IRRITABLE BOWEL SYNDROME

Irritable bowel syndrome - a functional gastrointestinal disorder manifested a combination of

violations of the act of defecation with a pain syndrome in the absence of organic changes in the
intestine.

At the international expert workshop in Rome (1988) was negotiated uniform definition of
irritable bowel syndrome (Rome criteria ") - a set of functional disorders of more than 3 months,
including abdominal pain (usually decreases after the act of defecation) and dyspeptic disorders
(flatulence , rumbling, diarrhea, constipation, or alternation, a feeling of incomplete bowel
movement, compelling urge to defecation).

In developed countries, in the adult population of irritable bowel syndrome develops with a
frequency of 14 to 48%. Women suffer from this disease in 2 times more often than men. It is
believed that functional disorders of the intestine affected 30-33% of children.

Etiology and pathogenesis

Irritable bowel syndrome - polietiologicheskoe disease. An important role in its development

assign neuro-psychological factors. Found that the syndrome of irritable bowel evacuation
function is disrupted as a thin and large intestine. Changes in the motor function of the intestine
may be related to the fact that these patients increased the sensitivity of receptors bowel wall to
stretch, causing pain and dyspeptic disorders arise from them at a lower threshold of excitability
than healthy people. A role in the formation of irritable bowel syndrome in children are
particularly food, in particular, insufficient intake of vegetable fiber. Significant importance is
attached to the loss of a conditioned reflex for defecation and asynergy pelvic diaphragm muscle
structure, which leads to violations of evacuation of bowel function.

Irritable bowel syndrome can develop secondarily in other diseases of digestive system: gastritis,
duodenitis, gastric ulcer and duodenal ulcer, pancreatitis, and others may have a role to play
carried over DCI, gynecological diseases in girls and pathology of the urinary system.

Clinical picture

Depending on the clinical manifestations are three variants of irritable bowel syndrome:
primarily diarrhea, primarily constipation and primarily with abdominal pain and flatulence.

Patients with a predominance of the main symptom of diarrhea - loose stools, sometimes with
an admixture of mucus and remnants of undigested food, usually 4 times a day, usually in the
morning, after breakfast, especially with emotional tension. Sometimes there are compelling
urge to defecation, flatulence.

In the second version of the irritable bowel syndrome, the delay in the chair (up to 1-2 times
per week). A number of children the act of defecation is regular, but is accompanied by
prolonged straining, a feeling of incomplete bowel movement, change shape and character of
stool (hard, dry, like sheep, etc.). In some children, constipation followed by diarrhea lasting
with subsequent resumption of constipation.

Patients with a third variant of irritable bowel syndrome dominated by cramping or dull,
pressing, arching abdominal pain, combined with its swelling. The pains occur or intensify after
a meal, with stress, before defecation and disappear after a discharge of gases. In addition to the
local manifestations in patients having frequent headaches,

feeling a lump in the throat when swallowing, vasomotor reactions, nausea, heartburn, belching,
heaviness in the epigastric region, etc. The hallmark of irritable bowel syndrome - the variety of
complaints. Note the discrepancy between the duration of the disease, the variety of complaints
and good appearance of sick children, physically normally developed.

Diagnosis and differential diagnosis

Irritable bowel syndrome diagnostics built on the principle of exclusion of other diseases of the
intestine often using functional, instrumental and morphological study.

The differential diagnosis of conduct with endocrine diseases (hypothyroidism, hyperthyroidism

- when locked, with Vipom, gastrinomoy - if you have diarrhea), a syndrome of impaired
intestinal absorption (lactase deficiency, celiac disease, etc.), gastrointestinal allergy, acute and
chronic constipation, etc.

Treatment

Treatment of patients with irritable bowel syndrome based on the normalization of the regime
and diet, psychotherapy, prescription drugs. To normalize the status of central and peripheral
nervous system, as well as intestinal motility prescribe exercise therapy, massage, physiotherapy
and reflexology. The drug of choice of drugs are cisapride, loperamide, trimebutin (debridat)
pinaveriya bromide (di-Zetel) mebeverin (dyuspatalin ) etc.

With irritable bowel syndrome with diarrhea has a good effect diosmektit (smectic) and
possesses a strong adsorption and tsitoprotek-effective properties. Apply as pre-and probiotics to
restore the normal microflora [enterol, bifidobacteria bifidum, bifidobakte-Rhee bifidum +
activated charcoal (probifor), lactobacilli atsidofil-WIDE + kefir fungi (atsipol) hilak-forte,
lineks and others], antibacterials (Intetriks, nifuroxazide, furazolidon, metronidazole, etc.),
vegetable preparations (brusniver and elekasol), reduce bloating, rumbling in the abdomen,
mucus in the stool.

With irritable bowel syndrome, with flowing locks, appoint ballast substances (bran, flax seed,
lactulose, etc.).

According to the testimony appoint: spasmodicals (Drotaverine, papaverine hydrochloride),

holinoblokatory [butilbromid Hyoscine (Buscopan), prifiniya bromide (riabal)], drugs, normalize
the state of the central and autonomic nervous system (the choice of drug depends on the
identified patient affective disorders), tranquilizers ( diazepam, oxazepam), antidepressants
(amitriptyline, azafen), neuroleptics (thioridazine) in combination with nootropics-mi and
vitamins of group B. The optimal treatment results can be obtained by the joint observation of
the patient and a pediatric neuropsychiatrist.

Forecast

Weather favorable.