Functional Bowel Disorders for the Colorectal Surgeon
Although most patients are referred to colorectal surgeons for consideration of possible surgical therapy, many of these patients have an existing functional bowel disorder. It may be the patient’s primary concern or a factor complicating other medical il
- PDF / 966,637 Bytes
- 14 Pages / 595.28 x 790.87 pts Page_size
- 98 Downloads / 223 Views
Key Concepts • Irritable bowel syndrome (IBS) may arise from motility disorders, visceral hypersensitivity, and/or dyssynergy of the brain-gut relationship. • Treatment for IBS often involves a combination of diet and medications. • Chronic pelvic pain has multiple names, causes, anatomic and physiologic features. Similarly treatment options are numerous, but algorithms can be followed.
Introduction Functional syndromes like IBS and chronic pelvic pain are a set of disorders that have roots in physiologic causes, but often include a strong psychological component. Chronic conditions like these are labeled “functional” when organic or anatomic causes have been ruled out. Most syndromes like these are poorly understood by gastroenterologists and colorectal surgeons who are generally more comfortable treating visible disease with specific procedural interventions. It is paramount that colorectal surgeons understand the symptoms, diagnostic criteria, and treatment strategies of these disorders, especially with respect to the role of medical management and physical therapy. These conditions can be vague and unremitting, causing frustration for the provider to definitively treat and for the patient to find relief permanence.
Irritable Bowel Syndrome Epidemiology Although IBS is the most commonly diagnosed gastrointestinal (GI) disorder, most colorectal surgeons do not have a good grasp of the intricacies associated with this common problem. It affects approximately 3–22 % of the population [1–3] depending on which criteria is
used for measurement. IBS is diagnosed based on clinical symptomatology and is 1.5–2 times more prevalent in women versus men with women having more complaints of abdominal pain and constipation and men complaining more of diarrhea [4].
Pathophysiology The pathophysiology of IBS is not well understood. It was initially thought to correlate with psychiatric illnesses, but since that time, other potential relationships have emerged. These include motility disorders, visceral hypersensitivity, and the notion of the brain-gut syndrome. More recently, other concepts like immune activation, genetic predisposition, altered intestinal permeability, history of acute gastrointestinal infection, and the human microbiome have been potentially implicated in the cause of IBS [5, 6]. It is interesting to note that more than 60 % of the human fecal load consists of bacteria, and alterations in the body’s bacteria quantitatively or qualitatively may either lead to or treat the symptoms of IBS. The natural history of IBS is generally one of a chronic, relapsing disease. A mere 2–5 % of patients are ultimately diagnosed with alternative organic GI disorders and only 12–38 % of cases improve over time [5]. However, it has been noted that in patients who develop symptoms of IBS after a gastrointestinal infection, their symptoms usually resolve after only 5–6 years [7]. It is most likely that IBS is caused by a combination of factors and may require a blend of therapeutic options.
Diagnosis and Symptoms Patients with I
Data Loading...
