UPDATES ON MANAGEMENT OF IRRITABLE BOWEL SYNDROME
UPDATES ON MANAGEMENT OF IRRITABLE BOWEL SYNDROME UPDATES ON MANAGEMENT OF IRRITABLE BOWEL SYNDROME
Pain modulatorsAntidepressant Ach 5HT Histamine Dose /effect uptake effect dayTCAsAmitriptyline ++++ +++ ++++ 25‐150mgDoxepin ++ +++ ++++ 25‐150mgDesipramine + +++ + 25‐150mgNortriptyline ++ + ++ 25‐150mgSSRIsCitalopram nil ++++ nil 20mgFluoxetine nil ++++ nil 20mgParoxetine nil ++++ nil 50mgSertraline nil ++++ nil 150mg
Psychosocial TherapiesCBT• Cognitive : to change underlying maladaptivethinking/perception of symptoms• Behavior : to modify dysfunctional behaviors• Best studied psychological therapy• NNT : 2• GOR : 1BHow does cognitive behavior therapy for irritable bowel syndrome work? A mediationalanalysis of a randomized clinical trialLackner JM; Jaccard J; Krasner SS; Katz LA; Gudleski GD; Blanchard EBGastroenterology. 2007 Aug;133(2):433‐44. Epub 2007 May 21.
- Page 3 and 4: Prevalence• Common GI condition
- Page 5 and 6: Prevalence in HK• Hong Kong 1000
- Page 7 and 8: Impact• Direct cost Prescription
- Page 9 and 10: Clinical manifestations• Othersbe
- Page 13 and 14: DIAGNOSIS
- Page 15 and 16: Manning criteria• > 3 of the foll
- Page 17 and 18: Symptom‐based diagnosticcriteriaL
- Page 19 and 20: How alarming ?SensitivitySpecificit
- Page 21 and 22: Diagnosis• Consensus statement is
- Page 23 and 24: Emerging specific Investigations•
- Page 25 and 26: PATHOPHYSIOLOGY
- Page 27 and 28: Genetic predisposition• Similar s
- Page 29 and 30: Visceral Hypersensitivity andBrain
- Page 31 and 32: Small Intestine BacterialOvergrowth
- Page 33 and 34: Psychological Dysfunction• Not et
- Page 35 and 36: General PrincipleNon pharmacologica
- Page 37: Compare components of placebo effec
- Page 40 and 41: Outcomes at six week follow-upKaptc
- Page 42 and 43: Patient Education• Explain about
- Page 44: Psychosocial Therapies• Interpers
- Page 48 and 49: Pharmacological treatment• IBS wi
- Page 51 and 52: NNT=5(95% CI 4‐9 )
- Page 53: Anti‐depressantsSSRI• Less publ
- Page 57 and 58: IBS WITH DIARRHEA
- Page 59 and 60: Alosetron• 1 st IBS specific medi
- Page 61 and 62: Summary of Treatment forIBS‐assoc
- Page 63 and 64: FiberNNT: 11(95%CI ,5‐100)
- Page 65: Tegaserod• Only 5HT4 Receptor ago
- Page 69 and 70: Lubiprostone• Selective C‐2 chl
- Page 71 and 72: Summary of Treatment forIBS‐assoc
- Page 73 and 74: Alternative Therapies• Peppermint
- Page 77 and 78: CASE SCENARIOIS IT REALLY IBS?
- Page 79 and 80: Ms.Cheung• Is it IBS?• Given ch
- Page 81 and 82: Mr.Leung• Is it IBS?• CT abdome
- Page 83 and 84: Points to note• Red flags for a c
Pain modulatorsAntidepressant Ach 5HT Histamine Dose /effect uptake effect dayTCAsAmitriptyline ++++ +++ ++++ 25‐150mgDoxepin ++ +++ ++++ 25‐150mgDesipramine + +++ + 25‐150mgNortriptyline ++ + ++ 25‐150mgSSRIsCitalopram nil ++++ nil 20mgFluoxetine nil ++++ nil 20mgParoxetine nil ++++ nil 50mgSertraline nil ++++ nil 150mg
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