Irritable Bowel Syndrome

Aka: Irritable Bowel Syndrome, Functional Chronic Diarrhea

advertisement

II. Epidemiology

  1. Prevalence
    1. Overall in U.S.: 5-10%
    2. Lifetime Prevalence: 10-22%
  2. Slightly more common in women (1.5 fold increased risk over men)
  3. Prevalence for elderly same as for young (however, peak time of diagnosis at 20-39 years old)
  4. Most common condition seen by Gastroenterologists

III. Pathophysiology

  1. Organic factors
    1. Gastrointestinal hypersensitivity
    2. Altered motility
    3. Neurohormonal factors
    4. Mucosal barrier dysfunction
  2. Provoked by psychosocial risk factors
    1. Prior physical or sexual abuse significantly increases risk
  3. Severe Gastroenteritis episode may be associated (Odds Ratio 5.9)
    1. Antibiotics (Rifamaxin, Neomycin) have reduced symptoms in some cases
  4. Familial association
    1. Risk increases 3 fold with Family History of Irritable Bowel Syndrome

IV. Associated Conditions

  1. Gastroesophageal Reflux Disease
  2. Dysphagia
  3. Globus Hystericus
  4. Fatigue
  5. Non-cardiac Chest Pain
  6. Urologic dysfunction
  7. Gynecologic disease (e.g. Chronic Pelvic Pain)
  8. Fibromyalgia
  9. Chronic Fatigue Syndrome
  10. Temperomandibular joint syndrome
  11. Food Allergy
  12. Low-fiber diet

V. Risk Factors: Psychosocial

  1. Anxiety Disorder
  2. Major Depression
  3. Somatization Disorder
  4. Sexual abuse or physical abuse
  5. Stressful life events
  6. Substance Abuse

VI. Types

  1. Alternating Diarrhea and Constipation
  2. Nervous Diarrhea
  3. Predominant Constipation
  4. Upper Abdominal Bloating and discomfort

VII. Symptoms

  1. Altered bowel habits
    1. Diarrhea
    2. Constipation
    3. Scybalous stools (hard, pellet-like stools)
    4. Mucus per Rectum (40% of cases)
    5. Incomplete evacuation sensation (69% of cases)
  2. Recurrent and Chronic Abdominal Pain (73% of cases)
    1. Upper abdominal discomfort after eating
    2. Left Lower Quadrant Abdominal Pain
    3. Right Lower Quadrant Abdominal Pain
    4. Abdominal Pain relieved with Defecation (52% of cases)
  3. Gaseousness
    1. Excessive Flatulence or Eructation
    2. Normal patients experience about 13 farts per day
    3. Abdominal Distention (32% of cases)
  4. Nausea or Vomiting
  5. References
    1. Ford (2008) JAMA 300(15): 1793-805 [PubMed]

VIII. Diagnosis: Rome III Criteria

  1. Abdominal symptoms persistent or recurrent for 6 months or more
    1. Symptoms occur on at least three days per month for at least 3 months
    2. Abdominal Pain, bloating or discomfort
    3. Marked change in bowel habits
      1. Change in stool frequency
      2. Change in stool consistency (Constipation or Diarrhea)
      3. Altered stool passage
        1. Straining for normal consistency stool
        2. Urgency of Defecation
        3. Incomplete evacuation
  2. Two or more below
    1. Pain relieved with Defecation
    2. Onset of pain is related to a change in frequency of stool
    3. Onset of pain is related to a change in appearance of stool

IX. Diagnosis: Manning Criteria

  1. Onset of pain linked to more frequent Bowel Movements
  2. Looser stools associated with onset of pain
  3. Pain relieved by stool passage
  4. Noticeable Abdominal Bloating
  5. Sensation of incomplete evacuation more than 25% of the time
  6. Diarrhea with mucus more than 25% of the time

X. Red Flags: Symptoms and signs suggestive of other diagnosis

  1. Nighttime Diarrhea
  2. Nocturnal Stool Incontinence
  3. Nocturnal awakening due to abdominal discomfort
  4. Abdominal Pain that interferes with normal sleep
  5. Visible or occult blood in stool
  6. Weight loss
  7. Recurrent Fever
  8. Family History of Colon Cancer
  9. Family History of Inflammatory Bowel Disease
  10. Elderly
  11. Diarrhea without pain suggests alternative diagnosis
  12. Laboratory abnormality
    1. Leukocytosis
    2. Anemia
    3. Increased Erythrocyte Sedimentation Rate (ESR)

