Irritable Bowel Disease (IBD)

Irritable Bowel Disease (IBD)
A chronic functional bowel disorder of unknown etiology that is characterized
by abdominal pain or discomfort and alterations in stool frequency and form.
There is also a lack of structural GI abnormality and underlying medical disease.
The disorder is more common in women and the average age of onset is
20 years. Onset can follow a bout of gastroenteritis.
SYMPTOMS
■ Chronic or intermittent diffuse colicky or crampy abdominal pain
■ Abdominal distention and bloating
■ Temporary relief with passage of flatus or bowel movement
■ Association with emotional upset or stress
EXAM
Abdominal exam is generally benign but may reveal a cordlike mass in the LLQ.

DIFFERENTIAL
Crohn disease, ulcerative colitis, infectious enterocolitis, colorectal cancer,
celiac sprue, endometriosis
DIAGNOSIS
■ Exclude organic causes
■ Labs: CBC, LFTs, albumin, ESR, celiac sprue serologies
■ Stool: O&P, C. difficile toxin
■ Consider referral for endoscopy and colonoscopy if symptoms are severe.
TREATMENT
■ Provide reassurance.
■ Tactfully explain visceral hypersensitivity and validate symptoms.
■ Dietary trials: Lactose-free, high-fiber diet
■ Antispasmodics: Dicyclomine, hyoscyamine, peppermint oil
■ Antidepressants: Desipramine, amitriptyline, fluoxetine, paroxetine
■ Constipation-predominant type:
■ ↑ Fluid intake.
■ Provide bowel habit training.
■ Tegaserod 6 mg BID
■ Osmotic laxatives
■ Diarrhea-predominant type: Loperamide, cholestyramine