IBS In The Elderly

Monica J. Cox ARNP-BC, MSN, MPHGeriatric Nurse Practitioner

G.I. Nurse PractitionerBorland-Groover Clinic

Jacksonville, Florida

OBJECTIVES

Describe Age-Related Changes In The Digestive System

Discuss The Neurophysiology of Irritable Bowel Syndrome

Describe The Current Approaches For Evaluating and Treating Elderly Patients With Irritable Bowel Syndrome

Alarm Symptoms Suggestive of Organic Disease

HISTORY

– Weight loss < 10 lbs

– Nocturnal symptoms

– Initial onset at age > 50 yrs

– Significant travel history

– Arthritis/rashes

FAMILY HISTORY

– Colon cancer

– Inflammatory bowel disease

– Celiac disease

Alarm Symptoms Suggestive of Organic Disease - continued

PHYSICAL FINDINGS– Fever– Oral ulcers– Palpable abdominal mass– Guaiac-positive stool– Other physical bleeding or obstruction

LABORATORY EVALUATION– Increased white blood cell count– Anemia– Abnormal chemistry– Increased thyroid-stimulating hormone– Elevated sedimentation rate or C-reactive protein

Types Of Neurons In The Small Intestinal Enteric Nervous System

Rome Criteria III At least 3 months, with onset at least 6 months previously of recurrent

abdominal pain or discomfort** associated with 2 or more of the following:

Improvement with defecation; and/or

Onset associated with a change in frequency of stool; and/or

Onset associated with a change in form (appearance) of stool

**Discomfort means an uncomfortable sensation not described as pain.

“Functional” Sydromesoften due to “Dysmotility”

Functional bowel disorders:– Non-ulcer dyspepsia– Irritable bowel syndrome

Defined motility disorders:– GI neuromuscular syndromes– Myopathies vs. Neuropathies

Dysfunction of Different GI OrgansProduces Similar Symptoms

Gullett – Chest pain, belching, dysphagia, regurg LES – Chest pain, pyrosis, belching, regurg Stomach – Regurg, fullness, dyspepsia, bloating Small bowel – Fullness, dyspepsia, discomfort,

bloating, change in bowel habits Colon – Fullness, discomfort, variable bowel

habits Thus, it is often necessary to test all organs

Sx’s of Small Bowel DysmotilityMay Indicate Disordered Transit

Too Slow Gas Fullness Bloating Cramps Altered Bowel Habits

Too Rapid Gas Fullness Bloating Cramps Altered Bowel Habits

Diagnostic Evaluation

Predominant Symptom

• Constipation:• Infrequent bowel

movements

• Obstructed defecation

Diagnostic Tests

• Colonoscopy

• Whole-gut transit test

• Anorectal motility plus balloon expulsion

• Defecating proctography

Diagnostic Evaluation

Predominant Symptom

Diarrhea:

Diagnostic Tests

• 24-hour stool volume and fat study

• Stool osmolality, electrolytes, and laxatives

• Transit test: small bowel and colon

• Colonic biopsies

• Breath test

Diagnostic Evaluation

Predominant Symptom

Pain:

Diagnostic Tests

• Plain abdominal x-ray

• Small bowel follow-through examination

• CT/MR imaging

• Pelvic ultrasound

Intestinal Concentration

Therapies for Visceral Pain

Thank You!