The irritable bowel syndrome

(Colitis, spastic colitis)

. Petty Pathophysiology of the syndrome, with apologies to the experts!

Functional bowel diseases are a group of disorders most frequently found in colonic disease, and for their high incidence, constitute an extremely important from a socio-economic, as stated keeping in mind that they are the most common cause of consultation at the clinic specialist in gastroenterology (50-70% of cases) is one of the main reasons for absenteeism from work in industrialized countries. Are affected mainly people between 20 and 40 years, with slight predominance of females, but their appearance is not exceptional in childhood. Instead, they rarely occur after 50 years. The irritable colon and altered intestinal motility or there is a disturbance of function of absorption and secretion of the colon. The terms of "spastic colitis" or "colitis" is improper because starebbero signifying the presence of an infection or inflammation of the colon, but that is entirely absent, although there are recent studies that relate this condition to a " inflammatory state "of the colon, but it would be more correct to speak of" lymphocytic colitis ", but it is an entity of relevance nosography dell'anatomopatologo.

Wishing to give a definition, we say that the gut has its own musculature is contracted, that there is an activity propulsion distance and segmentation, the first pushes the contents of the UME and the other slows it down, creating concamerazioni. Normally in healthy subject, this motility is not perceived, is coordinated and takes place in a time that goes from the mouth to the rectum than 96 hours in general. Happens, however, that some individuals, either by an increase in propagating waves that have a large amplitude and energy, you want a particular sensitivity to gaseous distension of the viscera, feel pain of colic type, that "comes and goes" , increases and decreases, and feel the curves "move", apply to visceral symptoms and report to the doctor to feel inside as if they had "a kind of washing machine (!)", meaning thereby the movement of the viscera and the swelling from right to left iliac fossa, which is often painful and spastic (string sign of colic). Symptoms may be caused by ingestion of food or cold drinks and accompany borborigni, abdominal rumblings and noises. There bloating extended to all the scope of colon or localized in one place. If you prevail, therefore, the propulsive activity, the food is, well, more quickly pushed through the intestines, causing gas, bloating and diarrhea. In other cases, however, the opposite occurs and prevails segmentante activity, so that the contents of the lumen, is dehydrated, the food passage slows, and stools become hard and dry. The disorders of transit of intestinal contents are playing different aspects: more or less painful constipation, alternating diarrhea and constipation, diarrhea morning or after meals is not accompanied by painful events, simple emission of filaments and ribbons of mucus. No one yet knows the exact causes of irritable bowel syndrome. We know that the fundamental activity of the colon, in normal conditions, is represented by the absorption of water and the formation of semi-solid stool. In the colon two phenomena are important for the formation of normal stool: 1) the absorption of water, sodium and chlorine, and a moderate secretion of potassium, 2) the processes of fermentation and putrefaction, produced by bacteria which constitute the normal intestinal microbial flora. It is understandable, therefore, as an alteration of these processes result in accelerated transit or with diarrhea or reduced transit constipation with and without rotting or, finally, alternating constipation and diarrhea for an ave the concomitant development of putrefactive processes el ' irritating action of microorganisms. Other symptoms, finally, have halitosis (fecaloide of breath odor in species diversity with constipation), nausea, the vomiting, belching, anorexia, bloating, flatulence, headache, dizziness, palpitations, migraine.

Etiological causes of S. irritable bowel.



· Alteration of nerves that control muscle contractions or the sensitivity of the intestine

° Factor genes. If you S.I.I. family, eg. in parents, children may become ill, so the twins

· Increased 5HT-producing cells. This release mediators that increase the motility (IL s, NO, histamine, poteasi stimulation with cells of myenteric nerve plexus).

° linking sex hormone, progesterone slows motility: is more common in women, they account for two thirds of people with this disease, the researchers believe that hormonal changes play an important role. For many women, symptoms increase during the menstrual periods.

· Events stressful. In any case, the stress can only aggravate the symptoms but never caused any psychosomatic profile of this type of patient is of various kinds. The patient S.I.I. is a meticulous obsessive maniac stool, hysterical with a tendency to locate various types of pain, or depression, delusional hypochondriacal, phobic often against cancer. What is certain is that if you interrogate these patients can be seen as basic characteristic of a stress condition. Many patients with irritable bowel syndrome are exchanged (and operated) for individuals suffering from appendicitis ..

