Overview of Irritable Bowel Syndrome

1
Overview ofIrritable Bowel Syndrome

• Arnold Wald, MD
• Professor of MedicineDepartment of
  Gastroenterology, Hepatology, and
  NutritionUniversity of Pittsburgh Medical Center
• Pittsburgh, Pennsylvania

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Irritable Bowel Syndrome

• Chronic or recurrent GI symptoms
• Lower abdominal pain/discomfort
• Altered bowel habits
• Bloating
• Not explained by structural or biochemical
  abnormalities

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IBS Clinical Subgroups

• Constipation predominant
• Diarrhea predominant
• Alternating constipation/diarrhea

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IBS Clinical Subgroups

• Constipation predominant
• Diarrhea predominant
• Alternating constipation/diarrhea

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Rome II Criteria for IBS

• At least 12 weeks or more, which need not be
• consecutive, in the preceding 12 months, of
• abdominal discomfort or pain that has 2 out
• of 3 features
• Relieved by defecation
• Onset associated with a change in frequency of
  stool
• Onset associated with a change in form
  (appearance) of stool

Gut. 1999.
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Epidemiology of IBS in US(15 to 20 of
Population)
Specialists 5
Primary care 15
Nonconsulters 80
25 to 50 of referrals to GIs are IBS
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Prevalence of Disorders in US

• IBS 15 - 20
• Dyspepsia 8
• GE reflux 7
• Asthma 4
• Diabetes 3

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IBS Symptoms Reduce Patient Well Being
Reduced sense of well being
Abdominal pain
Altered bowel habits
Cramps Bloating
Constipation Diarrhea Urgency
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Medical Costs Associated With IBS

• Estimated 8 billion annually in direct costs
• Increased physician visits for both GI and non-GI
  complaints
• IBS patients incur 74 more health care costs
  than do non-IBS sufferers

Drossman, et al. Dig Dis Sci. 199338(9)1569-1580
. Talley, et al. Gastroenterology.
1995109(6)1736-1741.
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Impact of IBS on Work

• Missed work 30 (1.7 days)
• Reduced days 46 (3 days)
• Turned down promotion 16
• Changed job, health reasons 9
• Changed work schedule 8

Hahn BA, et al. Digestion. 199960(1)77-81.
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Pathophysiology of IBS A Biopsychosocial
Disorder

• Biological
• Altered GI motor activity
• Altered visceral sensation
• Psychosocial
• Behavioral
• Cognitive
• Emotional

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Multiple Medications Are Used to Treat IBS

• Anticholinergics
• Tricyclic antidepressants
• SSRIs
• Antidiarrheals
• Bulking agents
• Laxatives
• Alosetron

Data support efficacy for diarrhea-predominant
IBS.
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New Treatment Paradigm for C-IBS
IO 13
5-HT4 agonists
Altered motility
Altered sensation