1. COLONUL IRITABIL
Boală funcţională caracterizată prin tulburări de tranzit, ce constă în general din alterananţa diareei cu constipaţia, dureri abdominale difuze (crampe), uneori emisia de mucus.
Nu fac parte din tablou: rectoragia, anemia, scăderea ponderală

2. COLONUL IRITABIL TABLOU CLINIC:
dureri abdominale: frecvent caracter colicativ, sau discomfort abdominal, simptome ce dispar în perioadele de relaxare, concediu.
tulburări de tranzit: caracteristică alternanţa diaree constipaţie; scaune sub formă de schibale acoperite cu mucus; diaree la emoţie, matinală.
emisie de mucus fără sânge
balonarea frecventă, ameliorată de emisia de gaze.

3. COLONUL IRITABIL-DIAGNOSTIC:
 Implică excluderea bolilor organice ale colonului!
CRITERIILE MANNING:
dureri abdominale care cedează după emisia de scaune
scaune ce devin mai frecvente şi mai moi în prezenţa durerii
balonare, distensie abdominală
senzaţia de evacuare incompletă a rectului
eliminarea de mucus la scaun
carecterul imperios al defecaţiei.

4. COLONUL IRITABIL-DIAGNOSTIC:
CRITERIILE ROMA:
-simptome continue sau recurente de:
 durere continuă sau discomfort care cedează la defecaţie şi/sau asociată cu modificări în frecvenţa scaunului, consistenţa scaunului
 şi două sau mai multe din următoarele pt. cel puţin un sfert din ocazii sau zile:
-frecvenţa scaunului modificată, forma scaunului alterată, pierderi de mucus, balonări sau senzaţie de distensie abdominală

5. IBS: Rome II criteria (2000)
COLONUL IRITABIL-DIAGNOSTIC:
IBS: Rome II criteria (2000)
At least 12 weeks or more, which need not be
consecutive, in the preceding 12 months of abdominal
discomfort or pain that has two out of three features:
(1) Relieved with defecation; and/or
(2) Onset associated with a change in frequency of stool; and/or
(3) Onset associated with a change in form (appearance) of stool.

6. IBS: Rome II criteria (2000)
COLONUL IRITABIL-DIAGNOSTIC:
IBS: Rome II criteria (2000)
Symptoms that cumulatively support the
diagnosis of IBS:
Abnormal stool frequency;
Abnormal stool form (lumpy/hard or loose/watery stool);
Abnormal stool passage (straining, urgency, or feeling of incomplete evacuation);
Passage of mucus;
Bloating or feeling of abdominal distension.

7. COLONUL IRITABIL DIAGNOSTIC PARACLINIC:
anuscopie, rectoscopie, colonoscopie, irigografie – pt. excluderea patologiei organice de colon.
 gastroscopie – excluderea suferinţei gastrice
 ecografie abdominală şi pelvină – pt. patologia pancreasului, colecistului, organelor genitale.
 evaluarea radiologică a intestinului subţire sau enterosopie – pt. patologia organică enterală.

8. COLONUL IRITABIL DIAGNOSTIC DIFERENŢIAL:
Neoplasmul anorectal şi de colon
Boli inflamatorii colonice (RUH, BC)
Diverticuloza colonică şi diverticulita
Deficitul de lactază
Dispepsia funcţională.

9. COLONUL IRITABIL TRATAMENT: dificil datorită componentei psihice.
1.Dietetic: se evită alimentele care produc simptome; în caz de constipaţie, dietă bogată în fibre +/- Forlax.
2. Medicamentos:
-antidiareice: Smecta, Imodium.
-antispastice: Spasmomen, Debridat, Ditecel, No-Spa; se caută preparatul cel mai eficient pentru pacient.
-sedative: Hidroxizin, Rudotel, psihoterapia.

10. COLONUL IRITABIL

11. IBS: Patient's concerns
DOCTOR
What is IBS?
Do I have
cancer?
I can't lead
a normal life
I have this
pain in my
abdomen
Where is
the toilet?
Can it be
treated?
A questionnaire was sent to people suffering from IBS (Dancey & Backhouse, 1993). They were asked how having IBS affected their lives. These are some of the findings.
The vast majority of sufferers complained that IBS was not explained fully enough to them - in some instances the sufferers did not even know what IBS meant. At the time of diagnosis, most had not heard of IBS. People wanted information about the condition and how to cope with it.
Some people were afraid that their symptoms were due to other more serious disease such as cancer or severe ulcerative colitis.
Sufferers reported that IBS affected their work - three-quarters said they had been absent from work due to IBS. Nearly half of sufferers said that having IBS affected their sex lives.
IBS sufferers felt isolated, over half knew no one else with IBS. Most said they did not talk about IBS to other people and some made great efforts not to let anyone know about their problems. Even when in pain, sufferers tried to hide their distress.
Nearly 70% of sufferers said that travel was restricted because of the frequent need to find a toilet. Concern about getting to a toilet could keep sufferers housebound.
Most respondents said that stress made their IBS worse and had modified their lifestyle as a result.
Having IBS affected all aspects of sufferers lives; work, leisure, travel and relationships. Sufferers wanted more information about IBS, its possible causes and treatment, and a greater appreciation of their condition.
Reference:
Dancey CP, Backhouse S. Towards a better understanding of patients with irritable bowel syndrome. J Adv Nurs 1993; 18:

12. Impaired daily function
IBS: Doctor's concerns
Psychological
comorbidity
Serious
disease
Hidden agenda
narcotics,laxatives,
benefits
Shall I refer?
Recent
stressful event
Impaired daily function
Drossman et al, 1995; 1997
Twelve key clinical questions have been suggested by Drossman to be asked during a first consultation to help to determine the nature of the condition and to help plan management. These include questions about the type of pain experienced by the patient and it’s history, the patient’s understanding of the illness, and the possible involvement of psychological and psychosocial factors. Other questions to be asked include the effect the disorder is having on the daily physical, psychological, and social activity of the patient and the reason for the patient’s visit or referral.
Reasons for the visit may include a worsening of functional status or new circumstances exacerbating the condition e.g. a change in diet or a concurrent medical disorder; concerns about having a serious disease; stress-related factors; a psychiatric co-morbidity such as depression or anxiety; impaired daily function e.g. recent inability to work or to socialise; a hidden agenda e.g. laxative abuse, to obtain narcotics, to gain disability benefits or the justification of illness to family or co-workers; or any combination of these.
The physician may also have to consider referral, perhaps because a colonoscopy or other procedure is required to complete an evaluation or because additional assessments are needed (e.g. psychological or psychiatric).
References:
Drossman DA. Diagnosing and treating patients with refractory functional gastrointestinal disorders. Ann Intern Med 1995; 123:
Drossman DA, Whitehead WE, Camilleri M. Irritable bowel syndrome: A technical review for practice guideline development. Gastroenterology 1997; 112: