Irritable Bowel Syndrome

Irritable Bowel Syndrome

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o Patients with psychological disturbances relate more frequent and debilitating illness than control populations. o An Axis I disorder coincides with the onset of GI symptoms in as many as 77% of patients. Colonic dysmotility in irritable bowel syndrome manifests as variations in slow-wave frequency and a blunted, late-peaking, postprandial response of spike potentials. * Visceral hyperalgesia is the second part of the traditional 3-part complex that characterizes irritable bowel syndrome. irritable-bowel-syndrome These patterns include IBS-D (diarrhea predominant), IBS-C (constipation predominant), IBS-M (mixed diarrhea and constipation), and IBS-A (alternating diarrhea and constipation). o Current theories integrate these widespread motility aberrations and hypothesize a generalized smooth muscle hyperresponsiveness. Traditionally, irritable bowel syndrome is a diagnosis of exclusion. o Laparoscopic full-thickness jejunal biopsy samples revealed infiltration of lymphocytes into the myenteric plexus and intraepithelial lymphocytes in a subset of patients. irritable-bowel-syndrome This concept is groundbreaking in that irritable bowel syndrome had previously been considered to have no demonstrable pathologic alterations.

. o Both colonic inflammation and small bowel inflammation have been discovered in a subset of patients with irritable bowel syndrome versus controls. * Altered GI motility includes distinct aberrations in small and large bowel motility. irritable-bowel-syndrome Irritable bowel syndrome (IBS) is a functional GI disorder characterized by abdominal pain and altered bowel habits in the absence of specific and unique organic pathology. The Manning criteria to distinguish irritable bowel syndrome from organic bowel disease. Notably, within 1 year, 75% of patients change subtypes, and 29% switch between constipation-predominant IBS and diarrhea-predominant IBS. This has led to proposed treatments with probiotics and antibiotics. irritable-bowel-syndrome o Enteroendocrine cells in postinfectious irritable bowel syndrome appear to secrete high levels of serotonin, increasing colonic secretion and possibly leading to diarrhea. The usefulness of these subtypes is debatable.

PathophysiologyTraditional theories regarding pathophysiology may be visualized as a 3-part complex of altered GI motility, visceral hyperalgesia, and psychopathology. o Patients who seek medical care have a higher incidence of panic disorder, major depression, anxiety disorder, and hypochondriasis than control populations. irritable-bowel-syndrome Patients who are prone to diarrhea demonstrate this disparity to a greater degree than patients who are prone to constipation. * Small bowel bacterial overgrowth has been heralded as a unifying mechanism for the symptoms of bloating and distention common to patients with irritable bowel syndrome. A unifying mechanism is still unproven. o Patients with postinfectious irritable bowel syndrome may have increased numbers of colonic mucosal lymphocytes and enteroendocrine cells. irritable-bowel-syndrome Neuronal degeneration of the myenteric plexus was also present in some patients. o The myoelectric activity of the colon is composed of background slow waves with superimposed spike potentials. o Small bowel dysmotility manifests in delayed meal transit in patients prone to constipation and in accelerated meal transit in patients prone to constipation and in accelerated meal transit in patients prone to constipation and in accelerated meal transit in patients prone to constipation and in accelerated meal transit in patients prone to constipation and in accelerated meal transit in patients prone to constipation and in accelerated meal transit in patients prone to constipation and in accelerated meal transit in patients prone to constipation and in accelerated meal transit in patients prone to constipation and in accelerated meal transit in patients prone to constipation and in accelerated meal transit in patients prone to constipation and in accelerated meal transit in patients prone to constipation and in accelerated meal transit in patients prone to constipation and in accelerated meal transit in patients prone to constipation and in accelerated meal transit in patients prone to constipation and in accelerated meal transit in patients prone to constipation and in accelerated meal transit in patients prone to constipation and in accelerated meal transit in patients prone to constipation and in accelerated meal transit in patients prone to constipation and in accelerated meal transit in patients prone to constipation and in accelerated meal transit in patients prone to constipation and in accelerated meal transit in patients prone to constipation and in accelerated.

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