Lecture Irritable Bowel Syndrome - Dr. Trần Ngọc Ánh

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Lecture Irritable Bowel Syndrome help you: recognize the typical clinical presentation for IBS; describe an appropriate diagnostic plan and ROME III; prescribe an appropriate therapeutic regimens.

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Nội dung Text: Lecture Irritable Bowel Syndrome - Dr. Trần Ngọc Ánh

by Dr TRẦN NGỌC ÁNH Hà Nội Medical University
Objectives 1.Recognize the typical clinical presentation for IBS 2.Describe an appropriate diagnostic plan and ROME III 3.Prescribe an appropriate therapeutic regimens IBS- Dr Trần Ngọc Ánh
GENERAL CONSIDERATIONS  IBS- a functional bowel disorder : abdominal pain, discomfort, altered bowel habits, absence of detectable structural abnormalities  IBS-other functional disordes: fibromyalgia, headech, backache, genitourinary symptoms IBS- Dr Trần Ngọc Ánh
GENERAL CONSIDERATIONS  Diagnosis: Clinical presentation  10-20% adult, adolescents: symptoms of IBS  W/M:2-3; 80% Severe in women IBS- Dr Trần Ngọc Ánh
IBS- Dr Trần Ngọc Ánh
PATHOPHYSIOLOGY Abnormal GUT motility Visceral Genetics hypersensitivity IBS IBS- Dr Trần Ngọc Ánh
PATHOPHYSIOLOGY IBS- Dr Trần Ngọc Ánh
PATHOPHYSIOLOGY Psychosocial factor  Heightened pain sensitivity to visceral stimulation of the brain gut axis  Fibromyalgia (49% have IBS)  Chronic fatigues syndrome (51%)  Chronic pelvic pain (50%)  JMTs (64%) Post infections causes: luminal irritation small bowel bacteries over growth, gas, food allergy IBS- Dr Trần Ngọc Ánh
CLINICAL FEATURES 1.Abdominal pain -Localition: 25% hypogastrium, 20% rightside, 20% left side, 10% epigastric -Episodic and crampy -Exacerbated by eating or emotional stress Improved by passage of flatus or stools Worsening during the premenstrual and menstrual phases IBS- Dr Trần Ngọc Ánh
CLINICAL FEATURES 2.Altered Bowel Habit -Most consistent clinical feature -Constipation alternaty with diarrhea, usually with onve of these symptoms predominantly -Constipations: episodic, continous and increasingly intractable to laxative . Interrupted with brief periods of diarrhea -Diarrhea Smll volumes of loose stools (
CLINICAL FEATURES Aggraved by emotional stress or eating Malabsortion or weight loss: not occur 3,Gas and Flatulence -Abdominal distension, increased belching or flatulence (Increased gas)-Quantitative measurement reveal: no more than a normal amount of intestinal gas -Impaired transit and tolerance of intestinal gas loads -Reflux gas from the distal to the more proximal intestine belching IBS- Dr Trần Ngọc Ánh
CLINICAL FEATURES 4,Upper Gastrointestinla symptoms  -Dyspepsia, heartburn, nausea, vomiting: 31.7% Dyspepsia have IBS (7.9% Non dyspepsia have IBS)  IBS 55.6% have dyspepsia IBS- Dr Trần Ngọc Ánh
CLINICAL FEATURES Typ of IBS Typ of IBS IBS- Dr Trần Ngọc Ánh
75% change subtyps, 29% swith between IBS-C, IBS-D over 1 years IBS- constipationm34% IBS diarhea 27% IBS alternating 39% IBS- Dr Trần Ngọc Ánh
CLINICAL FEATURES IBS- Dr Trần Ngọc Ánh
Spectrum of severity in IBS Clinical Mild Moderate Severe features Prevalence 70% 25% 55 Correlation +++ ++ + with Physiology Symptoms 0 + +++ Psychosocial 0 + +++ difficulties Health care + ++ +++ issues IBS- Dr Trần Ngọc Ánh
LABORATORY FINDINGS  Complete blood count  Sigmoidoscopy  Stool specimens  Air contrast barium enema  Colonoscopy  Exclude lactase deficiency  Hydrogen breath test  Evaluation after 3 weeks lactase free diet  Exclude celiac sprue (Serology test)  GI radiography, Gastroscopy, Ultrasonography IBS- Dr Trần Ngọc Ánh
APPROACH TO THE PATIENT  Careful history, physical examination, establish the diagnosis Recurrence of lowel abdominal pain with altered bowel habits over a period of time without progressive deterioration  Exclude -Disorder for the first time in old age -Persistent diarhea after a 48 h -Nocturnal diarrhea, steatose IBS- Dr Trần Ngọc Ánh
APPROACH TO THE PATIENT Young patients >40 years If patient have • Complete blood • Air contrast barium • Sedimentation rate count enema • Leucocyte or blood • Sigmoidoscopy • Colonoscopy in stool • Stool specimens • Stool volume >200ml • OTHER DIAGNOSTIC IBS- Dr Trần Ngọc Ánh
APPROACH TO THE PATIENT  Diagnostic criteria for irritable bowel syndrome ROME Recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months asscociated with 2 or 3 mor of the following Onset Onset asscociated Improvement asscociated with a change with with a change in form defecation in frequency of (appearance of stool stool) IBS- Dr Trần Ngọc Ánh