Investigation and Treatment of Irritable Bowel Syndrome

PCL
Investigation
• It is a diagnosis of exclusion
• Rome III [2006]criteria
o Recurrent abdominal pain or discomfort at least 3 days/month in the last 3 months associated with two or more of the following:
 Improvement with defecation
 Onset associated with changes in frequency of stool
 Onset associated with changes in form (appearance) of stool
o Criterion fulfilled for the last 3 months with symptoms onset at least 6 months prior diagnosis
• Manning’s Criteria
o Onset of pain linked to more frequent bowel movements
o Looser stools associated with onset of pain
o Pain relieved by passage of stool
o Noticeable abdominal bloating
o Sensation of incomplete evacuation more than 25% of the time
o Diarrhea with mucus more than 25% of the time
• Full blood count, X-ray, Colonoscopy, Gastroscopy, Sigmoidoscopy, CT, MRI. Important to note patients’ age and risk factors for differential diagnosis.
• Infectious diseases, Coeliac disease, Helicobacter pylori and Inflammatory bowel diesease
Treatment Options
• Diet
o Lactose intolerance – lactose free diet
o Fructose malabsoption – Restrict fructose and fructan intake
o Over eating or drinking may provoke gastrocolic response due to heightened sensitivity.
o Fibre – soluble fibre [psyllium] is found to be effective in the general IBS population especially to those who have constipation that is predominant of irritable bowel. However, it doesn’t reduce pain.
• Medication
o Antispasmodic [anticholinergic - hysocyamine or dicyclomine]
 Patients with cramps or diarrhea
o Stool softener or Laxatives
 Osmotic [Polyethylene glycol]
 Stimulant - Cathartic colon
 Lubiprostone is also a drug that helps chronic idiopathic constipation
o Antidiarrheals
 Opiate or Opioid analogs such as loperamide and diphenoxylate
o Serotonin - Improves gut motility
 Agonist [Tegaserod, SSRI] improves constipation predominant pain/diarrhea
 Antagonist [Alosetron] improves pain/diarrhea predominant constipation
o Tricyclic antidepressants
 Low dose can be effective
o Antibiotic
 Rifaximin can be used for bloating and flatulence, suggesting bacterial overgrowth
• Psychotherapy
o Brain-gut
o Cognitive behavioural therapy and hypnosis
• Alternative medicine
o Probiotics - Yogurt
o Yoga
o Herbal remedies
o Accupuncture