What causes Irritable Bowel Syndrome?
Irritable Bowel Syndrome
In an incomprehensible state in the abdomen - that swelling, then diarrhea, then constipation, then pain and discomfort - now there is a name: irritable bowel syndrome (IBS).
This functional disease, in other words, when examined by modern diagnostic methods, it is impossible to determine either ulcers or visible inflammation. It would seem that there is no reason for ill-health. And there are symptoms.
Someone will say: there is no ulcer - you need to rejoice, think, discomfort in the abdomen! Tell this to a girl who can not meet with young people, because she is suffering from constant bloating. Or a young man who knows all the public toilets on the way to work. Or someone who wakes up in the morning and feels a pain in the stomach, which for a time ceases only after going to the toilet.
Doctors are very serious about the IBS. It is not surprising, since the symptoms inherent in IBS occur in 10-20% of the adult population, with the most able-bodied - more than 80% of patients - age
It is not necessary to dissemble: despite all the efforts, the cause of irritable bowel syndrome is not yet known to scientists. It is believed that in IBS there is an increased sensitivity of the sensory apparatus of the intestine, which leads to a spastic response in response to a normal stimulus to contraction. The second mechanism is to reduce the threshold of perception of pain.
Predicted to IBS are, on the one hand, those who experience constant stress, psychological trauma. On the other hand, food poisoning and intestinal infections can provoke the onset of the disease.
And nevertheless it is necessary to dwell on the symptoms of IBS. The main ones are relapsing pain or discomfort in the abdomen, the beginning of which is associated with a change in the frequency or shape of the stool, and the improvement comes after defecation.
Additional symptoms include violation of stool frequency: constipation (stool less than 3 times a week) or diarrhea (stool more often 3 times a day), pathological form of the stool: cloddy, hard, liquid (watery), as well as a feeling of incomplete emptying, mucus secretion, bloating stomach.
To be able to talk about irritable bowel syndrome, it is necessary that the above symptoms be observed at least for six months.
In addition, there are so-called anxiety symptoms (fever, blood in bowel movements, weight loss, anemia), which make the diagnosis of IBS unlikely. And the last thing: IBS is a day visitor, nocturnal symptoms are not characteristic for him.
Since the disease has no specific signs, a clear description of the symptoms and type of pain will be required for the diagnosis. It is recommended to diagnose it on the first day of treatment of the patient, says the criteria worked out by the international commission in Rome. In practice, this led to the fact that the diagnosis of Irritable Bowel Syndrome is extremely spread. Soon the Central Institute of Gastroenterology conducted a study, and it turned out that the diagnosis of IBS was confirmed only in 24% of patients, and in 76% of patients other intestinal diseases or diseases with intestinal symptomatology. This led to the emergence of diagnostic standards in our country, which are necessary to exclude other pathologies. Only in the absence of it is diagnosed with IBS.
1. It's her again, "my friend says sadly, to whom his patient, who is ill with IBS, calls for the third time in a day. And I understand him. Among doctors, irritable bowel syndrome is sometimes jokingly referred to as irritated head syndrome, because in addition to the main symptoms are often those that are associated with a disruption of the central and autonomic nervous system. Whom in the throat when swallowing, pain in the muscles, headaches, heart palpitations, a feeling of incomplete inspiration, increased anxiety of patients. Here one gastroenterology is indispensable: it will be necessary to regulate the way of life, to analyze and establish normal relationships at home and at work, and sometimes - to use antidepressants.
2. It is necessary to comply with the diet, preferably - to include dietary fiber in your diet. It happens that certain foods provoke an increase in symptoms, and then the doctor asks the patient to keep a food diary.
3. In the treatment of irritable bowel syndrome, medications are used, of which the main are antispasmodics (duspatalin, dicetel) and intestinal motility regulators (motilium, debilitate, loperamide).
Irritable Bowel Syndrome
Functional diseases of the digestive tract are very common and characterized by the absence of organic pathology. Irritable Bowel Syndrome (IBS) is a functional bowel disease in which abdominal pain is associated with defecation or a change in the rhythm of defecation.
Approximately 20% of the general population meet the diagnostic criteria of IBS, but only 10% of them consult a doctor about gastrointestinal symptoms. Nevertheless, IBS is the most common cause of calls to the gastroenterologist and frequent absenteeism, and a reduced quality of life. Young women get sick 2-3 times more often than men.
