Categories: BlogColon Disorder

Irritable Bowel Syndrome

Definition: Relapsing abdominal pain with bloating, flatulence and change in bowel habits (alternating diarrhea and constipation) that improves with defecation, seen in middle aged women. This condition is a diagnosis of exclusion Etiology and association Unknown etiology, mostly women with history of childhood abuse. Unknown cause of increase in frequency of normal peristalsis and segmentation contraction of bowel. Can be diarrhea predominant, Constipation predominant or both (alternate consti-diarrhea). Symptoms and Clinical Presentation: Abdominal pain/cramping with change in bowel movements that gets better post defecation 20% constipation only, some diarrhea alone only, rest switch between diarrhea and constipation All have abdominal pain/bloat/gas/flatulence. No Bleeding, No Weight loss, No fever, No nocturnal Symptoms. No GI Pathology appreciated Get better with Fiber rich foot or go away with bowel movements Diagnosis (Rome criteria) – (at least 3 months; 3 days per month) 2/3 below. Change in Form and Appearance of Stool Diarrhea alternating with constipation [ie change in frequency] Pain relived by BM or by change in bowel habit (when you diarrhea, pain gone) Colonoscopy – normal mucosa Stool guaic negative, No WBC, Culture/Ova all negative, Abdominal CT negative Treatment and Management Best initial: High fiber diet and increase the bulk of the stool (help relief pain, if not use medication) Medication for pain of IBD Pain (antispasmotics) – Hyoscyamine, Dicyclomine, Belladonna alkaloid [relax bowel] Relax muscle wall contracture hence diminish pain – Can worsen GERD! If refractory pain can use TCA (anti HAM) can relax bowel and treat depression since many have…

Definition:

  • Relapsing abdominal pain with bloating, flatulence and change in bowel habits (alternating diarrhea and constipation) that improves with defecation, seen in middle aged women.
  • This condition is a diagnosis of exclusion

Etiology and association

  • Unknown etiology, mostly women with history of childhood abuse.
  • Unknown cause of increase in frequency of normal peristalsis and segmentation contraction of bowel.
  • Can be diarrhea predominant, Constipation predominant or both (alternate consti-diarrhea).

Symptoms and Clinical Presentation:

  • Abdominal pain/cramping with change in bowel movements that gets better post defecation
  • 20% constipation only, some diarrhea alone only, rest switch between diarrhea and constipation
  • All have abdominal pain/bloat/gas/flatulence.
  • No Bleeding, No Weight loss, No fever, No nocturnal Symptoms. No GI Pathology appreciated
  • Get better with Fiber rich foot or go away with bowel movements

Diagnosis

  • (Rome criteria) – (at least 3 months; 3 days per month) 2/3 below.
    • Change in Form and Appearance of Stool
    • Diarrhea alternating with constipation [ie change in frequency]
    • Pain relived by BM or by change in bowel habit (when you diarrhea, pain gone)
  • Colonoscopy – normal mucosa
  • Stool guaic negative, No WBC, Culture/Ova all negative, Abdominal CT negative

Treatment and Management

  • Best initial: High fiber diet and increase the bulk of the stool (help relief pain, if not use medication)
  • Medication for pain of IBD
  • Pain (antispasmotics) – Hyoscyamine, Dicyclomine, Belladonna alkaloid [relax bowel]
    • Relax muscle wall contracture hence diminish pain – Can worsen GERD!
    • If refractory pain can use TCA (anti HAM) can relax bowel and treat depression since many have depression anyways (amitriptyline is anticholinergic, relive neuropathic pain, antidepressant)
  • Medication for Diarrhea-Constipation predominant;
    • Diarrhea predominant
      • Rifaximine: non-absrobed Abx
      • Loperamide, Diphenoxylate,
      • Alosetron (arrest stool via 5HT)
      • EluxadolineL mu-opioid receptor agonist for diarrhea, relieves pain/slows bowel.
    • Constipation predominant
      • Always Fiber
      • Polyethylene glycol (PEG): non-absorbed bowel lubricant. If don’t work use below 2: lubipristone, Linaclotide
      • Lubiprostone (Cl channel activator that increase BM frequency)
      • Linaclotide (guanylate cyclase agonist) also like lubirpistone used if PEG not work.
      • Tegaserod (Side effects include diarrhea. This drug manipulate 5HT),
Vikram Tarugu

Dr. Vikram Tarugu is an award-winning Gastroenterologist with board certification earned from both the “American Board of Internal Medicine” and the “American Board of Internal Medicine Sub-Specialty in Gastroenterology“. Currently practicing in West Palm Beach & Okeechobee, FL. Dr. Vikram Tarugu is a proficient medical professional specializing in the diagnosis and treatment of digestive health complications. With over 20 years of in-the-field experience, 2,000+ procedures conducted, and 4,000 patients treated; Dr. Vikram Tarugu has been recognized as one of the best GI doctors, not only in the state of Florida in which he practices, but nationwide.

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