Definition: Irritable bowel syndrome is a disorder characterized most commonly by cramping, abdominal pain, bloating, constipation altered by diarrhea,gas and flatulence

Etiology: functional disorder

Clinical Picture:

Characterized by recurrent duration for 3-6 months
abdominal discomfort which increase before eating and decrease after defecation
stool abnormality
sense of incomplete emptying after defecation

Classification:
1. With diarrhea*2-4 times per day. Urgent pain, absence of diarrhea at night*
2. with constipation*absence of defecation > 2 days, alternating diarrhea with constipation*
3. Sense of incomplete emptying*
4. With prevalence of abdominal pain and meteorism

Signs which characterize functional genesis
recurrent process
absence of disease progression
increased symptoms after stress
connected with psycho-emotional stress
absence of complaints at night

Signs which exclude diagnosis IBS
rectal bleeding
weight loss
fever
first symptom after 50 yrs
night symptoms
family anamnesis

Diagnosis:

CBC: normal
intestinal dysbiosis
No organic pathology
irrigography – intestinal malfunction – hypo or hyper-motility

Treatment:
For pain : antispamodic eg alverine or dicyclomine
For excess of flatulence: simeticone and antacids ( Maalox+ is a combination of both)

Constipation:
Diet 3 consisting of lots of fibers,vegetable and fruits
purgative (increase peristalsis)
prokinetics – in case of hypo-motility
antidepressants eg amitriptyline
osmotic diuretic eg lactulose

Diarrhea:
Diet 4
Loperamide (decrease motility, increase tonus of anal sphincter)
Probiotics – normalisation of microflora
Sorbents – (binding toxins)
Antiseptics – in severe dysbiosis

Quiz
A 45-year-old woman who has had a hysterectomy presents to the emergency department with abdominal pain and vomiting. A mechanical small bowel obstruction is seen on the abdominal radiograph. What is the most likely cause for this obstruction?

Answer will be available in the next issue