Irritable Bowel Syndrome, a diagnostic nightmare

According to me diagnosing Irritable bowel syndrome, aka IBS isn't just a single nightmare, but a nightmare that may last for more than 90 days. Here are a few reasons why I think its more than a nightmare:
  • Although 1 in 7 people are affected by the disease worldwide (prevalence = 15%), the disorder doesn't have a conclusive diagnostic test since it is a functional GI disorder.
  • Diagnosis of IBS can prove to be expensive since it is a disease of exclusion. An array of tests have to conducted to rule out other diseases. If the patient doesn't have insurance or belongs to lower socioeconomic category, diagnosing the disease becomes near to impossible.
  • The patient is subjected to suffer from the symptoms for a maximum of 90 days in order to diagnose the disease and start with the treatment. This can be psychologically debilitating for the patient.

The Rome III category for diagnosing the disease states that a patient has IBS if she (female predominant disease) has 2 or more of the following characteristics of abdominal pain and discomfort for at least 3 days per month for 3 months

  1. Relieved by defecation
  2. Onset associated with a change in stool form/appearance
  3. Onset associated with a change in stool frequency

    Other symptoms may include
    1. Altered stool frequency, form and passage
    2. Mucorrhea
    3. Abdominal bloating or subjective distention
    4. Pain exacerbated by eating or emotional stress
    5. Increased pain in the premenstrual and menstrual phase
  • Poorly understood pathophysiology is a problem when doctors need to explain about the disease to their patient.

    Microscopic inflammation of small and large intestines have been found in a small group of IBS patients. Colonic dysmotility and hyperanalgesic viscera are also attributed to cause the disease. 



Once a patient with IBS has been diagnosed it is essential to not only prescribe medications for the same but also counsel her about the lifestyle changes she may have to forgo in order to manage her symptoms.

Medications for managing IBS symptoms include include those for:

Diarrhea: "CAL regime"
  • Cholestyramine resin 4 g with meals
  • Alosetron 0.5–1 mg bid (for women with severe IBS)
  • Loperamide 2–4 mg sos

Constipation:
  • Psyllium husk 3–4 g bid with meals
  • Methylcellulose 2 g bid with meals
  • Calcium polycarbophil 1 g qd to qid
  • Lactulose syrup 10–20 g bid
  • Polyethylene glycol 3350 17 g in 250 mL water qd
  • Lubiprostone 24 mg bid
  • Magnesium hydroxide 30–60 mL qd
Abdominal pain:
  • Smooth-muscle relaxant qd to qid
  • SSRI - begin small dose, increase as needed
  • Tricyclic antidepressants 25–50 mg hs

Comments

Post a Comment

Popular posts from this blog

What is a stomach with a leather bottle and signet ring called?

A man wearing a Signet ring and drinking from a leather bottle would probably be a man from medieval era. However the same cannot be told about stomach having a leather bottle appearance and Signet ring cells . Such a stomach is said to be cancerous, most commonly of the adenocarcinoma type. In order to diagnose the diffuse type of adeno gastic carcinoma an endoscopy followed by microscopic examination of the sample are performed. During endoscopy the stomach looks like a leather bottle and under the microscope signet ring cells make an appearance.  What could possibly be the reason behind these characteristic features? The leather bottle appearance is due to the thick and rigid stomach wall due to tumor infiltrating the submucosa. The Signet ring like appearance of the cells is due to mucin filled vacuoles pushing the nucleus to one side. (FYI - the other type of gastric Ca is the Intestinal type which has better prognosis and does not show the above m...
Read more

Patients in the ICU need "FAST HUGS IN BED P"lease

Here's something that might help you in your daily rounds in the Intensive Care Unit. While examining the patients in the ICU, one may use the following mneumonic to be sure that nothing is missed out. FAST HUGS IN BED P lease F -  Fluids/Feeding A -  Analgesics S  - Sedation T  - Thromboprophylaxis H  - Head up position U  - Ulcer prophylaxis G  - Glycemic control S  - Spontaneous breathing trial I  - Indwelling catheter N -  Nasogastric tube B  - Bowel care E  - Environment (eg Temperature) D  - De-escalation (Stopping a particular treatment) P  - Psychosocial support
Read more

Puddle sign... What's that?

Puddle is a small pool of fluid. Similarly   P uddle sign  is found when a pool of fluid gets accumulated in the peritoneal cavity ( ASCITES ). This  auscultatory sign   can successfully detect as less as  120 ml  of  free fluid in the abdomen.  On the other hand the two signs of percussion and palpation, namely  shifting dullness  and  fluid thrill  are elucited when the peritoneal fluid volume is more than  500 ml  and  1500 ml  respectively. " Like the silence before the storm, there is dullness before the thrill ." Let us presume that we have a patient with ascites and we are required to perform a diagnostic paracentesis (25ml fluid withdrawn using 5ml syringe). What are we required to look at? Color : Clear or cloudy yellow : Normal/TB Straw colored : Cirrhosis, Cancer (Ca), CHF, Nephrotic syndrome Bloody : Ca, TB, Pancreatic (Contain RBCs) Milky (Chy...
Read more