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IBS Dilemma

IBS History
Cumming in 1849 was the first to describe IBS as a dilemma in the London Medical Gazette. He wrote in his own words “the bowels are at one time constipated, at another lax, in the same person. How the disease has two such symptoms, I do not confess to explain ”

Cumming dilemma in the 18th century is still unsolved in the 21st century as we are still not sure of the pathogenesis of IBS and we are even not sure whether IBS is one or more disease

IBS is a challenging diagnosis
IBS symptoms are non-specific.
IBS signs are minimal and unrewarding .
IBS has no diagnostic tests.
IBS has a wide differential diagnosis including some serious diseases as colorectal cancer.

IBS is a safe disease
IBS is a functional disease with no mortality and no organic complications.
IBS symptoms are mostly tolerated and coped with.
IBS does not cause malabsorption or undernutrition and does not affect the general condition.
IBS exacerbations do respond rapidly to medications and even to placebos.

IBS is an important disease
IBS has a negative impact on the quality of life.
IBS has a negative impact on the national economy.
IBS is frequently mistaken with serious diseases of the colon including CRC.
IBS patients are frequently exposed to unnecessary surgery

IBS & Gynecology
In fact 79% of women diagnosed by gynecologists as having “chronic pelvic pain: were suffering from IBS. Walker (1990)

About 50% of hysterectomies or ovarian surgeries were not really indicated. Owens (1995)

About 50% of IBS women have undergone hysterectomy or ovarian surgery and a timely GI consultation should have reduced this rate. Burns (1986). Gambone (1990)

IBS is a commonly associated with other disorders
IBS and other functional GI disorders
especially dyspepsia (overlap syndromes).
2. IBS and psychiatric disorders especially anxiety
and depression.
3. IBS and diverticulosis coli.
4. IBS and IBD

IBS Diagnostic Criteria*

Recurrent abdominal pain or discomfort**
at least 3 days per month in the last 3 months associated with 2 or more of the following:
1. Improvement with defecation
2. Onset associated with a change in frequency of stool
3. Onset associated with a change in form (appearance)of stool

*Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis.
**Discomfort means an uncomfortable sensation not described as pain. In pathophysiology research and clinical trials, a pain/discomfort frequency of at least 2 days a week during screening evaluation for subject eligibility.

Concept of symptom criteria
Abdominal Pain



Chronic or intermittent abdominal pain


Chronic or intermittent abdominal pain relieved by defecation

 


Chronic or intermittent abdominal pain relieved by defecation and associated at its onset with change in the stool frequency or appearance

 

Rome Criteria Comparison

Rome I Rome II Rome III
At least 3 months of continuous
    or recurrent symptoms of
    abdominal pain or discomfort
    that is relieved by defecation
    and/or associated with a change
    in frequency of stool; and/or
    associated with a change in
    consistency of stool

Two or more of the following
    at least 25% of the time
  • altered stool frequency
  • altered stool form
  • altered stool passage (straining, urgency, feeling of incomplete evacuation)
  • passage of mucus; and/or
    bloating or feeling of abdominal distention
At least 12 weeks, which need not be
    consecutive, in the past 12 months, of
    abdominal discomfort or pain that has two of
    three features relieved by defecation; and/or
    onset associated with a change in frequency of
    stool; and/or onset associated with a change
    in form (appearance) of stool


The following symptoms are not essential
    but the more of them that are present,
    the more confident is the diagnosis:
  • abnormal stool frequency
  • abnormal stool form
  • abnormal stool passage
  • passage of mucus
    bloating or feeling of abdominal distention
At least 6 months, Symptoms of
    recurrent abdominal pain or
    discomfort and a marked change
    in bowel habit, with symptoms
    experienced on at least three
    days of at least three months.

 

Two or more of the following
    must apply:

  • Pain is relieved by a bowel movement
  • Onset of pain is related to a change in frequency of stool
  • Onset of pain is related to a change in the appearance of stool.
Source: Functional Bowel Disorders (2006). Longstreth, G.F., et.al. Gastroenterologyy 130:1480-1491.

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