irritable_bowel_syndrome.pptVIP

Irritable Bowel Syndrome Dr John Hamlin PhD MRCP Consultant Gastroenterologist Leeds General Infirmary Areas to cover: What is IBS? What are the typical symptoms? Taking a good history What examination should the GP do? What investigations should the GP do? Can it be diagnosed by the GP without a Ba enema or without referral ie. On clinical history? Treatments – what are they / the evidence / what about probiotics and yoghurt type drinks? Epidemiology Diagnosis of exclusion vs. disease entity Affects 10-25% of the population. 75% don’t seek medical care 50% of GI consults 1/3 diarrhoea 1/3 constipation 1/3 pain predominant symptom 2:1 F:M (4:1 in secondary care) Oscillating course Great effect on QOL Large drain on healthcare and economy Accounts for 20% self certification Av 14.8 sick days vs. 8.7 average Illness seeking behaviour: 3-4 times chance of abdominal surgery Aetiology?? Visceral hypersensitivity. Decrease balloon distension thresholds on the colon (Ritchie GUT 1973) Normal somatic pain thresholds Not seen in non medical seeking IBS Altered motility (inconsistent results) Psychological factors/central processing Post infectious (30% cases) Food intolerances Visceral hyperalgesia Evidence of visceral hyperalgesia (increased sensitivity to noxious stimuli in the gut) includes perception of pain from distention of a rectal balloon at smaller volumes than in normal patients Post-infectious or post-antibiotic Onset of IBS after an episodes of enteritis or antibiotics have been described. A meta-analysis found the prevalence of IBS to 9.8% after enteritis as compared to 1.2% in controls. Food allergies and sensitivities Bacterial overgrowth Stress Hormones The role of hormones in IBS is not yet fully understood. Menstruation frequently triggers or exacerbates IBS symptoms, while pregnancy and menopause can either worsen or improve symptoms. Defining the disease No biological markers Reliant on grouping of symptom patterns