{
 "topic": "Irritable Bowel Syndrome",
 "slug": "irritable-bowel-syndrome",
 "category_id": 15021,
 "passage_count": 14,
 "source_chars": 11685,
 "enough_material": true,
 "references": [
  {
   "title": "Signs and Symptoms in Pediatrics",
   "author": "Henry M. Adam,Jane Meschan Foy",
   "pages": [
    221
   ]
  },
  {
   "title": "Pediatric Nutrition (Ronald E. Kleinman, Frank R. Greer)",
   "author": null,
   "pages": [
    822
   ]
  },
  {
   "title": "Berkowitz's Pediatrics",
   "author": "Berkowitz, Carol D.;",
   "pages": [
    947
   ]
  },
  {
   "title": "The Clinician's Guide to Pediatric Nutrition",
   "author": "Natalie D. Muth;Mary Tanaka;",
   "pages": [
    363
   ]
  },
  {
   "title": "Textbook of Pediatric Gastroenterology, Hepatology and Nutrition (Stefano Guandalini, Anil Dhawan)",
   "author": null,
   "pages": [
    289
   ]
  },
  {
   "title": "Pediatric Dentistry: Infancy through Adolescence - Arthur J. Nowak, John R. Christensen, Tad R. Mabry, Janice A. Townsend, Martha H. Wells - 6th Edition (2018) 656 pp., ISBN: 978-0-323-60826-8",
   "author": "Arthur J. Nowak, John R. Christensen, Tad R. Mabry, Janice A. Townsend, Martha H. Wells",
   "pages": [
    98
   ]
  },
  {
   "title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024",
   "author": null,
   "pages": [
    2323,
    2403,
    2405
   ]
  },
  {
   "title": "Illustrated Textbook of Paediatrics (Tom Lissauer, Will Carroll)",
   "author": "Lissauer, Tom,Carroll, Will",
   "pages": [
    256
   ]
  }
 ],
 "passages": [
  {
   "source": "Signs and Symptoms in Pediatrics, p. 221",
   "text": "## **Irritable Bowel Syndrome** Irritable bowel syndrome (IBS) similar to that occurring in adults may be seen in children and adolescents.[8] Stools may alternate from diarrhea to constipation. In addition, Signs and Symptoms in Pediatrics the patient may have recurrent, crampy, abdominal pain. Late-onset lactose intolerance and fructose or sorbitol ingestion are important to rule out as causes of symptoms that may mimic IBS.[50,51] Symptoms of infl ammatory bowel disease or celiac disease may also be mistaken at fi rst for IBS. Standard treatment includes increased fi ber in the diet and anticholinergics; the tricyclic antidepressants can be used for diarrhea-predominant IBS, under experienced supervision. ## **Infl ammatory Bowel Disease**"
  },
  {
   "source": "Pediatric Nutrition (Ronald E. Kleinman, Frank R. Greer), p. 822",
   "text": "## _Irritable Bowel Syndrome_ Irritable bowel syndrome (IBS) may affect up to 3% of school-aged children,[36] and about one third of this group may have the diarrheapredominant form (IBS-D).[37] The Rome IV Committee defines IBS-D as Pediatric Nutrition, 8th Edition Chronic Diarrheal Disease **809** a change of stool consistency along with abdominal pain for least 4 days/ month for 2 months.[36] These patients do not have rectal bleeding, anemia, weight loss, or fever. Celiac disease should be ruled out. Treatment is often challenging; there is some limited evidence to support the use of probiotics, peppermint oil, elimination diets, and behavioral treatments.[36] ## _Diarrhea With Growth Failure/Malnutrition_ ## _Postgastroenteritis Diarrhea With Malabsorption_"
  },
  {
   "source": "Berkowitz's Pediatrics, p. 947",
   "text": "Irritable bowel syndrome (IBS) may lead to chronic diarrhea in infants and children. Affected children do not experience diarrhea at night, which is the sign of infectious or secretory diarrhea. Partially formed or liquid-first stool in the morning and increased frequency during the day are characteristic of IBS. Bowel movement tends to occur after each meal, suggesting a prominent gastrocolic reflex. Children have 3 to 10 mucus-containing stools per day. Alternating periods of constipation may occur. Affected children appear well throughout this illness, without weight loss, growth impairment, fever, leukocytosis, steatorrhea, or protein malabsorption. Their appetite remains good. The first line of treatment of children with IBS-predominant diarrhea is a high-residue diet. Different probiotics have been used recently for treatment of IBS in children with various success rates."
