1. Treatment Arvin M. Aningalan

2. Treatment Options Patient counseling and dietary alterations Diarrhea – Stool-bulking agents – Antidiarrheal Agents – Serotonin Receptor Antagonists Constipation – Serotonin Receptor Agonist – Stool-bulking agents Abdominal Pain – Antispasmodics – Antidepressant Drugs – Selective Serotonin Reuptake Inhibitors Antiflatulence Therapy Chloride Channel Activators

3. Stool-Bulking Agents High fiber diets and bulking agents Increased stool bulk Relieves diarrhea and constipation Reduce perception of rectal distention Decrease colonic transit times Psyllium produced greater improvements in stool pattern and abdominal pain than bran

4. Antispasmodics Anticholinergic drugs Provides temporary relief for symptoms such as painful cramps related to intestinal spasms Inhibit gastrocolic reflexes Given 30 minutes before meals Side effects include xerostomia, urinary hesitancy and retention, blurred vision and drowsiness. Synthetic anticholinergics reduces these side effects.

5. Antidiarrheal Agents Peripherally acting opiate based agents = initial therapy of choice for IBS-D Increase colonic contractions Delay in fecal transit Increase in anal pressure Reduction in rectal perception. Taken before anticipated occurence of events which are known to cause diarrhea

6. Antidepressant Drugs Tricyclic Antidepressants (TCA) Slows jejunal migrating motor complex transit propagation Delays orocecal and whole gut transit SSRI Accelerates orocecal transit (useful for IBS-C) Blunts perception of rectal distention Reduces magnitude of gastrocolic response

7. Antiflatulence Therapy Avoidance of flatogenic food Proper diet (eat slowly, refrain from chewing gum and drinking carbonated beverages) Pancreatic enzymes reduce bloating, gas and fullness.

8. Serotonin Receptor Antagonist 5-HT3 receptor antagonist (Alosetron) reduces perception of painful visceral stimulation Induces rectal relaxation Increases rectal compliance Delays colonic transit However, side effects include a possible occurence of ischemic colitis.

9. Serotonin Receptor Agonist Stimulation of 5-HT4 receptor stimulates peristalsis Relieves constipation but diarrhea is a major side effect.

10. Chloride Channel Activators Chloride secretion induces passive movement of sodium and water into the bowel lumen and improves bowel function.

11. Going back to our patient... Our patient presented with diarrhea and crampy hypogastric pain. If indeed our patient has irritable bowel syndrome, we can give: Diarrhea – Stool-bulking agents – Antidiarrheal Agents – Serotonin Receptor Antagonists

12. Going back to our patient... Our patient presented with diarrhea and crampy hypogastric pain. If indeed our patient has irritable bowel syndrome, we can give: Abdominal Pain – Antispasmodics – Antidepressant Drugs – Selective Serotonin Reuptake Inhibitors