Often, the disease is combined with non-ulcer dyspepsia, chronic fatigue syndrome, dysmenorrhea and frequent urination. A significant proportion of these patients are diagnosed with physical or sexual history. IBS involves a large number of symptoms, so the only reason for the development of this disease is unlikely. It is generally accepted that most patients develop symptoms in response to psychosocial factors, disorders of gastrointestinal motility, visceral sensitivity, or factors in the lumen intestines.Psychosocial factors.Most patients in general practice have no psychological problems, but about 50% of patients sent for hospitalization meet the criteria for a psychiatric diagnosis. A number of violations in such cases are defined, including anxiety, depression, somatoform disorders and neurosis. There are also frequent complaints of panic attacks. It is known that acute psychological stress and an obvious mental illness disrupt the visceral sensitivity and gastrointestinal motility both in patients with irritable bowel syndrome and in healthy people. There is an increased prevalence of pathological morbid behavior with frequent calls to the doctor for small symptoms and reduced stress resistance. These factors contribute, but do not cause IBS.
Disturbed gastrointestinal motility.There are a number of motor disorders, but none of them are diagnostic. In patients with diarrhea, the main symptom is recorded clusters of fast waves of contraction of the skinny guts, accelerated intestinal transit and an increased number of rapid and common contractions of the thick guts. Patients suffering from mostly constipation. reveal delayed orocecal transit and a reduced number of high-amplitude widespread waves of contractions of the colon, but there are no persistent signs of a change in motility.
Pathological visceral sensitivity (visceral hypersensitivity).IBS is associated with increased sensitivity to bowel straining when inflating or ballooning ileum, thick and rectum as a consequence of impaired transmission of information to the central nervous system or visceral sensitivity. This is more common in women with IBS mainly with diarrhea.
Enlightenment factors.IBS develops after an episode of gastroenteritis in 7-32% of patients, more often in young women and those with psychological problems. Others may have intolerance to certain food components, especially lactose and wheat. Also, the value of abnormalities in the intestinal microflora is assumed, leading to increased fermentation and gas production, and minimal inflammation.
In some patients there is a subtle, histologically undetectable inflammation of the mucosa shell, possibly leading to the activation of inflammatory cells and the release of cytokines, nitric oxide and histamine. This can trigger an abnormal secretory motor function and sensitize the nerve endings of the intestine.
The most common manifestation is recurrent pain in the abdomen. Usually, pain is noted in the form of colic, localized in the lower abdomen, it is relieved after defecation. Bloating is aggravated throughout the day; the cause is unknown, but this is not related to an increase in intestinal gas production. The frequency of defecation is variable. In most patients, diarrhea and constipation alternate, but patients should be divided into groups of patients with predominant constipation or diarrhea. With constipation, there is a tendency to a rare cantilever stool, usually along with abdominal pain or proctalgia. In patients with diarrhea, frequent defecation is noted in small portions and rarely - nocturnal symptoms. Often there is mucus in the stool, but there is no rectal bleeding.
Signs of irritable bowel syndrome:
- violation of defecation;
- mucus in the rectum;
- feeling of incomplete bowel movement;
- perform a colonoscopy to exclude colon cancer or IBD.
Despite the undoubtedly severe symptoms, patients with a normal constitution do not lose body weight. The physical examination does not reveal any abnormalities, although often there is bloating and tenderness in palpation.
The results of the examinations are normal. Positive diagnosis can be performed with confidence in patients younger than 40 years without using complex studies. Usually routine examinations are performed - OAK, ESR and sigmoidoscopy, but barium enema or colonoscopy should be performed only for elderly patients to exclude colorectal cancer. Patients with atypical symptoms should be examined to exclude organic gastrointestinal disease. Patients with predominant diarrhea are examined for the exclusion of microscopic colitis, malabsorption of bile acids, celiac disease, thyrotoxicosis and in developing countries - parasitic infections.
The most important steps are to establish a positive diagnosis and to calm the patient. Many are concerned that they have cancer, and a vicious circle of anxiety leading to colonic symptoms aggravating anxiety may be is broken by the explanation that the symptoms are not associated with an organic disease, but arise as a result of motor disorders and sensitivity intestines. In patients who are not persuaded, treatment is directed to the main symptoms. Restriction in the diet as a whole does not help, but up to 20% of patients can benefit from a non-cereal diet, some may respond to the exclusion of lactose. It is necessary to take action against the abuse of caffeine and artificial sweeteners, such as sorbitol. The role of probiotics is still not specified.
Patients with non-refractory symptoms sometimes experience improvement from amitriptyline therapy for several months. Side effects include dry mouth and drowsiness, but they are usually mild, and the drug is generally well tolerated. The drug can act by reducing visceral sensitivity and altering gastrointestinal motility.
Most patients note a remitting type of flow. Exacerbations often follow stressful events, discontent with the work performed and difficulties in interpersonal relationships.
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Sources: http://www.medkrug.ru/article/show/sindrom_razdrazhennogo_kishechnika, http://med36.com/ill/1193
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