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Symptoms and treatment of irritable bowel syndrome

 Symptoms and treatment of irritable bowel syndrome

Symptoms and treatment of irritable bowel syndrome


Irritable bowel syndrome is a functional disorder of the digestive system characterized by abdominal pain, as well as discomfort and changes in stool emptying in the form of constipation, diarrhea, or a combination noted in the absence of an organic bowel substrate.

Symptoms and treatment of irritable bowel syndrome

Irritable bowel syndrome - the most common digestive disorder

Who Is Irritable Bowel Syndrome?

Symptoms and clinical presentation

What Is Irritable Bowel Syndrome?

Diagnosis of the disease

Classification of irritable bowel syndrome

Differential diagnosis

An approach to treating irritable bowel syndrome

Conclusion

Irritable bowel syndrome - the most common digestive disorder

Although not a life-threatening condition, irritable bowel syndrome significantly impairs quality of life and puts a financial burden on the health system.

Irritable bowel syndrome (SIC) is one of the most common digestive disorders and is a common problem in primary and secondary health care. It is estimated that 40% of individuals who meet the diagnostic criteria for irritable bowel syndrome have no established diagnosis.

 

Although not a life-threatening condition, SIC significantly impairs the quality of life and financially burdens the healthcare system. In the world, it is the second most common cause of absence from work, while in the United States (US) it is estimated that 25-50% of visits to a gastroenterologist are caused by this problem.

 

Who Is Irritable Bowel Syndrome?

According to the results of various population studies, the prevalence of irritable bowel syndrome is between 10 and 15% worldwide.

Irritable bowel syndrome can occur in all age groups, including children and the elderly. However, this clinical entity is more commonly seen in the under-35s, with women predominating in gender distribution. SIC is associated with other disorders including fibromyalgia, chronic fatigue syndrome, gastroesophageal reflux disease, functional dyspepsia, non-cardiac genital pain, depression, and anxiety.

 

According to the results of various population studies, the prevalence of irritable bowel syndrome is between 10 and 15% worldwide, while according to data for the Republic of Croatia the prevalence is up to 29% (Zagreb 28%, Bjelovar-Bilogora County 26.52%, Osijek-Baranja County 29.16%).

 

Symptoms and clinical presentation

The localization of pain in irritable bowel syndrome may vary, and emotional stress or meals may exacerbate it.

Irritable bowel syndrome is characterized by chronic abdominal pain and impaired bowel disorder. Abdominal pain is most often of a character of variable intensity spasms and with periodic exacerbations, often associated with bowel emptying. The localization of pain can vary, and emotional stress or meals can make it worse. Flatulence and presence of gas are common and other symptoms of the disease are diarrhea, constipation, diarrhea and constipation, or alteration of the period of normal bowel emptying with periods of diarrhea and / or constipation.

 

Diarrhea is usually characterized by frequent small or moderate-volume stools (usually in the morning or after a meal), followed by cramping abdominal pain, urgency, false instincts on the stool, and a feeling of incomplete discharge. Half of the patients present with mucus in the stool. Abundant stools, bloody diarrhea, nocturnal or fatty diarrhea are not characteristic of irritable bowel syndrome. On the other hand, the constipation is characterized by "heavy" stools that are described to be pellet-shaped with frequent instincts on the stool - even when the end of the colon is empty.

 

What Is Irritable Bowel Syndrome?

Despite numerous studies and studies, the exact causes of irritable bowel syndrome remain unknown. Although there is an increased incidence and irregularity of bowel function in some patients, a specific pattern in alteration of bowel motility has not been established. One theory of emergence advocates hypersensitivity to nerve fibers in the gut, while immunohistological (hence pathological) studies highlight changes in the mucosal immune system. Some of the potential pathophysiological explanations include: the development of the syndrome after infectious inflammation in the digestive system, changes in the composition of microorganisms present in the gut (the so-called microflora), the influence of certain foods, genetic predisposition, psychosocial theory, and a number of other theories.

 

Diagnosis of the disease

The goal of imaging and laboratory diagnostics in accessing irritable bowel syndrome is primarily to exclude other pathogens.

