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Irritable bowel syndrome

  1. Gastroepato
  2. Gastroenterology
  3. Irritable bowel syndrome

notes bt dr. Claudio Italiano


Functional diseases of the colon are the most frequent group of diseases in the colic pathology, and, due to their high incidence, are an extremely important problem from the socio-economic point of view, as it is noted bearing in mind that they constitute

The most widespread cause of consultation at the specialist gastroenterology clinic (50-70% of cases) is one of the main reasons for absenteeism from work in industrialized countries. It affects mainly people between 20 and 40 years, with a slight prevalence of female sex, but their appearance in childhood is not exceptional. On the contrary, it is rare that they arise after the age of 50.

 In the irritable bowel intestinal the motility is impaired or there is a disturbance of the function of absorption and secretion of the colon.

The terms "spastic colitis", or "colitis" are improper, because they would mean the presence of an infection or inflammation of the colon, which instead is completely absent, although there are recent studies that correlate this condition to one " inflammatory state "of the colon, but it would be more correct to speak of" lymphocytic colitis ", but it is a nosographic entity pertaining to the anatomopathologist.

If we want to give a definition, we could say that the intestine has its own contracting musculature, ie there is an activity of distance propulsion and segmentation of bolus (cf. The movement of the colon); the first one pushes the contents of the light and the other slows it down, creating some confusions. Normally in the healthy subject, this motility is not felt, is coordinated and takes place in a time that does not extend from the mouth to the rectum over 96 hours in general.

It happens, however, that some individuals, whether for an increase in propagation waves that have a great breadth and energy, or because of a particular "sensitivity" to gaseous distension of the viscera, feel pain, of the colonic type, that is "come and go" , increases and reduces, and feel the loops "move", apply to visceral symptoms and report to the doctor to feel inside as if they had "a kind of washing machine (!)", meaning thereby the movement of the viscera and the swelling that it goes from the right to the left iliac fossa, which is often painful and spastic (a sign of the colonic cord). Symptoms can be caused by the intake of food or cold drinks and are accompanied by bourgeois, rumors and abdominal grunts. There is abdominal swelling extended to the entire area of ​​the colon or localized in one location.

Therefore, if the propulsive activity prevails, the food is, therefore, more rapidly pushed through the intestine, causing gas, swelling and diarrhea. In other cases, however, the opposite happens and the segmenting activity prevails, so that the content of the lumen, dehydrates, the passage of the food delays and the stools become hard and dry (constipation defecation and constipation). Congestion disorders of the intestinal contents therefore take on different aspects: more or less painful constipation, alternation of constipation and diarrhea, morning diarrhea, or after meals not accompanied by painful manifestations, simple emission of filaments and slivers of mucus. Nobody still knows exactly the causes of Irritable Colon Syndrome. We know that the fundamental activity of the colon, under normal conditions, is represented by the absorption of water and the formation of semi-solid stools.

At the colon level two phenomena are considered important for the formation of normal stools:

1) the absorption of water, sodium and chlorine, as well as a moderate potassium secretion;

2) fermentation and putrefaction processes, carried out by the bacteria that make up the usual intestinal microbiological flora. One understands, therefore, how an alteration of the same processes determines or an accelerated transit with diarrhea or a reduced transit with constipation and putrefactive facts or, finally, the alternation of a constipation and diarrheal for the concomitant development of putrefactive processes and irritant action of microorganisms. Other symptoms, finally, are halitosis (fecal odor of the breath especially in the variety with constipation), nausea, vomiting, belching, anorexia, meteorism, flatulence, headache, vertigo, palpitations, migraine.

Aetiopathogenic causes of S. irritable colon

- alteration of the nerves that control muscle contractions or the sensitivity of the intestine
- genetic factors. If it is S.I.I. in the family, for example in parents, children can become ill, just like homozygous twins
- increase in cells producing 5HT. These release mediators that increase motility (IL s, NO, histamine, can stimulate myenteric nerve cells).
- correlation with sexual hormones; progesterone slows motility: in women it is more frequent; they represent two thirds of people affected by this disease, the researchers believe that hormonal changes play an important role. In fact, for many women, symptoms increase during menstrual periods.
- stressful events.

In any case, stress can only aggravate symptoms but never cause them The psychosomatic profile of this type of patient is of various kinds. The patient suffering from S.I.I. is a meticulous obsessive, faecal maniac, hysterical with a tendency to localize various types of pain, or depressed, delusional hypochondriac, often phobic towards cancer. What is certain is that if these patients are interrogated, a stress condition is found as a basic characteristic. Many patients with irritable bowel are exchanged (and operated) for individuals suffering from appendicitis.
Gastroenteritis, in 7-32% of subjects after an acute episode of diarrhea (gastroenteritis) may give rise to the Irritable Colon.
antibiotics whose intake leads to the destruction of normal bacterial flora
Laxatives as well as some antidiarrheal drugs can cause "irritation" of the colon and contribute to the problem.
Food intolerances, consumption of dairy products, gum or sugar-free candies,: due to intolerance to sugar (lactose) in dairy products or sorbitol of artificial sweetener. In this case we advise you to submit to the Lactose Breath test

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