A common functional bowel disease characterized by abdominal pain and changes in bowel habits.
Symptoms include abdominal pain, abdominal distension, abdominal discomfort, and changes in bowel habits and fecal characteristics.
The cause of the disease is still unknown, and may be related to a variety of factors such as intestinal dyskinesia and abnormal visceral sensation.
Treatment methods mainly include general treatment, drug treatment, Chinese medicine treatment, etc.
Definition
Irritable bowel syndrome (IBS) is a group of intestinal dysfunctional disorders with persistent or intermittent episodes of abdominal pain, abdominal distension, abdominal discomfort, defecation habits, and changes in fecal characteristics, without structural and biochemical abnormalities of the gastrointestinal tract, and it is the most common type of functional intestinal disease.
It often occurs in conjunction with other gastrointestinal dysfunctions (e.g. functional dyspepsia).
Types
According to the patient’s fecal character, it is divided into diarrhea type, constipation type, mixed type and undetermined type, among which diarrhea type is more common and is the main type of patients with irritable bowel syndrome in China.
Morbidity
The prevalence of irritable bowel syndrome is 10% to 20% in adults in Europe and America, and 5.7% to 7.3% in China.
The disease can occur at any age, but it is more common in young and middle-aged people.
There are more women than men with irritable bowel syndrome, and the male to female ratio is about 1:2.
Causes
Causative factors
The cause of irritable bowel syndrome is not well understood. It may be related to a combination of factors such as abnormal gastrointestinal dynamics, abnormal visceral sensation, abnormal brain-gut regulation, intestinal infections, intestinal flora dysbiosis, psychosomatic abnormalities and genetic factors.
Basic etiology
Disorders of intestinal dynamics
Changes in intestinal dynamics may be the pathophysiologic basis for the development of this disease.
The intestinal manifestation of diarrhea-based irritable bowel syndrome is hyperdynamic, with a significant shortening of intestinal transit time and a significant increase in colonic dynamics; while constipated irritable bowel syndrome is the opposite, manifesting intestinal underdynamics.
Abnormal visceral sensation
Clinical trials have found that most of the disease is characterized by hypersensitivity to the sensation of intestinal lumen dilatation.
This is manifested by a decreased nociceptive threshold, an increased level of discomfort after rectal dilatation or abnormal visceral-somatic radiating pain, and a greater tendency to produce symptoms such as abdominal distension and abdominal pain.
Abnormal brain-gut regulation
Abnormalities in the processing of incoming intestinal signals by the central nervous system and in the regulation of the enteric nervous system are present in this disease. It can be understood as a hypersensitivity to the brain-gut nervous system.
Intestinal infections
Studies have shown that the probability of developing this disease is significantly higher after an acute intestinal infection.
Dysbiosis of intestinal flora
Studies have shown that the disease can manifest itself with a decrease in the number of beneficial bacterial flora and an increase in the number of harmful bacteria in the intestinal tract, especially after the use of antibiotics for intestinal infections. Therefore, intestinal dysbiosis may be associated with irritable bowel syndrome.
Psychosomatic Abnormalities
Irritable bowel syndrome is often accompanied by anxiety, depression, tension and other psychological abnormalities, and psychological stress, such as the death of a loved one, can also trigger or aggravate the disease, so psychosomatic abnormalities may be related to this disease.
Predisposing factors
Food Stimulation
Some foods may trigger or aggravate the disease. It may be related to food intolerance, such as lactose intolerance.
Drug irritation
Certain medications may trigger or aggravate irritable bowel syndrome.
Hormonal changes
Changes in estrogen and progesterone in women after puberty, etc. may also trigger or aggravate the disease.
Surgical irritation
Some abdominal surgeries may trigger or exacerbate Irritable Bowel Syndrome.
Pathogenesis
The pathogenesis of irritable bowel syndrome is also still unknown. It may be associated with the following mechanisms.