XI. Differential Diagnosis

  1. Colonic Adenocarcinoma
  2. Inflammatory Bowel Disease
    1. Ulcerative Colitis
    2. Crohn's Disease
  3. Abdominal Angina (Ischemic Colitis)
  4. Pseudo-obstruction (Diabetes Mellitus, Scleroderma)
  5. Intermittent Sigmoid Volvulus
  6. Toxic Megacolon or Bacterial overgrowth syndrome
  7. Endocrine causes
    1. Hypothyroidism or Hyperthyroidism
    2. Diabetes Mellitus
    3. Addison's Disease
  8. Malabsorption
    1. Celiac Sprue (strongly consider if Diarrhea with red flags)
    2. Lactose Intolerance
    3. Pancreatic insufficiency
  9. Giardiasis
  10. Endometriosis
  11. Psychiatric illness
    1. Depression
    2. Somatization
    3. Anxiety Disorder or Panic Disorder
  12. Medications
    1. Laxatives
    2. Constipating medications

XII. Evaluation

  1. General
    1. Avoid a piecemeal work-up
      1. Perform a complete evaluation the first time
      2. Avoid over-investigation
    2. Irritable bowel is no longer diagnosis of exclusion
      1. Diagnostic criteria above are sufficient to treat
      2. Lab and imaging are typically low yield in cases otherwise suggestive of Irritable Bowel Syndrome
    3. Indications for full evaluation and Gastroenterology
      1. Red flags present (see above) or
      2. Onset over age 50 years
  2. Careful History
    1. History of Gastrointestinal Symptoms
    2. Family History of gastrointestinal disease
    3. Marital History
    4. Sexual Abuse (strong correlation)
  3. Reasonable exam
    1. Thorough abdominal examination
    2. Also focus on possible endocrine causes
  4. Look for Food Intolerance (consider diet diary)
    1. Lactose Intolerance
    2. Sorbitol
    3. Wheat (Gluten Sensitive Enteropathy)

XIII. Labs: Initial, based on predominant symptom

  1. Constipation dominant
    1. Complete Blood Count (CBC)
    2. Serum Electrolytes or Chemistry panel (chem8)
    3. Thyroid Stimulating Hormone (TSH)
  2. Diarrhea predominant
    1. Evaluation in absence of negative red flags
      1. Complete Blood Count (CBC)
      2. Tissue transglutaminase IgA for Celiac Sprue
    2. Other tests to consider if indicated by history (previously recommended as part of standard default protocol)
      1. Stool Ova and Parasites
      2. Fecal Leukocytes
      3. Serum Electrolytes or chemistry panel
      4. Thyroid Stimulating Hormone (TSH)
      5. Erythrocyte Sedimentation Rate (ESR) or C-Reactive Protein (C-RP)
  3. Pain Dominant
    1. Complete Blood Count (CBC)
  4. Reference
    1. Fass (2001) Arch Intern Med 161:2081-8 [PubMed]

XIV. Diagnostics

  1. Colonoscopy of Flexible Sigmoidoscopy
    1. More uncomfortable in Irritable Bowel Syndrome
    2. Not absolutely indicated if remainder of evaluation suggests Irritable Bowel Syndrome
      1. Consider if red flags or age over 50 years
  2. Consider additional studies as indicated (to evaluate differential diagnosis)
    1. CT Abdomen with contrast
    2. Right upper quadrant Ultrasound
    3. Upper GI Study
    4. Barium Enema

