The irritable bowel syndrome 

Notes by dr Claudio Italiano

The functional bowel's diseases are a group of patologies more frequently reflected in the colic pathology, and, because of their high incidence, constitute an extremely important social question. Of course they are the most widespread consultation at the outpatient specialist in gastroenterology (50-70%) and they are one of the main reasons for absenteeism from work in the industrialized countries.Particularly people between 20 and 40 years are affected by colic pain, with slight prevalence of the female sex, but it's not exceptional occurrence in childhood.	.
On the contrary, it is rare that arise after 50 years. Bowel irritable syndrome is caracterized by intestinal motility disorders or by an alterated absorption and secretion colon fuctions. The terms "spastic colitis," or "colitis" are improper, because they would be to signify the presence of a colic infection or inflammation, which is totally absent. However recent studies have correlated this syndrome to a colic inflammatory condition, but it would be more accurate to speak of " a lymphocytic colitis".	.
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 If you want to give a definition, can say that the intestine is equipped to a muscle that contracts, ie there is a propulsion and a segmentation activity; the first one pushes the lumen contents and the other ones lows down, creating segments. Normally in the healthy subject, this motion is not perceived, it's coordinated and takes place along a time that, from the mouth to the rectum, is beyond 96 hours in general. It happens, however, that some individuals, or for an increase of wave propagation with a large amplitude and energy, or for a particular sensitivity to gaseous distension of viscera, feel pain, a caracteristic colic pain, that "goes and comes back", increases and decreases, and they feel the bends moving, due to the visceral moviments; they report the doctor to feel inside a "washing machine (!)", because this viscera movement and the swelling that goes from right to left iliac side, is often painful and spastic (sign of the colic rope). The symptoms can be caused by ingestion of food or cold or gassed drinks.They cause abdominal noise like a snake that moves!
  There are an abdominal swellings extended to the whole colic area or located at only one side. If propulsive activity prevails, the food is, well, as quickly pushed through the intestines, causing gas, swelling and diarrhea. In other cases, however, the opposite happens and segmenting activity prevails so that the contents of the lumen dries, the food transit slows and feces become tough and dry. The disorders of intestinal transit are caracterized by different aspects: constipation more or less painful, alternating constipation and diarrhea, morning diarrhea, or after a meal which is not accompanied by painful events, simple issue of filaments and tapes of mucus. Nobody yet knows the exact causes of the Irritable Bowel syndrome. We know that the core activity of the colon, in conditions of normality, is represented by absorption of water and by forming consisting faeces. At colic lumen two phenomena are important for the formation of normal stool: 
 
1) the absorption of water, sodium and chlorine, and a modest secretion of potassium; 
2) the processes of fermentation and rot, made by bacteria which are rappresented by the usual microbiological intestinal flora.
3) It is understandable, therefore, that an alteration of the same processes lead to an accelerated transit with diarrhoea or to a reduced transit with constipation and rot or, finally, to the alternation of costipation and diarrhoea , due to the development of irritant action of patogenetic bacteria. Other symptoms are also halitosis (faecaloid smell in the variety with constipation), nausea, vomiting, belching, anorexia, meteorism, flatulence, headache, dizziness, palpitations, migraine.

Irritable bowel syndrome aetiopatogenetic causes

Alteration of nerves that control muscle contractions or intestinal sensitivity
Genetic factors. If parents are affected by IBS, you can find, in the same family, for example, ill children and so the twins homozygous
Increase in cells that produce 5HT. These release mediators that increase the motility (IL s, NO, histamine, poteasi by stimulus with the nerve cells of plexi mioenteric).
Correlation with the sex hormones, progesterone slows motility: in women is more common, and they account for two thirds of people suffering from this disease; researchers believe that hormonal changes play an important role. For many women, in fact, symptoms increase during menstrual periods.
Stressful events. In any case, the stress can only aggravate the symptoms but never causarli psychosomatic The profile of this type of patient is of various kinds. The patient suffers from IBS. is a meticulous obsessive, faecal manic, hysterical with a tendency to locate various types of pain, or depressed, delirious hypochondriac, often fobicous against cancer. Naturally if they question these patients as there is a basic characteristic of stress condition. Many patients with irritable colon are exchanged (and operated) for individuals suffering from appendicitis 
Gastroenteriti in 7-32% of subjects after an episode of acute diarrhoea (gastroenteritis) may give rise to the IBS
 Antibiotics whose intake leads to the destruction of normal bacterial flora
Laxatives as well as some anti-diarrhoea drugs can cause "irritation" of the colon and contribute to the problem. 
Food intollerance, consumption of dairy products, rubber or sweets without sugar, for intolerance to sugar (lactose) in dairy products or artificial sweetener sorbitol, . In this case we recommend you to submit to breath tests lactose


Who is affected by I.B.S.?
 

