Ibs update gp_2020
- 1. Title Speaker Irritable Bowel Syndrome Update - Whats Changed? Speaker: Reuben Wong Gastroenterologist Associate Professor (Adj-NUS) Moderator: Dr Jarrod Lee Gastroenterologist
- 2. OUR CLINICS Mount Elizabeth Novena Specialist Centre Mount Alvernia Medical Centre D Gleneagles Medical Centre Farrer Park Medical Centre Parkway East Medical Centre Mount Elizabeth Medical Centre
- 3. OUR SERVICES General Endoscopy Advanced Endoscopy (EUS, ERCP, Capsule Endoscopy, Small Bowel Entersocopy, Complex Polyp Removal, Dilation and Stenting) 24hr pH Monitoring and High Resolution Manometry Hydrogen Breath Testing Colon Transit Studies Fibroscan Liver Assessment Nutrition and Dietetics Specialized Psychological Services
- 4. Scope 1. What is IBS? 2. Why do people get IBS? 3. Is there a cure for IBS? 4. What is new.
- 6. IBS Relief w defecation Change in frequency or stool consistency Associated with straining/urgency. mucus
- 7. What is IBS According to Rome III 10% of the time
- 9. IBS Subtyping Subtyping IBS-C >25% BSS 1/2 & <25% 6/7 IBS-D >25% BSS 6/7 & <25% 遜 IBS-M >25% BSS 1/2 & 3/4 Clinical common-sense prevails! Emphasis is on abnormal BMs Reduction in number of IBS-Us
- 10. My patients symptoms have changed! Is it really IBS? RK Wong et al. Inability of the Rome III criteria to distinguish FC from IBS-C. AJG 2010; 105(10); 2228-34
- 11. Is there a test for IBS? NO there isnt a single test Diagnosis based on: Patients symptoms Sometimes tests to exclude other conditions: Endoscopy Scans Blood tests (only in patients with alarm symptoms)
- 12. Patient asks Are you sure? Youve got IBS lets treat you! B Spiegel et al. Is IBS a diagnosis of exclusion: physician survey. AJG 2010; 105:848-58
- 13. No need to perform a standardized battery of tests in patients who meet the symptom based criteria for IBS Utility of Diagnostic Tests in IBS BD Cash et al. Utility of dx tests in IBS: systemic review. AJG 2002; 97: 2812-9
- 15. The multiple factors that result in IBS symptoms
- 17. Elsenbruch S. Brain, Behavior & Immunity 2011;25:386-94 The Role of the Brain-Gut Axis
- 18. The Evidence for Stress in IBS AGA Technical Review IBS. Gastroenterology 2002
- 20. The Role of Gut Bugs
- 23. Post-Infectious IBS Contaminated Food Bacteria/Virus Travels to Gut Vomitting Diarrhea Fever Immune System Kills bugs Infection Cleared Inflammation Persists Tummy Pain Altered Bowels Post-Infectious IBS
- 24. Why Does this Happen? Tornblom H et al, Scand Journ Gastroenterol 2005
- 28. Foods that cause symptoms FODMAPs FructansF OligosaccharidesO DisaccharidesD MonosaccharidesM AndA PolyolsP
- 29. Evidence for FODMAPs EP Halmos, P Gibson et al. Gastroenterology 2014
- 30. EP Halmos, P Gibson et al. Gastroenterology 2014 SatisfactionwithStool
- 32. We are Singaporeans We love our Spices!
- 33. Chili can cause pain and symptoms TRPV - receptors
- 35. The Role of Genes Study of 12,700 Norwegian Twins Concordance: 22.4% in IDENTICAL twins 9.1% in UNIDENTICAL twins Hereditability of 48.4% in WOMEN Other Factors Low Birth Weight Various genes have been identified Bengston MB et al, Gut 2006
- 37. Is IBS really that bad? Impairs quality of life Healthcare costs, days off work Patient Population N Mean (SD)1 Median (range)1 References Irritable Bowel Syndrome 146 22.08 (15.39) 17 (0, 69) R Wong et el. Clinical Gastroenterol Hepatol 2013;11:151-5 Advanced Cancer 64 18.5 (11.0) 17 (0, 60) I Higginson et al. Health and Quality Life Outcomes 2008:6:42 Dementia 152 32.9 (17.9) 30 (1, 82) J Ankri et al. Int Jour Geriatr Psych 2005;20:254-60 1 Zarit SH, Reever KE, Bach-Peterson J. Relatives of the Impaired Elderly: Correlates of Feelings of Burden. Gerontologist.1980;20(6):649-55 2 Reuben K Wong, DA Drossman et al. Partner Burden in IBS. Clinical Gastroenterol Hepatol 2013;11:151-5
- 38. Burden and Disease Severity 16.28 21.36 27.72 0 5 10 15 20 25 30 Mild (<36) Moderate (36-110) Severe (>110) ZBIScores(mean) Reuben K Wong, DA Drossman et al. Partner Burden in IBS. Clinical Gastroenterol Hepatol 2013;11:151-5
- 40. Its not hopeless! The Efficacy of Treatment
- 42. Anti- spasmodics AC Ford. IBS Treatment Sys Review. BMJ 2008
- 43. Elsenbruch S. Brain, Behavior & Immunity 2011;25:386-94
- 46. New treatment options Is there a role for dietary manipulation? New pharmacology Bugs & IBS
- 48. Breath Testing
- 51. New Symptom-Specific Pharmacology Constipation Predominant GC receptor agonists Linaclotide Bile acid modulators A3309 Dopamine Receptor Itopride Serotonin Receptor Modulators Accelerates colonic transit Cisapride Zelmac Prucalopride Efficacy in chronic constipation Mosapride
- 52. New Symptom-Specific Pharmacology Diarrhea Predominant Chloride Secretion Inhibitor Crofelemer Atypical Benzodiazepine Dextofisopam Carbon Adsorbent AST 120 Tryptophan Hydoxylase Inhibitor Opioid Receptor Agonist Eulaxadoxine CRF Antagonist 5-HT 3 Antagonists Alosetron Cilansetron Ramosetron
- 53. IBS symptoms & the Microbiota
- 55. Antibiotics Rifaximin SB Meenes, W Chey AJG 2012
- 57. IBS Symptom Relief Organ Transplant Metabonomic Effects FMT the holy grail of IBS Rx?
- 58. Complementary Alternative Medicine for IBS Hope or Hogwash?
- 59. Acupuncture
- 60. Peppermint Oil AC Ford. IBS Treatment Sys Review. BMJ 2008
- 62. Putting it all together IBS Correct Diagnosis Brain-Gut Medication FODMAPs Microbiota Tailor Rx to the patient & severity