Irritable Bowel SyndromeWorking with you as a

partner in health care, your gastroenterologist

at GI Associates will determine the best diagnostic and treatment measures for your unique needs.

©2010 GI Associates & Endoscopy Center. All rights reserved.

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Jackson, MS 39202601/355-1234

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Madison, MS 39110601/355-1234

Albert F. Chiemprabha, M.D.Pierce D. Dotherow, M.D.

Reed B. Hogan, M.D.James H. Johnston, III, M.D.

Ronald P. Kotfila, M.D.Billy W. Long, M.D.Paul B. Milner, M.D.

Michelle A. Petro, M.D.Vonda Reeves-Darby, M.D.

Matt Runnels, M.D.James Q. Sones, II, M.D.

April Ulmer, M.D., Pediatric GIJames A. Underwood, Jr., M.D.

Chad Wigington, D.O.Mark E. Wilson, M.D.

Cindy Haden Wright, M.D.Keith Brown, M.D., Pathologist

Samuel Hensley, M.D., Pathologist

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The information contained in this brochure is intended as an educational tool, not as a substitute for medical care when needed.

Table of Contents

1 IrritableBowlSyndrome

2 Causes

3 Symptoms

5 Treatment

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Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome(IBS)isjustwhatthenameimplies—abowelthatisirritable!Whatdoestheboweldowhenirritated?Itbehavesinadisorderlymannerandmaycauseyouconsiderabledistress! IBSisoneofthemostcommongastrointestinalproblemsseenbygastroenterologists,affectingabout20%oftheadultpopulation.Itaffectsmorewomenthanmen,isusuallyfirstnoticedinyoungadult-hood,andseldombeginsafterage50. IBSisasyndrome,apatternofgastrointestinalsymptomsthataffectsthedigestivetract.WhenapersonhasIBS,theintestinalsystemsimplydoesnotworkinanormal,orderlyfashion.OthernamesforIBSthatyoumayhaveheardarenervous stomach,irritable bowel,unstable colon,spastic colon,spastic bowel, colonic spasm,nervous gut,mucous colitis,spastic colitisorsimply colitis. IBSisnotrelatedtothemoreseriousinflammatory bowel disease (IBD), eventhoughthenamesseemsimilar.AndIBSdoesnotleadtoinflammatory bowel diseaseorulcerative colitis,asfarasweknow.

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Appendix

Rectum

Stomach

Small Intestine

Large Intestine

Flare-upsofIBSarequitecommonandmayberelatedtomanydifferentthings,asmentionedearlier.Althoughitisthoughtthatasmanyas75%ofthosewithIBSdonotseekmedicaladvice,soundmedicalcareisimportanttothosewhoselivesaredisruptedbysymptoms! And,becausethesymptomsofIBScanbethesameassymptomsofmoreseriousillnesses,symptomsthatpersistshouldbecarefullydiagnosedtoruleoutlife-threateningproblems. Workingwithyourgastroenterologist,aplanuniquelydesignedforyoucanbedevelopedsothatyoucanlivewithoutmuchdisruptionfromIBS.

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Will I always have IBS?

• Usuallyitisnotnecessarytoeliminatefoodsfromyourdiet,unlessyouknowthattheycausesymptoms.Forinstance,manypeoplehaveanintoleranceforlactosefoundinmilkandotherdairyproducts.Ifyouknowthatyouaresensitivetoaparticularfoodorfoodgroup,avoidit.

• Avoidchewinggumandcarbonatedbeverages,sincetheyarelikelytoincreasegas.

• Avoidcaffeine,andnicotine(inanyformoftobacco),whichactasstimulantstobowelmuscle.

• Somepeoplemayfindithelpfultoavoidbeer,wine,liquorandotheralcoholicbeverages.Suchbeveragesmayactasirritantsandmayworsensymptoms.

Lifestyle Change

• Exercise,relaxationtechniques,andadditionalsleep/restareafewlifestylechangesthatmayhelpthosewithIBS.Somepeoplebenefitbysimplifyingtheirlivesandreducingstress.Rethinkingprioritiesandmakingneededchangeswillhelpcontrolsymptoms.Oftenfriendsandfamilycanhelp,andinextremecases,psychotherapymayalsobeusefultodealwithmoredifficultissues.Yourgastroenterologistcanreferyoutoaqualifiedmentalhealthprofessional.

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What causes it? Noonefullyunderstandswhatcausesirritablebowelsyndrome.Inthepast,sincenotruecauseofIBShadbeenfound,IBSwasthoughttobecausedbystressof“nerves”,andattimes,justnottakenveryseriously.But,extensivestudyoftheproblemhasfoundthatthosepersonswithIBShavecolontissuethatisnormallymoresensitive,thatrespondsmorestronglytostimuli.

OftenIBSsymptomsarenotrelatedtostressatall.But,weknowthatthesymptomsofIBSmaybeworsenedbystressinsomeindividuals.Everyonehasadifferenttolerancelevelforstress.

What is normal or orderly bowel function? Normally,theamountoftimeneededforfoodtopassthroughtheentireGItractisaboutthreedays.Thatperiodoftimeisknownastransit time,whichvariesalotfrompersontoperson.

Thedigestiveprocessitselfisacombinationofmechanicalandchemicalprocessingthatoccursallalongthedigestivetract.TheactualmovementoffoodthroughtheGItractishelpedbycontinuouswavesofmuscularcontractionsknownasperistalsis. Foodentersthedigestivesystemthroughthemouth,whereitischewedandmixedwithsaliva.Itthenenterstheesophagus,whichisthetube

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The digestive

process itself is

a combination

of mechanical

and chemical

processing that

occurs all

along the

digestive tract.

