UPDATES ON MANAGEMENT OF IRRITABLE BOWEL SYNDROME

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Alosetron• Ischemic colitis (0.1‐1% ) , severe constipation (28% )• Withdrawn from market in Nov 2000• Reintroduce in June 2002 with strict prescribingregulations• Indications :• NNT : 7women with severe diarrhea‐predominant symptoms >6 monthsFail conventional treatment• GOR : 1B
Summary of Treatment forIBS‐associated DiarrheaGOR Benefits S/ELoperamide 2C Diarrhea ConstipationParalytic ileusAlosetron 1B DiarrheaGlobalSevere constipationischemic colitis
Page 1 and 2:
UPDATES ON MANAGEMENT OFIRRITABLE B
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 and 54: Anti‐depressantsSSRI• Less publ
Page 55 and 56: Psychosocial TherapiesCBT• Cognit
Page 57 and 58: IBS WITH DIARRHEA
Page 59: Alosetron• 1 st IBS specific medi
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
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UPDATES ON MANAGEMENT OF IRRITABLE BOWEL SYNDROME

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