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  Irritable bowel syndrome

Irritable bowel syndrome (IBS) is a disorder of that describes the functioning of the bowels. Symptoms of this disease are unusual or changed bowel habits and abdominal pain. The reason for the change in bowel functioning is not indicated in any typical clinical tests. This is a common disease accounting for up to fifty percent of reasons for a visit to the gastroenterologist. There are four categories for irritable bowel syndrome: IBS-D, IBS-C, IBS-A, and IBS-PI, based on symptoms and patient history. IBD-D is irritable bowel syndrome-diarrhea and presents mainly with diarrhea. IBD-C is irritable bowel syndrome – constipation and presents mainly with constipation. IBD-A is irritable bowel syndrome which alternates between constipation and diarrhea. IBD-PI is irritable bowel syndrome that begins after a diagnosed infection of the gastrointestinal tract.

Irritable bowel syndrome
Irritable bowel syndrome


A similar disorder that is rarer than IBS is chronic functional abdominal pain or CFAP. This disease is diagnosed if there are no changes in the function of the bowels.

IBS is often confused with inflammatory bowel disease because of the (IBD) acronym. However, IBD is a more serious condition than IBS.

Symptoms

There are a broad range of symptoms for IBS. The primary symptom is abdominal pain and pain occurring with functional bowel changes, without any apparent cause or structural condition of the digestive tract. The pain is usually ameliorated with a bowel movement. Pain is not so bad that it wakes patients up in the evening. The disease usually begins in young adults.

Diagnosis

Diagnosis of irritable bowel syndrome is made using sets of criteria, the Manning criteria and the Rome process. The Manning criteria was established in 1978 and details four common symptoms that distinguish organic causes of changes in bowel functioning from IBS. The Rome I criteria was established in 1992 by a multinational committee of specialists. Physicians rely on a variety of criteria and tests to determine the diagnosis of IBS. The Rome III criteria is the latest criteria and includes pediatric contents for criteria for diagnoses.

IBS can diagnosed based on a twelve week history of the patient, which may or may not be consecutive.

The first step is meeting two out of these three features in regards to abdominal pain:

 pain relieved with moving the bowels AND/OR
 onset of pain associated with change in frequency of the stool AND/OR
 onset of pain occurs with change in form or appearance of the bowel movement

The diagnosis of IBS is made when these symptoms appear with the above criteria:

• Abnormal stool appearance (lumpy/hard or loose/watery stool);
• Abnormal stool movement (straining, urgency, or feeling of incomplete evacuation);
• Abnormal stool occurrence (for research purposes, "abnormal" may be defined as move than 3 bowel movements per day and less than 3 bowel movements per week);
• Passage of mucus;
• Bloating or feeling of abdominal distention.

Supportive symptoms of IBS-d (diarrhea) involve at least one of these: greater than three bowel movements per day, loose or watery stools or urgency – feeling of uncontrolled bowels; or a combination of two of the previous symptoms and fewer than three bowel movements per week or straining during a bowel movement. IBS-C, or irritable bowel syndrome – constipation is diagnosed using two criteria that occur in addition to the pain criteria. The first is the patient either experiences at least fewer than three bowel movements per week or hard or lumpy stools or straining during a bowel movement. The second is the patient experiences two of these three symptoms: or two of these symptoms: fewer than three bowel movements per week or hard or lumpy stools or straining during a bowel movement and one of these symptoms: more than three bowel movements per day, loose stools or urgency.

Symptoms that are not typical of IBS and require further evaluation for more serious a more serious condition are:

 Abnormal physical examination
 Diarrhea that awakens/interferes with sleep
 Weight loss
 Pain that awakens/interferes with sleep
 Blood in the stool (visible or microscopic)
 Fever

Evaluations or procedures to rule out other diseases or conditions are:

 blood tests: complete blood count, liver enzymes, electrolytes, renal function, erythrocyte sedimentation rate
 sigmoidoscopy or colonoscopy
 abdominal ultrasound or CT scan
 stool chemistry (e.g. tests for exocrine pancreas insufficiency and other malabsorption conditions), stool microbiology, fecal fat
 H2-tests for lactose intolerance and fructose malabsorption
 esophagogastroduodenoscopy (EGD, gastroscopy)
 blood tests or deep duodenal biopsy for celiac disease

Cause:

The exact cause of IBS-C, IBS-D, or IBS-A is not known. IBS-PI, irritable bowel syndrome-post infection, occurs after an attack of enteritis or a course of antibiotics. Good allergies continue to be considered as a cause of IBS, but there is no defining research. A bacterial overgrowth may also be the cause of IBS, as seventy-eight to eighty-four percent of patients have a bacterial overgrowth. Thirty-five percent of those patients improved after being treated with neomycin for the overgrowth.

Stress has been noted to trigger an attack of IBS. An association has been noted between IBS, chronic pelvic pain, stress, fibromyalgia, and chronic fatigue syndrome. There is no distinct explanation, other than the view that there is a psychological and neurological connection to IBS episodes.

Treatment:

Major dietary alterations will help a person suffering from IBS. Some of the recommendations are eating small meals throughout the day, increase soluble fiber foods, decrease insoluble fiber foods and replacing dairy with soy or rice based foods. Patients should avoid or decrease red meats, coffee (any kind), alcohol, artificial sweeteners, fatty or fried foods and carbonated beverages. Studies have indicated that patients with IBS are extremely sensitive to fructose and fats. Soluble fiber is recommended for consumption as 20 grams per day in patients with non diarrhea IBS. Symptoms may have an increased period before relief occurs. Depending on the type of IBS, medications recommended can either be stool softeners, laxatives or anti-diarrhea medicine. Anti-spasmotic drugs are used to help with the painful cramps caused by the diarrhea.

Alternative therapies used to treat IBS are acupuncture and probiotics. Probiotics are consumed to increase the ‘good’ bacteria in the digestive tract.

Anti-depressants have been used to improve symptoms by treating the usually co-existent depression in patients.

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