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Clinical Presentation of IBS
- 1. Diarrhea predominant in >3 stools per week
- 2. Constipation predominant: <3 stools per week
- 3. Lower abdominal pain
- 4. Mucus passage
- 5. Abdominal bloating/distension
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Most Common Etiology of IBS
Women, caucasian, <50yo
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Mann Criteria
- Chronic or recurrent abdominal pain for at least 6 months and two or more of the following:
- 1. Abdominal pain relieved with defication
- 2. Abdominal pain associated with looser stools or more frequent stools
- 3. Abdominal distension
- 4. Mucus in stools
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Rome III criteria for IBS
- Recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months and associated with 2 of the following:
- 1. relieved with defecation
- 2.Onset associated w. a change in frequency or form of stool
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Treatment of Constipation Predominant IBS
- 1. Dietary modification
- 2. Bulk forming laxatives
- 3.Lubiprostone (amitiza)
- 4. Linaclotide (Linzess)
- 5. Tegaserod (Zelnorm)
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Dietary Modification/ lifestyle modifications in constipation predominant IBS
- 1. Increased fluid intake (NONCAFFEINATED DRINKS)
- 2. Increase dietary soluble fiber fiber (20-35mg/day)
- 3. Be active
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Laxatives in the treatment of constipation predominant IBS
- 1. Bulk forming: Psyllium soluble fiber (takes a couple of days)
- 2. Hyperosmotic agen: PEG (miralax) increases water in stool (17g in 8oz of water daily)
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Lupiprostone (Amitiza)
- >Use after fiber/laxative tried
- >It is a Cl- channel activater that increases intraluminal fluid that softens stool
- >Approved for: IBS-C in WOMEN 18 YEARS AND OLDER
- >dose: 8 mcg BID
- >Side effects: Nausea, diarrhea, flatulence
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Linaclotide (Linzess)
- >Guanylate Cyclase-C agonists (accelerates GI transit time and pain relief)
- >APPROVED IN IBS-C IN ADULTS (MEN AND WOMEN)
- >290mcg daily 30 min before food (works within one week)
- >CONTRAINDICATED IN PEDS
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Tegaserod (Zelnorm)
- >class: Serotonin (5-HT4) agonist
- >relieves pain and increases bowel frequency
- >6 mg BID
- >REMOVED FROM THE MARKET: only available to women with emergency IND
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Treatment of Diarrhea Predominant IBS
- 1. Dietary Modifications
- 2. Loperamide
- 3. Antispasmotic
- 4. Alosetron
- 5. Rifaximin (not currently indicated but being studied)
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Dietary Modifications for Diarrhead Predominant IBS
- 1. Lactose and caffeine free diet
- 2. Avoid: herbal teas continaing senna, artificial sweeteners
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Loperamide (Imodium)
- >Class: opiod agonist
- >Decreases GI motility
- >4mg initially, then 2 mg after each loose stool
- >DO NOT EXCEED 16MG/DAY)
- >Side effects: dizziness, constipation, cramping, nausea
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Antispasmotic therapy in IBS
- >Ex. Dicyclomine(Bentyl) or Hyoscyamine (Levsin)
- short term relief of abdominal pain and discomfort
- >side effects: blurry vision, dry mouth, urinary retention, constipation (anticholinergic effects)
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Alosetron (Lotronex) in IBS
- >Class: Serotonin (5HT3) antagonist this class blocks pain, colonic transit, GI secretions
- >APPROVED FOR USE IN WOMEN WITH SEVERE REFRACTORY IBS-D
- >Dose: 0.5mg bid x 4 weeks
- > Side effects: constipation (stop if this occurs), abdominal
- >on the market WITH RESTRICTIONS (PROMETHEUS)
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Rifaximin (Xifaxan) in IBS
- OFF LABLE FOR IBS W/OUT CONSTIPATION
- Reduced symptoms and bloating for up to 3 months
- In trials
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Adjunctive Treatment in IBS
- 1. Probiotics
- 2. Antidepressants (pain)
- 3. Pyschotherapy
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Probiotics in IBS
- Bifidobacterium (ADULTS) and lactobacillus (CHILDREN)
- Take for 4 weeks
- Normalizes the GI tract
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Antidepressants in IBS
Indicated for PAIN associated with eatting
- TCAs(diarrhea-predominant IBS with severe abdominal pain) AVOID IN CONSTIPATION (more evidence for this)
- SSRIs (paroxetine) may improve well being and good if experiencing depression and pain
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