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Irritable bowel syndrome

Irritable bowel syndrome (IBS, or spastic colon) is a symptombased diagnosis characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits. As a functional bowel disorder, IBS has no known organic cause. Diarrhea or constipation may predominate, or they may alternate (classified as IBS-D, IBS-C or IBS-A, respectively). IBS is more likely to occur after an infection (post-infectious, IBS-PI), a stressful life event, or onset of maturity. Although there is no cure for IBS, there are treatments that attempt to relieve symptoms, including dietary adjustments, medication and psychological interventions. Classification IBS can be classified as either diarrhea-predominant (IBS-D), constipation-predominant (IBS-C) or IBS with alternating stool pattern (IBS-A or pain-predominant). In some individuals, IBS may have an acute onset and develop after an infectious illness characterized by two or more of the following: fever, vomiting, diarrhea, or positive stool culture. This post-infective syndrome has consequently been termed "post-infectious IBS" (IBS-PI)


Abdominal pain or cramping A bloated feeling Gas (flatulence) Diarrhea or constipation sometimes even alternating bouts of constipation and diarrhea Mucus in the stool

Causes Active infections The cause of IBS is unknown, but several hypotheses have been proposed. The risk of developing IBS increases sixfold after acute gastrointestinal infection. Post-infection, further risk factors are young age, prolonged fever, anxiety, and depression

Small intestinal bacterial overgrowth Protozoal infection Blastocystis Dientamoeba fragilis Blastocystis Dientamoeba fragilis

Food is forced through intestines more quickly, causing gas, bloating and diarrhea. Food passage slows, and stools become hard and dry. Abnormalities in system Abnormal serotonin levels. Certain foods. For instance, chocolate, milk and alcohol might cause constipation or diarrhea. Carbonated beverages and some fruits and vegetables may lead to bloating and discomfort Stress may aggravate symptoms Hormonal changes play a role in this condition

Differential diagnosis Colon cancer, inflammatory bowel disease, thyroid disorders and giardiasis can all feature abnormal defecation and abdominal pain. Less common causes of this symptom profile are carcinoid syndrome, microscopic colitis, bacterial overgrowth, and eosinophilic gastroenteritis; Risk factors

IBS symptoms first appear before the age of 35 for about half of those with the disorder. More women than men are diagnosed with this condition. people who have a first-degree relative such as a parent or sibling with IBS are at increased risk of the condition.

Complications IBS isn't associated with any serious conditions, such as colon cancer. But, diarrhea and constipation, both signs of irritable bowel syndrome, can aggravate or even cause hemorrhoids. Tests and diagnosis

Flexible sigmoidoscopy. . Colonoscopy


Computerized tomography (CT) scan. (abdominal and pelvis). Lactose intolerance tests. Stool microscopy and culture (to exclude infectious conditions) Blood tests: Full blood examination, Liver function tests, Erythrocyte sedimentation rate, serological testing for coeliac disease Abdominal ultrasound (to exclude gallstones and other biliary tract diseases) Endoscopy and biopsies (to exclude peptic ulcer disease, coeliac disease, inflammatory bowel disease, malignancies) Hydrogen breath testing (to exclude fructose and lactose malabsorption)

Comorbidities Headache, Fibromyalgia, Chronic fatigue syndrome and Depression Inflammatory bowel disease (IBD) Abdominal surgery Endometriosis Other chronic disorders: Interstitial cystitis may be associated with other chronic pain syndromes, such as irritable bowel syndrome and fibromyalgia. The connection between these syndromes is unknown.

Treatments and drugs Laxatives For patients who do not adequately respond to dietary fiber, osmotic laxatives such as polyethylene glycol, sorbitol, and lactulose can help avoid "cathartic colon" which has been associated with stimulant laxatives. Lubiprostone (Amitiza), is a gastrointestinal agent used for the treatment of idiopathic chronic constipation and constipationpredominant IBS. Lubiprostone is a bicyclic fatty acid (prostaglandin E1 derivative) that acts by specifically activating ClC-2 chloride channels on the apical aspect of gastrointestinal epithelial cells, producing a chloride-rich fluid secretion. These secretions soften the stool, increase motility, and promote spontaneous bowel movements (SBM). Unlike many laxative products, Lubiprostone does not show

signs of tolerance, dependency, or altered serum electrolyte concentration. Antispasmodics The use of antispasmodic drugs (e.g., anticholinergics such as hyoscyamine or dicyclomine) may help patients, especially those with cramps or diarrhea. Antispasmodics can be divided in two groups: neurotropics and musculotropics.

