_ofirritable bowel syndrome概述ofirritable肠易激综合征课件

IO 1 Overview of Irritable Bowel Syndrome Arnold Wald, MD Professor of Medicine Department of Gastroenterology, Hepatology, and Nutrition University of Pittsburgh Medical Center Pittsburgh, Pennsylvania Irritable Bowel Syndrome w Chronic or recurrent GI symptoms Lower abdominal pain/discomfort Altered bowel habits Bloating w Not explained by structural or biochemical abnormalities 2 IBS Clinical Subgroups w Constipation predominant w Diarrhea predominant w Alternating constipation/diarrhea 3 IBS Clinical Subgroups w Constipation predominant w Diarrhea predominant w Alternating constipation/diarrhea 4 Rome II Criteria for IBS At least 12 weeks or more, which need not be consecutive, in the preceding 12 months, of abdominal discomfort or pain that has 2 out of 3 features: w Relieved by defecation w Onset associated with a change in frequency of stool w Onset associated with a change in form (appearance) of stool Gut. 1999. 5 Epidemiology of IBS in US (15% to 20% of Population) Specialists 5% 25% to 50% of referrals to GIs are IBS Nonconsulters 80% Primary care 15% 6 Prevalence of Disorders in US IBS:15% - 20% Dyspepsia:8% GE reflux:7% Asthma:4% Diabetes:3% 7 IBS Symptoms Reduce Patient Well Being Reduced sense of well being Abdominal pain Altered bowel habits Cramps Bloating Constipation Diarrhea Urgency 8 Medical Costs Associated With IBS w Estimated $8 billion annually in direct costs w Increased physician visits for both GI and non-GI complaints w IBS patients incur 74% more health care costs than do non-IBS sufferers Drossman, et al. Dig Dis Sci. 1993;38(9):1569-1580. Talley, et al. Gastroenterology. 1995;109(6):1736-1741. 9 Impact of IBS on Work Missed work:30% (1.7 days) Reduced days:46% (3 days) Turned down promotion:16% Changed job, health reasons: 9% Changed work schedule: 8% Hahn BA, et al. Digestion. 1999;60(1):77-81. 10 Pathophysiology of IBS: A Biopsychosocial Disorder w Biological Altered GI motor activity Altered visceral sensation w Psychosocial Behavioral Cognitive Emotional 11 Multiple Medications Are Used to Treat IBS w Anticholinergics w Tricyclic antidepressants w SSRIs w Antidiarrheals w Bulking agents w Laxatives w Alosetron* *Data support efficacy for diarrhea-predominant IBS. 12 IO 1