 There is no good noninvasive screening tests so clinical suspicionThere is no good noninvasive screening tests so clinical suspicion
is necessary to make this diagnosis.is necessary to make this diagnosis.
 The signs / symptoms of this disorder (abd pain,altered bowelThe signs / symptoms of this disorder (abd pain,altered bowel
function) meet the clinical criteria for IBS.function) meet the clinical criteria for IBS.
 Women with endometriosis * 6 more to be diagnosed with IBS.Women with endometriosis * 6 more to be diagnosed with IBS.
 Symptoms that correlated with endometriosis in women who hadSymptoms that correlated with endometriosis in women who had
IBS &laparoscopically proven endometriosis were:IBS &laparoscopically proven endometriosis were:
 Worsening of symptoms premenstruallyWorsening of symptoms premenstrually
 Intermenstrual bleeding.Intermenstrual bleeding.
 On physical exam:On physical exam:
 > Vaginal forniceal tenderness.> Vaginal forniceal tenderness.
 The gold standard for diagnosis is laparoscopy with biopsiesThe gold standard for diagnosis is laparoscopy with biopsies
confirmingconfirming endometriosis.endometriosis.

4. Management:Management:
 Women are having more severe disease.Women are having more severe disease.
 IBS classified as mild, moderate, or severe depending:IBS classified as mild, moderate, or severe depending:
 Symptoms (particularly abd pain)Symptoms (particularly abd pain)
 Health-related QOLHealth-related QOL
 Presence of comorbid health conditionsPresence of comorbid health conditions
 Psychological distress,Psychological distress,
 Health care costs.Health care costs.
 The cornerstone of therapy is developing a therapeutic clinician-The cornerstone of therapy is developing a therapeutic clinician-
patient relation & optimizing communication skills in activepatient relation & optimizing communication skills in active
listening, empathy, setting realistic goals, educating&reassuringlistening, empathy, setting realistic goals, educating&reassuring
patients&setting boundaries& dealing with time constraints.patients&setting boundaries& dealing with time constraints.

5. Management:Management:
 Diet: Gluten avoidance,fatty food avoidance,FOFMAP avoidance.Diet: Gluten avoidance,fatty food avoidance,FOFMAP avoidance.
 Increase Fibre.Increase Fibre.

6. Management:Management:
 Alternative Medicine:Alternative Medicine:
 Enteric-coated peppermint oil & STW5 (Iberogast)Enteric-coated peppermint oil & STW5 (Iberogast)
 STW5 (Iberogast) is an OTC standardized mixture of herbsSTW5 (Iberogast) is an OTC standardized mixture of herbs
(angelica root, bitter candy tuft, caraway fruit, celandine,(angelica root, bitter candy tuft, caraway fruit, celandine,
chamomile flowers, lemon balm leaves, liquorice root, peppermintchamomile flowers, lemon balm leaves, liquorice root, peppermint
leaves, St Mary’s thistle),used to treat other functional disorders,leaves, St Mary’s thistle),used to treat other functional disorders,
has a good side effect profile&thought to work on muscarinic /has a good side effect profile&thought to work on muscarinic /
serotonergic receptors to affect GI muscle tone & secretion&helpserotonergic receptors to affect GI muscle tone & secretion&help
bloating, gas&bloating, gas&dyspepsia.dyspepsia.

7. Management:Management:
 Probiotics:Probiotics:
 Improve global IBS symptoms, including abdominal pain, bloating,Improve global IBS symptoms, including abdominal pain, bloating,
and flatulence.and flatulence.

21. Take Home PointsTake Home Points
 IBS is a chronic medical conditionIBS is a chronic medical condition
characterized by abdominal pain,characterized by abdominal pain,
diarrhea or constipation, bloating,diarrhea or constipation, bloating,
passage of mucus and feelings ofpassage of mucus and feelings of
incomplete evacuationincomplete evacuation
 Precise etiology of IBS is unknown andPrecise etiology of IBS is unknown and
therefore treatment is focused ontherefore treatment is focused on
relieving symptoms rather that “curingrelieving symptoms rather that “curing
disease”disease”

22. Take Home PointsTake Home Points
 Although many IBS patients complainAlthough many IBS patients complain
of symptoms after eating, true foodof symptoms after eating, true food
allergies are uncommonallergies are uncommon
 Specific therapies are determined bySpecific therapies are determined by
individual patient symptomsindividual patient symptoms
 Life-style modifications and possibleLife-style modifications and possible
alternative therapies may relievealternative therapies may relieve
symptomssymptoms
 Surgery has NO Role in treatment of IBSSurgery has NO Role in treatment of IBS