2. Introduction
• Exiting and confusing period because of the
Definition revolution in the concept of FGID
• It relates to the progress of the knowledge
Abdominal
Bloating
pain – the diversity of etiologic factors
– pathophysiological mechanisms
so
Altered
• No single, unifying mechanism has emerged to
bowel explain symptoms.
motility
so
• No universally effective therapy for IBS.
3. IBS history
• “. . . occasional pain in the intestines and derangement of their powers of
digestion, with flatulence . . .”
Powell, 1818
• “. . . spasmodic stricture of the colon – an occasional cause for confinement
of the bowels . . .”
Howship, 1830
• “. . . the bowels are at one time constipated, at another time lax, in the same
person . . . how the disease has two such different symptoms I do not profess
to explain . . .”
Cumming, 1849
4. Rome Diagnostic Criteria for IBS
Rome III criteria (2006) Rome II criteria ( 1999)
• At least 3 months, with onset at least 12 weeks or more in the last 12 months
6 months previously of recurrent of abdominal discomfort or pain with
abdominal pain or discomfort** 2 /3 of the following
associated with 2 or more of the • Relieved by defecation
following: • Associated with a change in
• • Improvement with defecation; frequency of stool
and/or
• Associated with a change in
• • Onset associated with a change in consistency of stool
frequency of stool;
• and/or
The second group of criteria included in
• • Onset associated with a change in Rome I are now considered supportive
form (appearance) of stool rather than mandatory in the
diagnosis.
**Discomfort means an uncomfortable
sensation not described as pain.
5. Rome III Criteria* –
Irritable Bowel Syndrome
Recurrent abdominal pain or discomfort at least 3 days/m
In the last 3 months associated with 2 or more :
Onset Onset
Improvement associated with associated with
with and and
a change in a change in
defecation frequency of form
stool (appearance) of
stool
* Criteria fulfilled for the last 3 months with symptom onset at least 6
months prior to diagnosis.
Longstreth G., Gastroenterology 2006
6. Rome III – Subtypes of IBS
100
75
%
Hard or lumpy 50
stools
IBS-C IBS-M
25
IBS-U IBS-D
0
0 25 50 75 100
% Loose or watery stools
7.
8. Does the patient with IBS really need treatment?
prevalence
Sweden 13%
Canada Belgium 8%
Denmark 7%
12% UK 22%
Netherlands 9% China 23%
US France 20% Germany 12%
10–20% Spain 13% Japan 25%
Nigeria 30%
IBS data not included
Australia 12%
New Zealand 17%
Camilleri et al. Aliment Pharmacol Ther 1997;11:3–15 Müller-Lissner et al. Digestion 2001;64:200–4
Drossman. Dig Dis Sci 1993;38:1569–80 Talley. Balliêre’s Clin Gastroenterol 1999;13:371–84
Talley et al. Gastroenterology 1991;101:927–34 Thompson et al. Dig Dis Sci 2002;47:225–35
9. Worldwide prevalence of IBS
70
60
50
Prevalence (%)
40
30
20
10
0
UK1 USA2 New France4 China5 Nigeria6 Denmark7
Zealand3
1
Heaton et al., 1992; 2Longstreth and Wolde-Tsadnik, 1993
3
Welch and Pomare, 1990; 4Bommalaer et al., 1986
5
Bi-zhen and Qi-Ying, 1988; 6Olubuyide et al., 1995; 7Kay et al., 1994
10. Frequency of IBS vs other important diseases
• US prevalence of IBS up to 20% 1
• US prevalence rates for other common diseases 2
– diabetes 3%
– asthma 4%
– heart disease 8%
– hypertension 11%
1
Camilleri and Choi, 1997
2
Adams and Benson, 1991
11. IBS results in productivity burden
Absenteeism from work or school
during the last 12 months
14
12
10
Days per year
8
6 p=0.0001
4
2
0
IBS Non-IBS
Drossman et al., 1993
12. Physician visits per year
6
5 GI complaints
Number of visits per year
4 Non-GI complaints
3
2
1
0
IBS Non-IBS
Drossman et al., 1993
AGA Teaching Unit in IBS, 1997
13. Does the patient with IBS really need treatment?
Costs of IBS
• IBS results in an estimated $20
• $8.4 billion estimated direct
billion in lost productivity costs
charges in 1992. Talley 1995
annually in the US. Martin, 2001
• IBS sufferers use significantly more
• 2/3 of expenditures are for indirect healthcare resources than non-IBS
costs. Fullerton 1998 sufferers Longstreth 2000 . Drossman
WA, 1993
16. Overlap in the symptomatology
of functional GI disorders
Functional Functional
abdominal abdominal
pain bloating
Functional Functional
diarrhea constipation
IBS
17. FIDG : part of a spectrum of disorders characterized
by chronic pain and discomfort
Primary Degree of overlap with secondary condition(%)
diagnosis FMS CFS IBS TMD
FMS NA 70 32-80 75
CFS 35-70 NA 58-92 20
IBS 32-65 58-92 NA 32-65
TMD 13-18 20 64 NA
MCS 33-55 30 ND ND
Dadabhoy D & Claw DJ , 2006
18.
19.
20.
21.
22. Impact of IBS on QoL compared
with other medical conditions
IBS-C General population IBS-D
Migraine Asthma GERD
90
70
SF–36 score
50
30
0
Physical Physical Bodily General Vitality Social Emotional Mental
functioning role pain health functioning role health
Frank et al. Clin Ther 2002;24:675–89
23.
24.
25.
26.
27.
28.
29.
30. IBS - Conceptual Model
Early Life
• Genetics
• Environment Psychosocial
Factors
• LIfe stress
• Psychologic state
• Coping
• Social support
CNS ENS
Physiology
• Motility
• Sensation
•Inflammaton Outcome
IBS • Medications
• Symptom • MD visits
experience • Daily function
• Behavior • Quality of life
31. Psychosocial Stress and Other Cognitive Factors
model of the putative importance of chronic life stress and enteric infection/inflammation
and their interactions with both early life factors and concurrent modifying factors,
in the genesis of the CNS-ENS dysregulation present in IBS.
GI, gastrointestinal; EI, extraintestinal.
