Irritable+Bowel+Syndrome+(IBS)

//Western Diagnosis// A. spastic colon B. functional bowel disorder C. motility disorder involving entire GI tract D. women 3: men 1 E. 50% of all GI referrals

Etiology
1. no anatomic cause 2. emotional factors 3. stress 4. diet 5. drugs 6. hormones

Pathology
1. proximal SI hypersensitive to food 2. LI hypersensitive to pressure and hormones

Signs & Symptoms
1. almost always in waking state 2. triggered by stress, food 3. abdominal pain, constipation or diarrhea, postprandial distention 4. pain relieved by defecation 5. looser and more frequent stools with onset of pain 6. sense of incomplete evacuation after bm

two types
i. variable bm ii. alternating constipation and diarrhea iii. mucorrhea iv. lower abd pain, usually in LLQ v. colicky or dull ache vi. fatigue, depression, anxiety, difficulty concentrating, headache, Nausea, bloating, flatulence
 * spastic colon**

i. urgent, watery diarrhea immediately upon rising in morning or during or after a meal
 * painless diarrhea**

Diagnosis
1. thorough history 2. characteristic sx patterns 3. rule out all other GI disorders with similar sx: UC, malabsorption, lactose intolerance, celiac disease, duodenal ulcers, gastroenteritis 4. comprehensive stool examination 5. sigmoidoscopy 6. at least 2 of the following for 12 weeks in a 12 month period: better w/ defecation, change in stool frequency, change in stool form & appearance, migratory abdominal pain, frequently worse during or after a meal, frequently worse w/ stressors, worse with menses

Treatment
1. support 2. counseling 3. relaxation 4. elimination diet - food allergies 5. limit sorbitol and fructose - sugars 6. high fiber diet - psyllium, flax seeds, citrus pectin (stabilizes and bulks stools) 7. peppermint oil 3-6 0.2 mg caps/d - MUST BE ENTERIC COATED 8. Tryptophan/5HTP? - a few studies have had results

high fructose corn syrup consumption may play a role. high fructose is not fully broken down d/t lessened glucose and increases glycolysis of the intestinal lining