1. IBS In The Elderly Monica J. Cox ARNP-BC, MSN, MPH Geriatric Nurse Practitioner G.I. Nurse Practitioner Borland-Groover Clinic Jacksonville, Florida

2. OBJECTIVES l Describe Age-Related Changes In The Digestive System l Discuss The Neurophysiology of Irritable Bowel Syndrome l Describe The Current Approaches For Evaluating and Treating Elderly Patients With Irritable Bowel Syndrome

6. Alarm Symptoms Suggestive of Organic Disease l HISTORY –Weight loss < 10 lbs –Nocturnal symptoms –Initial onset at age > 50 yrs –Significant travel history –Arthritis/rashes l FAMILY HISTORY –Colon cancer –Inflammatory bowel disease –Celiac disease

7. Alarm Symptoms Suggestive of Organic Disease - continued l PHYSICAL FINDINGS –Fever –Oral ulcers –Palpable abdominal mass –Guaiac-positive stool –Other physical bleeding or obstruction l LABORATORY EVALUATION –Increased white blood cell count –Anemia –Abnormal chemistry –Increased thyroid-stimulating hormone –Elevated sedimentation rate or C-reactive protein

8. Types Of Neurons In The Small Intestinal Enteric Nervous System

10. Rome Criteria III l At least 3 months, with onset at least 6 months previously of recurrent abdominal pain or discomfort** associated with 2 or more of the following: l Improvement with defecation; and/or l Onset associated with a change in frequency of stool; and/or l Onset associated with a change in form (appearance) of stool ** Discomfort means an uncomfortable sensation not described as pain.

11. “ Functional ” Sydromes often due to “ Dysmotility ” l Functional bowel disorders: –Non-ulcer dyspepsia –Irritable bowel syndrome l Defined motility disorders: –GI neuromuscular syndromes –Myopathies vs. Neuropathies

12. Dysfunction of Different GI Organs Produces Similar Symptoms l Gullett – Chest pain, belching, dysphagia, regurg l LES – Chest pain, pyrosis, belching, regurg l Stomach – Regurg, fullness, dyspepsia, bloating l Small bowel – Fullness, dyspepsia, discomfort, bloating, change in bowel habits l Colon – Fullness, discomfort, variable bowel habits l Thus, it is often necessary to test all organs

13. Sx ’ s of Small Bowel Dysmotility May Indicate Disordered Transit l Too Slow l Gas l Fullness l Bloating l Cramps l Altered Bowel Habits l Too Rapid l Gas l Fullness l Bloating l Cramps l Altered Bowel Habits

14. Diagnostic Evaluation Predominant Symptom Constipation: Infrequent bowel movements Obstructed defecation Diagnostic Tests Colonoscopy Whole-gut transit test Anorectal motility plus balloon expulsion Defecating proctography

15. Diagnostic Evaluation Predominant Symptom l Diarrhea: Diagnostic Tests 24-hour stool volume and fat study Stool osmolality, electrolytes, and laxatives Transit test: small bowel and colon Colonic biopsies Breath test

16. Diagnostic Evaluation Predominant Symptom l Pain: Diagnostic Tests Plain abdominal x-ray Small bowel follow- through examination CT/MR imaging Pelvic ultrasound

19. Intestinal Concentration

20. Therapies for Visceral Pain

22. Thank You!