IBS

true or false

IBS is related to IBD

true or false

IBS is related to IBD

false

true or false

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)

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

are the side effects of which drug class?

tricyclic antidepressants

• diarrhea

• sleep defects

are the AdR of which drug class?

SSRI

true or false

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.

Diagnose the severity of this patient:

A. mild IBS-C

B. moderate IBS- C

C. severe IBS-C

moderate IBS-C