Intestinal motility disorders
The passage of food through the mouth-cecum is short in the diarrheal form of irritable bowel syndrome and prolonged in the constipated form, which has reduced high-amplitude peristaltic contractions of the colon. Therefore, it is hypothesized that the pathogenesis of the disease may be related to intestinal motility disorders.
Abnormal visceral sensory function
Visceral hypersensitivity exists in this disease and can spread throughout the GI tract, but is most prominent with increased rectal sensitivity. Therefore, it is hypothesized that hypersensitivity may be associated with irritable bowel syndrome.
Altered intestinal permeability
Some irritable bowel syndromes present with manifestations such as increased intestinal permeability. Therefore, it is hypothesized that factors such as impaired integrity of the intestinal mucosa or altered pressure on both sides of the membrane may also be part of the pathogenesis of the disease.
Symptoms
The onset of irritable bowel syndrome is usually slow and insidious, with intermittent episodes and periods of remission.
The duration of the disease can range from years to decades, and general health is mostly unaffected.
Typical symptoms
Abdominal pain
All patients experience varying degrees of abdominal pain.
The pain is confined to one spot or is felt throughout the abdomen, most commonly in the lower abdomen, left lower abdomen or around the umbilicus.
The nature of the abdominal pain varies, but it is not progressively worse, and very rarely the patient wakes up with pain during sleep.
It can be relieved after defecation and bowel movement.
Diarrhea
Characteristics of diarrhea
Usually 3 to 5 times a day, up to a dozen times in a few severe cases.
Diarrhea does not occur at night (this is very rare in organic disease), usually only in the morning, about 1/3 can be induced by eating.
Changes in fecal character
The feces are often thin and pasty, but may also be soft or watery.
There is mucus, but no pus or blood.
Constipation
Difficulty in defecation, dry stools, and small amount of stools, in the form of sheep’s dung or thin rods, with mucus on the surface.
It is intermittent in the early stage, but may become persistent in the later stage, and may even depend on laxatives for a long time.
Other symptoms
In addition to insomnia, rapid heartbeat, head and back pain, and a bad taste in the mouth, the following symptoms may be present.
Upper gastrointestinal symptoms
Irritable bowel syndrome may be accompanied by symptoms of indigestion or gastroesophageal reflux such as heartburn, acid reflux, belching, and bloating.
Genitourinary symptoms
Urinary tract symptoms such as urinary frequency, urgency, and difficulty urinating.
Painful sexual intercourse and loss of libido.
Psychosomatic symptoms
Irritable Bowel Syndrome (IBS) may also present with varying degrees of psychosomatic abnormalities, such as anxiety, depression and nervousness.
Consultation
Department of Medicine
Gastroenterology
If the following symptoms recur, it is advisable to consult a doctor promptly.
Unexplained abdominal pain, especially when accompanied by weight loss and anemia.
Abdominal bloating, especially worse in the afternoon.
Abnormal frequency of bowel movements (>3 times per day or <3 times per week).
Abnormal defecation process, such as diarrhea, constipation, straining, and feeling of incomplete defecation.
Mucus on the surface of the stool.
Preparation for medical treatment
Preparation for consultation: registration, preparation of documents, FAQs
Tips for the doctor
Before going to the doctor, try to keep a record of the symptoms you have experienced and how long they have lasted.
Prolonged indigestion may require a gastroenteroscopy.
Preparation Checklist
Symptom list
Pay particular attention to the time of onset of symptoms, special symptoms, and so on.
Are there any symptoms such as abdominal pain or discomfort? How long have they lasted?
Are there any changes in bowel movements or stool texture from normal?
Is there any blood in the stool?
Any symptoms of acid reflux, nausea or vomiting?
Have you eaten unclean food or drunk unhygienic water recently?
Have you taken any medication recently? For example, salicylates, glucocorticoids, antibiotics, etc.?
Have you had gastroscopy, colonoscopy, or other related tests?
Medical History Checklist
Any previous intestinal diseases?
Any recent surgical treatment?