STRESSSTRESSThe Role Of

leadingfromthemouthtothestomach.Whileinthestomach,thefoodisfurtherprocessed,bothmechanically(byachurningmotion)andchemically(bydigestivejuicesthatarepresentinthestomach). Thecontentsofthestomachthenemptyintothesmall intestineswherenutrientsareabsorbedthroughtheintestinalwallintothebloodstream.Theremainingmaterialpassesintothecolon,whereliquidsareabsorbedfromthewastematter,makingitdrierandmoresolid. Asthewastecontinuesonthroughthecolon,liquidscontinuetobeabsorbeduntilwasteispassedfromthebodythroughtherectumandanus.

Is IBS a problem of motility? Motility isatermusedtodescribethenaturalrateatwhichfoodmovesthroughthedigestivesystem(asdescribedintheprecedingsection).Motilityisverycomplex—wearejustnowbeginningtounderstandallthefactorsthataffectmotilityrate.Weknowthathormones,nerves,andelectricalimpulsescontrolcolonmuscle.Theelectricalactivityinthecolonissimilartotheelectricalimpulsesintheheart.Inaddition,motilitycanbeaffectedbythetypeoffoodyoueat,howmuchfoodyoueat,howfastyoueatandstress. Iffoodmovesthroughthesystemtoofast,liquiddoesnothavetimetobeabsorbedinthecolon,sostoolislooseandmoreliquid.Iffoodmovestooslowlythroughthecolon,toomuchliquidisabsorbedandconstipationistheresult.Therateatwhichfoodmovescanalsocausegas,crampingandpain.

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Motility is a term used

to describe the

natural rate at

which food

moves through

the digestive

system.

manytimesitwillhelpcontrolsymptoms.SomeofthemedicationsoftenhelpfulforIBSinclude:

• Anticholinergics:Suchasatropine andbelladonna actbyblockingthenervesthatcausethecontractionswithintheintestines.

• Antispasmotics:SuchasBentylandLevsinalsoblocknerveactivitythatcausesGImusclecontractions/spasms.

• Prokinetics:SuchasReglan helpregulatemuscleactivityinpartsoftheGItract.

• Bulk agents:SuchasCitrucil,Metamucil, and Benefibermaybehelpfultorelieveconstipation.

• Antidiarrheals:SuchasLomotil andImodium, maybeprescribedtocontroldiarrhea.

• AntidepressantsandMood-elevators:SuchasElavil andProzacmaybehelpfulinalimitednumberofpatientswhodon’timprovewiththetreatmentsdescribedabove.RecentstudiessuggestthatthemedicationsPaxilandZoloft helpeveninIBSpatientswhoarenotdepressed.

Diet• Provideregularmealtimes

foryourselfthatallowyoutoenjoyeatingslowlyandtoavoidgulpingfoodandswallowingair.Itishelpfultoavoideatinginthecar,whenyouaredistracted,hurriedandtryingtoavoidtraffic.

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What are the symptoms of IBS? ApersonwithIBSmayhaveoneormanyofthesymptomslistedbelow.Oftentheyoccurinapatternandmayhavebeenpresentforalongtime. Symptomsmaybemildlyuncomfortabletoextremelypainful.Sometimessymptomsdonotinterferewithdailyactivitiesorthesymptomsmaydisruptlifeinamajorway.

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Abdominal pain•Thatmaygetbetter

afterhavingabowelmovementorexpellinggas

•Thatisusuallyexperiencedlowandontheleftsideoftheabdomen,butmaybelocatedinotherareas.

•Maybedullorsharp,steadyorcramp-like.

Diarrhea •Looserand/ormore

frequentbowelmovements

•Withorwithoutpain

Constipation•Withorwithoutpain•Mayalternatewith

diarrhea

Bloating or a swollen-feeling abdomen

•Belchingwhentryingtorelievefeelingsofexcessgas.

•Asensationoffullness, evenafterabowelmovement.

Mucus in bowel movements

•Withanappearancethatisclearandslimy

•Maybepresentinsmallamountsorcoatallofthestool

Heartburn •Regurgitationof

stomachcontentsintotheesophaguscausedbyabdominaltensionanddiscomfort.

Emotional distress •Symptomscanbe

disruptivetolife•Thesamestresses

thatcauseIBSmayalsocauseemotionaldistress

How is IBS diagnosed? BecausethesymptomsofIBSareverymuchlikesymptomsofmoreseriousdiseases,diagnosisinvolvesmanydifferentteststoruleoutlife-threateningproblems.Also,itisveryimportanttodescribeyoursymptomscarefullytoyourgastroenterologist,sothatheorshewillhaveanaccuratedescription. Diagnosiswillbebasedonyourhistory,aphysicalexamination,bloodtests,andstoolsamplestocheckforthepresenceofblood(fecal occult blood).Basedonthoseresults,additionaltestsmaybeordered.Additionally,acolonoscopy maybeorderedsothatyourgastroenterologistcanactuallyviewtheinsideofyourcolon.

What is the treatment for IBS ItwillbereassuringforyoutoknowyouhaveIBSandnotamoreseriousillness.Afteradiagnosishasbeenmade,treatmentisbasedonrelievingyoursymptomssothatyoucanenjoylifetothefullest.Treatmentmayincludemedication,changesindietandmodifyinglifestyletoreducestress(ifthatseemstobeafactor).Workingwithyouasateam,yourgastroenterologistwilldevelopatreatmentplanthatworksforyouandmayincludeoneormoreoftheoptionslistedbelow.

Medication

Yourgastroenterologistmayrecommendmedicationtohelpminimizeyoursymptoms.Itmayberecommendedonlyasneededforflare-upsorforregularuseuntilyougetbetter.AlthoughmedicationcannotcureIBS,

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