· Gastroenteritis in 7-32% of patients after an acute episode of diarrhea, (gastroenteritis) can give rise to the Irritable Bowel.

· Antibiotics whose recruitment leads to destruction of normal bacterial flora

· Laxatives as well as some anti-diarrheal drugs can cause "irritation" of the colon and contribute to the problem.

· Food intolerance, consumption of dairy products, sugar-free gum or candy,: intolerance to sugar (lactose) in milk or sweetener sorbitol artificiale.In this case we recommend to submit to breath tests to lactose

Who is affected by S.I.I.?

Not to confuse some signs that are typical of other major diseases, in 1998, a multinational committee of experts in Rome, has created a suitable test to accurately diagnose the irritable bowel syndrome.
ROME II Diagnostic Test:
The patient S.I.I. must have had:

· In the previous 12 months for at least 12 weeks (not necessarily consecutive) of abdominal pain or discomfort with at least two of the following characteristics:

Essential symptoms

Regresses evacuation
Onset associated with a change in frequency of bowel movements
Onset associated with a change in stool consistency
Additional symptoms

Altered bowel frequency (less than three weeks to three or more per day)
Altered stool consistency (hard / goat poltacee / liquid)
Evacuation disorders (stress, urge urgency, sensation of incomplete evacuation)
Presence of mucus in the stool.
Bloating or feeling of abdominal distension

It 'clear, therefore, that if major symptoms appear, warning signs, they are not typical of irritable bowel syndrome:

Pain disturbing sleep
Diarrhea that awakens or interferes with sleep
Blood in stool (visible or occult)
Weight Loss
Fever
Abnormal physical examination
Investigations to be performed to rule out other diseases and diagnosis of IBS

Antigliadin antibodies, anti-endomysial and anti transglutaminase: This test serves to check the presence (positive) AGA antibodies that indicate celiac disease (gluten intolerance).
Breath test for the presence of Helicobacter pylori;
Small bowel barium radiography for the control of the small intestine. Can be considered a troublesome question because the contrast is inserted via a tube through his nose.
colonoscopy to exclude organic causes such as, for example, tumors or diverticula.
ultrasound method to monitor location, size and morphology of internal organs.
stool sample, should check for the presence of harmful parasites and / or fungi
thyroid hormones, control the level of thyroid hormones for ecludere so any malfunctions.
tests for the detection of food intolerance, should be to establish the presence of allergies and / or intolerances. It 'better to undergo tests I.B.A. (Surveys bioematologiche foods) rather than the Vega test.
Therapy.

. In most cases you can successfully control the symptoms of irritable bowel lighter learning to control stress and changing your diet and your lifestyle. But if your symptoms are moderate or severe, you may need extra help.

For S.I.I. with constipation your doctor may suggest to enrich your diet with fiber supplements such as psyllium or methylcellulose, or lactulose; so how can prescribe anti-diarrheal drugs (OTC) derivatives such as loperamide (opioids!) to fight diarrhea . In some cases, it may advise the anticholinergic or calcium channel modulators that certain activities affecting the nervous system, relieve painful bowel spasms. If your symptoms include pain and depression, instead of, your doctor may recommend a tricyclic antidepressant drug or a selective serotonin reuptake inhibitor (SSRI). These medications help relieve depression as well as inhibit the activity of neurons that control bowel. For diarrhea and abdominal pain are listed tricyclic antidepressants such as imipramine and amitriptyline. Side effects of these substances include, usually, insomnia, nausea, dry mouth and constipation (sometimes, however, side effects may be worse). The selective serotonin reuptake inhibitors such as fluoxetine (the active ingredient of the famous Prozac) or paroxetine, in contrast, can help in cases of depression, abdominal pain and constipation. Not always the SSRIs are effective medicines.

Selective reuptake inhibitors which are commonly prescribed

Fluoxetine
Sertraline
Paroxetine.

personal notes from dr. Italiano Claudio

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