description of colon and irritable bowel syndrome and types and method to diagnosis and also treatment and drugs

1. (IBS)(IBS)
IRRITABLE BOWELIRRITABLE BOWEL
SYNDROMESYNDROME
By
Wisam Gatea Hani
1

2. CONTENTS
 Colon structure and function .
 Definition of irritable bowel syndrome .
 Epidemiology of IBS.
 Causes of IBS .
 What does the colon do in IBS?
 Symptoms of IBS .
 Types of IBS .
 Diagnosis of IBS .
 Treatment and drugs
 References 2

3. Colon structure and function
 Colon is the part of the large intestine , the last
portion of the human gastrointestinal tract is
approximately 5 to 5.5 feet long with a diameter of
about 2.5 inches, is located between the cecum
and rectum.
It is divided into four sections,
ascending, transverse
,descending and sigmoid colon
3

4. Function
1.The organ for storing waste products by
elimination of toxic waste material in the
form of stool
2.Reabsorbing water from wastes and
maintaining water balance in the
body.
3.Serves at the site for the growth of
beneficial bacteria and other
microorganisms
4

5. Irritable bowel syndrome
 Irritable Bowel Syndrome is not a disease. It's a
functional disorder, which means that the bowel
simply does not work as it should.
 (IBS) is a common disorder that affects the large
intestine (colon).
 (IBS) commonly causes cramping, abdominal
pain, bloating, gas, diarrhea and constipation
5

6. Epidemiology
Prevalence 3 - 22% world-wide
Reason for 20 - 50% of gastroenterology visits.
26%prevalence among children with recurrent
abdominal pain.
40%onset before age 35.
50%onset age 35 – 50.
Female > Male (3:1(
6

7. What does the colon do in IBS?
The contraction of the colon muscles and the
movement of its contents is controlled by nerves,
hormones, and impulses in the colon muscles.
These contractions move the contents inside the
colon toward the rectum.
During this passage, water and nutrients are
absorbed into the body , and what is left over is
stool.
7

8. CONT..
A few times each day contractions push the
stool down the colon, resulting in a bowel
movement.
However, if the muscles of the colon do not
contract in the right way, the contents inside the
colon do not move correctly.
-resulting in abdominal pain, cramps,
constipation, a sense of incomplete
stool movement, or diarrhea
8

9. 9

10. Causes of IBS
1. Abnormal gastrointestinal (GI) tract movements.
2. A change in the nervous system communication
between the GI and brain
3. Sensory and motor disorders of the colon.
4. Dietary allergies or food sensitivities.
5. Neurotransmitter imbalance“(decreased
serotonin levels).
6. Stress
10

11. PATHOPHYSIOLOGY
 IBS pathophysiology is not clear
 Many theories have been put forward , but the
exact cause of IBS is still uncertain
1. Alteration in GI motility : alteration in frequency
and irregularity of luminal contractions
2. Visceral hypersensitivity : increased sensation in
response to stimuli
3. Brain gut axis : alteration in communications
between enteric nervous system and CNS
4. Post infectious :about 10% of IBS cases are
triggered by an acute gastroenteritis infection
5. Genetics
11

12. Who else gets IBS?
-People who have panic disorder or other
psychological conditions.
People who have a family history of IBS.-
-People with other conditions including chronic
fatigue syndrome, fibromyalgia, a condition
that causes widespread muscle and soft tissue
pain and tenderness, and temporo-mandibular
(tm) disorder which causes pain and
discomfort in the jaw muscles and joint.
12

13. Symptoms of IBS
Most symptoms:-
1-Pain, distension or abdominal discomfort and
bloating
2-Abnormal bowel habits with periods of
constipation and/or diarrhea
Sensation of incomplete bowel movement-3
Mucus in the stool -4
13

14. Types of IBS
IBS can be subdivided into:
1-Constipation-predominant :the person tends to
alternate constipation with normal stools.
Symptoms of abdominal cramping or aching are
commonly triggered by eating.
2-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.
3-Alternating constipation and diarrhea(IBS-A(
or (IBS-M) mixed IBS 14

