{"id":635,"date":"2020-02-17T20:31:27","date_gmt":"2020-02-17T15:01:27","guid":{"rendered":"https:\/\/medicineplexus.com\/?p=635"},"modified":"2020-02-17T20:31:27","modified_gmt":"2020-02-17T15:01:27","slug":"irritable-bowel-syndrome","status":"publish","type":"post","link":"https:\/\/medicineplexus.com\/irritable-bowel-syndrome\/","title":{"rendered":"Irritable Bowel Syndrome"},"content":{"rendered":"\n<p><strong>Irritable Bowel Syndrome<\/strong><\/p>\n\n\n\n<p>According <strong>Rome IV criteria,<\/strong> Irritable bowel syndrome (IBS) <strong>Recurrent abdominal pain, averaging \u2265 1 day\/week, in last 3 months, with \u2265 2 <\/strong>of the <strong>following criteria:<\/strong><\/p>\n\n\n\n<ul><li>Related to defecation<ul><li>Associated with a <strong>change in frequency<\/strong> of stool<\/li><\/ul><ul><li>Associated with change in form <strong>(appearance)<\/strong> of stool.<\/li><\/ul><\/li><\/ul>\n\n\n\n<p><strong>Pathophysiology<\/strong><\/p>\n\n\n\n<ul><li>Innate\/Acquired host-related factors<\/li><li>Psychiatric illness<\/li><li>Life stressors<\/li><li>Intestinal permeability.<\/li><li>Bile Acid malabsorption<\/li><li>Immune function.<\/li><\/ul>\n\n\n\n<p>Altered colonic &amp; small bowel motility \u00e0 High-amplitude propagated contractions <strong>(HAPCs)<\/strong> \u00e0 Enhanced gastro-colic response \u00e0 <strong>Rectal hypersensitivity<\/strong> \u00e0 <strong>Diarrhea<\/strong><\/p>\n\n\n\n<p>Increased segmental (non-propulsive) contractions \u00e0Decreased HAPCs \u00e8Reduced rectal sensation \u00e0 Rectal hyposensitivity \u00e0 <strong>Constipation<\/strong><\/p>\n\n\n\n<p><strong>Clinical Features<\/strong><\/p>\n\n\n\n<ul><li>Bloating, Pain, Abdominal distention<\/li><li>Abnormal stool form (hard &amp;\/or loose)<\/li><li>Abnormal stool frequency<\/li><li>Straining at defecation<\/li><li>Urgency<\/li><li>Feeling of incomplete evacuation<\/li><li>Passage of mucus per rectum<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"473\" height=\"327\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-215.png?w=473\" alt=\"\" class=\"wp-image-644\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-215.png 473w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-215-300x207.png 300w\" sizes=\"(max-width: 473px) 100vw, 473px\" \/><\/figure>\n\n\n\n<p><strong>Types Of IBS<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"475\" height=\"267\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-216.png?w=475\" alt=\"\" class=\"wp-image-645\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-216.png 475w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-216-300x169.png 300w\" sizes=\"(max-width: 475px) 100vw, 475px\" \/><\/figure>\n\n\n\n<p><strong>Pharmacotherapy<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"624\" height=\"370\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-217.png?w=624\" alt=\"\" class=\"wp-image-646\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-217.png 624w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-217-300x178.png 300w\" sizes=\"(max-width: 624px) 100vw, 624px\" \/><\/figure>\n\n\n\n<p><strong>Antispasmodics<\/strong><\/p>\n\n\n\n<ul><li><strong>Hyoscyamine, Dicyclomine &#8211; <\/strong>Block muscarinic acetylcholine receptors, causing smooth muscle relaxation<\/li><li><strong>Peppermint oil capsules, enteric coated &#8211; Calcium-channel blocking activity, leading to smooth muscle relaxation NNT = 3<\/strong><\/li><li><strong>Phloroglucinol<\/strong><\/li><li><strong>Mebeverine &#8211; <\/strong>Sodium-channel blocking activity,<\/li><li><strong>Trimebutine &#8211; <\/strong>Peripheral \u03bc-, \u03ba-, and \u03b4-opioid receptor agonist<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"475\" height=\"322\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-218.png?w=475\" alt=\"\" class=\"wp-image-647\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-218.png 475w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-218-300x203.png 300w\" sizes=\"(max-width: 475px) 100vw, 475px\" \/><\/figure>\n\n\n\n<p><strong>Lifestyle Changes &amp; Dietary Alterations<\/strong><\/p>\n\n\n\n<ul><li><strong>Diary card symptom tracking help identify exacerbating &amp; alleviating factors<\/strong> &amp; increase sense of control<\/li><li><strong>Moderate exercise<\/strong> for 20 &#8211; 60 min x 3 to 5 days\/week improves IBS symptoms<\/li><li><strong>Low-fat diet<\/strong><\/li><li>Diet low in fermentable oligosaccharides, disaccharides, monosaccharides, &amp; polyols <strong>(FODMAPs) &#8211; IBS-D<\/strong><\/li><\/ul>\n\n\n\n<p><strong>Nonpharmacologic Psychological Therapies<\/strong><\/p>\n\n\n\n<ul><li>Cognitive Behavioral Therapy (CBT)<\/li><li>Hypnotherapy<\/li><li>Multicomponent Psychological Therapy<\/li><li>Dynamic Psychotherapy<\/li><li>Significantly more effective than usual management, supportive therapy, or placebo in patients with IBS,<\/li><li>With an overall &#8211; NNT = 4<\/li><\/ul>\n\n\n\n<p><strong>IBS-D <\/strong><strong>\u00e0 ARRE (Alosetron, Ramo, Rifaximin, Eluxadoline)<\/strong><\/p>\n\n\n\n<p><strong>Alosetron<\/strong><\/p>\n\n\n\n<ul><li><strong>Selective 5-HT3 antagonist <\/strong>that reduces abdominal pain &amp; bowel movement (BM) frequency &amp; urgency<\/li><li>Indicated only in<strong> WOMENS with more severe IBS-D <\/strong>who have inadequate response to conventional therapy<\/li><li><strong>Starting dose &#8211; <\/strong>0.5 mg BD &amp; increased up to 1mg BD<\/li><li>A\/E- Constipation, abdominal discomfort<\/li><li><strong>Blackbox Warning: <\/strong>Discontinue in patients who develops <strong>Constipation &amp; Ischemic Colitis.<\/strong><\/li><li>Initial U.S. Approval: 2000 then in&nbsp; 2008 &#8211; LOTRONEX should be discontinued in patients who have not had adequate control of IBS symptoms after 4 weeks of treatment with 1 mg twice a day<strong>. Available under a specific risk management program<\/strong><\/li><\/ul>\n\n\n\n<p><strong>Ramosetron<\/strong><\/p>\n\n\n\n<ul><li>5-HT3 antagonist<\/li><li><strong>In Japan<\/strong> Ramosetron used in treatment of <strong>IBS-D in both men &amp; women<\/strong><\/li><li><strong>Response rates respectively of 47% to 51%,<\/strong> compared with 27% to 32% with placebo (p &lt; 0.001)<\/li><li>A\/E- Constipation, abdominal discomfort<\/li><\/ul>\n\n\n\n<p><strong>Eluxadoline &#8212; 2015<\/strong><\/p>\n\n\n\n<ul><li><strong>Mixed <\/strong><strong>\u03bc-opioid &amp; \u03ba-opioid receptor agonist<\/strong>, &amp; <strong>\u03b4-opioid antagonist<\/strong> that is locally active in GI tract<\/li><li>75 or 100 mg BID. indicated in adults for IBS-D<\/li><li>AEs &#8211; Constipation, Nausea, &amp; Abdominal pain: ~7\u20139% of patients<\/li><li>Lower dose of 75 mg BID in patients who are post cholecystectomy<\/li><li>C\/I- Patients with history of alcohol abuse or addiction<\/li><li><strong>FDA warns increased risk of serious pancreatitis with drug eluxadoline in patients without gallbladder<\/strong><\/li><\/ul>\n\n\n\n<p><strong>Rifaximin &#8212; 2015<\/strong><\/p>\n\n\n\n<ul><li>Semi-synthetic derivative of rifampin &amp; acts by binding to bacterial DNA-dependent RNA polymerase blocking &amp; steps in transcription<\/li><li>Non-systemic antibiotic &#8211; 550 mg&nbsp; TDS<\/li><li>NNT = 10.6 &amp; NNH = 8971<\/li><li>A\/E- Nausea (3%) &amp; Increased ALT (2%).