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irritable bowel syndrome

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by

hy shin

on 12 December 2012

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Transcript of irritable bowel syndrome

Epidemiology Risk Factor Irritable
Bowel
Syndrome Gastroenterology Education and Support Prognosis Some patients spontaneous improvement over time
Usually relapsing disorder Pathophysiology Treatment Clinical Feature Diagnosis Shin Hae Young Abdominal Pain Bowel Habit Change Essential Most common Bloating and Visible Distension Noncolonic Symptoms Uncommon Poor prognosis indicator presence of excessive psychological distress or anxiety

long duration of complaints Reassurance and careful explanation of functional nature of disease Dietary Alterations SUMMARY Treatment depends on severity of disorder
- education
- reassurance
- dietary/life style
changes Most patients
have mild symptoms
Moderate symptoms ( gut acting agents ) new serotonin modulator
antispasmodics
antidiarrheals
Fiber supplements Severe and
refractory symptoms Antidepressants
other psychological
treatment Medication Any
Question ?? - impaired transit and tolerance of
intestinal gas loads

- reflux gas from distal to proximal
intestine : belching

- visible distention with increase in
abdominal girth

- gas : bloating, belching, flatus,
reflux symptom

- more common among female patients Central
Dysregulation Local inflammation Psychological
Factor Genetic Factor Abnormal Motility high-amplitude
propagated contraction(HAPC) rectal sensitivity gastrocolic response Diarrhea Constipation high-amplitude
propagated contraction rectal sensitivity Abdominal pain increase in phasic contraction in T. ileum and colon discrete clusters of jejunal contraction
: increase frequency and duration fatty meal, distention, CCK stress
anger
instillation of deooxycholic acid
corticotropin-relaeasing hormone
CCK infusion
fatty meal Increased motility cannot be used as a diagnostic marker primary < Secondary Visceral hypersensitivity Serine protease signaling molecule significant increase in stools of IBS-D patients derived from mast cell or fecal microbiota via activation of proteinase-activated receptors (PARS) repeated distention of S-colon abnormal sensitization within dorsal horn of spinal cord or higher up in CNS Rectal hypersensitivity induced by Putative neurotransmitter serotonin
neurokinins
calcitonin gene-related peptide
capsaicin receptor on nerve fiber
N-methyl-D-aspartate (NMDA) receptor Mast Cell Activated mast cell release
tryptase and histamine correlated with abdominal pain T-Lymphocyte increased in mucosa

lymphocytic infiltration of
myenteric plexus neuron degeneration
in severe IBS Post-infectious IBS 7-30% bacterial enteritis more than 3 weeks
: risk of postinfection IBS is incrase psychological distress increase risk CD3, CD4, CD8,
Macrophage Abnormal release
of 5-HT 5-HT signalling
abnormal in IBS clustering of IBS in families Twins study
monozygotic > dizygotic environmental component
is much greater Depression
anxiety
somatization alteration in brain response to visceral stimuli Food Wheat intolerance or allergy Sugar malabsorption Abnormal colonic flora increased colonic fermentation
production of excess gas
development of symptom pre-and probiotic therapy for IBS Intestinal Bacterial
overgrowth 광필이와 햬영이 associated with HAPC Visceral hypersensitivity
Full transcript