Irritable Bowel Syndrome (IBS)

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Epidemiology of IBS

Irritable bowel syndrome (IBS) is a major functional gastrointestinal (GI) disorder that affects many people globally. The disorder has a fluctuating prevalence rate of between 10% and 15% depending on the country and risk factors. For such a functional disorder to occur, the body must have been suffering some structural or biochemical abnormalities. Diagnostic tests can explain the symptoms of IBS, and it is estimated that approximately 40% of patients globally have experienced mild IBS.

Additionally, 35% and 25% of patients have experienced moderate and severe IBS, respectively. Unfortunately, many people are unaware of the IBS symptoms, although physicians have identified it as one of the most common disorders in middle-aged individuals.  Gastroenterologists have diagnosed several cases of IBS, and they argue that the disorder accounts for about 12% of all cases presented to the primary care providers.

Treatment goals for the patient

The treatment goal for Jordan will not primarily focus on easing the bowel complications but rather to soothe her stomachaches, pain, and bloating, which she claims to be associated with the IBS. Therefore, the ARNP should strive to attain the goal of symptom relief and improved quality of life for the patient. To ameliorate the symptoms, the care provider can advise the patient to exercise regularly while recommending appropriate antibiotics, probiotics, antispasmodics, and peppermint oil.

First-line and second-line drug therapy for IBS

The first-line therapy for IBS should be the modification of dietary habits. For instance, the ARNP should advise the patient to avoid foods that are known to be gas-producing and those that contain highly fermentable oligosaccharides, disaccharides, and monosaccharides, as well as polyols. Foods rich in that content are the most common aggravating symptoms of IBS. The initial treatment approach for IBS entails the nonpharmacologic management of the condition. The nonpharmacological management primarily focuses on lifestyle changes, particularly dietary changes, and foregoing foods that may worsen (Schmick, & Hornecker, 2017).

It is crucial to monitor diets and their respective symptoms to identify foods that are typically problematic. However, lifestyle changes may not completely improve the conditions, and it is recommended that second-line therapy be adopted immediately, and this involves the use of medications. However, medical treatment should focus on the predominant symptom of the condition. In this case, her treatment options should focus on relieving abdominal pain, bloating, constipation, and diarrhea. This implies that specific treatment options such as probiotics, antibiotics, tricyclic antidepressants, and selective serotonin reuptake inhibitors must be considered. The medications can modulate chloride channels and serotonin.

 

References

International Foundation for Gastrointestinal Disorders. (December 24, 2016). Treatments for IBS. International Foundation for Gastrointestinal Disorders, Inc. https://www.aboutibs.org/what-is-ibs-sidenav/treatments-for-ibs.html

Schmick, M., & Hornecker, J. (15, 2017). US Pharmacist. Irritable Bowel Syndrome: A Review of Treatment Options. US Pharm, 42(12):20-26. https://www.uspharmacist.com/article/irritable-bowel-syndrome-a-review-of-treatment-options

Pharmacology

Irritable Bowel Syndrome

Introduction.

Irritable bowel syndrome is an intestinal disorder which causes abdominal pains accompanied by stomach pains, constipation and diarrhea. (Drossman, Mayer, Camilleri & Whitehead 2018)). A woman who is 35 years old by the name Jordan is diagnosed having the disease because she experiences severe diarrhoea without blood stains but rather accompanied with cramps and the only way to relieve this is through defecation. Following the studies done on medical history, it is revealed that other signs of this disease include stomach issues, cholecystectomy and HTN. Jordan is working in an environmental department in the large house, and she usually avoids to consume cigarette and alcohol.

Epidemiology of irritable bowel syndrome.

According to Canavan, Card & West (2014), irritable bowel syndrome is a disorder commonly known to affect gastrointestinal functioning with high prevalence rates of about 10-15% in the area. Functional disorder describes a manner in which a condition shows the absence of structural and biochemical abnormalities when diagnosing symptoms of the disease. According to statistics, the information reveals that patients with mild IBS are 40%, 35% have moderate IBS, and 25% are suffering severely from IBS. Physicians are the only people capable of identifying the symptoms of IBS unlike other individuals and is commonly diagnosed by Gastroenterologists.

