Irritable bowel syndrome in short IBS is used to describe a heterogeneous group of abdominal symptoms characterized by chronic abdominal pain, discomfort ,bloating and alteration of bowel habits for which no organic cause can be found .Most are probably due to disorders of intestine motility.

Clinical presentation:

The clinical presentation of IBS can vary from person to person.

1. Female are more frequently affected than males.
2. Abdominal pain (relives by defecation).
3. Bloating.
4. Tenesmus.
5. Altered bowel habit (constipation alternating with diarrhea).
6. Mucus in the stool.
7. Nausea, dyspareunia, pain in the back, urinary frequency.
8. Depression.

If the symptoms are more than 6 moths than the IBS is called chronic Irritable bowel syndrome.

Causes:

What cause the IBS is still unknown but some hypotheses have been proposed.

• Post infection of acute gastrointestinal infection.
• Immune Reaction.

Risk Factors:

• Foods: Chocolate, milk, alcohol cause constipation, fruits and vegetable may triggers the symptoms.
• Stress.
• Hormone: Signs and symptoms are worse during menstrual period.

Pathophysiolgy:

In the IBS the contraction of the Intestinal muscle wall is stronger and last longer than normal that cause intestines more quick, causing gas, bloating and diarrhea.

Diagnosis:

There no pathological abnormalities in IBS so diagnosis relies on symptoms of patients but 1^st step is to exclude other diagnosis so:

• If young blood test, Liver test, celiac serology, urine test, Sigmoidoscopy with rectal biopsy is sufficient.
• If patient is aged or has any marker or organic diseases colonoscopy may be needed.
• If diarrhea is prominent do Liver functions test, stool culture, thyroid function test, antiendomysial antibody.
• Further investigation should be guided by symptoms and includes :
  1. Upper GI endoscopy( Dyspepsia and reflux)
  2. Small bowel radiology( Crohn’s disease )
  3. ERCP(pancreatitis)

Criteria for diagnosis IBS:

1. Abdominal pain for at least 12 weeks out of the previous 12 months. These 12 weeks do not have but be consecutive.
2. The abdominal pain or discomfort has two of the following three features.

• Relived by having a bowel movement.
• When it starts, there is a change in how often you have a bowel movement.
• When it starts, there is a change in the form of the stool or the way it looks.

Management:

1. Diet: Fiber intake such as psyllium or methylcellulose may help for constipation.
2. Avoid foods which worsen the symptoms.
3. Exercise regularly.
4. Drink plenty of fluid.
5. Loperamide 2mg after each loose stool if diarrhea is severe.
6. Antispasmodic may help (mebeverine 135 mg 3 times a day) in colic and bloating.
7. Antidepressant medication (eg. Selective serotonin reuptake inhibitor or tricyclic antidepressants )
8. Medication specifically for IBS:

• Alosetron: nerve receptor that designed to relax the colon and slow the movement of the bowel.
• Lubiprostone: Used for women who have IBS with constipation.

Conclusion:

Irritable bowel syndrome is a non organic abdominal symptoms, which doesn’t cause damage to colon .IBS is diagnosed with symptoms .Irritable bowel syndrome be managing your diet, life style and stress.

References:

• Harrison’s Principles of Internal Medicine, 17^th edition.
• Oxford handbook of clinical medicine, 7th edition.
• Davidson’s Principles and Practice of Medicine, 20th Edition
• health.google.com
• en.wikipedia.org
• mayoclinic.com
• webmd.com
• digestive.niddk.nih.gov
• familydoctor.org

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