XV. Management: General Measures

  1. See the patient frequently
    1. Maintain a strong doctor-patient relationship
    2. Offer frequent reassurance
    3. Identify and treat emotional stressors
    4. Answer patients questions in unhurried environment
  2. Do not downplay symptoms as psychiatric
    1. Irritable Bowel is a real functional bowel problem
    2. Explain physiology and absence of serious illness
  3. Reduce stressors
    1. Teach Relaxation Techniques
    2. Teach coping mechanisms for chronic illness
  4. Exercise
  5. Consider Probiotics (weak evidence)
    1. Bifidobacterium infantis
    2. Bifidobacterium bifidum MIMBb75
      1. Decreases overall irritable bowel symptoms
      2. Guglielmetti (2011) Aliment Pharmacol Ther 33(10): 1123-32 [PubMed]
  6. General Diet recommendations
    1. Get adequate fluid intake (>64 ounces/day)
    2. Bulk agents (gradually increase)
      1. Metamucil
      2. Citrucel
      3. High fiber-bran or other soluble Dietary Fiber (absorbs water)
    3. Avoid FODMAPS (Fementable Oligo- di and mono saccharides and polyols)
      1. Avoid fructose (e.g. apples, pears, high fructose corn syrup)
      2. Avoid Fructans (fructooligosaccharides, inulins, levans - e.g. high fiber bars)
      3. Avoid Lactose (consider challenge with quart of skim milk)
      4. Avoid Polyols (sugar Alcohols: Sorbitol, xylitol, mannitol, malitol
      5. Avoid Galactooligosaccharides (e.g. brussel sprouts, onions)
    4. Consider avoiding other provocative agents
      1. Consider Elimination Diet (although no evidence to support this)
      2. Avoid Caffeine
      3. Avoid Alcohol
      4. Avoid Legumes and other gas producing foods (see FODMAPS above)
      5. Avoid Artificial Sweeteners and carbonated beverages (see Polyols above)
      6. Avoid Fatty meals
      7. Corn, wheat and citrus may also exacerbate Irritable Bowel Syndrome
      8. Some fiber can also exacerbate symptoms
  7. Avoid Provocative or addictive medications
    1. Stimulant Laxatives (except brief use)
      1. Correctol
      2. Dulcolax
      3. Cascara
    2. Sedatives or Tranquilizers (Benzodiazepines)
    3. Narcotics

XVI. Management: Diarrhea predominant Irritable Bowel

  1. Consider eliminating lactose, Caffeine from diet
  2. Exclude Gluten Sensitive Enteropathy as cause
  3. Cholestyramine 4 grams qhs to 6 times daily
    1. Limited evidence
  4. Loperamide (Imodium) 2-4 mg qid prn
    1. Before meals
    2. As needed in stressful social situations
  5. Ondansetron (Serotonin antagonist)
    1. Reduces rapid transit
  6. Rifaximin (Xifaxan)
    1. Small improvements in symptoms (NNT 10) at a high cost ($1300 for a 14 day course)
    2. Relapse by 6 months is common
  7. Eluxadoline (Viberzi)
    1. Schedule IV Opioid agonist similar to Imodium, but taken daily at $1000/month
    2. Marginal efficacy (NNT 11) for decreased Diarrhea and Abdominal Pain at 6 months
    3. Risk of serious Pancreatitis (deaths have occurred) due to sphincter of odi spasm
      1. Contraindicated in prior Cholecystectomy, prior Pancreatitis or >3 Alcohol drinks per day
      2. https://www.fda.gov/safety/medwatch/safetyinformation/safetyalertsforhumanmedicalproducts/ucm546771.htm
    4. (2016) Presc Lett 23(6):32
    5. (2017) Presc Lett 24(5):27
  8. Alosetron (Lotronex)
    1. Risk of Constipation and Ischemic Colitis
      1. Iatrogenic deaths have occured
      2. Black box warning: Signed Informed Consent needed
    2. FDA controlled prescriptions only for women with IBS with Diarrhea
      1. Requires special Informed Consent and must be part of a prescriber program
    3. Dose: 1 mg daily (may advance to bid)
  9. Peppermint
    1. Pittler (1998) Am J Gastroenterol 93:1131-5 [PubMed]

XVII. Management: Pain dominant Irritable Bowel

  1. Chronic Pain
    1. Tricyclic Antidepressants
      1. Amitriptyline (Elavil) 25 mg orally at bedtime
      2. Desipramine (Norpramin) 50 mg orally three times daily
    2. Tegaserod (Zelnorm)
      1. Withdrawn from market in 2007 due to cardiovascular risks (but still available for limited use)
      2. Nyhlin (2004) Scand J Gastroenterol 39:119-26 [PubMed]
    3. SSRI medications may be effective as adjunct (e.g. Zoloft)
      1. However, not first-line agents due to insufficient evidence
      2. Tabas (2004) Am J Gastroenterol 99:914-20 [PubMed]
  2. Post-prandial pain: Anticholinergic
    1. Avoid chronic, frequent use
    2. Trial for 2 weeks and stop if no effect
    3. Dicyclomine (Bentyl) 10-20 mg, 15 min before meal
    4. Hyoscyamine (Levsin) 0.125 to 0.25 mg before meal
    5. Peppermint Oil (see reference below)

