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“Upper & Lower GI Diseases” Lecture of Gastroentero-Hepatology System, FKUH

Fardah Akil
Centre of Gastroentero-Hepatology, Wahidin Sudirohusodo Hospital Teaching
Internal Medicine, Faculty of Medicine, Hasanuddin University
Recurrent abdominal pain or discomfort at least 3 days
per month in the last 3 months associated with 2 or
more of the following : (ROME III criteria)
 improved with defecation
 onset associated with a change in frequency of stool
 onset associated with a change in form (appearance)
of stool
 The most common functional
bowel disorder and effects
predominantly women (70%

 Can cause great discomfort,
sometimes intermittent or
continous,for many decades
in patient’s life and can have
significantly negative impact
on quality of life
 Mostly between the ages 20
and 40 years
 20% consult a physician, only
a small percentage visit a
 > 60% have psychological
disturbances (anxiety,
somatoform, personality
disorders or chronic pain
syndrome); 35% have a
history of sexual abuse
IBS can be cause by many factors,such as :
 Disturbed bowel motility
 Visceral hypersensitivity
 Bacterial overgrowth /postinfective IBS
(Shigella, salmonella, campylobacter)
 Stress response : psychological problems
 Abdominal pain or
discomfort that is linked to
bowel function
 Not explained by
biochemical or structural
With symptoms onset at least 6
based solely on stool consistency
and not frequency, urgency and
straining (The Rome III ) :
1. IBS with constipation (IBS-C)
2. IBS with diarrhea (IBS-D)
3. Mixed IBS (IBS-M)
4. Unsubtype IBS
Alarm feature indicate that the
diagnosis might not be IBS
 Symptom & sign
 Laboratory : CBC, Thyroid stimulating
hormone & serologies, stool test
 Endoscopy of LGI
 Lactose intolerance
 Food intolerance
 Infections
 Celiac disease
 Tropical sprue
 Small bowel bacterial
 Microscopic colitis
 Decreased QOL
 Time off work & school
 Personal expense of medication & physician
 Psychological problem (depression & anxiety)

 Dietary modification
 Fiber supplements
 Physichotherapy

Pharmacologic agents : antidiarrheal, enemas & suppositories,
laxantive,antispamotics, tricyclic antidepressants, selective
serotinin reuptake inhibitors (SSRIs = citalopram, fluoxetine),
serotinin receptor, probiotics