1. IRRITABLE BOWEL SYNDROME
RAGHAV GARG
MBBS 2011

2. WHAT IS IRRITABLE BOWEL SYNDROME
 irritable bowel syndrome can be defined
,as an idiopathic clinical entity characterized by
chronic(more than 3months)abdominal pain or discomfort
that occurs in association with altered bowel habits
 Most are due to disorders of intestinal motility.

3. SYMPTOMS
These symptoms may be continuous or intermittent.
Consensus definition of irritable bowel syndrome is
abdominal discomfort or pain that has two of the
following three features;
1.Relieved with defecation.
2.Onset associated with a change in frequency
of stool
3.onset associated with a change in form of
stool
.

4.  Other symptoms supporting the diagnosis include
 abnormal stool frequency;
 abnormal stool form (lumpy or hard;loose or watery);
 abnormal stool passage (straining, urgency,or feeling of
abdominal distention

5. Signs
 Examination often unremarkable
 Generalized abdominal tenderness

6. PATHO -PHYSIOLOGY OF IBS
SUGGETSED THEORIES
1.Altered responses of general stress circuits.
2.The alternation of autonomic and
neuroendocrine systems in response to visceral
stimulation.
3. Serotonin release
4.low grade inflammation
5. IBS secondary to GIT
infections

7. 6.Increased lactobacilli, coliform in IBS
7. Genetic factors

8. TREATMENT

9. Constipation
1.bulk purgatives Ispaghulla and pysllium
Methyl cellulose
2. Anthraquinones tegaserod
Diarrhoea
1.Bulking agent
2.Antisecretory Sulfasalazine
Mesalazine

10. TREATMENT
 FOOD INTOLERANCE  TRY EXCLUSION DIET
 CONSTIPATION
1. INCREASE FIBER UPTAKE
2. BULK PURGATIVES
 ISPAGHULA AND PSYLLIUM
 NATURAL COLLOIDAL MUCILAGE FORMS GELATINOUS MASS
BY ABSORBING WATER
 3-12 g OF HUSK IS MIXED WITH WATER OR MILK
 TAKEN DAILY ACT IN 1- 3 DAYS

11.  METHYLCELLULOSE
 SEMISYNTHETIC COLLOIDAL HYDROPHILIC DERIVATIVE OF
CELLULOSE
 4-6 g/day
 They have non fermentable fiber better than lactulose which ferments
3 .ANTHRAQUINONES
 TEGASEROD
 NEW SELECTIVE 5 – HT4 RECEPTOR PARTIAL AGONIST WITH NO
ACTION ON OTHER RECEPTORS
 IT ENHANCES RELEASE OF Ach AND calcitonin GENE RELATED
PEPTIDE WHICH PROMOTE PERISTALTIC REFLEX AND COLONIC
SECRETION
 elimination t1/2 of absorbed drug 11 hr

12.  STIMULANT PURGATIVES
(PHENOLPHTHALEIN AND BISACODYL)
ARE CONTRAINDICATED

13.  DIARRHOEA
1. Bulking agent
as absorbants ispaghula and other bulk forming colloid are
useful in both constipation and diarrhoea .
They modify the consistency and frequency of stools by
absorbing water

14.  ANTISECRETORY
SULFASALAZINE
 compound of 5-aminosalicylic acid with sulfapyridine linked
through azo bond.
 5-ASA  it inhibits COX and LOX ,decreased PG and LT, they play
minor role in the therapeutic effect.
 Inhibition of cytokine, PAF, TNF and nuclear transcription factor
 Migration of inflammatory cells into bowel wall is interfered and
mucosal secretion is reduced

15.  DOSE -3-4 g/day induces remission over a few
weeks but relapses are common after stoppage
 Maintenance therapy with 1.5-2 g/day postpone
relapse
 Adverse effects
 Rashes ,fever, joint pain, hemolysis

16.  MESALAZINE
 formulated as delayed release preparation by
coating of 5-ASA with acrylic polymer
 This helps in effective delivery of the drug
 DOSE - 2.4 gm prevents relapses
 adverse effects are less than sulfasalazine

17.  OTHER FORMS – 5 ASA enemas
 Olsalazine
 Balsalazine
 Other drugs helpful
 Corticosteroids
 Immunosuppressants
 Antispasmodic  in colic and bloating

18. Antimotility drug
 (opoid drugs  codiene , diphenoxylate , loperamide )
 Contraindicated as they increase the intraluminal pressure

19. THANK YOU