Irritable Bowel Syndrome

Irritable bowel syndrome 'IBS' is a benign gastrointestinal disorder characterized by chronic abdominal pain and altered bowel habits in the absence of any disorder. Is a chronic condition, with no cure. If the diagnosis is well-established is not likely to change. There are two different types, diarrhea-predominant and constipation-predominant disease.

MANAGEMENT
Dietary modification - A careful dietary history may reveal patterns of symptoms related to dairy and gas-producing foods. Given the similarity of symptoms between IBS and lactose intolerance, an empiric trial of a lactose free diet should be considered. Exclusion of foods that increase flatulence beans, onions, celery, carrots, raisins, bananas, apricots, prunes, brussel sprouts, wheat, pretzels, and bagels should be eliminated. Underlying visceral hyperalgesia in IBS may explain the exaggerated discomfort experienced with consumption of gas-producing foods.

Although the efficacy of fiber supplements has not been proven, some improvement has been demonstrated in patients with IBS whose primary complaints are abdominal pain and constipation. A trial of fiber is reasonable in all patients. Other alternatives are hypnosis, biofeedback, and psychotherapy to help reduce anxiety levels, encourage health promoting behavior.

MEDICATIONS
Pharmacologic agents are only an adjunct to treatment in IBS. The chronic use of drugs should generally be minimized or avoided because of the lifelong nature of this disorder.

• Antispasmodic agents are the most frequently used; the use should be on an as needed basis and/or in anticipation of stressors with known exacerbating effects.
• Antidepressants have analgesic properties independent of their mood improving effects and may therefore be beneficial in patients with neuropathic pain, limited evidence support benefit of tricyclic antidepressants in relieving abdominal pain.
• Antidiarrheal agents - In diarrhea-prone patients with IBS, the stools characteristically are Ioose and frequent but of normal total daily volume
• Motility Modulators, 5-hydroxytryptarnine (serotonin) 4 receptor agonists tegaserod appears to be modestly effective in women with constipation predominant IBS.