Neurotropics, such as a phenobarbital like Donnatal or atropine, act at the nerve fibre of the parasympathicus but also affect other nerves and have side effects. Musculotropics such as mebeverine act directly at the smooth muscle of the gastrointestinal tract, relieving spasm without affecting normal gut motility.

Tricyclic antidepressants Serotonin agonists

Tegaserod (Zelnorm), a selective 5-HT4 agonist for IBS-C, is available for relieving IBS constipation in women and chronic idiopathic constipation in men and women Selective serotonin reuptake inhibitor anti-depressants (SSRIs), because of their serotonergic effect, would seem to help IBS, especially patients who are constipation predominant. Serotonin antagonists (Alosetron)

Other agents Magnesium aluminum silicates and alverine citrate drugs can be effective for irritable bowel syndrome. Rrifaximin can be used as an effective treatment for abdominal bloating and flatulence. Domperidone, a dopamine receptor blocker and a parasympathomimetic, has been shown to reduce bloating and abdominal pain as a result of an accelerated colon transit time and reduced faecal load, that is a relief from hidden constipation; defecation was similarly improved Medications may consist of stool softeners and laxatives in constipation-predominant IBS, and antidiarrheals (e.g., opiate, opioid, or opioid analogs such as loperamide, codeine, diphenoxylate) in

diarrhea-predominant IBS for mild symptoms and stronger opiates such as morphine and oxycodone for severe cases. Drugs affecting serotonin (5-HT) in the intestines can help reduce symptoms. Serotonin stimulates the gut motility and so agonists can help constipation-predominate irritable bowel, while antagonists can help diarrhea-predominant irritable bowel.

Treatment focuses on the relief of symptoms so that you can live as normally as possible.

Anti-diarrheal medications. loperamide (Imodium), can help control diarrhea. Anticholinergic medications Antidepressant medications tricyclic antidepressant or a selective serotonin reuptake inhibitor (SSRI). relieve depression as well as inhibit the activity of neurons that control the intestines, or imipramine (Tofranil) and amitriptyline. Side effects of these drugs: drowsiness and constipation. SSRIs, such as fluoxetine (Prozac, Sarafem) or paroxetine (Paxil), may be helpful in the case of depression and pain during constipation. (These medications can worsen diarrhea) Antibiotics. Rifaximin, Fiber supplements. Fiber supplements, such as psyllium (Metamucil) or methylcellulose (Citrucel), with fluids may help control constipation. Counseling. If antidepressant medications don't work, you may have better results from counseling.

Medication specifically for IBS Two medications are currently approved for specific cases of IBS:

Alosetron (Lotronex). Alosetron (receptor antagonist) - relax the colon and slow the movement of waste through the lower bowel. The drug was removed from the market soon after its original approval because it was linked to serious complications. Alosetron is not approved for use by men. Generally, alosetron should only be used if usual therapy for IBS has failed.

Lubiprostone (Amitiza). Lubiprostone is approved for adult women and men who have IBS with constipation. Lubiprostone is a chloride channel activator (twice a day). It works by increasing fluid secretion in small intestine to help with the passage of stool.

Common side effects include nausea, diarrhea and abdominal pain. More research is needed to fully understand the effectiveness and safety of lubiprostone. Recommended only for those with IBS and severe constipation for whom other treatments have failed. Probiotics Probiotics can be beneficial in the treatment of IBS, taking 10 billion to 100 billion beneficial bacteria per day is recommended for beneficial resultsA number of probiotics have been found to be effective including: Lactobacillus plantarum and Bifidobacteria infantis, however, one review found that only Bifidobacteria infantis showed efficacy. (Some yogurt is made using probiotics that may help ease symptoms of irritable bowel syndrome.) Herbal remedies

Peppermint oil: Enteric coated peppermint oil capsules have been suggested for IBS symptoms in adults and children There is evidence of a beneficial effect of these capsules and it is recommended that peppermint be trialed in all irritable bowel syndrome patients. Occasionally nausea and perianal burning occur as side effects. Iberogast: The multi-herbal extract Iberogast was found to be significantly superior to placebo via both an abdominal pain scale and an IBS symptom score after four weeks of treatment. Cannabis Kiwifruit IBS/C Commiphora mukul Plantago ovata

Pprognosis Irritable bowel syndrome may be a lifelong condition. For some people, symptoms are disabling and reduce the ability to work, travel, and attend social events. Symptoms can often be improved or relieved through treatment. IBS does not cause permanent harm to the intestines, and it does not lead to a serious disease, such as cancer.