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IBS In The Elderly. Monica J. Cox ARNP-BC, MSN, MPH Geriatric Nurse Practitioner G.I. Nurse Practitioner Borland-Groover Clinic Jacksonville, Florida. OBJECTIVES. Describe Age-Related Changes In The Digestive System Discuss The Neurophysiology of Irritable Bowel Syndrome

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ibs in the elderly

IBS In The Elderly

Monica J. Cox ARNP-BC, MSN, MPH

Geriatric Nurse Practitioner

G.I. Nurse Practitioner

Borland-Groover Clinic

Jacksonville, Florida

objectives
OBJECTIVES
  • Describe Age-Related Changes In The Digestive System
  • Discuss The Neurophysiology of Irritable Bowel Syndrome
  • Describe The Current Approaches For Evaluating and Treating Elderly Patients With Irritable Bowel Syndrome
alarm symptoms suggestive of organic disease
Alarm Symptoms Suggestive of Organic Disease
  • HISTORY
    • Weight loss < 10 lbs
    • Nocturnal symptoms
    • Initial onset at age > 50 yrs
    • Significant travel history
    • Arthritis/rashes
  • FAMILY HISTORY
    • Colon cancer
    • Inflammatory bowel disease
    • Celiac disease
alarm symptoms suggestive of organic disease continued
Alarm Symptoms Suggestive of Organic Disease - continued
  • PHYSICAL FINDINGS
    • Fever
    • Oral ulcers
    • Palpable abdominal mass
    • Guaiac-positive stool
    • Other physical bleeding or obstruction
  • LABORATORY EVALUATION
    • Increased white blood cell count
    • Anemia
    • Abnormal chemistry
    • Increased thyroid-stimulating hormone
    • Elevated sedimentation rate or C-reactive protein
rome criteria iii
Rome Criteria III
  • At least 3 months, with onset at least 6 months previously of recurrent abdominal pain or discomfort** associated with 2 or more of the following:
  • Improvement with defecation; and/or
  • Onset associated with a change in frequency of stool; and/or
  • Onset associated with a change in form (appearance) of stool

**Discomfort means an uncomfortable sensation not described as pain.

functional sydromes often due to dysmotility
“Functional” Sydromesoften due to “Dysmotility”
  • Functional bowel disorders:
    • Non-ulcer dyspepsia
    • Irritable bowel syndrome
  • Defined motility disorders:
    • GI neuromuscular syndromes
    • Myopathies vs. Neuropathies
dysfunction of different gi organs produces similar symptoms
Dysfunction of Different GI OrgansProduces Similar Symptoms
  • Gullett – Chest pain, belching, dysphagia, regurg
  • LES – Chest pain, pyrosis, belching, regurg
  • Stomach – Regurg, fullness, dyspepsia, bloating
  • Small bowel – Fullness, dyspepsia, discomfort, bloating, change in bowel habits
  • Colon – Fullness, discomfort, variable bowel habits
  • Thus, it is often necessary to test all organs
sx s of small bowel dysmotility may indicate disordered transit
Too Slow

Gas

Fullness

Bloating

Cramps

Altered Bowel Habits

Too Rapid

Gas

Fullness

Bloating

Cramps

Altered Bowel Habits

Sx’s of Small Bowel DysmotilityMay Indicate Disordered Transit
diagnostic evaluation
Predominant Symptom

Constipation:

Infrequent bowel movements

Obstructed defecation

Diagnostic Tests

Colonoscopy

Whole-gut transit test

Anorectal motility plus balloon expulsion

Defecating proctography

Diagnostic Evaluation
diagnostic evaluation15
Predominant Symptom

Diarrhea:

Diagnostic Evaluation

Diagnostic Tests

  • 24-hour stool volume and fat study
  • Stool osmolality, electrolytes, and laxatives
  • Transit test: small bowel and colon
  • Colonic biopsies
  • Breath test
diagnostic evaluation16
Predominant Symptom

Pain:

Diagnostic Evaluation

Diagnostic Tests

  • Plain abdominal x-ray
  • Small bowel follow-through examination
  • CT/MR imaging
  • Pelvic ultrasound