Treatment goals for Jordan.

The goals of treatment aim at improving the quality of life and relief of pain to achieve quality health improvements. The first goal is set to ease the bowel problems accompanied by cramps which are responsible for the discomfort of the woman. Secondly, the targeted pain to be relieved is stomach pains and bloating usually accompanied by this IBS.

The first line and second-line drug therapy

The first-line consideration is the modification of dietary habits which is done by avoiding the gas-producing foods and foods rich in high fermentable monosaccharides, disaccharides, oligosaccharides and polyols are known to worsen the symptoms of IBS. The non-pharmacological management of IBS is the initial treatment approach followed by the drug therapy for the individuals with predominant symptoms. This treatment is done following a specific strategy of limited evidence-based medicine responsible for the treatment of

irritable bowel syndrome (Greed & Guthrie, 2015).

A pharmacist has a role in educating and monitoring patients about the disorder, thus help them to understand more about the symptoms of IBS. The treatment has to be done at the individual level even if all patients experience the same symptoms of abdominal pains, diarrhoea and disordered defecation to focus on the predominant symptom. Combination of dietary interventions and treatments is useful in relieving abdominal pain, diarrhoea, bloating and constipation. Treatments include probiotics, tricyclic antidepressants, antibiotics, selective serotonin reuptake inhibitors, among other drugs.

To begin with, smooth muscle relaxants are useful in the treatment of intestinal cramping. Anti-diarrhoea medication is applied to reduce the frequency of bowel movements, thus aid in the improvement of consistency of stool. According to Greed and Guthrie (2015), antibiotics are also useful in the treatment of IBS since it alters the composition of the gut flora responsible for causing fermentation of the undigested carbohydrates responsible in constipation. Besides, there is low dose diarrhoea which works in the guts nervous system to reduce reaction to food and relief the emotional stress. Finally, laxatives are medicines designed to patients experiencing constipation as the predominant symptom (Vanuytsel, Tack & Boeckxstaen (2014).

 

 

References

Canavan, C., West, J., & Card, T. (2014). The epidemiology of irritable bowel syndrome. Clinical epidemiology6, 71.

Creed, F., & Guthrie, E. (2015). Psychological treatments of the irritable bowel syndrome: a review. Gut30(11), 1601-1609.

Drossman, D. A., Camilleri, M., Mayer, E. A., & Whitehead, W. E. (2018). AGA technical review on irritable bowel syndrome. Gastroenterology123(6), 2108-2131.

Vanuytsel, T., Tack, J. F., & Boeckxstaens, G. E. (2014). Treatment of abdominal pain in irritable bowel syndrome. Journal of gastroenterology49(8), 1193-1205.

Advanced Pharmacology

The diagnosis of IBS is dependable on whether a person has typical IBS symptoms. The general practitioner would assess a patient for the IBS having any of the symptoms below.

  • Having a stomach pain or experiencing a discomfort (abdominal pain).
  • Bloating
  • Changes in the habits of the bowel that may include constipation, frequent passing of stool and diarrhea.

The above will make the GP to consider a diagnosis especially when one experiences an abdominal pain that gets either comforted by the release of stools or that which connected to frequent diarrhea or when there is a change in the consistency of the stools (Halmos, Power, Shepherd, Gibson & Muir, 2014). The above should also be accompanied by other symptoms such as needing to strain when passing the stools or feeling the sense of urgency, bloating, tension or hardness in the stomach and pressing of the mucus from the back passage.

The diagnosis of the IBS can also be made by carrying out various tests on “red flag” a factor showing that an individual has more severe conditions that may include cancer. In this case, the symptoms may include weight loss that is unexpected and lumps that are swollen in the stomach of an individual or the back passageway. Also, in severe cases, the diagnosis can be made based on the bleeding of a person from back passage (rectum) or due to anemia (Ahl, Mikocka-Walus, Gordon & Andrews, 2013).

There are also other tests recommended for the IBS especially when a family has the history of ovarian or bowel cancer or when an individual is over sixty years and having an alteration in the bowel routine that have taken a period of six weeks and above. Here, the doctor will recommend the patient to have a colonoscopy to determine the abnormalities in the gut. In this diagnosis, the rectum and the large bowel get assessed by the use of an endoscope, inserted into the rectum.

