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Irritable Bowel Syndrome

1. Á¤ÀÇ

±¸Á¶Àû ÀÌ»ó¾øÀÌ abdominal pain°ú bowel habit change¸¦ º¸ÀÌ´Â À§Àå°üÁúȯÀ¸·Î

ºÐ¸íÇÑ Áø´ÜÀû Ç¥ÁöÀÚ°¡ ¾øÀ¸¹Ç·Î ÀÓ»óÀû ¾ç»ó¿¡ ±âÃÊÇÏ¿© Áø´ÜÇÑ´Ù.

* IBSÀÇ Áø´Ü¿¡ ÇÊ¿äÇÑ Rome criteria(Tab 288-1)

3°³¿ù ÀÌ»ó Áö¼ÓÇÏ´Â abdominal pain/discomfort + ¹èº¯ÈÄ Áõ»óÈ£Àü

and/or stool frequency, consistency change

+ Àû¾îµµ 25%¿¡¼­ ´ÙÀ½ 2°¡Áö ÀÌ»óÀ» ¸¸Á·

i) stool frequency change

ii) stool consistency change

iii) stool passageÀå¾Ö

iv) sense of incomplete evacuation

v) stool mucusÁ¸Àç(+)

2. ÀÓ»óÀû Ư¡

young people disorder(45¼¼ ÀÌÀü¿¡ ¹ß»ý)

M : F = 1: 2-3 (severe IBDÀÇ 80%°¡ ¿©¼º)

abdominal pain + bowel habit change(constipation, diarrhea, or both)

1) Abdominal pain

site - ¿©·¯ºÎÀ§

nature - episodic and crampy

malnutrition, sleep deprivationÀº µå¹°´Ù

½Ä»ç³ª Á¤½ÅÀû ½ºÆ®·¹½º·Î ¾ÇÈ­µÇ°í ¹èº¯ÈÄ ¿ÏÈ­µÈ´Ù.

2) Altered bowel habit

mc pattern : constipation -> diarrhea

¨ç constipation : episodic, °á±¹Àº contiuous

laxative¿¡ ¹ÝÀÀX

stool : hard with narrowed caliber

´ëºÎºÐ sense of incomplete evacuationÀ» °æÇèÇÑ´Ù.

¨è diarrhea

small volume of loose stool

stool volume < 200 mL

nocturnal diarrhea(-)

½Ä»ç³ª Á¤½ÅÀû ½ºÆ®·¹½º·Î ¾ÇÈ­µÊ.

malabsorption, wt loss(-)

¸¹Àº ¾çÀÇ mucus passage°¡ ÀÖ´Ù => "mucous colitis"´Â IBSÀ» ÁöĪÇÏ´Â ¸»

¨é Gas & Flatulence(Æ÷¸¸°¨)

abd. distention, flatulence¡è

Áõ°¡µÈ °¡½º¶§¹®ÀÌ ¾Æ´Ï¶ó distention¿¡ ´ëÇÑ tolerance°¨¼Ò¶§¹®

¨ê Upper GI sx

25-50%¿¡¼­ dyspepsia, heartburn, nausea, vomitingÈ£¼Ò

* small bowel motilityÀÇ Æ¯Â¡Àû ¼Ò°ß

0-9ºÐ °£°ÝÀ¸·Î clustered contrations,Æò±Õ 46ºÐ Áö¼Ó

3. º´Å»ý¸®

º´ÀÎÀ¸·Î abnormal gut motor & sensory activity, central neural dysfunction,

psychological disturbances, stress, luminal factorµîÀÌ Á¦½ÃµÇ°í ÀÖ´Ù.

¨ç colonic motor activity

rectosigmoid motor activity : ½Ä»çÈÄ 3½Ã°£±îÁö Áõ°¡

¨è visceral stimulation¿¡ ´ëÇØ sensory response¡è

(visceral afferenct dysfunctionÀǹÌ)

4. Ä¡·á

¨ç Reassurance

¨è Diet : coffee, disaccharides, legumes, cabbage¼·ÃëÁ¦ÇÑ

¨é stool bulking agent(high fiber diet)

20%¿¡¼­ Áõ»ó¾ÇÈ­¸¦ È£¼ÒÇÏÁö¸¸ ¼öÁÖÈÄ ÀÚ¿¬¼Ò½Ç

¨ê antispasmodics(anticholinergics)

ÀϽÃÀû Áõ»óÈ£Àü

gastrocolic reflex¾ïÁ¦ -> ½ÄÈÄ ÅëÁõ Á¶Àý

¡Å ½ÄÀü 30ºÐÈÄ º¹¿ë

S/E : xerostomia, voiding hesitancy & retention, blurred vision, drowsiness

¨ë Antidiarrheal agent: diphenoxylate(Lomotil)

ÀϽÃÀûÀ¸·Î »ç¿ëÇÑ´Ù.

Ä¡·á¸ñÇ¥´Â high fiber diet·Î ´ëüÇϴ°Í

¨ì Antidepressant

diarrhea-predominant IBS¿¡¼­ TCA(imipramine)Àº orocecal & whole-gut transit delay

=> motor inhibitory effect

¡Å TCA´Â visceral afferent neural fxÀ» º¯È­½ÃŲ´Ù.

ÁÖ·Î diarrhea-predominant IBSȯÀÚ¿¡¼­ È£ÀüµÇ°í º¯ºñȯÀڴ ȣÀüµÇÁö ¾Ê´Â´Ù.

TCA¿Ü¿¡ SSRIµµ È¿°úÀû

¨í °¡½ºÁ¦°ÅÁ¦: simethicone, antacid, activated charcol - ½Ç¸Á½º·± °á°ú