Diagnosis is made on the basis of the clinical picture after the diagnostic work-up has been done to exclude underlying organic bowel disease. In clinical practice, Roman (IV) criteria are most commonly used on the basis of which disease is defined as recurrent abdominal pain that occurs on average at least once a week in the last three months, associated with two or more of the following criteria: associated with discharge, association with changes in the frequency of stools and the association with changes in the shape (appearance) of the stool.

 

Unfortunately, there is no specific laboratory test to confirm this diagnosis. The goal of imaging laboratory diagnostics is primarily to exclude other agents of symptoms, and the following tests are most commonly used: complete blood count, C-reactive protein (CRP) and / or fecal calprotectin, serological testing for celiac disease, colon cancer screening, native x-ray examination abdomen, anorectal monometry and balloon expulsion test.

 

Classification of irritable bowel syndrome

Irritable bowel syndrome subtypes are classified based on the patient's predominant symptom in the bowel emptying habit. Bristol stool form scale (BSFS) is used to characterize the consistency of a chair. On this basis, the following are distinguished:

 

Irritable bowel syndrome with predominant constipation;

Irritable bowel syndrome with predominant diarrhea;

Irritable bowel syndrome with mixed bowel movements;

Unclassified Irritable Bowel Syndrome (satisfying diagnosis but cannot be classified in any of the previous groups).

Differential diagnosis

The differential diagnosis of irritable bowel syndrome is very wide. In patients whose disease is predominantly characterized by diarrhea, the following diagnoses should be excluded: celiac disease, microscopic colitis, bacterial infection, or inflammatory bowel disease. Disease with predominant constipation should be distinguished from organic bowel disease, dysinergic defecation or "slow emptying bowel".

 

If the patient presents with one of the following so-called "alarming symptoms", it is essential to exclude malignant bowel disease primarily. These symptoms include age of onset over 50 years of age, blood in the stool or rectal bleeding, nocturnal diarrhea, progressive abdominal pain, unexplained weight loss, iron deficiency anemia, elevated CRP or fecal calprotectin, and a positive family history of colorectal cancer, ie. inflammatory bowel disease.

 

An approach to treating irritable bowel syndrome

A change in lifestyle and diet is necessary at the onset of the disease, and later pharmacological and other treatment modalities may be recommended.

Establishing a trusting doctor-patient relationship and continuity of care are the keys to treating patients with irritable bowel syndrome, as there are no unique and specific therapies. Patients with mild and intermittent symptoms of the disease are not advised to routinely administer drug therapy. At the onset of illness, a change in lifestyle and diet is necessary. Examples include avoiding foods that cause bloating and gas (eg, beans, selenium, onions, carrots, bananas, apricots, plums, sprouts, wheat germs, pretzels, alcohol and caffeine), then consuming a diet of poor fermenting oligo-, di- and monosaccharides and polyols (FODMAP), and in some cases avoiding lactose and gluten.

 

In the case of constipation, it is recommended to use seeds of Indian Dandruff (Latin called Plantago psyllium), osmotic laxatives, lubiprostone or other laxatives. In case of prolonged diarrhea, loperamide or cholestyramine may be taken. In case of pain, antispasmodics and, alternatively, antidepressants are introduced into the therapy. Routine use of probiotics is not recommended, while anxiolytics may only be used for a limited period of less than two weeks. Also, antibiotics are not routinely administered to patients with irritable bowel syndrome, although patients with moderate to severe symptoms without constipation (especially those who are bloated) who do not respond to other treatment modalities are advised to take rifaximin for two weeks.

 

Other treatment regimens mention alternative treatment for herbs (eg peppermint oil), fecal microbiota transplantation, acupuncture, enzyme replenishment, and the use of ketotifen mast cell stabilizers, but still with unclear therapeutic outcome. Ultimately, physical activity for 20-60 minutes 3-5 days a week is recommended, as it has been proven to relieve symptoms of irritable bowel syndrome.

 

Conclusion

Irritable bowel syndrome is a common disorder, but is still a mystery. Most patients suffer from irritable bowel syndrome all their lives. Nevertheless, most patients find a way to relieve their symptoms.


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