Biliary Diseases

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IN THE NAME OF GOD
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IBS

• Ahmad Shavakhi.MD
• Associate professor of internal medicine
• Isfahan University of medical sciences

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• A 43 years old woman presented to clinic
• Abdominal pain
• Diarrhea
• From 6 months ago
• Pain alleviated with deification
• Denied weight loss, or other symptoms
• Normal exam

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subtypes of IBS

• IBS with constipation (hard or lumpy stools 25
  percent / loose or watery stools lt25 percent of
  bowel movements)
• IBS with diarrhea (loose or water stools 25
  percent / hard or lumpy stools lt5 percent of
  bowel movements)
• Mixed IBS (hard or lumpy stools 25 percent /
  loose or watery stools 25 percent of bowel
  movements)
• Unsubtyped IBS (insufficient abnormality of stool
  consistency to meet the above subtypes)

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"Alarm" or atypical symptoms

• Rectal bleeding
• Nocturnal or progressive abdominal pain
• Weight loss
• Laboratory abnormalities such as anemia, elevated
  inflammatory markers, or electrolyte disturbances
• Positive FHx

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Diagnostic evaluation

• Diarrhea predominant IBS
• Stool cultures
• Celiac disease screening
• Twenty-four hour stool collection
• Colonoscopy or flexible sigmoidoscopy and biopsy

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Diagnostic evaluation

• Constipation predominant IBS
• plain film of the abdomen
• Flexible sigmoidoscopy and colonoscopy

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Refractory symptoms
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Refractory symptoms
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Refractory symptoms
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Treatment
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Indication for non pharmalogical treatment

• Mild and intermittent symptoms
• Do not impair quality of life

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Indication for drug

• Mild to moderate symptoms who fail to respond to
  initial management
• Moderate to severe symptoms that affect quality
  of life

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Non pharmacological treatment

• Education and reassurance
• Food allergy testing
• Physical activity

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Gas-producing foods

• such as
• cabbage
• Onions
• Broccoli
• Wheat
• potatoes
• Celery
• Apricot

• beans
• carrots
• Raisins
• Bananas
• apricots
• prunes
• pretzels

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Patients with IBS may benefit from exclusion
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• We suggest a diet low in (FODMAPs) in IBS with
  abdominal bloating or pain despite exclusion of
  gas producing foods

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• We suggest a two-week trial of a gluten-free diet
  in patients with diarrhea predominant IBS with
  significant abdominal bloating and flatulence
  whose symptoms have failed to improve with a low
  FODMAP diet and avoidance of gas producing foods

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Fiber

• The role is controversial
• No serious side effects and potential benefit
• psyllium should be considered in patients with
  IBS whose predominant symptom is constipation

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IBS -C

• PEG

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IBS-D

• Loperamide
• Bile acid sequestrants

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Abdominal pain

• Antispasmodic agents
• Antidepressants
• Peppermint

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Rifaximine

• bloating, who have failed to respond to other
  therapies

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Probiotics

• Not routinely recommended in patients with IBS

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The end