JSC “ Medical University Astana” Department of Internal Diseases №1 Done by:

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1. JSC “ Medical University Astana” Department of Internal Diseases №1 Done by:
2. Introduction••••••First described in 1771.50% of patients present
3. World Prevalence of IBSAdapted from Camilleri M,
4. Prevalence of IBS
5. Types of IBS:IBS can be subdivided intoConstipation-predominant
6. The Positive Diagnosis of IBS:A Symptom-Based ApproachAdapted
7. Identify Red FlagsHistory Unintentional weight loss Onset
8. The balance of IBS diagnosis
9. Association of bowel symptoms with stool consistencyTillisch et al Am J Gastroenterol. 2005; 100:896-904
10. Defining Stool ConsistencyBristol Stool Form ScaleHardNormalLoose
11. Changes to IBS classification Rome III SummaryNo
12. ManningKruisRomeRome IRome IIRome III197819841989 199019992006IBS diagnostic criteriaRome IV2016INTERNAL USE ONLY. DO NOT COPY. DO NOT DISTRIBUTE EXTERNALLY.
13. oidoscopy- 1the lower part of the colon(sigmoid)withtedtube(sigmoidoscope18Additional tests:-Flexible sigmThis test examines). a flexible, ligh
14. 2- Computerized tomography (CT) scan :-CT scans producecross-sectionalX-rayimagesofinternalorgans19
15. 3- Colonoscopy :-In some cases, your doctor
16. 4- Lactose intolerance tests :-Lactase is an
17. 9
18. TREATMENTPATIENT EDUCATIONDIETARY INTERVENTIONPHARMACOTHERAPYPSYCHOTHERAPY/COGNITIVE AND BAHAVIOR THERAPYHYPNOTHERAPY
19. Drug Treatment of IBSAbdominal pain/discomfortAntispasmodicsAntidepressants— TCAs/SSRIsBloating and
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Introduction••••••First described in 1771.50% of patients present

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JSC “ Medical University Astana” Department of Internal Diseases №1 Done by:

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Слайд 1JSC “Medical University Astana”
Department of Internal Diseases №1
Done by: Suleymanov

M.
463 GM
Checked by: Dr. scient. med.,professor
Baidurin S.A.
Astana 2018
IRRITABLE BOWEL

SYNDROME

JSC “Medical University Astana”Department of Internal Diseases №1Done by: Suleymanov M.463 GMChecked by: Dr. scient. med.,professor Baidurin

Слайд 2Introduction
•
•
•
•
•
•
First described in 1771.
50% of patients present

of sufferers are symptom free after 5 years. GPs will

diagnose one new case per week.
GPs will see 4-5 patients a week with IBS.
Point prevalence of 40-50 patients per 2000 patients.

Introduction••••••First described in 1771.50% of patients present

Слайд 3World Prevalence of IBS
Adapted from Camilleri M, et al. Aliment

Pharmacol Ther. 1997;11:3.
Muller-Lisners et al. Digestion. 2001;64:200.
Canada
13.5%
US 10-20%
Peru
18%
Nigeria 30%
France 9.4%
UK

22%

Australia

12%

New Zealand

17%

China 23%

Japan 25%

Germany

12%

World Prevalence of IBSAdapted from Camilleri M, et al. Aliment Pharmacol Ther. 1997;11:3.Muller-Lisners et al. Digestion. 2001;64:200.Canada13.5%US

Слайд 4Prevalence of IBS

Слайд 5Types of IBS
:IBS can be subdivided into
Constipation-predominant :the person tends

to alternate constipation with normal stools. Symptoms of abdominal cramping

or aching are
.commonly triggered by eating
Diarrhea-predominant : the person tends to experience diarrhea first thing in the morning or after eating. The need to go to the toilet is typically
.urgent and cannot be delayed
(Alternating constipation and diarrhea(IBS-A -3

-1

-2

or (IBS-M) mixed IBS

Types of IBS:IBS can be subdivided intoConstipation-predominant :the person tends to alternate constipation with normal stools. Symptoms

Слайд 6The Positive Diagnosis of IBS:
A Symptom-Based Approach
Adapted from Paterson et

al. Can Med Assoc J. 1999;161:154.
American Gastroenterological Association. Gastroenterology. 1997;112:2120.
Identify

Current Primary Symptoms
Abdominal pain / discomfort
Bloating
Constipation/Diarrhea

Look for ‘Red Flags’ Based on:
History
Physical exam
Laboratory tests

Perform Selected Physical and Diagnostic Tests to Rule Out Organic Disease

Make a Positive Diagnosis

The Positive Diagnosis of IBS:A Symptom-Based ApproachAdapted from Paterson et al. Can Med Assoc J. 1999;161:154.American Gastroenterological

Слайд 7Identify Red Flags
History
 Unintentional weight loss
 Onset in older patient

(>50 years)
 Family history of cancer or IBD
Initial labs
 HGB


WBC
 ESR
Abnormal chemistry
 TSH

Physical

 Abnormal exams

 Rectal bleeding / obstruction

 Positive flexible sigmoidoscopy

or colonoscopy (>50 years)

Adapted from a technical review. Gastroenterology. 1997;112:2120.

