IRRITABLE BOWEL SYNDROME

• Most commonly diagnosed gastrointestinal condition.

• The prevalence of IBS - 10 to 15 percent.
• 2:1 female predominance
• 25 to 50 percent of all referrals to gastroenterologists
• 12% of primary care provider visits
• The second highest cause of work absenteeism after the common cold
• increased health care costs, with some studies suggesting annual direct and
indirect costs of up to $30 billion

The etiology of IBS is unknown, but various hypotheses have been generated
including abnormal gut motility, bacterial overgrowth, food allergies, altered visceral
sensitivity, infectious triggers, hormonal disruption, and disorders of the serotonin
reuptake transport system.

MANNING CRITERIA

Pain relieved with defecation

More frequent stools at the onset of pain
Looser stools at the onset of pain
Visible abdominal distention
Passage of mucus
Sensation of incomplete evacuation

ROME III
Recurrent abdominal pain or discomfort for at least three days per month in
the previous three months with symptom onset in six months prior to diagnosis
with two or more of the following:
� Pain relieved with defecation, and/or
� Onset associated with a change in frequency of stool, and/or
� Onset associated with a change in form (appearance) of stool

SUBTYPES - IBS with constipation, IBS with diarrhea, Mixed IBS, Unsubtyped

Patients with typical IBS symptoms and no alarm features require few tests beyond the
history and exam.
Consider obtaining a CBC and chemistry panel in most patients, but reserve thyroid
testing, extensive stool testing (including O & P ), and other blood work (such as
antibody studies for celiac sprue) for patients with findings that are concerning for a
specific alternate diagnosis.
TREATMENT

Therapeutic relationship

Dietary modification

Behavioral treatments may be considered for motivated patients who associate symptoms
with stressors, although their benefits remain controversial Eg: Hypnosis, biofeedback,
and psychotherapy

Antispasmodics - hyoscine, cimetropium, pinaverium, and peppermint oil

Antidepressants – TCA, SSRI

Antidiarrheal agents – Loperamide

5-HT-3 receptor antagonists (alosetron (Lotronex), cilansetron, ondansetron and

granisetron ) - diarrhea predominant cases

5-HT-3 receptor agonists – Tegaserod (Zelnorm) has cardiovascular side-effects

Lubiprostone - locally acting chloride channel activator in IBS-C