???? Irritable bowel syndrome

1
????Irritable bowel syndrome

• ????????
• ????????

2
5 steps of????

• ?????????''?????''??? (Find a anwserable question
  )
• 2. ????
• 3. ????
• 4. ????
• 5. ??

3

• ???????IBS??
• ?????????????,?IBS???
• ????????,?????,?IBS???!!!
• ??IBS?????!

4
??

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• ??
• ????
• ????
• ????
• ??

5
??

• ????????????IBS???,IBS????????,????????IBS???????
  ?,??????????????,???????????? ( Delvaux,2003) ?
  

6
??

• 1892?,Sir William Osler???? mucous
  colitis(??????)????tubular casts(?????)??,?????
  ??????????????(Maxwell Mendall,1997)?

7
??

• 1929????????? irritable colon????,????????????(M
  axwell Mendall,1997)?
• ????????? irritable colon?mucous
  colitis????IBS? (Greenberg?Amitrone
  Galiczynski,2002)

8
??

• IBS????????????????,????????
• ???????????,???????(Goroll Mulley,2000)?

9
????

• Delvaux,2003--
• IBS?????????10-20,??????????
• ?????????????????????,???????,????????????????????
  ?????????
• ?????20-50??????

10
????

• IBS??????????9-22??,??????,???????????,?????????
  ????????IBS?(Saito? Locke?Talley?
  Zinsmeister?Fett. Melton, 2000)

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????

• ?????????????-????????????????
• ???-????????
• ???????
• ???????,??????????

12
????

• ?????????????-????????????????
• ???-????????
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• ???????,??????????
• (?,2001)

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• ???????-???????,?
• ????????(?,2001)--
• (?) ?????????
• (?) ??????????
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14
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• (?) ???????(?,2001)--
• ???????????????
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• ?????????????-????????-????????-?????????
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15
????

• (?) ??????????(?,2001)--
• ?????????????
• ???????????
• ????????????

16
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• (?) ?????????(?,2001)--
• ?????
• ?????
• ????????????????

17
????

• ???????????????,??????,???????????????????,???????
  ???????????(?,2001) ?

18
????

• ??,?????????????????????????????????
• ??????????????????????????(?,2003)?

19
????

• ?????????????????????????????,??????,??????????,?
  ???????????,??????????
• ????????????????????????(?,1997)?

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????

• Manning criteria
• Kruis criteria
• Rome criteria

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Symptoms That May Warrant a More Extensive
Evaluation

• Age of onset symptoms 50 years
• Progression or worsening of symptoms without
  periods of relief
• Nighttime symptoms
• Rectal bleeding
• Anemia , hypoalbuminemia
• Anorexia

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Symptoms That May Warrant a More Extensive
Evaluation

• Recurrent vomiting
• Family history of colon cancer
• Abnormal physical findings (such as a mass)
• Extraintestinal manifestations , as seen in
  inflammatory bowel disease
• Unexplained weight loss

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??

• ??????????????????????????????????????????50?????,
  ?IBS???????
• 96???????,????IBS
• ?????IBS????52,???48???????????

24

• ?????1???????,???2????????,IBS?????????10
• 4??Rome criteria8??Rome I criteria????????????
  ???IBS?

25
??

• ???IBS??
• ?????IBS???
• ????IBS???!!!
• ??????????10??

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????

• Goroll, A. H., Mulley, J. A.(2000). Primary
  care medicine. (4th ed., pp.485-490).
  Philadelphia Lippincott Williams Wilkins.
• Greenberg, M. R., Amitrone, M.,
  Galiczynski, E. M.(2002). A contemporary review
  of irritable bowel syndrome. Physician Assistant,
  26 (8), 26-34.
• Delvaux, M.(2003). Functional bowel disorders
  and irritable bowel syndrome in Europe. Aliment
  Pharmacology Therapy, 18(Suppl.3), 75-79.

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????

• Maxwell, P. R., Mendall, M.
  A.(1997).Irritable bowel syndrome. Lancet,
  1997(350), 1691-1693.
• Saito, Y. A., Locke, G. R., Talley, N. J.,
  Zinsmeister, A. R., Fett, S. L., Melton, L. J.
  III. (2000). A comparison of the Rome and Manning
  criteria for case identification in
  epidemiological investigations of irritable bowel
  syndrome. American J Gastroenterology, 95(10),
  2816-2824.

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????
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Manning Criteria (1978)

• A validation study of the Manning criteria, by
  Talley and colleagues, found a sensitivity of 58
  and specificity of 74 in discriminating IBS from
  a variety of organic gastrointestinal diseases.
  Other studies have reported a sensitivity varying
  from 58 to 81 and specificity from 67 to 87.

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Kruis(1984)

• Main points
• A scoring system including the answers of a
  questionnaire and the results of eight basic
  investigations was established. Using the
  weighted score (more than 44 points), at a
  sensitivity of 64, the specificity for the
  diagnosis of IBS was 99.

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Rome I, Rome II, Rome III, and the Rome
committees Terminology and Bibliography (by
Drossman D. A.)

• Rome I All documents published in the
  Gastroenterology International Journal from 1992
  -1995 as well as Rome I book is considered as
  Rome I.
• Rome II All documents published either in the
  GUT
• Supplement (416-261999) or the book is
  considered as Rome II.
• Rome III a committee was formed in 2001 for
  Rome III. They included Drossman, Corazziari,
  Delvaux, Spiller, Talley, Thompson and Whitehead.
  The committee will begin their work in May, 2003
  and the publications will be released in 2006 as
  a supplement in Gastroenterology, and as the Rome
  III book. All documents published in 2006will
  be considered as Rome III.

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