15. 15

16. Diagnosis of IBS
Rome criteria:-
According to these criteria, you must have
certain signs and symptoms before a doctor
diagnoses irritable bowel syndrome.
The most important are abdominal pain and
discomfort lasting at least 12 weeks, though the
weeks don't have to occur consecutively.
You also need to have at least two
of the following: 16

17. 1-A change in the frequency or consistency of
your stool.
-for example you may change from having one
normal formed stool every day to three or
more loose stools daily, or you may have only
one hard stool every three to four days.
2-Straining, urgency or a feeling that you can't
empty your bowels completely.
Mucus in your stool . -3
Bloating or abdominal distension. -4
17

18. Additional tests
1-Flexible sigmoidoscopy:-
This test examines the lower part of the colon (sigmoid) with
a flexible, lighted tube (sigmoidoscope).
18

19. 2- Computerized tomography (CT) scan :-
 CT scans produce cross-sectional X-ray images of
internal organs
19

20. 3- 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

21. 4- Lactose intolerance tests :-
-Lactase is an enzyme you need to digest the sugar
found in dairy products.
-If you don't produce this enzyme, you may have
problems including abdominal pain, gas and
diarrhea.
-To find out if this is the cause of your symptoms,
your doctor may order a breath test
or ask you to exclude milk
and milk products from your
diet for several weeks.
21

22. TREATMENT
STRATEGIES
 Treatment involves a mix of drug , diet ,and
psychosocial interventions .
22

23. A-DIETARY MODIFICATION
 Avoid food that trigger symptoms (such as
gases forming foods as lentils , legumes ,
and beans )
 Low FODMAP diet ( Fermentable Oligo Di
Mono-saccharides And Polyols) :- are short
chain carbohydrates that are poorly
absorbed in small intestine .
 Fiber supplementation :- may improve
symptoms of constipation and diarrhea
23

24. B- PHARMACOLOGICAL
THERAPIES
1- Antispasmodics :-
dicyclomine, hyoscine N-butylbromide,
clidinium ,peppermint oil, mebeverine ,and
pinaverium
2- Tricyclic antidepressants : -
imipramine , amitriptyline , nortriptyline
3- selective serotonin reuptake inhibitors
(SSRIS):-
fluoxetine, sertraline , paroxetine , citalopram
,
escitalopram
4- probiotics :- improvement in global symptoms ,
24

25.  Drugs for IBS-C :-
 Laxatives :- psyllium
 Chloride channel activators:- lubiprostone
 Serotonin agonists:- tegaserod , mosapride
 Guanylate cyclase -C agonists :- linaclotide
 Drugs for IBS-D:-
o Antibiotics :- Rifaximin
o Antimotility agents :- loperamide ,
diphenoxylate
o Serotonin antagonists :- alosetron , cilansetron
25

26. GERD: GASTROESOPHAGEAL REFLUX DISEASE
26

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28. 28
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30. 30

32. References
1-Anonymous (2010), Irritable bowel syndrome (English). Medical Subject
Headings. U.S. National Library of Medicine.
2-Article:Amanda Chan Date: 06 January 2011 Time: 10:11 AM ET
3-March 9, 2011 | Author: Kristie Brehant | Posted in Disease and Illness
http://mdhba.com/disease-and-illness/ibs-help/
4-http://www.naturalnews.com/IBS.html
Friday, October 08, 2010 by: Tony Isaacs
5-Alan Jensen EzineArticles.com Expert Author
Joined December 13, 2010
6-©2010State Government of Victoria
7-Irritable bowel syndrome. The National Digestive Diseases Information
Clearinghouse. http://digestive.niddk.nih.gov/ddiseases/pubs/ibs/. Accessed
June 2, 2009.
8-Clinical Therapeutics, Volume 30, Issue 5, May 2008, 8Pages 884-901-8
Roja Rahimi, Shekoufeh Nikfar, Mohammad Abdollah
9-Gastrointestinal Endoscopy, Volume 70, Issue 5, November 2009, Pages 942-946
S. Bennett Hooks III, Travis J. Rutland, Jack A. Di Palma
10-Pharma Guide By DAHSHAN HASSAN DAHSHAN