References

Ahl, A., Mikocka-Walus, A., Gordon, A., & Andrews, J. M. (2013). Are self-administered or minimal therapist contact psychotherapies an effective treatment for irritable bowel syndrome (IBS): A systematic review. Journal of Psychosomatic Research75(2), 113–120. .

Halmos, E. P., Power, V. A., Shepherd, S. J., Gibson, P. R., & Muir, J. G. (2014). A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology, 146(1), 67-75.

Advanced Pharmacology

Irritable bowel syndrome affects 10 to 15 percent of the U.S. population to some degree. This condition is defined as abdominal pain and discomfort with altered bowel habits in the absence of any other mechanical, inflammatory, or biochemical explanation for these symptoms. Irritable bowel syndrome is more likely to affect women than men and is most common in patients 30 to 50 years of age(Ghoshal , & Shukla ,2018).

            Clinicians should focus on four major goals when treating IBS patients: (1) improve the individual symptoms of IBS (i.e. abdominal pain and discomfort, bloating, constipation, and diarrhea); (2) ameliorate the global symptoms of IBS (3) prevent complications of IBS which include unnecessary surgery, risky diagnostic procedures, and adverse medication side effects from polypharmacy; and (4) reduce the impact of IBS on individual patients by improving quality of life, and minimize the global impact on society by reducing health care costs(Dehkordi, &Solati 2017).

            ANTISPASMODIC AGENTS

Antispasmodic agents relax smooth muscle in the gut and reduce contractions. Dicyclomine (Bentyl) and hyoscyamine (Levsin) act through anticholinergic or antimuscarinic properties.  The anticholinergic effects of antispasmodics limit their use, especially in the long term.

            ANTIDIARRHEAL AGENTS

A systematic review9 of loperamide (Imodium) for the treatment of IBS found that it improved diarrhea symptoms. Loperamide slows intestinal transit, increases intestinal water absorption, and increases resting sphincter tone. Because loperamide does not cross the blood-brain barrier, side effects are less than other opioids, but it should be used with caution.

            ANTIDEPRESSANT

Antidepressants have been shown to relieve pain with low doses. The successful use of low doses supports a mechanism of action separate from the recognized psychiatric effects. It is thought that tricyclic antidepressants facilitate endogenous endorphin release and block norepinephrine reuptake, which leads to enhancement of descending inhibitory pathways blockage of the pain neuromodulator serotonin (Thomas & Luthin, 2015).

Tricyclic antidepressants may slow intestinal transit time and aid in the treatment of diarrhea. Studies showed that tricyclic antidepressants improve global symptoms, abdominal pain, and diarrhea, tricyclic and related antidepressants are not recommended for patient with predominant constipation (Thomas & Luthin, 2015).

 

References

 

Agrawal A., Whorwell P.J. (2017) Review article: Abdominal bloating and distention in functional gastrointestinal disorders – epidemiology and exploration of possible mechanisms. Aliment Pharmacol Ther 27:2–10

 

Thomas RH, Luthin DR. Pharmacotherapy. 2015 Jun; 35(6):613-30. Epub 2015 May 27.

Dehkordi AH, Solati K. Journal of Advanced Pharmaceutical Technology & Research. 2017 Apr-Jun; 8(2): 67-72

 

Ghoshal UC, Shukla R, Ghoshal U. Gut and Liver. 2017 Mar 15; 11(2): 196-208

Song KH, Jung HK, Kim HJ, Koo HS, Kwon YH, Shin HD, Lim HC, Shin JE, Kim

SE, Cho DH, Kim JH, Kim HJ, The Clinical Practice Guidelines Group Under the Korean Society of Neurogastroenterology and Motility. Journal of Neurogastroenterology and Motility, 2018 Apr 1; 24(2): 197-215

Yindra Isaac

Advanced Pharmacology

Irritable Bowel Syndrome (IBS) is a functional disorder that apart from leading to health deterioration it also reduces a patients’ quality of life. It is characterized by discomfort and uncontrollable pain with abnormal defecation (Eriksson, Andren and Eriksson, 2016)

Treating of IBS aims at relieving the pain caused by some of the symptoms so that the patient can continue to live a comfortable life. Eriksson, Andren and Eriksson, (2016), explains that some mild symptoms, at the beginning of the condition can be managed by adopting a healthy lifestyle, for example changing ones diet such as eating foods rich in fiber, incorporating a lot of fluids in the diet. In addition, living an active lifestyle and having enough rest.