<\/li><li>No reports <em>C. difficile <\/em>or drug-resistant bacteria<\/li><\/ul>\n\n\n\n<p><strong>IBS- C (SPELL PTT)<\/strong><\/p>\n\n\n\n<p><strong>Lubiprostone &#8212; 2006<\/strong><\/p>\n\n\n\n<ul><li><strong>Chloride channel activator &#8211;<\/strong> <strong>intestinal fluid secretion, Increases motility<\/strong>, thereby facilitating passage of stool &amp; alleviating symptoms associated with constipation<\/li><li>Indication: 8-mcg capsule for <strong>IBS-C in women \u2265 18yr<\/strong><\/li><li>A\/E- Nausea &amp; Diarrhea<\/li><\/ul>\n\n\n\n<p><strong>Linaclotide<\/strong><\/p>\n\n\n\n<ul><li>FDA approved in <strong>2012 for IBS-C<\/strong><\/li><li><strong>Guanylate cyclase-C (GC-C) agonist, Increase in cGMP,<\/strong> Secretion of Cl &amp; HCO3 into gut, through activation of (CFTR) ion channel, resulting in increased intestinal fluid &amp; accelerated transit.<\/li><li>Indication: 290 mcg (5 mcg\/kg\/d) OD in <strong>both men &amp; women<\/strong><\/li><li>A\/E: Diarrhea (2%), Abdominal Pain.<\/li><li><strong>Black box warning <\/strong><strong>&#8211;<\/strong> Risk of <strong>serious dehydration in pediatric patient, C\/I in &lt;6yr age, Avoid use in 6yr to less than 18yr.<\/strong><\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"463\" height=\"223\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-219.png?w=463\" alt=\"\" class=\"wp-image-648\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-219.png 463w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-219-300x144.png 300w\" sizes=\"(max-width: 463px) 100vw, 463px\" \/><\/figure>\n\n\n\n<p><strong>Plecanatide<\/strong><\/p>\n\n\n\n<ul><li>U.S. FDA Approval: <strong>2018<\/strong><\/li><li><strong>Guanylate cyclase-C (GC-C) agonist,<\/strong> increase in cGMP, Secretion of Cl &amp; HCO3 into intestinal lumen, through activation of (CFTR) ion channel, resulting in increased intestinal fluid &amp; accelerated transit.<\/li><li>3mg(0.05 mg\/kg\/d) OD indicated in adults IBS-C<\/li><li>M\/C adverse reaction is <strong>diarrhea &gt;2%.<\/strong><\/li><li><strong>Black box warning<\/strong> &#8211; Risk <strong>of serious dehydration in pediatric patient, C\/I in &lt;6yr age. Avoid use in 6 to &lt; 18yr.<\/strong><\/li><\/ul>\n\n\n\n<p><strong>Te<em>Na<\/em>panor<\/strong><\/p>\n\n\n\n<ul><li>Ardelyx will file NDA with 2 successful phase 3 trials<\/li><li><strong>NHE3 inhibitor-to reduce absorption of <em>Na+,<\/em> leading to increased Na+ within gut causing retention of fluid in gut, loosening stool,<\/strong><\/li><li>Primary endpoint- Combined responder rate for 6 of 12 weeks, tenapanor vs. placebo.<ul><li>at least 30 percent reduction in abdominal pain,<\/li><\/ul><ul><li>&nbsp;increase of one or more complete spontaneous bowel movements (CSBM) in same week.