27 Dec 2014

Management of irritable bowel syndrome

IBS (Irritable bowel syndrome) is characterized by recurrent abdominal pain and alteration in bowel habits. After the diagnosis is made most important step is reassurance of the patient, because many patient will have a fear of colonic malignancy because of this symptom. In mild cases there is only symptoms at the time of stress, these people need not be treated. Those with severe  symptoms should receive treatment. All the symptoms will not be controlled with medication.

1. Patient counselling - This is done to reasssure the patient./
2. Lifestyle Changes - Since stress is part of normal life, in this modern era try to avoid stress as possible, you should spend time to relax, enjoy the life. Adequate sleep at night and regular exercise are also helpful. Patient should avoid tobacco, excessive use of caffeine and alcohol.
3. Diet  - Certain dietary recommendations are advised in people with IBS. Small frequent meals will help to reduce the symptoms. Food with low fat and high carbohydrate such as rice, cereals, vegetables and food with low fat and high protein (fish, skimmed milk and low fat cheese) may be advised. In patient with loosestools, fruits, fruit juices and dairy products are NOT advised. 
Certain patients have aggravation of symptoms after taking coffee, legumes, cabbage, disaccharide. Such patients should avoid these things. Excessive fructose and artificial sweeteners (sorbitol, mannitol) may produce loose stool, abdominal cramp and flatulence(feeling of fullness in abdomen) . Four week of very low carbohydrate  that is20 grams per day reduce symptoms in many patients.   

Medication used in the treatment of IBS.
1. Stool-Bulking Agents.
High fiber diet ,bulking agents such as hydrophyllic colloid help in relieving symptoms. It will increase the stool weight, decrease in colonic transit time ,improve constipation. It is also useful in diarrhea prone patients.
2. Agents to reduce abdominal pain(Antispasmodics).
These are given to reduce the abdominal pain. Majority experience pain shortly after food intake. So these drugs are given 30 minutes before food intake. Anticholinergic such as dicyclomine is beneficial.
3. Agents that reduce diarrhea(loose stools).
Antidiarrheal agents used to treat are loperamide, opiate, cholestyramine. Agents such as loperamide is useful especially in stressful situation.
4. Antidepressant Drugs.
Effect of anti depressant in IBS is independent of its antidepressant action. Abdominal pain also improves with anti depressants. Tricyclic anti depressants are used. Examples are desipramine, SSRI (Selective serotonin reuptake inhibitor) are also useful. mainly in IBS C patients.
5. Agent that reduce the flatulence
Patients are advised to eat slowly, avoid chewing gum and carbonated drinks. Antibiotics and pancreatic enzyme may be tried.
6. Modulation of Gut Flora.  
Antibiotic is used to treat a subset of people with IBS. The agent used is rifaximin. 
7. Serotonin Receptor Agonist and Antagonists
These agents are also tried in IBS. Chloride Channel Activators Lubiprostone is tried.

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