On the other hand, pharmacological treatment methods such as laxatives aim at easing the patient’s process of defecation as it is associated with a lot of pain International Foundation for Gastrointestinal Disorders (2018). Such drugs either relax the small intestines (colon) to slow movement of waste of ease diarrhea by reducing the rate at which muscles contract which makes passing stool a less painful process.

According to the International Foundation for Gastrointestinal Disorders (2018), first line of treatment for the condition is obtaining the needed information regarding IBS and implementing certain lifestyle changes. If a change in lifestyle does not change, a patient can use Antispasmodics such as dicyclomine. However, it has limited reach in treating IBS but it greatly relieves pain associated with some symptoms. Other pharmaceutical medication is Anti-diarrheal agents such as Imodium which is effective in relieving symptoms of diarrhea. In general, laxatives can ease passing stool as well as relieve symptoms of constipation but should only be used as instructed and if possible, under strict supervision of a trained physician.

References

Eriksson, E. M., Andrén, K. I., & Eriksson, H. T. (2016). Non-Pharmacological Approach to Irritable Bowel Syndrome. Irritable Bowel Syndrome – Novel Concepts for Research and Treatment. doi:10.5772/66373

International Foundation for GastroIntestinal Disorders. (2018). Treatments for IBS. Retrieved from https://www.aboutibs.org/what-is-ibs-sidenav/treatments-for-ibs.html

Gretell Alfonso- Discussion 10

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Discussion 10

The epidemiology of Irritable Bowel Syndrome is unknown (Endo, Y., Shoji, T., & Fukudo, S. (2015). However, I believe that in Jordan’s case it is influenced by the patient’s history of gallbladder removal. The way this intestinal disorder is diagnosed is through patient symptoms. IBS symptoms are belly pain with relief of defecation, gassy, diarrhea which affects the large intestine only (Endo, Y., Shoji, T., & Fukudo, S. 2015). Treatment goals for 35 year old Jordan would be to alleviate the cramping, constipation and diarrhea episodes in order to live a normal life as best as possible. Also, educating the patient on the treatment they will receive and what to expect with IBS is one of the goals for this patient.

As far as first line therapy for IBS I would start Jordan with a first line medication therapy of Atropine and Hyoscyamine which will both help with cramping and diarrhea episodes. These medications need to be taken 30 minutes before a meal (Woo, T. M., & Robinson, M. V. (2016) pg.221). Both of these two medications will help with the diarrhea and constipation plus the gastrointestinal irritability that the patient might have. I would also explain to the patient that this condition doesn’t have a cure and all we will treat is the symptoms. Another detail I would add in the patients plan of care is dieting habits and the fact that part of the reasons why the diarrhea is occurring is because of the gallbladder removal history. As far as diet I would recommend the patient to eat no fatty or greasy foods and more of fibers to improve GI health and other symptoms in general of IBS.

Second line of therapy for IBS would be Dicyclomine in case the first line therapy doesn’t work for Jordan (Woo, T. M., & Robinson, M. V. (2016) pg. 221). I would also add to the second line therapy a prebiotic and probiotic which might also help the patient have a better defecation experience. Dicyclomine is a medication that will decrease the bowel movements and stomach cramping. The prebiotic and probiotics will help by using the natural fibers and making the stool easier to pass through the rectum while defecating (Irritable Bowel Syndrome (IBS). (2017).

References

Endo, Y., Shoji, T., & Fukudo, S. (2015). Epidemiology of irritable bowel syndrome.

Retrieved March 10, 2020, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4367204/

Irritable Bowel Syndrome (IBS). (2017). Retrieved March 10, 2020, from

syndrome

Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for advanced practice nurse

prescribers (4th ed.). Philadelphia, PA: F.A. Davis Company.

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