1. Overview of Irritable Bowel Syndrome
Arnold Wald, MD
Professor of Medicine Department of Gastroenterology, Hepatology, and Nutrition University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania

2. Irritable Bowel Syndrome
Chronic or recurrent GI symptoms
Lower abdominal pain/discomfort
Altered bowel habits
Bloating
Not explained by structural or biochemical abnormalities

3. IBS Clinical Subgroups
Constipation predominant
Diarrhea predominant
Alternating constipation/diarrhea

4. IBS Clinical Subgroups
Constipation predominant
Diarrhea predominant
Alternating constipation/diarrhea

5. Rome II Criteria for IBS
At least 12 weeks or more, which need not be
consecutive, in the preceding 12 months, of
abdominal discomfort or pain that has 2 out
of 3 features:
Relieved by defecation
Onset associated with a change in frequency of stool
Onset associated with a change in form (appearance) of stool
Gut

6. Epidemiology of IBS in US (15% to 20% of Population)
CONFIDENTIAL
Epidemiology of IBS in US (15% to 20% of Population)
Specialists 5%
Primary care
15%
Nonconsulters
80%
25% to 50% of referrals to GIs are IBS

7. Prevalence of Disorders in US
IBS: 15% - 20%
Dyspepsia: 8%
GE reflux: 7%
Asthma: 4%
Diabetes: 3%

8. IBS Symptoms Reduce Patient Well Being
Abdominal
pain
Reduced sense of
well being
Altered bowel
habits
Cramps
Bloating
Constipation
Diarrhea
Urgency

9. Medical Costs Associated With IBS
Estimated $8 billion annually in direct costs
Increased physician visits for both GI and non-GI complaints
IBS patients incur 74% more health care costs than do non-IBS sufferers
Drossman, et al. Dig Dis Sci. 1993;38(9):
Talley, et al. Gastroenterology. 1995;109(6):

10. Impact of IBS on Work Missed work: 30% (1.7 days)
Reduced days: 46% (3 days)
Turned down promotion: 16%
Changed job, health reasons: 9%
Changed work schedule: 8%
Hahn BA, et al. Digestion. 1999;60(1):77-81.

11. Pathophysiology of IBS: A Biopsychosocial Disorder
Biological
Altered GI motor activity
Altered visceral sensation
Psychosocial
Behavioral
Cognitive
Emotional

12. Multiple Medications Are Used to Treat IBS
Anticholinergics
Tricyclic antidepressants
SSRIs
Antidiarrheals
Bulking agents
Laxatives
Alosetron*
*Data support efficacy for diarrhea-predominant IBS.

13. New Treatment Paradigm for C-IBS
IO 13
New Treatment Paradigm for C-IBS
5-HT4
agonists
Altered
motility
Altered
sensation