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IN THE NAME OF GOD

This study examines the prevalence of Irritable Bowel Syndrome (IBS) and other gastrointestinal (GI) disorders in primary care practice. It also provides diagnostic evaluation, treatment indications, and non-pharmacological and pharmacological treatment options for IBS.

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IN THE NAME OF GOD

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  1. IN THE NAME OF GOD

  2. IBS Ahmad Shavakhi.MD Associate professor of internal medicine Isfahan University of medical sciences

  3. Prevalence of Diagnosis IBS 12% Other GI 15% IBS IBD 14% 28% 13% others Peptic 20% Other 88% Liver 10% Primary Care Practice Gastroenterology Practice

  4. Doctor Visits by Gender USA AFRICA INDIA

  5. A 43 years old woman presented to clinic • Abdominal pain • Diarrhea • From 6 months ago • Pain alleviated with deification • Denied weight loss, or other symptoms • Normal exam

  6. subtypes of IBS • IBS with constipation (hard or lumpy stools ≥25 percent / loose or watery stools <25 percent of bowel movements) • IBS with diarrhea (loose or water stools ≥25 percent / hard or lumpy stools <5 percent of bowel movements) • Mixed IBS (hard or lumpy stools ≥25 percent / loose or watery stools ≥25 percent of bowel movements) • Unsubtyped IBS (insufficient abnormality of stool consistency to meet the above subtypes)

  7. "Alarm" or atypical symptoms • Rectal bleeding • Nocturnal or progressive abdominal pain • Weight loss • Laboratory abnormalities such as anemia, elevated inflammatory markers, or electrolyte disturbances • Positive FHx

  8. Diagnostic evaluation • Diarrhea predominant IBS : • Stool cultures • Celiac disease screening • Twenty-four hour stool collection • Colonoscopy or flexible sigmoidoscopy and biopsy

  9. Diagnostic evaluation • Constipation predominant IBS : • plain film of the abdomen • Flexible sigmoidoscopy and colonoscopy

  10. Refractory symptoms

  11. Refractory symptoms

  12. Refractory symptoms

  13. Treatment

  14. Indication for non pharmalogical treatment • Mild and intermittent symptoms • Do not impair quality of life

  15. Indication for drug • Mild to moderate symptoms who fail to respond to initial management • Moderate to severe symptoms that affect quality of life

  16. Non pharmacological treatment • Education and reassurance • Food allergy testing • Physical activity

  17. Gas-producing foods beans carrots Raisins Bananas apricots prunes pretzels • such as • cabbage • Onions • Broccoli • Wheat • potatoes • Celery • Apricot

  18. Patients with IBS may benefit from exclusion

  19. We suggest a diet low in (FODMAPs) in IBS with abdominal bloating or pain despite exclusion of gas producing foods

  20. We suggest a two-week trial of a gluten-free diet in patients with diarrhea predominant IBS with significant abdominal bloating and flatulence whose symptoms have failed to improve with a low FODMAP diet and avoidance of gas producing foods

  21. Fiber • The role is controversial • No serious side effects and potential benefit • psyllium should be considered in patients with IBS whose predominant symptom is constipation

  22. IBS -C • PEG

  23. IBS-D • Loperamide • Bile acid sequestrants

  24. Abdominal pain • Antispasmodic agents • Antidepressants • Peppermint

  25. Rifaximine • bloating, who have failed to respond to other therapies

  26. Probiotics • Not routinely recommended in patients with IBS

  27. The end

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