Not to confuse some signs that are typical of other more serious diseases, in 1998 a multinational committee of experts in Rome, has created a suitable test to accurately diagnose the Irritable Bowel Syndrome.
Diagnostic Test ROME II:
The IBS affected patients are caracterized by:
In the previous 12 months, for at least 12 weeks (not necessarily consecutive) they have suffered of abdominal pain or intestinal discomfort and at least 2 of the following characteristics:
Symptoms essential
A pain which calms with evacuation
It is associated with a change in frequency of evacuations
Pain is associated with a change in the consistency of stools
Symptoms additional
Alterated frequency of evacuations (less than three per week or more than three per day)
Alterated consistency of the faeces (harsh / goat, springs / liquid)
Disorders of the evacuation (effort, urgent stimulus, a feeling of incomplete evacuation)
Presence of mucus in the feces.
Swelling or feeling of abdominal distension
E’ chiaro, perciò, che se compaiono dei sintomi più importanti, segni di allarme, essi  NON sono tipici della Sindrome del Colon Irritabile:

It's clear, therefore, that if symptoms appear more important, like warning signs, they are NOT typical  for IBS, I.E.:
A pain that disturbs sleeping
A diarrhoea which wakes or interferes with sleep
a Bloody faeces (visible or hidden)
a weight loss
Fever
Abnormal physical examination


Investigations you need to exclude other diseases and to diagnose IBS
Finding antigliadina antibodies, anti-endomisium, anti transglutaminase: This test is used to monitor the presence (positive) antibody AGA to check for Coeliac disease (gluten intolerance).
Breath tests to investigate the presence of Helicobacter pylori;
Clisma radiological examination of the small intestine for control of the small intestine. It can be considered a nuisance examination because the contrast fluid is inserted through a sondino nose.
Colonoscopy to exclude organic causes such as tumors or diverticula.
Ultrasound method to control home, size and morphology of internal organs.
Examination of the faeces, should check for the presence of harmful parasites and / or mycetes
Thyroid hormones, check the level of thyroid hormones to exclude hyperthyroidism
Tests for the detection of food intolerance, should be to determine the presence of allergies and / or food intolerances. And it's preferable to undergo tests I.B.A. (Food bioaematological tests) rather than to Vega testing.

Therapy.
In most cases you can successfully take control of the IBS lighter symptoms lighter, learning to control stress and changing your diet and your lifestyle. But if your symptoms are severe or moderate, you may need an extra help.
For the constipation IBS variety your doctor may suggest to enrich your diet with supplements of fiber such as psyllium or methyl-cellulose, or lattulose; so as he can prescribei anti-diarrhoea drugs such as loperamide (opioids!) to stop diarrhoea . In some cases, it could recommend the anticholinergics or modulators of calcium channels that regulate nervous system, mitigate the intestinal painful spasms. If your symptoms include pain and depression, on the other hand, your doctor may suggest a drug like as a tricyclic antidepressant selective serotonin reuptake inhibitor (SSRIs). These drugs help to alleviate depression as well as inhibit the activity of neurons that control the intestine. For diarrhea and abdominal pain, are given tricyclic antidepressants such as amitriptyline and imipramine. The side effects of these substances include, normally, insomnia, nausea, dry mouth and constipation (sometimes But the side effects can be much worse). The selective reuptake inhibitor of serotonin such as fluoxetine (active ingredient of the famous Prozac) or paroxetine, on the contrary, they can help in case of depression, abdominal pain and constipation. Not always medicines, SSRIs are effective.
Selective reuptake inhibitors that are prescribed
Fluoxetine
Sertraline
Paroxetine.
 

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