XVIII. Management: Constipation Dominant Irritable Bowel

  1. Use gastro-colic response
    1. Wake-up, eat breakfast and anticipate stool in AM
  2. First line: Bulk agents (e.g. Fiber, Psyllium, bran)
    1. Titrate to 20-30 grams per day
    2. Risk of bloating initially (requires adequate hydration)
    3. Evidence to support is lacking, but remains a central tool in IBS management
  3. Second line (use at bedtime for AM stool)
    1. Improves stool frequency, but may not alter Abdominal Pain
    2. Osmotic agents
      1. Polyethylene glycol (Miralax) 1 capful in 8 ounces at bedtime (preferred)
      2. Lactulose 1-2 teaspoons at bedtime
      3. Milk of Magnesia 1-2 tablespoons at bedtime
    3. Consider Stimulant Laxatives if osmotic agents fail
      1. Senna or Cascara
      2. Bisacodyl
  4. Third line (prescription agents that increase GI transit and intestinal fluid)
    1. Amitiza (Lubiprostone)
      1. Drossman (2009) Aliment Pharmacol Ther 29(3): 329-41 [PubMed]
    2. Linzess (Linaclotide)
      1. Expensive ($7 per pill) for minimal efficacy (NNT 5-8) for decreased pain
      2. (2012) Prescr Lett 19(12): 68-9
    3. Trulance (Plecanatide)
  5. Restricted Use agent (emergency use only due to risk)
    1. Tegaserod (Zelnorm): 5-HT4 agonist
      1. Cardiovascular event risk prompted removal from U.S. market in 2007
      2. Dose: 6 mg bid 30 minutes before meals
  6. Other agents potentially useful
    1. Guar-Gum
      1. Parisi (2002) Dig Dis Sci 47:1696-704 [PubMed]
    2. Peppermint
      1. Pittler (1998) Am J Gastroenterol 93:1131-5 [PubMed]
    3. Loxiglumide (cholecystokinin-A receptor antagonist)

XIX. Management: Other specific symptoms or comorbidities

  1. Excessive Flatus (gas)
    1. See General dietary recommendations (including FODMAP avoidance) as above
    2. Simethicone 40 to 125 mg up to qid
    3. Beta-galactosidase (Beano)
  2. Comorbid Mood Disorders
    1. Major Depression
      1. SSRI Medications or other Antidepressants
    2. Anxiety
      1. See Anxiety Management

XX. Resources

  1. International Foundation for Functional GI Disorders
    1. http://www.iffgd.org
  2. American College of Gastroenterology
    1. http://www.ACG.GI.org

XXI. References

  1. (2015) Presc Lett 22(5):29
  2. Camilleri (2000) Gastroenterology 120:652-68 [PubMed]
  3. Camilleri (1999) Am J Med 107(5A):27F-32S [PubMed]
  4. Chang (2006) Curr Treat Options Gastroenterol 9(4):314-23 [PubMed]
  5. Drossman (1999) Am J Med 107(5A):41S-50S [PubMed]
  6. Hammer (1999) Am J Med 107(5A):5S-11S [PubMed]
  7. Heymann-Monnikes (2000) Am J Gastroenterol 95:981-4 [PubMed]
  8. Holten (2003) Am Fam Physician 67(10):2157-62 [PubMed]
  9. Jailwala (2000) Ann Intern Med 133:136-47 [PubMed]
  10. Mertz (2003) N Engl J Med 349:2136-46 [PubMed]
  11. Naliboff (1999) Curr Rev Pain 3:144-52 [PubMed]
  12. Ringel (2001) Annu Rev Med 52:319-38 [PubMed]
  13. Viera (2002) Am Fam Physician 66:1867-80 [PubMed]
  14. Weinberg (2014) Gastroenterology 147(5):1146-8 +PMID:25224526 [PubMed]
  15. Wilkins (2012) Am Fam Physician 86(5): 419-26 [PubMed]

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "Irritable Bowel Syndrome." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Studies

Ontology: Irritable Bowel Syndrome (C0022104)

Definition (MEDLINEPLUS)

Irritable bowel syndrome (IBS) is a problem that affects the large intestine. It can cause abdominal cramping, bloating, and a change in bowel habits. Some people with the disorder have constipation. Some have diarrhea. Others go back and forth between the two. Although IBS can cause a great deal of discomfort, it does not harm the intestines.