Have family members experienced similar symptoms?
Checklist
Test results for the last 6 months to bring to the doctor’s office
History of recurrent abdominal pain and change in bowel habits.
Clinical manifestations
The following symptoms are important in the diagnosis of the disease.
Persistent or spasmodic abdominal pain, which may improve significantly after defecation or evacuation.
Changes in fecal character, such as loose stools or dry, clumpy sheep’s dung-like stools.
More or less frequent bowel movements than before.
Abnormal bowel movements, such as a feeling of incomplete bowel movement (heaviness).
Indigestion symptoms such as bloating.
Sleep disturbances and frequent insomnia.
Laboratory Tests
Stool test
Stool tests provide a direct look at the nature of the stool, and abnormal results can help your doctor diagnose irritable bowel syndrome.
If the appearance of the feces is dry or hard, or if the feces are mushy/watery, etc., this may support the doctor’s diagnosis of irritable bowel syndrome.
There is no need to fast or drink before the stool test, and the specimen should be sent in a special container in a timely manner without mixing with urine or other impurities.
Blood Biochemistry
Blood biochemistry is the measurement of the levels of various ions, sugars, lipids, proteins, enzymes, hormones, and metabolites present in the blood.
Thyroid stimulating hormone and blood calcium concentration tests can help doctors rule out the interference of hyperthyroidism and hypercalcemia-induced bowel movement abnormalities and other related disorders to further confirm the diagnosis of Irritable Bowel Syndrome (IBS).
Fasting and water restriction should be observed before the blood biochemistry test.
Pathogenetic examination (fecal bacterial culture or smear to observe the dominant bacteria)
Pathogenetic testing can help the doctor to identify the cause of abnormal bowel movements, such as whether the diarrhea is caused by parasites or bacterial infections, and to rule out other related diseases.
Specimens for fecal bacterial culture should be in special specimen boxes provided by the hospital laboratory to avoid mixing with other bacteria.
Imaging
The main imaging tests for irritable bowel syndrome are abdominal CT and ultrasound, which can help doctors rule out organic gastrointestinal diseases.
Metal objects, such as belts, need to be removed from the abdomen before the exam. Parental assistance is required for the examination of children.
Colonoscopy
Conditions that require colonoscopy include: recent weight loss; vomiting blood, black stools, or stools with blood or pus; abdominal mass; family history of colorectal cancer or colorectal polyps; and elevated tumor markers, especially carcinoembryonic antigen (CEA).
Colonoscopy is intuitive and clear, and can also be used to biopsy suspicious areas and rule out organic bowel disease, such as ulcerative colitis and colorectal tumors.
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Diagnostic criteria
The diagnosis of irritable bowel syndrome is based on the Rome criteria, i.e., there is no inflammatory response, anatomical, metabolic abnormality, or tumor that can explain the changes, and the diagnosis is made by recurrent episodes of abdominal pain, at least once a week for the last 3 months, accompanied by 2 or more of the following symptoms.
Abdominal pain associated with defecation.
Symptoms are accompanied by a change in the frequency of bowel movements.
Symptoms occur with a change in the character (appearance) of the stool.
The diagnosis of irritable bowel syndrome is based on the characteristic pattern of bowel movements, the timing and character of the pain, and the exclusion of other diseases by various tests.
Differential diagnosis
Colorectal tumors
Similarities: abdominal pain, diarrhea, and constipation are common and should be differentiated in people over 50 years of age.
Differences: Differential diagnosis can be made by endoscopy.
Ulcerative colitis
Similarity: Fever and pain around the umbilicus may occur.
Difference: Ulcerative colitis is usually accompanied by mucus, pus and blood in the stool. In addition, the site of pain is usually the left lower abdomen, except around the umbilicus. Irritable bowel syndrome pus and blood stools are less obvious than ulcerative colitis. It can be identified by endoscopy.
Treatment
Aims of treatment
Eliminate the symptoms and improve the general condition.
