PEDBASE.org - The Pediatric Database - Detailed information of IRRITABLE BOWEL SYNDROME (IBS)

IRRITABLE BOWEL SYNDROME (IBS)

DEFINITION:

A functinal gastrointestinal disorder characterized by three months of abdominal pain and an altered pattern of defecation.

EPIDEMIOLOGY:

incidence: 10-20% of adults
age of onset:
- adolescence
risk factors:
- familial - other members of the family with IBS or other gastrointestinal disorders
- F > M (2-3:1)

PATHOGENESIS:

1. Etiology

unknown
the persistent or recurrent gastrointestinal symptoms cannot be explained by any structural or biochemical abnormalities

CLINICAL FEATURES:

1. Diagnostic Criteria

1. A 3 month history of:

abdominal pain
altered pattern of defecation

2. Abdominal Pain

relieved with defecation
associated with a change in stool frequency and consistency
tends to be crampy and occurs anywhere in the abdomen

3. Altered Pattern of Defecation

1. Involves 2 or more of the following:

altered stool frequency
- alternating patterns of constipation and diarrhea
altered stool form
- lumpy & hard; loose & watery
altered stool passage
- straining, urgency, feeling of incomplete evacuation
passage of mucous
bloating or feeling of abdominal distension

4. Associated Symptoms

1. Somatic/Psychologic Complaints

anxiety
depression
dizziness
fatique
headaches
nervousness
palpitations
panic attacks
sexual dysfunction
sleep disturbances
weakness

5. Pertinent Negatives

1. Features suggesting an organic etiology:

abdominal pain with eating
fever or chills
food sensitivities
abuse of laxatives, cathartics, antacids
inability to take foods or juices
use of antibiotics or caffeine
recurrent vomiting +/- blood
hematochezia
melena
weight loss

6. Physcial Examination

generally negative
may find mild to moderate abdominal tenderness without rebound or guarding
increased abdominal girth during a painful episode

INVESTIGATIONS:

1. First Line

1. Serum

CBC, electrolytes, BUN, creatinine, calcium, ESR, liver function tests

2. Urine

urinalysis, C&S

3. Stool

occult blood, C&S, O&P

4. Imaging Studies

abdominal x-ray

5. Proctosignoidoscopy

MANAGEMENT:

1. Diagnosis

1. Clinical - based on history of 3 months of abdominal pain with an altered pattern of defecation in a person who is otherwise healthy; exclusion of other diagnoses

2. Education

diagnosis, epidemiology, prognosis, treatment options
discuss patients agenda (hidden [secondary gain], fear of disease, concurrent life stresses, family strife, disability)

3. Goals of Therapy

symptomatic control to improve social and work functioning
not curative

4. Management Strategies

1. Supportive

1. Primary

counselling for a chronic disease with no cure
prove regular follow-up and support
reassure that IBS is a common, benign disorder and does not carry a risk for other diseases; also reassure that symptoms are not due to serious organic etiology (i.e., cancer, inflammatory bowel disease)
analagies

1. Headache

while some people get headaches others get gut aches and with only symptomatic manage-ment in both

2. Toothpaste

normally the GI tract is like a full tube of toothpaste - a little squeeze and out comes the stool
in IBD, the GI tract is like an almost empty tube of toothpaste - with a squeeze alot (diarrhea) or alittle/none (constipation) stool comes out

2. Psychotherapy

or supportive counselling sessions for somatic and psychologic complaints

2. Abdominal Pain

1. Dicyclomine (Bentylol)

10-20 mg po before meals
for abdominal pain developing after meals
rarely used in children or adolescents

2. Amitriptyline

for chronic abdominal pain
rarely used in children or adolescents

3. Altered Stool Frequency

1. Diarrhea

1. Loperamide (Imodium)

1-2 tabs po tid

2. Constipation

bran 1 tablespoon po tid
(mainstay of management of IBS in children with the analogy that fibre turns the GI tract from like a near-empty tube of toothpaste to a full tube)
psyllium 1 tablespoon po tid

3. Motility Regulator

1. Trimebutine Maleate (Modulon)

600 mg po daily
not recommended for children under 12 years

4. Gas, Bloating, or Flatus

avoid gas-forming foods

Pediatric Database - IRRITABLE BOWEL SYNDROME (IBS)

Pediatric Organization - Pedbase [at] Gmail.com