Wednesday, May 24, 2017

Introduction to Irritable bowel syndrome



Introduction
Also referred to as spastic colon or spastic colitis, irritable bowel syndrome is marked by chronic abdominal pain, alternating constipation and diarrhea, and abdominal distention. This disorder is extremely common; 20% of patients, however, never seek medical attention.

Etiology
The cause and pathogenesis of this functional disorder remain poorly understood. Generally associated with psychological stress, the disorder may result from physical factors, such as diverticular disease, ingestion of irritants (coffee or raw fruits or vegetables), lactose intolerance, abuse of laxatives, food poisoning, or colon cancer. Contributing factors include abnormal gut motor and sensory activity, central neural dysfunction, and luminal factors.

Clinical Features

Irritable bowel syndrome characteristically produces intermittent, crampy lower abdominal pain. The pain is usually relieved by defecation or passage of flatus. It typically occurs during the day. Pain intensifies with stress or 1 to 2 hours after meals. The patient may experience constipation alternating with diarrhea, with one being the dominant problem. Mucus is usually passed through the rectum. Abdominal distention and bloating are common.

Diagnosis
A history and physical examination should be performed. A careful patient history is required to determine contributing psychological factors such as a recent stressful life change. The diagnosis must also rule out other disorders, such as amebiasis, diverticulitis, colon cancer, and lactose intolerance. Appropriate diagnostic procedures include sigmoidoscopy, colonoscopy, barium enema, rectal biopsy, and stool examination for blood, parasites, and bacteria.

Treatment

Therapy aims to relieve symptoms and includes counseling to help the patient understand the relation between stress and her illness. Strict dietary restrictions aren’t beneficial, but food irritants should be investigated and the patient instructed to avoid them. Rest and heat applied to the abdomen are helpful, as is judicious use of sedatives (phenobarbital) and antispasmodics (propantheline or diphenoxylate with atropine sulfate). However, with chronic use, the patient may become dependent on these drugs. Increasing bulk in the diet and administering psyllium and an antidiarrheal, such as loperamide, also helps. If the cause of irritable bowel syndrome is chronic laxative abuse, bowel training may help correct the condition.

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