IRRITABLE BOWEL

SYNDROME
AR.KARUPPIAH
 OVERVIEW

• WHAT IS IBS?
• CLINICAL EVALUATION
• HOW TO DIAGNOSE?
• TREATMENT
• IBD VS IBS
 IBS
• A FUNCTIONAL GASTRO INTESTINAL
DISORDER CHARACTERISED BY
ABD.PAIN,DISCOMFORT,ALTERED
BOWEL FUNCTION AND
BLOATING/DISTENSION
• MALE:FEMALE-1:2
 CLASSIFICATION

• Diarrhoea predominant
• Constipation predominant
• Mixed or alternate
 FACTORS
• BRAIN-GUT AXIS
• VISCERAL HYPERSENSITIVITY
• GENETIC
• PSYCHOSOCIAL STRESSORS
• GASTRO-COLIC REFLEX.
 CLINICAL MANIFESTATIONS
• ABD.PAIN/DISCOMFORT
• DIARRHOEA
• CONSTIPATION
• DISTENSION/BLOATING SENSATION
• STRAINING/URGENCY/INCOMPLETE
EVACUATION
• PASSAGE OF MUCUS
 DIAGNOSIS

• MANNING CRITERIA
• ROME’S I CRITERIA
• ROME’S II CRITERIA
• ROME’S III CRITERIA
 ROME FOUNDATION
• This foundation is functioning for the
BENEFIT of people with FGID’S.
• Rome’s criteria is a consensual
process formed by research studies
and final decision is made by
investigators organised into
commitees in ROME,ITALY.
 ROME’S II VS ROME’S III
ROME’S II-1999 ROME’S III-2008
• Atleast 3 months or • Abdominal discomfort or
pain associated with 2 or
more need not be more of the following at
consecutive in the least 25% ofthe time: at
preceding 12 month of least once per week for at
abd.discomfort/pain least 2 months before
that has 2 out of 3 diagnosis
features a. Improved with
defecation
• Sym. relieved by
b. Onset associated
defecation with a change in frequency
• Onset ass.with change of stool
in frequency of stools c. Onset associated
• With change in form of with a change in form of
 ROME’S II VS III

• RATIONALE FOR IMPLEMENTATION

• ROME’S III BETTER THAN II
• Wang,laiu etal study showed Rome II
picked up more pt’s than III but
ROME III is more reliable, patients
diagnosed by this criteria have more
severe symptoms,better for clinical
practice.
 EFFECT OF IBS

• SECOND COMMON CAUSE FOR

ABSENTEEISM
• MISSED LEISURE ACTIVITIES
• NEGATIVE QUALITY OF LIFE
 DIFFERENTIAL DIAGNOSIS
• IBD
• DIETARY INTOLERANCE
• PARASITIC,BACTERIAL INFECTION
• MALABSORPTION
• PSYCHIATRIC DISORDERS
 MULTI COMPONENT
TREATMENT APPROACH

• DIETARY MODIFICATION
• EDUCATION AND REASSURANCE
• PHARMACOTHERAPY
• PSYCHOTHERAPY
 PHARMACOTHERAPY

• SYMPTOM RELIEF
smooth muscle relaxant and
antimotility agents/prokinetics.
• PSYCHOLOGICAL AGENTS
antidepressants and ssri’s
 PSYCHOTHERAPY

• PAIN BEHAVIOUR MANAGEMENT

• RELAXATION TECHNIQUES
• STRESS MANAGEMENT
 IBD VD IBS
IBD IBS
• SYMPTOMS- • SYMPTOMS-
abd.pain/discomfort,al
Abd.pain/cramps,diarr teration in bowel
hoea, habits,passage of
wt.loss,fatigue,blood mucus, bloating,
in distension.
stools,extraintestinal • PSYCHOSOCIAL AND
symptoms. NO
• MULTIFACTORIAL ORGANIC/METABOLIC
• MEDICAL AND CAUSE
SURGICAL TREATMENT • MEDICAL AND
 REFERENCES

• Pediatric gas.enterology by carlin

cunningham
• Romecriteria.org
• Emedicine
• Helpforibs.com