Irritable bowel syndrome - Chronic
Definition
A common functional, chronic, and episodic gastrointestinal disorder which primarily affects motility of the gut , and is characterized by abdominal pain, discomfort, and defecation disturbances.
Medical History
* Bacterial gastroenteritis
* Drug therapy finding
* Family history of Irritable bowel syndrome
* Food intolerance
* Psychological finding
* Victim of abuse
* Stress
Findings
* Abdominal distension
* Abdominal pain
* Altered appetite
* Altered bowel function
* Finding related to ability to defecate
* Flatulence
* Heartburn
* Indigestion - Chronic
* Lethargy
* Mucus in stool
* Psychological finding
Tests
Suspected irritable bowel syndrome (IBS)
* Complete blood count: CBC in irritable bowel syndrome is normal .
Differential Diagnosis
* Colon cancer
* Gastrointestinal obstruction
* Inflammatory bowel disease - Chronic
* Rectal prolapse
* Celiac disease - Chronic
* Intestinal infectious disease
* Finding relating to psychosocial functioning
* Lactose intolerance - Chronic
* Hypothyroidism - Chronic
* Hyperthyroidism - Chronic
* Intestinal malabsorption of fat
Treatment
Drug Therapy
Irritable bowel syndrome with abdominal pain
AMITRIPTYLINE HYDROCHLORIDE
Adults: Initial dose 10 to 25 mg orally at bedtime; titrate to maintenance dose 10 to 100 mg orally at bedtime
DESIPRAMINE HYDROCHLORIDE
Adults: Initial dose 10 to 50 mg orally at bedtime; titrate to maintenance dose 10 to 150 mg at bedtime
IMIPRAMINE HYDROCHLORIDE
HYOSCYAMINE
Adults: 0.125 to 0.25 mg orally every 4 hours (maximum, 1.5 mg per day)
DICYCLOMINE HYDROCHLORIDE
Adults: Initial dose 20 mg orally four times daily; maintenance dose 20 to 40 mg orally four times daily; discontinue if ineffective after 2 weeks
Irritable bowel syndrome with chronic diarrhea
LOPERAMIDE HYDROCHLORIDE
Adults: Initial dose 4 mg orally; then maintenance dose 4 to 8 mg orally per day
Pediatrics: dose not established, but 0.08 to 0.24 mg/kg per day in 2 to 3 divided doses has been used
Irritable bowel syndrome with constipation
POLYETHYLENE GLYCOL 3350
Adults: 17 g (about one heaping tablespoon) orally per day dissolved in 4 to 8 ounces of water, juice, soda, coffee, or tea
BISACODYL
Adults: 5 to 15 mg orally once daily (maximum, 30 mg/day) OR 10 mg suppository rectally once daily; use for more than 7 days is not recommended
Pediatrics (6 to 11 yrs): 5 mg orally once daily OR 5 mg suppository rectally once daily; use for more than 7 days is not recommended
PSYLLIUM HYDROPHILIC MUCILLOID
METHYLCELLULOSE
CALCIUM POLYCARBOPHIL
Irritable bowel syndrome with psychosocial disturbance
PAROXETINE HYDROCHLORIDE
FLUOXETINE HYDROCHLORIDE
Procedural Therapy
Suspected and known irritable bowel syndrome with psychological symptoms
* Cognitive - behavior therapy: Cognitive behavioral therapy may improve some individual symptoms associated with irritable bowel syndrome (IBS) .
Non-Procedural Therapy
Irritable bowel syndrome
* Symptom Diary
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