IBS is common. It affects about twice as many women as men and is most often found in people younger than 45 years. No one knows the exact cause of IBS. There is no specific test for it. Your doctor may run tests to be sure you don't have other diseases. These tests may include stool sampling tests, blood tests, and x-rays. Your doctor may also do a test called a sigmoidoscopy or colonoscopy. Most people diagnosed with IBS can control their symptoms with diet, stress management, probiotics, and medicine.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases
Definition (MSHCZE) Funkční porucha tlustého střeva, „střevní neuróza“, projevující se četnými obtížemi, zejm. ve vyprazdňování (nadýmání, průjmy, zácpa atd.). (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI_NCI-GLOSS) A disorder of the intestines commonly marked by abdominal pain, bloating, and changes in a person's bowel habits. This may include diarrhea or constipation, or both, with one occurring after the other.
Definition (NCI) Gastrointestinal symptoms characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause.(NICHD)
Definition (MSH) A disorder with chronic or recurrent colonic symptoms without a clearcut etiology. This condition is characterized by chronic or recurrent ABDOMINAL PAIN, bloating, MUCUS in FECES, and an erratic disturbance of DEFECATION.
Definition (PSY) Functional disorder of the colon that is generally psychosomatic.
Definition (CSP) chronic noninflammatory disease characterized by abdominal pain, altered bowel habits consisting of diarrhea or constipation or both, and no detectable pathologic change; a variant form is characterized by painless diarrhea; it is a common disorder with a psychophysiologic basis; called also spastic or irritable colon.
Concepts Disease or Syndrome (T047)
MSH D043183
ICD9 564.1
ICD10 K58 , K58.9
SnomedCT 10743008, 155783000, 197124009, 266525002, 192434000
LNC LA10555-3
English Irritable Bowel Syndrome, COLON SPASTIC, IRRITABLE BOWEL SYNDROME, IBS, irritable bowel, irritable bowel syndrome (diagnosis), irritable bowel syndrome, mucous colitis, irritable colon, Colon spastic, Colitis mucous, Irritable bowel syndrome NOS, Irritable Bowel Syndrome [Disease/Finding], colon spasm, nervous colitis, colons spastic, functional bowel disease, Irritable;colon, Colitis;mucous, bowels irritable, colon spastic, disease irritable bowel, irritable colon syndrome, bowel ibs irritable syndrome, bowels irritable syndrome, irritable bowel disease, bowel disease irritable, bowel syndrome irritable, irritable bowel syndrome (IBS), irritable bowel disease (IBD), spastic colitis, syndrome irritable bowel, IBD, membranous colitis, colon irritable, colon spasms, functional bowel syndrome, irritable bowel syndromes, Functional bowel syndrome, Irritable colon (disorder), Irritable bowel syndrome (disorder), Irritable colon, Irritable bowel syndrome, Irritable bowel - IBS, [X]Psychogenic IBS, Irritable colon - Irritable bowel syndrome, Already mapped above AAHA ID #: 739, spastic colon, mucus