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1、IRRITABLEBOWELSYNDROME(IBS)Dr.MohamedShekhaniMBChB-CABM-FRCPIBS:EpidemiologyAcommondisorder,witha7%prevalence.Womenare1.5timesmorelikelytobeaffectedthanmen,mostcommonlybetweenages20-40years.Onsetaftertheageof50yearsisuncommon.IBS:PathophysiologyNotwellunderstood,mayv
2、arydependingonthesubtype&include:AbnormalGITmotilityVisceralafferenthypersensitivityAutonomicinnervationabnormalities.Alteredmucosalimmunesystemactivationmayoccur,particularlyinpatientswithdiarrheawhodevelopsymptomsafteranacutegastroenteritis(postinfectiousIBS).Depre
3、ssion,anxiety,aH/Osexualabuse,phobias,somatizationarecommonlyassociated,butnotpsychosocialfactors.Health-relatedqualityoflife(HRQOL)scoresarelowerinIBSthaninunaffectedpersons,but?Causeoreffect.IBSpatientswhoseekevaluation&treatmentaremorelikelytohavecomorbidpsychiatr
4、icillness&psychologicalstressislikelytoexacerbatesymptoms.IBS:burdenIBSiscostly,withdirect&indirect(includingdecreasedworkproductivity)costsestimatedat$20billion,withIBSpatientsconsuming>50%moreinhealthcareresourcesthanmatchedcontrols.Increasedhealthcareutilizationin
5、IBSpatientsisdirectlyrelatedtosomatizationlevels.IBD:DiagnosisBasedsolelyonclinicalgrounds.Asnobiochemical,radiographic,endoscopicorhistologicmarkerexists,thedignosisdependsonRomecriteria.NowdependsonRome3,butonlyRomeIcriteriahavebeenevaluatedforaccuracy,withasensiti
6、vityof71%&specificityof85%.TheACGtaskforceonIBShasrecommendedasimplerdefinition:Abdpainassociatedwithalteredbowelhabits(changeinstoolformorfrequency)overaperiodofatleast3months.Diagnosis:Rome3Recurrentabdpainordiscomfort(abnsensationnotdescribedaspain)atleast3daysamo
7、nthinpast3months(withonset>6monthsprior)associatedwithtwoormoreofthefollowing:ImprovementwithdefecationOnsetassociatedwithchangeinfrequencyofstoolOnsetassociatedwithchangeinform(appearance)ofstoolAbsenceofalarmindicatorsthatsuggestotherdiseases:Age>50yearsMaleShorthi
8、storyofsymptomsDocumentedweightlossNocturnalsymptomsFamilyhistoryofcoloncancerRectalbleedingRecentantibioticuseIBD:DiagnosisRomeIII
