4/18/18 Irritable Bowel Syndrome (IBS) Dr. Andy Liu, MD PGY-4, - - PDF document

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4/18/18 Irritable Bowel Syndrome (IBS) Dr. Andy Liu, MD PGY-4, - - PDF document

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4/18/18 Irritable Bowel Syndrome (IBS) Dr. Andy Liu, MD PGY-4, Division of Gastroenterology Cumming School of Medicine, University of Calgary April 17, 2018 Financial disclosure Thank You to Our Name: Dr. Andy Liu, MD Speaker

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Irritable Bowel Syndrome (IBS)

  • Dr. Andy Liu, MD

PGY-4, Division of Gastroenterology Cumming School of Medicine, University of Calgary April 17, 2018

Financial disclosure

Name: Dr. Andy Liu, MD Speaker Financial compensation – Ignite Nutrition ✓

Thank You to Our Sponsors!

Their dona+ons to this event helped

  • make it happen

$5 of each +cket sold being donated to

  • the Canadian Diges+ve Health

Founda+on

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Disclaimers

  • Presentation for information purposes only
  • All treatments should be used under supervision of MD or RD
  • Off-label use of medications will be discussed

IBS

  • Abdominal pain with changes in bowel

movements

  • 15% of Canadian population
  • Second most common cause of

absenteeism

  • Economic impact of $6.5 billion

Prognosis

Chronic

  • No long
  • term serious consequences

Not curable, but manageable

  • YOU are in control!
  • Causes
  • Functional disorder
  • Visceral hypersensitivity
  • Abnormal gut motility
  • Gut microbiome
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Visceral hypersensitivity

60 100 140 180 % Reporting pain Rectosigmoid balloon volume (mL) 20 40 60 IBS Normal

= IBS patients have lower pain thresholds

Whitehead WE et al. Dig Dis Sci. 1980;25:404-13.

Diagnosis

  • NOT “in your head”
  • NOT a diagnosis of exclusion
  • Symptoms-based with limited evaluation
  • Strict clinical criteria: Rome IV (2017)

Rome IV

Abdominal pain:

Average one day per week in the past three months

With Two of the following three features:

  • 1. Pain related to BM
  • 2. Change in frequency of BM
  • 3. Change in appearance of BM

Simren M et al. Curr Gastroenterol Rep. 2017;19:15.

Subtypes

  • Constipation-predominant
  • Diarrhea-predominant
  • Mixed constipation and diarrhea
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Red flags

  • Bleeding
  • Greasy stools
  • Nocturnal symptoms
  • Weight loss

Non-pharmacologic: Exercise

  • Dietary changes
  • Probiotics
  • Anti
  • spasmodics

Treatment

Pharmacologic:

  • Drugs
  • Exciting (and expensive) new

drugs

Exercise

30-60 minutes moderate-high intensity exercise 3-5 times per week

75 patients 38 patients: Exercise 37 patients: Sedentary 12 weeks Patients in exercise group had:

  • Trend towards clinical

improvement

  • Significantly less worsening
  • f IBS symptoms

Johannesson E et al. Am J Gastroenterol. 2011;106(5):915.

Low FODMAP diet

“Fermentable oligo-, di-, mono-saccharides and polyols”

  • Poorly absorbed sugars
  • Fermented to produce gas
  • Abdominal pain and bloating (recall “visceral hypersensitivity”!)
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Low FODMAP diet

“Fermentable oligo-, di-, mono-saccharides and polyols”

30 IBS patients and 8 healthy controls 21 days low FODMAP Or 21 days normal diet Do a survey 21 days low FODMAP Or 21 days normal diet Do a survey Patients on low FODMAPs diet had: Significantly less bloating, pain, and passage of wind

Halmos et al. Gastroenterol. 2014;146(1):67-75

Caveats

  • CAREFUL: low FODMAPs ≠ healthy diet!
  • MUST be done under RD supervision

There’s an app for that

Monash University - $10.99

Probiotics

  • CAREFUL: un-regulated industry
  • Small effect only – match the probiotic with the symptom
  • Choose evidence based probiotics & measure outcome
  • Align (Bifidobacterium infantis 35624) - $30/month
  • TuZen (Lactobacillus plantarum 299v) - $45/month
  • Visbiome (combination) - $90/month
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Anti-spasmodics

  • Reduce colonic motor activity
  • Relax smooth muscles of the gut
  • Most require prescription
  • A natural option: peppermint oil
  • Watch for acid reflux!
  • IBGard (unique delivery mechanism) - $60/month

Non-pharmacologic: Exercise

  • Dietary changes
  • Probiotics
  • Anti
  • spasmodics

Treatment

Pharmacologic:

  • Drugs
  • Exciting (and expensive) new

drugs

Drugs: IBS-C

  • 1. Laxatives: how do I choose?
  • RestoraLAX (PEG 3350) 17 g once or twice daily - $1/dose
  • Milk of magnesia, lactulose
  • Dulcolax, Senokot
  • Enemas, colonoscopy prep
  • 2. Constella (linaclotide) 290 mcg daily
  • Also pain-modulating

Drugs: IBS-D

Imodium (loperamide) 2 mg before meals 1.

$1/dose

  • Safe
  • Titratable
  • Olestyr (cholestyramine) 4 g daily

2.

Especially if gallbladder removed

  • Titratable
  • Viberzi (eluxadoline) 100 mg twice daily

3.

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IBS tips

  • 1. Eat smaller, regular meals
  • 2. Low FODMAP diet
  • 3. Stay hydrated
  • 4. Decrease caffeine
  • 5. Don’t eat late at night

Raman M et al. The Complete Health and Diet Guide. 2011. Robert Rose Inc. Toronto.

IBS tips

  • 6. Wear looser clothing
  • 7. Reduce stress
  • 8. Exercise
  • 9. Work with your MD and RD

10.See your doctor if any red flag symptoms arise

Raman M et al. The Complete Health and Diet Guide. 2011. Robert Rose Inc. Toronto.

Thank you!

Andy.Liu@ahs.ca