colitis, -- Irritable Bowel Syndrome, Colitides, Mucous, Colitis, Mucous, Colon, Irritable, Irritable Bowel Syndromes, Mucous Colitides, Syndrome, Irritable Bowel, Syndromes, Irritable Bowel, Irritable Colon, Mucous Colitis, Mucous colitis, Irritable colon syndrome, Spastic colon, Adaptive colitis, Membranous colitis, Colon spasm, Functional bowel disease, IBS - Irritable bowel syndrome, Irritable bowel, Nervous colitis, Spastic colitis, IC - Irritable colon, bowel; disease, functional, bowel; functional syndrome, bowel; irritable, bowel; syndrome, functional, colitis; spastic, colon; irritable, colon; spasm, colon; spastic, irritable bowel; syndrome, spasm; colon, spastic; colitis, spastic; colon, syndrome; bowel, functional, syndrome; functional, bowel, syndrome; irritable bowel, IBS (irritable bowel syndrome)
Dutch slijmerige colitis, colitis met slijm, prikkelbaar colon, prikkelbare darm, colon spastisch, spastisch colonsyndroom, spastisch colon, functioneel darmsyndroom, Irritable bowel syndrome, colitis; spastisch, colon; prikkelbaarheid, colon; spasme, colon; spastisch, darm; aandoening, functioneel, darm; functioneel syndroom, darm; prikkelbaarheid, darm; syndroom, functioneel, irritable bowel; syndroom, spasme; colon, spastisch; colitis, spastisch; colon, syndroom; darm, functioneel, syndroom; functioneel, darm, syndroom; irritable bowel, prikkelbare darmsyndroom, Colon, prikkelbaar, Darm, prikkelbare, Colitis, mukeuze, Prikkelbaredarmsyndroom, Syndroom, prikkelbaredarm-
French Colite glaireuse, SCI, Côlon spastique, Côlon spasmodique, Colite mucoïde, COLON SPASMODIQUE, SYNDROME DU COLON IRRITABLE, Colopathie fonctionnelle, Colite muqueuse, Colite spasmodique, Côlon irritable, Syndrome de l'intestin irritable, Syndrome du côlon irritable, Colite muco-membraneuse, Colite mucomembraneuse, Entérite muco-membraneuse, Entérite mucomembraneuse, SCI (Syndrome du Côlon Irritable)
German Kolitis mucosa, IBS, spastisches Kolon, Kolonspasmus, COLON IRRITABILE, COLONSPASMUS, funktionelles Kolonsyndrom, Reizkolon-Syndrom, Colitis mucosa, Colon irritabile, Irritable-Bowel-Syndrom, Irritables Kolon, Kolon, irritables, Reizdarm, Reizkolon, Kolitis, muköse
Italian Sindrome del colon irritabile, Colon spastico, Intestino irritabile, Sindrome da colon irritabile, Colite mucosa, Colite spastica, Colon irritabile, IBS, Sindrome funzionale intestinale, Sindrome dell'intestino irritabile
Portuguese Síndrome de cólon irritável, Intestino irritável, Colite mucosa, Cólon espástico, Cólon irritável, COLON ESPASTICO, SINDROME DO INTESTINO IRRITAVEL, Síndrome intestinal funcional, Cólon Irritável, Síndrome de Colo Irritável, Síndrome do Cólon Irritável, Síndrome do Colo Irritável, Síndrome de Cólon Irritável, Síndrome de Intestino Irritável, Síndrome de intestino irritável, Colite Mucosa, Síndrome do Intestino Irritável, Colo Irritável
