Transcript Biliary Diseases - Isfahan University of Medical Sciences

IBS
Ahmad Shavakhi.MD
Associate professor of internal medicine
Isfahan University of medical sciences
Prevalence of Diagnosis
IBS
12%
IBD
14%
Other
88%
Primary Care
Practice
Peptic
20%
Other GI
15%
Liver
10%
28%
13%
others
Gastroenterology
Practice
IBS
Doctor Visits by Gender
USA
AFRICA
INDIA
A
43 years old woman presented to clinic
 Abdominal pain
 Diarrhea
 From 6 months ago
 Pain alleviated with deification
 Denied weight loss, or other symptoms
 Normal exam
subtypes of IBS
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IBS with constipation (hard or lumpy stools ≥25 percent /
loose or watery stools <25 percent of bowel movements)
IBS with diarrhea (loose or water stools ≥25 percent / hard
or lumpy stools <5 percent of bowel movements)
Mixed IBS (hard or lumpy stools ≥25 percent / loose or
watery stools ≥25 percent of bowel movements)
Unsubtyped IBS (insufficient abnormality of stool
consistency to meet the above subtypes)
"Alarm" or atypical symptoms
 Rectal
bleeding
 Nocturnal or progressive abdominal pain
 Weight loss
 Laboratory abnormalities such as anemia,
elevated inflammatory markers, or
electrolyte disturbances
 Positive FHx
Diagnostic evaluation
 Diarrhea
 Stool
predominant IBS :
cultures
 Celiac disease screening
 Twenty-four hour stool collection
 Colonoscopy or flexible sigmoidoscopy and
biopsy
Diagnostic evaluation
 Constipation
 plain
predominant IBS :
film of the abdomen
 Flexible sigmoidoscopy and colonoscopy
Refractory symptoms
Refractory symptoms
Refractory symptoms
Treatment
Indication for non
pharmalogical treatment
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
Mild and intermittent symptoms
Do not impair quality of life
Indication for drug
Mild to moderate symptoms who fail to
respond to initial management
 Moderate to severe symptoms that affect
quality of life

Non pharmacological
treatment
 Education
and reassurance
 Food allergy testing
 Physical activity
Gas-producing foods
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such as
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cabbage
Onions
Broccoli
Wheat
potatoes
Celery
Apricot
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beans
carrots
Raisins
Bananas
apricots
prunes
pretzels
Patients with IBS may benefit
from exclusion
 We
suggest a diet low in (FODMAPs) in
IBS with abdominal bloating or pain despite
exclusion of gas producing foods
 We
suggest a two-week trial of a gluten-free
diet in patients with diarrhea predominant
IBS with significant abdominal bloating and
flatulence whose symptoms have failed to
improve with a low FODMAP diet and
avoidance of gas producing foods
Fiber
 The
role is controversial
 No serious side effects and potential
benefit
 psyllium should be considered in patients
with IBS whose predominant symptom is
constipation
IBS -C
 PEG
IBS-D
 Loperamide
 Bile
acid sequestrants
Abdominal pain
 Antispasmodic
agents
 Antidepressants
 Peppermint
Rifaximine
 bloating,
who have failed to respond to
other therapies
Probiotics
 Not
IBS
routinely recommended in patients with
THE END