Academic journal article International Journal of Child Health and Human Development

Adolescence and Gastrointestinal Disorders

Academic journal article International Journal of Child Health and Human Development

Adolescence and Gastrointestinal Disorders

Article excerpt

Introduction

Gastroenterology is the study of the digestive system and its disorders named after three ancient Greek words: gaster (gen.: gastros) (stomach), enteron (intestine) and logos (reason). The field in question include the organs from the mouth to anus.

Irritable bowel syndrome

The Rome III diagnostic criteria for irritable bowel syndrome (IBS) includes recurrent abdominal pain or discomfort at least three days per month in the last three months associated with two or more of the following: 1) improvement with defecation, 2) onset associated with a change in the frequency of stool, 3) onset associated with a change in form (appearance) of stool (1). Prior to making the diagnosis of IBS, there should be no clinical evidence of an organic cause.

IBS is divided into three general categories: IBS constipation predominant (IBS-C), IBS diarrhea predominant (IBS-D), and a mixed or alternating stool pattern (IBS-M).

Visceral hypersensitivity is a term used when describing functional abdominal pain. Anorectal manometry is a test that uses a catheter with pressure sensors to detect both anal sphincter and rectal pressure. A balloon is attached to the tip of the catheter and used to distend the rectum, simulating the distention caused by the descent of stool into the rectal vault. Studies have shown that patients with IBS have decreased thresholds for sensation and discomfort when the balloon is inflated. This evidence suggests that patients with IBS have a hypersensitive enteral nervous system leading to more intense abdominal discomfort (2).

Previous gastrointestinal infection (viral, bacterial or parasitic) may predispose patients to postinfectious IBS. Typically, these patients have a better prognosis in regards to symptom resolution. Research suggests that enteral flora plays a pivotal role in the development of symptoms associated with IBS, especially IBS-D.

Epidemiology

IBS is a debilitating disorder that is estimated to cost 1.35 billion dollars in the United States. Up to 15 percent of the population in North America meets the criteria for IBS. An estimated 25 to 50 percent of referrals to gastroenterologists are for patients with IBS. Women outnumber men 2:1, especially for IBS-C (3).

Differential diagnosis

A thorough history and physical exam can usually lead to an accurate diagnosis of IBS without ordering expensive and potentially invasive testing. Specific concerns identified during the office visit (i.e. weight loss, focal abdominal pain, hematochezia) should prompt further investigation into other possible etiologies for the patient's symptoms.

Management

IBS affects not only the patient, but the family as a whole. In order to effectively manage symptoms of IBS, the patient, including the family, must be accepting of the diagnosis. Because genetics plays a role, it is not unusual to learn of other family members sharing a diagnosis of IBS. It is tempting for the clinician to "rule-out" other disorders by ordering a multitude of tests. Testing can be invasive, expensive, unnecessary and avoidable if the time is taken to obtain a complete and thorough history and physical examination. Understanding the specific triggers that elicit symptoms is central to treating this condition.

Pharmacologic treatment should be tailored towards the individual's symptoms. Given that an imbalance of intestinal flora may lead to symptoms of IBS, probiotic therapy has been found to be beneficial. Even more encouraging, the use of a two week course of rifaximin, a non-absorbable antimicrobrial agent, has been shown to be efficacious in IBS without constipation and with long standing symptom resolution. More importantly, the drug itself is well tolerated with few adverse reactions (4).

Narcotics should be avoided in patients with IBS. Narcotic bowel syndrome is the result of narcotic use to treat symptoms of IBS subsequently leading to worsening symptoms and likely narcotic dependency. …

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