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 ¿ÏȵȴÙ.
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 ¾ÇȵÊ.
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»ó¾Çȸ¦ 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