Spanish Colon espástico, Intestino irritable, Colon irritable, Síndrome de colon irritable, Colitis mucosa, COLON ESPASTICO, Síndrome intestinal funcional, síndrome de intestino irritable, síndrome de colon irritable, colon irritable, síndrome de colon irritable (trastorno), colon irritable (trastorno), colon adaptable, Síndrome del Intestino Irritable, colitis espástica, colitis mucosa, colitis nerviosa, colon espástico, enfermedad funcional del intestino, espasmo colónico, Síndrome del intestino irritable, colitis membranosa, Colitis Mucosa, Colon Irritable, Síndrome del Colon Irritable
Japanese 痙性結腸, 過敏性結腸症候群, 結腸痙攣, ｶﾋﾞﾝｾｲﾀﾞｲﾁｮｳｼｮｳｺｳｸﾞﾝ, ｹｲｾｲｹｯﾁｮｳ, ｶﾋﾞﾝｾｲﾀﾞｲﾁｮｳ, ｶﾋﾞﾝｾｲﾁｮｳｼｮｳｺｳｸﾞﾝ, ｶﾋﾞﾝｹｯﾁｮｳ, ｶﾋﾞﾝｾｲｹｯﾁｮｳｼｮｳｺｳｸﾞﾝ, ｹｯﾁｮｳｹｲﾚﾝ, ﾈﾝｴｷｾｲﾀﾞｲﾁｮｳｴﾝ, 粘液性結腸炎, 過敏性大腸, 過敏性結腸, 過敏性大腸症, 過敏性腸症, 結腸炎-粘液, 結腸炎-粘液性, 痙攣性結腸, 結腸-過敏, 大腸炎-粘液性, 刺激結腸, 結腸-過敏性, 粘液結腸炎, 過敏性大腸症候群, 過敏腸管症候群, 粘液性大腸炎, 過敏性腸症候群, 過敏結腸, ｷﾉｳｾｲﾁｮｳｶﾝｼｮｳｺｳｸﾞﾝ, 機能性腸管症候群
Swedish Irritabel tarm
Czech syndrom dráždivého tračníku, colon irritabile, kolitida mukózní, tračník dráždivý, Syndrom dráždivého tračníku, Mukózní kolitida, Spastický tračník, Funkční střevní syndrom, IBS
Finnish Ärtyvän suolen oireyhtymä
Russian OBODOCHNOI KISHKI RAZDRAZHENIIA SINDROM, TOLSTOGO KISHECHNIKA RAZDRAZHENIE, TOLSTOI KISHKI RAZDRAZHENIIA SINDROM, KOLIT SLIZISTYI, SINDROM RAZDRAZHENNOGO KISHECHNIKA, РАЗДРАЖЕННОГО КИШЕЧНИКА СИНДРОМ, СИНДРОМ РАЗДРАЖЕННОГО КИШЕЧНИКА, СИНДРОМ РАЗДРАЖЕННОЙ КИШКИ, SINDROM RAZDRAZHENNOI KISHKI, КИШЕЧНИКА РАЗДРАЖЕННОГО СИНДРОМ, ОБОДОЧНОЙ КИШКИ РАЗДРАЖЕНИЯ СИНДРОМ, RAZDRAZHENNOGO KISHECHNIKA SINDROM, KISHECHNIKA RAZDRAZHENNOGO SINDROM, VOSPALENNOGO KISHECHNIKA SINDROM, OBODOCHNAIA KISHKA RAZDRAZHENNAIA, ОБОДОЧНАЯ КИШКА РАЗДРАЖЕННАЯ, ВОСПАЛЕННОГО КИШЕЧНИКА СИНДРОМ, КОЛИТ СЛИЗИСТЫЙ, ТОЛСТОГО КИШЕЧНИКА РАЗДРАЖЕНИЕ, ТОЛСТОЙ КИШКИ РАЗДРАЖЕНИЯ СИНДРОМ
Korean 자극성 장증후군
Croatian SINDROM IRITABILNOG CRIJEVA
Polish Zespół drażliwego jelita, Zespół nadwrażliwego jelita, Zespół jelita nadwrażliwego
Hungarian IBS, Irritabilis bél, Colon spasticum, Spastikus vastagbél, Irritabilis colon, Irritabilis vastagbél syndroma, Irritabilis bél syndroma, Colitis, nyákos, Nyákos colitis, Funkcionális bél syndroma
Norwegian Irritabel tarm, IBS, Irritabel tarm-syndrom
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Functional diarrhea (C0156173)

Concepts Disease or Syndrome (T047)
ICD9 564.5
ICD10 K59.1
SnomedCT 47812002
Dutch functionele diarree, diarree; functioneel, functioneel; diarree, Functionele diarree
French Diarrhée fonctionnelle
German funktionelle Diarrhoe, Funktionelle Diarrhoe
Italian Diarrea funzionale
Portuguese Diarreia funcional
Spanish Diarrea funcional, diarrea funcional (trastorno), diarrea funcional
Japanese 機能性下痢, ｷﾉｳｾｲｹﾞﾘ
English functional diarrhea (diagnosis), functional diarrhea, Diarrhoea;functional, Functional diarrhea, Functional diarrhoea, Functional diarrhea (disorder), diarrhea; functional, functional; diarrhea, Diarrhea;functional, functional diarrhoea
Czech Funkční průjem
Korean 기능적 설사
Hungarian Funkcionális hasmenés
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Bowel Disorders

advertisement

2020 Family Practice Notebook, LLC. Terms | Privacy (EHS) | About | Site Map | Blog

Footer Site Logo