IBS and Dyspepsia

Functional Bowel
Disorders
Functional dyspepsia
Irritable bowel syndrome
Functional Bowel Disorders
• Functional gastrointestinal disorders

are a common diagnosis in
gastroenterology,
• accounting for around 40% of all
referrals to gastroenterology.
• They are thought to be disorders of
brain–gut interaction, with alterations
in motility, visceral hypersensitivity, gut
microbiota, immune and mucosal
function, as well as alterations in
central nervous system processing.
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functional Dyspepsia
• Dyspepsia is the term used to describe
postprendial epigastric pain or
discomfort associated with other
symptoms like bloating, hiccough and
nausea and early satiety
• Functional dyspepsia accounts for
60% of cases of dyspepsia.
• Functional dyspepsia, defined as 3
months of dyspepsia without an
organic cause
• Chronic Dyspepsia affects up to 20%
of the population at some time in life
and many patients have no serious
underlying disease
functional Dyspepsia
Pathophysiology
Gastric Motor Dysfunction
also is found in 25 to 50% of functional dyspeptics.
The relation of these defects to symptom induction is
uncertain;
many studies show poor correlation between symptom
severity and the degree of motor dysfunction.
Visceral Afferent Hypersensitivity
was first demonstrated in patients with irritable bowel syn
Patients with dyspepsia may experience discomfort
with fundic distention to lower pressures than healthy control
Helicobacter pylori
.The importance of H. pylori in the genesis of functional
dyspepsia is controversial, but most investigators believe it is
of minor importance.
Psychological facters
functional dyspepsia is associated with a reduced sense of
physical and mental well-being and is exacerbated by stress
Causes of secondary dyspepsia
Upper gastrointestinal disorders

• Peptic ulcer disease
• H.pylori gastritis
• Gastric malignancy
• Gallstones
Other gastrointestinal disorders
• Pancreatic disease (cancer, chronic
pancreatitis)
• Hepatic disease (hepatitis,
metastases)
Causes of secondary dyspepsia
Drugs
• Non-steroidal anti-inflammatory drugs
(NSAIDs)
• Iron and potassium supplements
• Corticosteroids
• Digoxin
Others
• Alcohol
• Psychological, e.g. anxiety, depression
• pregnancy
Dyspepsia
'Alarm' features in dyspepsia
• Weight loss
• Anaemia
• Vomiting
• Haematemesis and/or melaena
• Dysphagia
• Palpable abdominal mass
An algorithm for the
investigation of dyspepsia .
treatment of functional
Dyspepsia
• patients benefit from H. pylori
eradication therapy and this should be
offered to infected individuals
• restrictive diets are of little benefit but
smaller portions and fat restriction may
help
• Prokinetic drugs (e.g. metoclopramide)
• fundus-relaxing drugs (e.g.buspirone)
• Acid suppression medication PPI
• tricyclic antidepressants amitriptyline
• psychotherapy
IRRITABLE BOWEL
SYNDROME
IRRITABLE BOWEL
SYNDROME
• Irritable bowel syndrome (IBS) is a

functional bowel disorder
characterized by abdominal pain or
discomfort and altered bowel habits
in the absence of detectable
structural abnormalities
IRRITABLE BOWEL
SYNDROME
• Approximately 20% of the general

