Irritable Bowel Syndrome (IBS) Questions PDF

*IRRITABLE BOWEL SYNDROME* *Irritable bowel syndrome (IBS) is a disorder characterized by* *chronic abdominal pain and altered bowel patterns. Patients* *may have diarrhea or constipation, or a mix of both. IBS affects* *women 2 to 2.5 times more often than men.* *IBS has no known cause. Psycho...

*IRRITABLE BOWEL SYNDROME* *Irritable bowel syndrome (IBS) is a disorder characterized by* *chronic abdominal pain and altered bowel patterns. Patients* *may have diarrhea or constipation, or a mix of both. IBS affects* *women 2 to 2.5 times more often than men.* *IBS has no known cause. Psychologic stressors (e.g.,* *depression, anxiety, panic disorders, posttraumatic stress disorder)* *are associated with the development and exacerbation* *of IBS. Many people with IBS have a family member with the* *disorder. Patients may report a history of GI infections and* *adverse reactions to food. Diet intolerances that may contribute* *to symptoms include gluten and fermentable oligo-, di-,* *and monosaccharides and polyols (FODMAPs). Examples of* *oligosaccharides are wheat and rye products, some fruits and* *vegetables, onions, garlic, legumes, and nuts. The disaccharide* *lactose is found in milk and milk products. Fructose is a* *monosaccharide found in honey, apples, pears, and high-fructose* *corn syrup. Polyols are found in apples, pears, stone* *fruits, cauliflower, mushrooms, and artificial sweeteners, like* *sorbitol.* *criteria* *for diagnosing IBS require the presence of abdominal pain* *and/or discomfort at least 1 day per week for 3 months that is* *associated with 2 or more of the following: related to defecation,* *change in stool frequency, and change in the stool form.6* *Depending on the stool patterns, IBS is categorized as IBS with* *constipation (IBS-C), IBS with diarrhea (IBS-D), IBS mixed, and* *IBS unsubtyped. Other common symptoms include abdominal* *distention, nausea, flatulence, bloating, urgency, mucus in the* *stool, and sensation of incomplete evacuation. Non-GI symptoms* *may include fatigue, headache, and sleep problems.* *The key to diagnosis is a thorough history and physical* *assessment. Ask patients to describe symptoms, health history* *(including psychosocial factors, such as stress and anxiety),* *family history, and drug and diet history. Determine if and how* *IBS symptoms interfere with school, work, and social activities.* *Diagnostic tests are used to rule out other disorders, such as* *CRC, IBD, endometriosis, and malabsorption disorders (lactose* *intolerance, celiac disease).* *No single therapy is effective for all patients with IBS. Treatment* *includes psychologic support, diet and lifestyle changes, and* *drugs to regulate stool output and reduce discomfort. Patients* *may benefit from keeping a diary of symptoms, diet, and episodes* *of stress to help identify any factors that trigger the IBS symptoms.* *Cognitive behavior therapy and stress management techniques* *may help a patient cope. Participating in regular exercise* *reduces bloating, constipation, and stress-related symptoms.* *Review with the patient foods that are high in FODMAPs. Teach* *them to follow a low-FODMAP diet.7 If dairy products tend to* *cause symptoms, yogurt may be the best option because of the lactobacillus* *bacteria it contains. Probiotics can improve symptoms.* *Tell the patient with flatulence to avoid common gas-producing* *foods, such as broccoli and cabbage. For those with IBS-C, encourage* *a high-fiber diet to produce soft, painless bowel movements.* *Drug therapy focuses on the dominant bowel symptom and* *pain. All patients with IBS may receive benefit from antidepressants* *and antispasmodic agents (hyoscyamine, dicyclomine).* *Antispasmodics decrease GI motility and smooth muscle* *spasms, reducing pain and diarrhea.* *Treatment for IBS-D includes rifaximin, the opioid agonist* *eluxadoline (Viberzi), and the selective serotonin 5-HT3 antagonist* *alosetron.6 Eluxadoline decreases colonic contractions to* *reduce diarrhea and pain. Alosetron is only given to women with* *severe IBS-D that did not respond to other therapy. Because of* *serious side effects (severe constipation, ischemic colitis), it is* *available only in a restricted access program. Eluxadoline and* *alosetron are taken daily. Rifaximin is given as a 2-week course* *of treatment with repeated courses as needed. Loperamide may* *help some patients.* *Besides laxative therapy, those with IBS-C may take linaclotide* *(Linzess). It is contraindicated in patients with a history* *of mechanical obstruction or prior bowel surgery. Women with* *IBS-C may benefit from lubiprostone (Amitiza).*