Upper & Lower GI Diseases Lecture of Gastroentero-Hepatology System, FKUH

Fardah Akil
Centre of Gastroentero-Hepatology, Wahidin Sudirohusodo Hospital Teaching
Internal Medicine, Faculty of Medicine, Hasanuddin University
Recurrent abdominal pain or discomfort at least 3 days
per month in the last 3 months associated with 2 or
more of the following : (ROME III criteria)
improved with defecation
onset associated with a change in frequency of stool
onset associated with a change in form (appearance)
of stool
The most common functional
bowel disorder and effects
predominantly women (70%
patients)

Can cause great discomfort,
intermittent or continous,for
many decades in patients life
and can have significantly
negative impact on quality of
life
Mostly between the ages 20
and 40 years
20% consult a physician, only
a small percentage visit a
gastroenterologist
> 60% have psychological
disturbances (anxiety,
somatoform, personality
disorders or chronic pain
syndrome); 35% have a
history of sexual abuse
(women)
IBS can be cause by many factors,such as :
Disturbed bowel motility
Visceral hypersensitivity
Bacterial overgrowth /postinfective IBS
(Shigella, salmonella, campylobacter)
Stress response : psychological problems
SYMPTOMS AND SIGN :
Abdominal pain or
discomfort that is linked to
bowel function
Not explained by
biochemical or structural
abnormalities
With symptoms onset at least 6
month
IBS SUBTYPE
CLASSIFICATION
based solely on stool consistency
and not frequency, urgency and
straining (The Rome III ) :
1. IBS with constipation (IBS-C)
2. IBS with diarrhea (IBS-D)
3. Mixed IBS (IBS-M)
4. Unsubtype IBS
Alarm feature indicate that the
diagnosis might not be IBS
Symptom & sign
Laboratory : CBC, Thyroid stimulating
hormone & serologies, stool test
Endoscopy of LGI
Lactose intolerance
Food intolerance
Infections
Celiac disease
Tropical sprue
Small bowel bacterial
overgrowth
IBD
Microscopic colitis
Decreased QOL
Time off work & school
Personal expense of medication & physician
visits
Psychological problem (depression & anxiety)

Dietary modification
Fiber supplements
Physichotherapy

Pharmacologic agents : antidiarrheal, enemas & suppositories,
laxantive,antispamotics, tricyclic antidepressants, selective
serotinin reuptake inhibitors (SSRIs = citalopram, fluoxetine),
serotinin receptor, probiotics