Sub types of IBS
(1)IBS with predominant constipation
(2)IBS with predominant diarrhea
(3)IBS with mixed bowel habits will have:
¼ bowel movement is constipation
¼ bowel movement is diarrhea
IBS unclassified:
-Characteristics of IBS met, but not able to be placed into any of the 1,2,3 above
No specific abnormality to this disorder
Altered motility and hypersensitivity
Also, there is inflammation and alteration in fecal flora and bacterial overgrowth
Food sensitivity role
Genetic predisposition
High frequency and irregular luminal contractions=diarrhea
Prolonged transit time=constipation
Increase sensitivity to cholecystokinin and meal = diarrhea
Hypersensitivity to GIT distension leads to somatic pain and bloating complaints
Intestinal inflammation=diarrhea
Stool from diarrhea predominant IBS has revealed high serine-protease activity
So, serine protease inhibitors will prevent pain and diarrhea
High mast cells – increase pain
Increased cytokines-increase awareness of pain
Associated with :
Abuse[r/o in young women]
Fibromyalgia
CFS
GERD
Functional dyspepsia
Non cardiac chest pain
Psychosis
Depression
Anxiety
Somatization
LAB:

Not definitive:
Diarrhea:
Fecal calprotectin
Fecal lactoferrin
Celiac disease antigliadin antibodies and anti-transglutaminase antibodies
Giardia antigen detection or NAA assay
If can’t do calprotectin /lactoferrin, then do C-reactive protein levels
CBC
Colorectal screening that is age appropriate
Anorectal manometry and balloon expulsion testing to r/o dyssnergic defecation in severe constipation
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