population fulfil diagnostic criteria
for IBS but only 10% of these
consult their doctors because of
gastrointestinal symptoms.
• Female predominent
IRRITABLE BOWEL
SYNDROME
Etiology
The pathogenesis of IBS is poorly
understood
• psychosocial factors
anxiety
depression
somatisation and neurosis
• altered gastrointestinal motility
no consistent evidence of
abnormal motility
IRRITABLE BOWEL
SYNDROME
• altered visceral sensation
a consequence of altered central
nervous system processing of
visceral sensation.
IRRITABLE BOWEL
SYNDROME
Physiological factors
• IBS may be a disorder of the brain–gut
axis, with alterations in visceral
hypersensitivity.
• There is some evidence that IBS may
be a serotoninergic (5-HT) disorder,
• as evidenced by relatively excessive
release of 5-HT in diarrhoea-
predominant IBS (IBS-D) and relative
deficiency with constipation-
predominant IBS (IBS-C
IRRITABLE BOWEL
SYNDROME
• luminal factors
➢ following an episode of gastroenteritis
➢ intolerant of specific dietary components,
particularly lactose and wheat FODMAPs
(fermentable oligo-, di- and
monosaccharides, and polyols).
➢ gut microflora change
➢ gut dysbiosis probiotics
➢ Small intestinal bacterial overgrowth
(SIBO) rifaximin.
IRRITABLE BOWEL
SYNDROME
Clinical features
• Colicky abdominal pain
• Altered bowel habit
• Abdominal distension and bloating
• Rectal mucus
• Feeling of incomplete defecation
IRRITABLE BOWEL
SYNDROME
Abdominal Pain
• Abdominal pain episodic and crampy
• Mostly lower /st left upper
• The pian is mild it may interfere with
daily activities.
• Pain is often exacerbated by eating or
emotional stress and improved by passage
of flatus or stools
• Night pain is also unusual
IRRITABLE BOWEL
SYNDROME
• Altered Bowel Habits
• The most common pattern is constipation
alternating with diarrhea, usually with one
of these symptoms predominating.
• Stools are usually hard with narrowed
caliber
• Diarrhea resulting from IBS usually
consists of frequent small volumes of
loose stools
• Nocturnal diarrhea does not occur
• Diarrhea may be aggravated by emotional
stress or eating.
• Stool may be accompanied by passage of
large amounts of mucus
IRRITABLE BOWEL
SYNDROME
• Gas and Flatulence
abdominal distention
increased belching
flatulence,
IRRITABLE BOWEL
SYNDROME
The diagnosis
is clinical no need for investigations unless
secondary disease suspected (IBS with
alarm features)
Features supporting a diagnosis of IBS
• Symptoms > 6 months without progressive
deterioration,
• absence of other systemic symptoms such
as anemia and weight loss
• without any evidence of blood.
• Frequent consultations for non-GI
problems
• Previous medically unexplained symptoms
• Stress worsens symptoms
•
IRRITABLE BOWEL
SYNDROME
Diagnostic Criteria (Rome IV)
Recurrent abdominal pain or discomfort at

least 1 days per wee in the last 3 months
associated with two or more of the
following:
1. pain related to defecation

2. Onset associated with a change in
frequency of stool
3. Onset associated with a change in form
(appearance) of stool
IRRITABLE BOWEL
SYNDROME
Diagnosis
Is clinical for typical symptom
With alarm features
▪ Full blood count
▪ GSE
▪ lower GI endoscopy
(sigmoidoscopy, Colonoscopy)
alarm features.
Diarrhoea-predominant
IRRITABLE BOWEL
SYNDROME
Alarm features
• Age > 50 years; male gender
• Weight loss
• Nocturnal symptoms
• Family history of colon cancer
• Anaemia
• Rectal bleeding
IRRITABLE BOWEL SYNDROME
Management
• Reassure the patient
• advice on regular meals intake, adequate fluid
intake, decreasing fat intake avoid legume with
increase fibers lactose free
• Low FODMAP low lactose fructose sorbitol
• wheat-free diet
• Treatment of the predominant symptoms
Stool-Bulking Agents
High-fiber diets and bulking agents, such as bran
Antispasmodics for pain dominent IBS mebeverin
Antidepressant Drugs
mood-elevating effects, antidepressent
whole-gut transit, indicative of a motor inhibitory
effect. Tricyclic agents may also alter visceral afferent
neural function
Serotinin receptor antagonists

• 5HT3 receptor antagonist such as alosetron
• uesd for diarrhea predominent
• reduces perception of painful visceral stimulation
in IBS.
• It also induces rectal relaxation, increases rectal
compliance
• And delays colonic transit
• Nonabsorbable antibiotics, such as rifaximin
• Guanylate cyclase-C receptor agonist Linaclotide
• chloride channel activators, lubiprostone
• Probiotics,
The selective serotonin reuptake inhibitor (SSRI)
paroxetine accelerates orocecal transit, raising the
possibility that this drug class may be useful in
constipation-predominant patients.
Antiflatulence Therapy
• seldom satisfactory, except in obvious aerophagia
or disaccharidase deficiency.
• Patients should be advised to eat slowly; avoid
chewing gum or drinking carbonated beverages;
and avoid consuming artificial sweeteners,
legumes, and foods of the cabbage family.
• Simethicone, antacids, and activated charcoal have
all been tried, usually with disappointing results.
IRRITABLE BOWEL
SYNDROME
IRRITABLE BOWEL
SYNDROME
Prognosis
• Most patients have a relapsing and
remitting course. Exacerbations often
follow stressful life events, occupational
dissatisfaction and difficulties with
interpersonal relationships

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Functional Bowel

• Functional gastrointestinal disorders

Upper gastrointestinal disorders

• Irritable bowel syndrome (IBS) is a

• Approximately 20% of the general

Recurrent abdominal pain or discomfort at

1. pain related to defecation

Serotinin receptor antagonists

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