IBS is a very common cause of pain abdomen It may be associated with diarrhea or constipation In our world, around 10% of people suffer from IBSEvery tenth person has IBS IBS is more common in women, we will discuss symptoms of IBSPain is the most common symptom of IBS Pain can occur in any part, the duration is more than 6 months Patient also has diarrhea, or constipation Other symptoms are gas in the stomach, bloating, the urgency of stool, feeling of incomplete evacuation and straining during passing stool.
Some patients may pass mucus Pain is associated with bowel movement Pain may increase, decrease or occur during bowel movement Patient may have anxiety or depression also IBS patients may be sad or maybe anxious or restless Some symptoms never occur in IBS patients Weight loss, feet swelling, anemia, blood in the stool, stool desire during sleep don’t occur in IBS Patient will these symptoms usually don’t have IBS In these patients we have to rule out Tuberculosis, cancer, and ulcers If the patient has fever or anemia, IBS is unlikely If a family history of colon cancer is there.
IBS is unlikely and If symptoms start after the age of 50, IBSis unlikely Let’s know the causes of IBS Mucosa inflammation is the cause of IBS Our intestine has an inner lining called mucosa IBS patients has swelling of this lining This will cause pain in the abdomen And bowel habits are disturbed Intestine movements are altered increased movements cause diarrhea Reduced movement can cause constipation Large bowel bacteria in IBS patients are altered Our colon has bacteria which are beneficial Bacteria are altered in IBS patients.
These bacteria produce either gas or fatty acids Which can cause pain or diarrhea IBS patients are intolerant to certain food items FODMAP diet can cause pain in IBS FODMAP to mean fermentable carbohydrates Certain carbohydrates are not absorbed in the small intestine And enter in large bowel Our food should be digested in small intestine In IBS, some carbohydrates enters the large bowel Bacterial fermentation of carbohydrates in large bowel forms gas or short-chain fatty acids Which cause pain abdomen or diarrhea.
IBS patients may be intolerant to gluten or fructose Gluten is present in wheat Fructose is present in fruit Gluten and fructose can cause symptoms of pain and diarrhea in IBS patients, Gluten is fructose may not be absorbed in the small intestine and enters the large bowel Bacterial fermentation produces gas or short-chain fatty acids Bile acids can be crucial in IBS Our liver forms bile acids for fat digestion Bile acids should be absorbed in the terminal part of the small intestine called ileum In IBS patients, bile acids may not be absorbed in ileum and reach the colon.
And cause diarrhoea visceral hypersensitivity is a common cause of pain in IBS it means normal contents can cause pain in IBS Fat in diet, can cause pain abdomen in IBS patients That’s why IBS patients should have less fat in diet SIBO, small bowel bacterial overgrowth is a common component of IBS Normally small bowel does not have bacteria IBS patient can have SIBO Bacteria in the small bowel can ferment carbohydrate and produce gas Gas will cause pain How we diagnose IBS There is no test for IBS IBS is diagnosed by symptoms and examination.
If the patient has alarming symptoms Age >50, blood in the stool, decreased appetite, weight loss, pedal edema, and anemia don’t occur in IBS Other problems such as tuberculosis, ulcer, cancer should be ruled out IBS does not require testing If examination and history suggest IBS we use ROME IV criteria for IBS diagnosis What are ROME IV criteria Patient should have pain for more than 6 months and at least once a week in last 3 months Pain should be related to bowel movement Either pain should increase or decrease.
After pain onset, the patient should have diarrhea or constipation After pain onset, stool form should change We use the Bristol stool scale for pain If stool shape is 1 or 2, it is constipation 3, 4 are normal, 5,6,7 are diarrhea If > 25% stool is 1,2 on the scale, it’s IBC constipation If >25% stool are 5,6,7 it’s IBC diarrhea IF both are more than 25%, its mixedIf both are less than 25%, its unclassified For diagnosis of IBS, we don’t require extensive testing We do CBC to rule out anemia do ESR/CRP/fecal calprotectin to rule out an ulcer.
To differentiate IBS and IBD, we do fecal calprotectin IBS patients have normal fecal calprotectin We do IgA anti-tissue transglutaminase for celiac disease We do glucose breath test for SIBOWe do thyroid test We do stool examination for ova, cyst We take drug history, medicine of diabetes, hypertension can cause stomach problems For constipation, we do colonic transit study Patient ingest some markers, which are followed by X-ray We do anorectal manometry to rule out obstructive defecation.
For a doctor to make a diagnosis of IBS, a person must have had recurrent abdominal pain on average at least one day per week during the previous three months that is associated with two or more of the following:
- The pain is increased or unchanged after a bowel movement
- A change in frequency of bowel movements
- A change in stool form or appearance.