Paterson et al. Can Med Assoc J. 1999;161:154.

Camilleri et al. Aliment Pharmacol Ther. 1997;11:3.

Red Flags

Слайд 8The balance of IBS diagnosis

Слайд 9Association of bowel symptoms with stool consistency
Tillisch et al Am

J Gastroenterol. 2005; 100:896-904

Слайд 10Defining Stool Consistency
Bristol Stool Form Scale
Hard
Normal
Loose

Слайд 11Changes to IBS classification Rome III Summary
No change to basic

criteria
Length of time needed to define chronicity reduced to 6

months
Threshold 3 days / month introduced for frequency of pain / discomfort
Subtyping simplified (stool consistency)
Stability of subtypes and link to other features like visceral sensitivity and response to treatment remain to be determined

Changes to IBS classification Rome III SummaryNo change to basic criteriaLength of time needed to define chronicity

Слайд 12Manning
Kruis
Rome
Rome I
Rome II
Rome III
1978
1984
1989 1990
1999
2006
IBS diagnostic criteria
Rome IV
2016
INTERNAL USE ONLY. DO

NOT COPY. DO NOT DISTRIBUTE EXTERNALLY.

ManningKruisRomeRome IRome IIRome III197819841989 199019992006IBS diagnostic criteriaRome IV2016INTERNAL USE ONLY. DO NOT COPY. DO NOT DISTRIBUTE EXTERNALLY.

Слайд 13oidoscopy- 1
the lower part of the colon
(sigmoid)
with
ted
tube
(sigmoidoscope
18

Additional tests

:-Flexible sigm
This test

examines
). a flexible, ligh

oidoscopy- 1the lower part of the colon(sigmoid)withtedtube(sigmoidoscope18Additional tests:-Flexible sigmThis test examines). a flexible, ligh

Слайд 142- Computerized tomography (CT) scan :-
CT scans produce
cross-sectional
X-ray
images
of

internal
organs
19

Слайд 153- Colonoscopy :-
In some cases, your doctor may perform this
diagnostic

test, in which a small, flexible tube is

used
to
examine
the
entire
length
of
the
colon.
20

3- Colonoscopy :-In some cases, your doctor may perform thisdiagnostic test, in which a small, flexible tube

Слайд 164- Lactose intolerance tests :-
Lactase is an enzyme you need

to digest the sugar
-
.
If
found in dairy products
you don't produce this

enzyme, you may have

problems including abdominal pain,
diarrhea

gas and

,To find out if this is the cause of your
your doctor may order a breath test
or ask you to exclude milk
and milk products from your
.diet for several weeks

symptoms-

4- Lactose intolerance tests :-Lactase is an enzyme you need to digest the sugar-.Iffound in dairy productsyou

Слайд 179

Слайд 18TREATMENT
PATIENT EDUCATION
DIETARY INTERVENTION
PHARMACOTHERAPY
PSYCHOTHERAPY/COGNITIVE AND BAHAVIOR THERAPY
HYPNOTHERAPY

Слайд 19Drug Treatment of IBS
Abdominal pain/discomfort
Antispasmodics
Antidepressants
— TCAs/SSRIs
Bloating and distention
Antiflatulents
Antispasmodics
Dietary modification
Constipation
Fiber
Laxatives
PEG solutions
Diarrhea
Opioids
—Loperamide
Cholestyramine
Abdominal
pain/
discomfort
Bloating/
distention
Altered

bowel
function
None of these medications effectively treat the multiple symptoms of

IBS;

they may exacerbate individual symptoms (eg, fiber and bloating,

antispasmodic, constipation).

Drug Treatment of IBSAbdominal pain/discomfortAntispasmodicsAntidepressants— TCAs/SSRIsBloating and distentionAntiflatulentsAntispasmodicsDietary modificationConstipationFiberLaxativesPEG solutionsDiarrheaOpioids—LoperamideCholestyramineAbdominalpain/discomfortBloating/distentionAltered bowelfunctionNone of these medications effectively treat the

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