<\/li><\/ul><\/li><\/ul>\n\n\n\n<p><strong>Elobixibat<\/strong><\/p>\n\n\n\n<ul><li><strong>Inhibitor of ileal bile acid transporter (IBAT),<\/strong> is safe &amp; effective for treating chronic constipation<\/li><li>Blocking enterohepatic circulation&nbsp;of&nbsp;bile acids, <strong>increasing bile acid concentration in gut, which accelerates intestinal passage &amp; softens stool.<\/strong><\/li><li>(5mg) BD \u2013 Indicated for Chronic Constipation in <strong>Japan.<\/strong><\/li><li>Once\u2010daily administration safe &amp; tolerated up to 20 mg in female &amp; male patients with CC<\/li><\/ul>\n\n\n\n<p><strong>Serum-derived Bovine Immunoglobulin<\/strong><\/p>\n\n\n\n<ul><li>Helps <strong>to maintain immune balance &amp; gut barrier function.<\/strong><\/li><li>Placebo-controlled pilot study showed significant <strong>decrease in abdominal pain, flatulence, bloating, urgency, loose stools, &amp; total days with IBS <\/strong><strong>symptoms<\/strong>.<\/li><li>SBI exhibited similar safety profile to placebo.<\/li><li>One patient survey suggest that SBI use<ul><li>Clinically relevant decreases in daily stool frequency<\/li><li>Improvements in overall management of their condition &amp; aspects of QoL.<\/li><\/ul><\/li><\/ul>\n\n\n\n<p><strong>EC-Peppermint Oil<\/strong><\/p>\n\n\n\n<ul><li>Reduce GI smooth muscle motility by <strong>acting as calcium antagonist<\/strong><\/li><li>Triple-coated microsphere formulation to facilitate SR in small intestine, &amp; to reduce AEs associated such as heartburn, abdominal pain, or anal burning<\/li><li>Dose = 0.6 mL TDS<\/li><li>4-week, placebo controlled trial significant improvement in abdominal pain\/discomfort, bloating, urgency, &amp; pain at evacuation in IBS-D &amp; IBS-M<\/li><\/ul>\n\n\n\n<p><strong>Tong-Xie-Yao-Fang Granules<\/strong><\/p>\n\n\n\n<ul><li>TXYF granules consist 4 herbal products: <em>&#8211; <\/em><strong>Decreases elevated colon smooth muscle tension &amp; spontaneous activity &amp; also downregulate 5-HT &amp; SP.<\/strong><\/li><li><strong>Significantly higher rate of relief of global symptoms in<\/strong> TXFY group during weeks 1 to 4<\/li><li>M-TXYF was significantly superior to routine pharmacotherapies (RP) in clinical therapeutic efficacy (NNT) = 5.7)<\/li><li>Significantly reduce scores of abdominal pain abdominal distention, diarrhea, &amp; frequency of defecation.<\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Irritable Bowel Syndrome According Rome IV criteria, Irritable bowel syndrome (IBS) Recurrent abdominal pain, averaging \u2265 1 day\/week, in last 3 months, with \u2265 2 of the following criteria: Related to defecation Associated with a change in frequency of stool Associated with change in form (appearance) of stool. Pathophysiology Innate\/Acquired host-related factors Psychiatric illness Life[&#8230;]\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_seopress_robots_primary_cat":"","_seopress_titles_title":"","_seopress_titles_desc":"","_seopress_robots_index":"","footnotes":""},"categories":[3],"tags":[],"_links":{"self":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts\/635"}],"collection":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/comments?post=635"}],"version-history":[{"count":0,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts\/635\/revisions"}],"wp:attachment":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/media?parent=635"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/categories?post=635"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/tags?post=635"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}