UPDATES ON MANAGEMENT OF IRRITABLE BOWEL SYNDROME

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Ms.Cheung• F/ 33• History of ileal resection >10 years ago, ? Length of ileum resected• Pathology report : non‐specific ileilits• Not on regular medication for long time• C/O chronic diarrhea for years• Loose stool 4‐5 times per day• Associated with mild abdominal discomfort, relieved by defecation• No intermittant constipation• Symptoms partially controlled by imodium• Stool and blood test unremarkable• Colonoscopy performed : NAD
Ms.Cheung• Is it IBS?• Given cholestyramine 2 sachets/ day,diarrhea symptoms much improved• Bile salt malabsorption
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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
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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
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Diagnosis• Consensus statement is
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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 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: CASE SCENARIOIS IT REALLY IBS?
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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