IBS

true or false

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IBS is related to IBD

false

true or false

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IBS is a syndrome, not a disease, and it is more common in women

true

list the contributing factors to IBS

• altered GI motility (constipation - slow, diarrhea - fast)

• altered sensation (visceral hypersensitivity)

• psychological factors (condition, stress)

what are the clinical presentation of IBS?

• abdominal pain and discohfortness that are relieved by bowel movement

• bloating

• diarrhea, constipation, or mixing of both

• psychological condition (depression, anxiety, stress)

therapy for mild IBS symptoms

diet and education

therapy for moderate IBS symptoms

diet, education, and symptom-directed pharmacotherapy

therapy for severe IBS symptoms

diet, education, gut-acting pharmacotherapy, antidepressants, and referral

what are some alarming S/Sx that exclude IBS treatment?

• anemia

• ≥ 10 lbs weight loss

• FH of colorectal cancer, IBD, or celiac sprue

what are food to avoid for IBS?

• raw fruits and vegetables

• high fat foods

• caffeinated, alcoholic, and carbonated beverages

• food rich in insoluble sugars or fructose

what are the recommended daily fiber intake for IBS?

20-25g

initial management of IBS in patients with CC of pain, gas and bloating

• dietary fiber

• osmotic laxative

initial management of IBS in patients with CC of diarrhea

antidiarrhea

initial management of IBS in patients with CC of constipation

• fiber

• antispasmodic

• antidepressant

why does antispasmodic (anticholinergic) are used in IBS? (2)

• they treat pain and/or bloating

• they induce intestinal smooth muscle relaxation

list the 2 antispasmodic agents for IBS

dicyclomine, hyoscyamine

dosing of antispasmodic

3 times daily prior to meal or PRN (reduce risk of tolerance)

• dry mouth

• constipation

• blurred vission

• difficulty in urination

• confusion (especially in elderly)

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caution: high dose in IBS-C, elderly

antispasmodic

• use if patient have both pain and GI symptoms associated to mental conditions

• primarily use for IBS ion moderate to severe abdominal pain

antidepressant

list the 2 antidepressant classes that are used for IBS

tricyclic and SSRI

• blurred vision

• cognitive changes

• constipation

• dry mouth

• orthostatic hypotension

• sexual dysfunction

• tahycardia

• urinary retention

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are the side effects of which drug class?

tricyclic antidepressants

• diarrhea

• sleep defects

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are the AdR of which drug class?

SSRI

true or false

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SSRI are used for patients that are IBS-C predominant with moderate-severe abdominal pain

true

LT is a 37 years old female with severe constipation.

* constipation since college
* normal bowel function occasionally for years
* constipation got worse in the past 3 years
* stools are hard and require much straining to pass
* 3-7 days between bowel movement
* patient use a whole bottle of Mg citrate if no bowel movement in 6-7 days

LT complains of “heaviness”, bloating and abdominal flatulence. Her symptoms resolve with bowel movement but gradually return. Patient also admits to significant stress in life.

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Diagnose the severity of this patient:

A. mild IBS-C

B. moderate IBS- C

C. severe IBS-C

moderate IBS-C