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What is the clinical presentation of IBS?
abdominal pain, cramping, gas, passage of mucus and extreme urgency; urinary symptoms, lower back pain, fatigue and painful sex
IBS does not cause _________, changes in bowel ________ or _______ risk of colorectal cancer
inflammation; tissue; increase
What are some predisposing factors of IBS?
female>male; lower socioeconomic status; <50 yrs
What is the pathophysiology of IBS?
abdominal pain associated with abnormal bowel movements; can be constipation-predominant or diarrhea-predominant or alternate between the two; due to somatovisceral and motor dysfunction of intestine
What are the 4 different subtypes of IBS?
IBS with constipation (IBS-C)
IBS with diarrhea (IBS-D)
Mixed IBS (IBS-M)
Unsubtyped IBS (IBS-U)
What is the diagnostic criteria for IBS?
recurrent abdominal pain at least 1 day/week in previous 3 months
must have at least 2 of the following:
increase in pain related to defecation
change in frequency of stools
change in appearance of stools
What are alarm features of IBS?
rectal bleeding, weight loss, iron deficient anemia, nocturnal symptoms, family history of colorectal cancer, IBD or celiac disease, and onset at >50 yrs
What are some non-pharmacologic treatment options for IBS?
Avoid food that makes symptoms worse, daily fiber, adequate fluid intake, exercise and avoid postponing defecation
What are the steps of treatment for IBS-C predominant?
1. increase fiber and fluid intake
2. add bulk-forming laxative, consider antispasmodic or anticholinergics
2.5 consider lubiprostone and linaclotide for constipation and abdominal pain
3. Antidepressants- SSRIs
4. serotonin 4 agonist
What are the steps of treatment for IBS-D predominant?
1. eliminate lactose and caffeine, foods that increase symptoms
2. add loperamide or antispasmodic; replace with eluxadoline if pain persists
2.5 consider rifaximin
3. add serotonin-3 antagonist
4. antidepressants- TCAS
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