The Pathophysiology of Irritable Bowel SyndromeCME - Medscape

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The Pathophysiology of Irritable Bowel Syndrome CMESlide 19.I believe that the other aspect of future research will be the development of more specific individualized treatments based on theunderlying peripheral pathophysiological mechanisms. These might be dietary recommendations, for instance, the exclusion ofgluten or FODMAPs, biofeedback-based treatments for defecation disorders, bile acid sequestrants, or 5-HT-3 antagonists for IBS-Dand urgency; prokinetics or secretagogues for IBS-C; and possibly probiotics, nonabsorbable antibiotics, anti-inflammatory agents,tight-junction modulators, and even lubiprostone, as shown from the porcine ischemia model to restore normal barrier function,reduction of immune activation, and restoration of intestinal functions.Slide 20.Thank you for participating in this activity. You may now take the CME posttest by clicking on the “Earn CME Credit” link. Pleasealso take a moment to complete the program evaluation that follows.Pg.18
www.medscape.org/lecture/ibs/pathophysiologyThis article is a CME certified activity. To earn credit for this activity visit:http://www.medscape.org/viewarticle/779326Abbreviations5-ASA = 5-aminosalicylic acid5-HT = 5-hydroxytryptamineBA = bile acidCNS = central nervous systemCRF = corticotropin-releasing factorFODMAP = fermentable oligosaccharides, disaccharides,monosaccharides and polyolGC-C = guanyl cyclase CGI = gastrointestinalHV = healthy volunteersIBAT = ileal bile acid transporterIBS = irritable bowel syndromeIBS-C = constipation-predominant irritable bowel syndromeIBS-D = diarrhea-predominant irritable bowel syndromeIgA = immunoglobulin-ANTC = normal transit constipationSCFA = short-chain fatty acidSNP = single nucleotide polymorphismSTC = slow transit constipationReferences1. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, SpillerRC. Functional bowel disorders. Gastroenterology. 2006;130:1480-1491.2. Saito YA, Schoenfeld P, Locke GR 3rd. Epidemiology of irritable bowelsyndrome in North America: a systematic review. Am J Gastroenterol.2002;97:1910-1915.3. Lembo A, Camilleri M. Chronic constipation. N Engl J Med.2003;349:1360-1368.4. Camilleri M. Peripheral mechanisms in irritable bowel syndrome.N Engl J Med. 2012;367:1626-1635.5. Camilleri M, McKinzie S, Busciglio I, et al. Prospective study of motor,sensory, psychologic, and autonomic functions in patients with irritablebowel syndrome. Clin Gastroenterol Hepatol. 2008;6:772-781.6. Sadik R, Stotzer PO, Simrén M, Abrahamsson H. Gastrointestinal transitabnormalities are frequently detected in patients with unexplained GIsymptoms at a tertiary centre. Neurogastroenterol Motil. 2008;20:197-205.7. Wong BS, Camilleri M, Carlson P, et al. Increased bile acid biosynthesis isassociated with irritable bowel syndrome with diarrhea. Clin GastroenterolHepatol. 2012;10:1009-1015.8. Keita AV, Söderholm JD. The intestinal barrier and its regulation by neuroimmune factors. Neurogastroenterol Motil. 2010;22:718-733.9. Rao AS, Camilleri M, Eckert DJ, et al. Urine sugars for in vivo gut permeability: validation and comparisons in irritable bowel syndrome-diarrheaand controls. Am J Physiol Gastrointest Liver Physiol. 2011;301:G919-G298.10. Cuppoletti J, Blikslager AT, Chakrabarti J, Nighot PK, Malinowska DH.Contrasting effects of linaclotide and lubiprostone on restitution ofepithelial cell barrier properties and cellular homeostasis after exposureto cell stressors. BMC Pharmacology. 2012;12:3.11. Rajilić-Stojanović M, Biagi E, Heilig HG, et al. Global and deep molecularanalysis of microbiota signatures in fecal samples from patients withirritable bowel syndrome. Gastroenterology. 2011;141:1792-1801.12. Camilleri M. Pharmacology of the new treatments for lowergastrointestinal motility disorders and irritable bowel syndrome. ClinPharmacol Ther. 2012;91:44-59.DisclaimerThe educational activity presented above may involve simulated case-based scenarios. The patients depicted in these scenarios are fictitious andno association with any actual patient is intended or should be inferred.The material presented here does not necessarily reflect the views of Medscape, LLC, or companies that support educational programming onmedscape.org. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration andoff-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed.Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.Medscape Education © 2013 Medscape, LLCPg.19
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The Pathophysiology of Irritable Bowel SyndromeCME - Medscape

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