Treatment method
General treatment
Avoid sensitive foods and reduce intake of gas-producing foods (dairy products, soy, lentils, etc.) and high-fat foods.
High-fiber foods (e.g., bran) can stimulate colonic motility and have a significant effect on improving constipation.
Patient explanatory work with patients, specifically including psychotherapy and biofeedback therapy.
Studies have shown that carbohydrates may have a certain relationship with this disease, so the ketogenic diet can be used to treat this disease, but the treatment needs to be preceded by a consultation with a doctor or a dietitian, and the specific treatment method will be formulated by the doctor or the dietitian.
Medication
Antispasmodics
Indications: Can be used for a short period of time as prescribed by the doctor in case of abdominal pain.
Effects: It can relieve muscle spasm of the intestines, reduce the sensitivity of the intestines, and help to reduce abdominal pain.
Commonly used drugs: anticholinergics (such as scopolamine, etc.); smooth muscle calcium antagonists (such as mebeverine, etc.); ion channel modulators (such as trimethoprim, etc.).
Regulation of gastrointestinal motility
Effects: It can act on the stomach wall, thus speeding up the peristalsis of the stomach and accelerating the digestion and absorption of food to relieve the symptoms of gastric distension.
Commonly used drugs: Mosapride, pantoprazole, metoclopramide and other drugs.
Pregnant women, lactating women, elderly patients, children need to be used with caution.
Psychotropic drugs
Sedatives, antidepressants and anxiolytics can be used as prescribed by the doctor with some effect.
For example, tricyclic antidepressants help relieve diarrhea, abdominal pain and bloating.
Eliminate gastrointestinal flatulence
Dimethicone has the effect of eliminating gas and defoaming, which is more commonly used clinically.
Intestinal probiotics
Patients with predominantly diarrhea may be accompanied by disorders of intestinal flora, and the application of intestinal probiotics can be helpful.
Lactobacillus, Bifidobacterium, Clostridium casei, yeast, etc. are the main probiotics.
Prognosis
Cure
Although irritable bowel syndrome has a long and recurrent course, the prognosis is generally good and does not affect life expectancy.
Hazards
Irritable bowel syndrome can adversely affect a patient’s emotional state and quality of life.
Psychological disorders such as depression and anxiety
The treatment time for irritable bowel syndrome is relatively long, and most of the efficacy is not very significant, which is likely to cause negative psychological changes and adverse emotions, which are manifested as repeated seeking of medical treatment and suspicion of illness.
Systemic symptoms
People with mental symptoms such as anxiety and depression may have dizziness, headache and sleep disorders.
Various discomforts caused by irritable bowel syndrome and bad moods such as depression and anxiety are mutually reinforcing, forming a vicious circle.
Daily
Daily Management
Dietary management
Avoid long-term consumption of irritating foods.
Avoid overeating and eat regularly.
Avoid drinking strong tea, coffee, etc.
Do not drink alcohol during treatment.
Work and rest management
Work and rest on time, do not stay up late, and ensure sufficient sleep.
Lifestyle management
Keep in a good mood and avoid bad emotions.
Exercise actively.
Quit smoking.
Follow-up
Importance of follow-up examination: Regular follow-up examination helps to find out whether there are complications in time, which is crucial to the treatment effect of the disease.
Timing of follow-up: Follow the doctor’s instructions for regular follow-up; if symptoms such as abdominal pain, bloating, abdominal discomfort, changes in bowel habits and/or stool patterns occur, it is recommended to consult the doctor promptly.
Tests to be done at follow-up: Stool tests may be required.
Prevention
Eat less or no spicy and stimulating foods, such as chili peppers and ginger.
Keep a regular routine and avoid staying up late.
Eat less or no fatty foods, such as animal liver and fatty meat.
Quit smoking and drinking.
Avoid stimulating drinks such as strong tea and strong coffee.
Exercise appropriately, such as jogging, playing ball games, etc., to improve physical fitness and resistance.