io 1 overview of irritable bowel syndrome arnold wald, md professor of medicine department of...
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Overview ofIrritable Bowel Syndrome
Overview ofIrritable Bowel Syndrome
Arnold Wald, MDProfessor of Medicine
Department of Gastroenterology, Hepatology, and Nutrition
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania
Arnold Wald, MDProfessor of Medicine
Department of Gastroenterology, Hepatology, and Nutrition
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania
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Irritable Bowel SyndromeIrritable Bowel Syndrome
Chronic or recurrent GI symptoms
– Lower abdominal pain/discomfort
– Altered bowel habits
– Bloating
Not explained by structural or biochemical abnormalities
Chronic or recurrent GI symptoms
– Lower abdominal pain/discomfort
– Altered bowel habits
– Bloating
Not explained by structural or biochemical abnormalities
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IBS Clinical Subgroups IBS Clinical Subgroups
Constipation predominant Diarrhea predominant Alternating constipation/diarrhea
Constipation predominant Diarrhea predominant Alternating constipation/diarrhea
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IBS Clinical Subgroups IBS Clinical Subgroups
Constipation predominant Diarrhea predominant Alternating constipation/diarrhea
Constipation predominant Diarrhea predominant Alternating constipation/diarrhea
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Rome II Criteria for IBSRome II Criteria for IBS
At least 12 weeks or more, which need not beconsecutive, in the preceding 12 months, ofabdominal discomfort or pain that has 2 outof 3 features:
Relieved by defecation
Onset associated with a change in frequency of stool
Onset associated with a change in form (appearance) of stool
At least 12 weeks or more, which need not beconsecutive, in the preceding 12 months, ofabdominal discomfort or pain that has 2 outof 3 features:
Relieved by defecation
Onset associated with a change in frequency of stool
Onset associated with a change in form (appearance) of stool
Gut. 1999.
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Epidemiology of IBS in US(15% to 20% of Population)Epidemiology of IBS in US(15% to 20% of Population)
Specialists 5%Specialists 5%
25% to 50% of referrals to GIs are IBS
Nonconsulters80%
Nonconsulters80%
Primary care15%
Primary care15%
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Prevalence of Disorders in US Prevalence of Disorders in US
IBS: 15% - 20%
Dyspepsia: 8%
GE reflux: 7%
Asthma: 4%
Diabetes: 3%
IBS: 15% - 20%
Dyspepsia: 8%
GE reflux: 7%
Asthma: 4%
Diabetes: 3%
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IBS Symptoms Reduce Patient Well Being
IBS Symptoms Reduce Patient Well Being
Reduced sense ofwell being
Reduced sense ofwell being
Abdominalpain
Abdominalpain
Altered bowelhabits
Altered bowelhabits
CrampsBloatingCrampsBloating
Constipation DiarrheaUrgency
Constipation DiarrheaUrgency
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Medical Costs Associated With IBS
Medical Costs Associated With IBS
Estimated $8 billion annually in direct costs
Increased physician visits for both GI and non-GI complaints
IBS patients incur 74% more health care costs than do non-IBS sufferers
Estimated $8 billion annually in direct costs
Increased physician visits for both GI and non-GI complaints
IBS patients incur 74% more health care costs than do non-IBS sufferers
Drossman, et al. Dig Dis Sci. 1993;38(9):1569-1580.Talley, et al. Gastroenterology. 1995;109(6):1736-1741.
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Impact of IBS on WorkImpact of IBS on Work
Missed work: 30% (1.7 days)
Reduced days: 46% (3 days)
Turned down promotion: 16%
Changed job, health reasons: 9%
Changed work schedule: 8%
Missed work: 30% (1.7 days)
Reduced days: 46% (3 days)
Turned down promotion: 16%
Changed job, health reasons: 9%
Changed work schedule: 8%
Hahn BA, et al. Digestion. 1999;60(1):77-81.
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Pathophysiology of IBS: A Biopsychosocial Disorder
Pathophysiology of IBS: A Biopsychosocial Disorder
Biological
– Altered GI motor activity
– Altered visceral sensation
Psychosocial
– Behavioral
– Cognitive
– Emotional
Biological
– Altered GI motor activity
– Altered visceral sensation
Psychosocial
– Behavioral
– Cognitive
– Emotional
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Multiple Medications Are Used to Treat IBS
Multiple Medications Are Used to Treat IBS
Anticholinergics
Tricyclic antidepressants
SSRIs
Antidiarrheals
Bulking agents
Laxatives
Alosetron*
Anticholinergics
Tricyclic antidepressants
SSRIs
Antidiarrheals
Bulking agents
Laxatives
Alosetron*
*Data support efficacy for diarrhea-predominant IBS.
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5-HT4
agonists
5-HT4
agonists
AlteredAlteredmotilitymotility
AlteredAlteredsensationsensation
New Treatment Paradigm for C-IBSNew Treatment Paradigm for C-IBS