Sindrome dell'intestino irritabile: diagnosi e terapia - Gastrolearning

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Presentazione standard di PowerPointSindrome dell'intestino irritabile: diagnosi e terapiaRelatore: Prof. E. Corazziari (Roma)FGID: DEFINITION Variable combination of chronic or recurrent gastrointestinal symptoms not explained by structural or biochemical abnormalitiesDrossman et al Gastroenterol Int 1990;3:159FUNCTIONAL BOWEL DISORDERS ROME EVOLUTIONFrom the Irritable Colon Syndrome toFunctional Bowel DisordersIrritable Bowel Syndrome (Pain + Bowel Disorders)Functional Constipation (+/- Pain)Functional Diarrhea (no Pain)Functional Abdominal BloatingUnspecified bowel disordersIBS PREVALENCE IN ITALY4E Corazziari et al. Digest and Liver Disease 2008;40:944-950FACE-FACE INTERVIEWPhysical Ex. & USRandom/Electoral Rollsn=46,139 Resp. R 63,2%IBS ROME I CRITERIAF= 10.7%M= 5.4%LA DIAGNOSI DI IBSIBS- DIAGNOSTIC CRITERIAHOW TO MAKE A DIAGNOSIS OF A CHRONIC FUNCTIONAL DISORDER WHEN NO BIOLOGICAL MARKER EXISTS ?By exclusionPositive-Symptom based IBS- DIAGNOSTIC CRITERIA Exclusion of the Diseases with Detectable Diagnostic Markersuseful to detect relevant disorders in few patients butit requires to submit many patients to many investigations with elevated costs and risks of iatrogenic damage andit does not offer any certainty about the origin of symptomsIBS-DIAGNOSTIC CRITERIAPositive symptom-based diagnosisOFFER CONFIDENT DIAGNOSIS?Reduce unneeded investigationsPlan treatmentStrengthen patient compliance to treatment and coping ability with chronic suffering and daily limitationsIBS-U7%IBS SUBGROUPS ACCORDING TO ROME QUESTIONNAIRE AND DIARY CARDN=68K= 0.6Piacentino D et al DDW 20109ABDOMINAL PAIN AND BLOATING DIFFER IN RELATION TO EATING AND DEFECATION IN IBS PATIENTSCarboni S, Cantarini R, Badiali D, Pallotta N, Corazziari E. DDW 2007TWO YEAR (IN)STABILITY OF ROME II IBSWilliams et al APT 2006; 23: 197-20530% IDENTICAL IBS subtypesROME II IBSN= 69718% ABD PAIN37% BOWEL45% NO SYMPTOMS52% NOT IBS18% CHANGED SUBTYPES17%DCM11%4%7%10 %4%11When the same population was studies again after 7 years, about eighty percent of the original population responded to the questionnaire, a different pattern of symptom turnover was recorded. Patients who were symptoms free remained largely symptom free, those reporting reflux symptoms seldom changed their main symptom profile to dyspepsia or IBS. In contrast the flux between the diagnoses of dyspepsia and IBS was substantial.IBS-C-CIC AND IBS-D-FD OVERLAPFord A.C. et al. Aliment Pharmacol Ther 2014;39:312-321ONE YEAR (IN)STABILITY (%) OF ROME III IBS-C & FCWong et al. Am J Gastroenterol 2010;105:2228FC WELLIBS-MWELLIBS- C1425.5221764135.53913When the same population was studies again after 7 years, about eighty percent of the original population responded to the questionnaire, a different pattern of symptom turnover was recorded. Patients who were symptoms free remained largely symptom free, those reporting reflux symptoms seldom changed their main symptom profile to dyspepsia or IBS. In contrast the flux between the diagnoses of dyspepsia and IBS was substantial.BOWEL CHARACTERISTICS IN IBS-C vs CIC%* p30%) URINARY Interstitial cystitis Incontinence Detrusor instability MUSCOLOSKELETAL Fibromyalgia Backache HeadacheWhorwell et al 1986; Nyhlin et al 1993; Triadofilopoulos et al 1991 SEXUAL Dyspareunia Decreased libido Inhibited orgasm PSYCHOLOGICAL Affective disorders Stress sensitivity Illness behavior Health seeking behavior COMORBIDITIES ASSOCIATED WITH IBS*p

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