Menu Expand
Irritable Bowel Syndrome - ECAB

Irritable Bowel Syndrome - ECAB

Uday C Ghoshal

(2012)

Additional Information

Book Details

Abstract

Irritable bowel syndrome is a part of the family of gastrointestinal motility disorders and is characterized by abdominal pain and altered bowel habits. It is highly prevalent throughout the world with the reported prevalence rates lying between 9% and 25%. The incidence of IBS varies between different ethnic groups and the incidence has also been reported to be different in males and females. The incidence also varies between various clinical subgroups (diarrhea-predominant/constipation-predominant) of the disorder.

This is a chronic condition and is the most frequent symptom complex in patients who visit gastroenterologists throughout the world. However, this is one of the least understood GI disorders as it is not a disease but a complex of symptoms. The symptoms are often severe and quite bothersome, and thus have a negative effect on the patient’s quality of life and activity level, often leading to psychiatric complications. Besides this, a substantial economic burden of the disease and its impact in terms of man hours lost per annum make it one of the most troublesome symptom complexes in medicine, which need to be solved.

This book has been designed to update the readers on the extensive research done over these years and on the many new potential mechanisms of pathogenesis of this troublesome condition. The reader will also be updated on the changing epidemiology of the condition. Diagnostic approach and management of IBS have also been thoroughly reviewed with an emphasis on the recent updates in the field. Typical supportive case scenarios have been included to exemplify and highlight various points discussed. Thus, it provides an excellent opportunity to widen one’s perspective in this area.


Table of Contents

Section Title Page Action Price
Front Cover Front Cover
Front Matter ia
Elsevier Clinical Advisory Board:Gastroenterology/Hepatology ic
Copyright ie
About the Authors if
Contents ih
ECAB Clinical Update Information i
Foreword v
Irritable Bowel Syndrome: Epidemiology and Pathogenesis 1
Introduction 2
Epidemiology 2
Etiology 4
Postinfectious IBS 4
Pathophysiology of IBS 6
Genetic Factors 7
Psychological Factors 8
Visceral Hypersensitivity 9
Effect of Nutrients 10
Role of Serine Protease 10
Stress and Visceral Sensitivity 10
GI Motility 11
Dysregulation of Brain-Gut Axis 11
Neuropeptides and Hormones 12
Altered Serotonin Signaling 13
Inflammatory Changes 13
Defective Mucosal Barrier 14
Food Hypersensitivity 14
Evolution of Diagnostic Criteria for IBS 14
Rome I Criteria 15
Rome II Criteria 15
Rome III Criteria 17
Irritable Bowel Syndrome: Diagnosis 27
Diagnosis 28
Clinical Manifestations 28
Chronic Abdominal Pain 28
Altered Bowel Habits 29
Other Symptoms 29
Diagnosis Criteria 30
Manning Criteria (presence of any four of the six symptoms) 30
Rome Criteria 30
Red Flag Symptoms which Are Not Typical of IBS 32
Subtypes of IBS 32
Validity of Different Criteria 33
Diagnostic Evaluation 35
Blood Biochemistry and Endoscopy 35
Imaging in Suspected IBS 37
Investigation for Celiac Disease 37
Investigation for Lactose Intolerance 38
Other Diagnostic Studies 40
Diagnostic Approach 40
Indian Data 41
Summary 43
Case Studies Irritable Bowel Syndrome: Diagnosis 47
Case I 47
History 47
Examination and Management 47
Discussion 48
Case II 49
History 49
Examination and Management 49
Discussion 49
Management of Irritable Bowel Syndrome 50
Natural History and Subtype Durability 51
Diagnosis in a Clinical Setting 51
Primarily Symptomatic Diagnosis 53
Treatment 56
Dietary Management 56
Supplements and Preparations 57
Conventional Pharmacological Management 57
Antidiarrheal Agents 58
Antispasmodics 58
Prokinetics 59
Laxatives 59
Serotonergic Drugs 59
Psychological Therapies 60
Antidepressants 61
Recent Advances in Management of IBS 62
Developmental Drugs 62
Discussion 62
Prognosis 64
Personal Clinical Experience and Management 64
Conclusion 66
Case Studies Management of Irritable Bowel Syndrome 73
Case Study I 73
History 73
Physical Examination 73
Management 73
Case Study II 74
History 74
Physical Examination 74
Management 74
Irritable Bowel Syndrome: Could a Subset of this Syndrome Have Organic Basis? 75
Evidences that Organic Diseases can be Misdiagnosed as IBS 76
Celiac Disease and other Causes of Malabsorption Syndrome 76
SIBO Syndrome 78
Fecal Evacuation Disorders 80
Evidences Suggesting that IBS may have Organic Basis 81
Postinfectious IBS 81
Small Intestinal Permeability in IBS 82
Could IBS have Genetic Basis? 82
Available Data on Role of Genetic Polymorphism in IBS 83
Genes of Serotonergic System 83
Genes of Adrenergic System 84
Polymorphism in Cholecystokinin Genes 85
Polymorphism in Cytokine Genes 85
Conclusions and Future Directions 86
Case Study Irritable Bowel Syndrome: Could a Subset of this Syndrome Have Organic Basis? 93
Case Study 93
History 93
Management 94
Discussion 94
Editor’s Summary 95
Forthcoming Books 97