  },
  {
   "source": "The Clinician's Guide to Pediatric Nutrition, p. 363",
   "text": "amount recommended for age and not completely eliminated from the diet while treating the constipation with medications. ## **Irritable Bowel Syndrome** Irritable bowel syndrome (IBS) is a complex pathology and falls under the umbrella of disorders of gut-brain interaction. Irritable bowel syndrome causes recurrent abdominal pain, bloating, discomfort, and changed frequency and consistency of bowel movements. The symptoms include abdominal pain at least 4 days per month for at least 2 months with one or more of the following signs: abdominal pain related to defecation, Chapter 21. Gastrointestinal, Autoimmune, and Inflammatory Conditions **351** **Table 21-1.** Dietary and Lifestyle Changes to Prevent and Treat Constipation in Children and Adolescents"
  },
  {
   "source": "Textbook of Pediatric Gastroenterology, Hepatology and Nutrition (Stefano Guandalini, Anil Dhawan), p. 289",
   "text": "||Diagnostic criteria for children from 4years of age:| ||Must include at least two of the following occurring at least once per<br>week for a minimum of 1 month with insuffcient criteria for a<br>diagnosis of irritable bowel syndrome:<br>1. Two or fewer defecations in the toilet per week in a child of a<br>developmental age of at least 4 years<br>2. At least 1 episode of fecal incontinence per week<br>3. History of retentive posturing or excessive volitional stool<br>retention<br>4. History of painful or hard bowel movements<br>5. Presence of a large fecal mass in the rectum<br>6. History of large-diameter stools that can obstruct the toilet<br>After appropriate evaluation, the symptoms cannot be fully<br>explained by another medical condition| |||"
  },
  {
   "source": "Pediatric Dentistry: Infancy through Adolescence - Arthur J. Nowak, John R. Christensen, Tad R. Mabry, Janice A. Townsend, Martha H. Wells - 6th Edition (2018) 656 pp., ISBN: 978-0-323-60826-8, p. 98",
   "text": "Inflammatory bowel disease (IBD) is a disorder of intestinal inflammation caused by chronic conditions, whose incidence is rising in children.[66] The etiology is unknown but it may be a combination of genetics, host immunity, and environmental factors.[66] IBD encompasses ulcerative colitis (inflammation of the colon and rectum) and Crohn disease (inflammation of the large intestine, small intestine, or both).[66] Diarrhea and abdominal pain are common features of the disorder in children and adults, but some children may not have any laboratory abnormalities (anemia, iron deficiency, elevated inflammation markers, etc.).[66] Malnourishment may be present in children with Crohn disease because of suboptimal dietary intake, increased gastrointestinal losses, or malabsorption, which may lead to growth failure and osteoporosis.[66] Endoscopic evaluation (both upper endoscopy and colonoscopy) is the gold standard in IBD diagnosis.[66] Goals of therapy are mucosal healing and long-lasting remission, but"
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 2403",
   "text": "**Irritable Bowel Syndrome (IBS)** can be classified into the same four subtypes as adult IBS, depending on stool pattern: IBS with constipation (IBS- C), IBS with diarrhea (IBS- D), IBS with constipation and diarrhea, and unspecified IBS. Diagnosis of IBS requires abdominal pain on four or more days per month associated with defecation and/or a change in frequency of stool from baseline and/or a change in form/ Downloaded for mohamed ahmed (dr.mms2020@gmail.com) at University of Southern California from ClinicalKey.com by Elsevier on April 21, 2024. For personal use only. No other uses without permission. Copyright \u00a92024. Elsevier Inc. All rights reserved. 2390 Part XVI u The Digestive System Table 389.11 Alarm Symptoms Usually Needing Further ~~Investigations in Children with Chronic~~ Abdominal Pain ## Table 389.13 Diagnostic Criteria* for Irritable Bowel Syndrome Must include all of the following: - Pain that wakes up the child from sleep"
  },
  {
   "source": "Illustrated Textbook of Paediatrics (Tom Lissauer, Will Carroll), p. 256",
   "text": "## **Irritable bowel syndrome** This disorder, also common in adults, is associated with altered gastrointestinal motility and an abnormal sensation of intra-abdominal events. Symptoms may be precipitated by a gastro-intestinal infection. Studies of pressure changes within the small intestine of children with irritable bowel syndrome suggest that abnormally forceful contractions occur. It has also been shown that affected adults experience pain on inflation of balloons in the intestine at substantially lower volumes than do controls. There is therefore an inter-play between these two factors, both of which are modulated by psychosocial factors such as stress and anxiety. There is often a positive family history and a characteristic set of symptoms, although not all patients experience every symptom: - [ non-specific abdominal pain, often peri-umbilical, ] may be worse before or relieved by defaecation - [ explosive, loose, or mucousy stools] - [ bloating] - [ feeling of incomplete defecation]"
  },
  {
   "source": "MedStudy Pediatrics Core 11th Edition 2024-2025, p. 333",
   "text": "and psychotherapy, have been shown to be some of the most effective treatments. Do not confuse IBS with IBD! Irritable bowel syndrome (IBS) is a chronic, benign, functional disorder that causes no long-term damage and can be managed supportively. Inflam- matory bowel disease (IBD) is much more severe and is characterized by chronic inflammatory changes that can cause anemia, weight loss, and malnutrition! See more on IBD under Inflammatory Bowel Disease (IBD) on page 10-25. * Abdominal migraine is a form of migraine seen mainly in children 2-10 years of age in which the abdominal pain, ranging from dull to severe, is poorly localized. The pain is accompanied by 2 2 of the following: loss of appetite, nausea, vomiting, and pallor. Etiology is uncertain, but the majority of these children have a family history for migraines. The child has no symp- toms between attacks. Diagnosis is clinical. Treatment consists of hydration, good sleep habits, nonsteroi- dal antiinflammatory drugs (NSAIDs), antinausea"
  },
  {
   "source": "Update in Pediatrics, p. 371",
   "text": "Irritable bowel syndrome (IBS) is a type of functional abdominal pain disorder and it is divided into diarrhea predominant, constipation predominant, constipation and diarrhea predominant, and unspecified. Diagnostic criteria are in Table 15.8. For patients with constipation and abdominal pain, it is recommended to treat the constipation first. If there is continued discomfort, then the patient should be treated for irritable bowel syndrome\u2014constipation predominant (Hyams et al. 2016). **Table 15.8** Diagnostic criteria for irritable bowel syndrome"
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 2405",
   "text": "Table 389.16 Diagnostic Criteria for Functional Constipation in Children with Chronic Abdominal Pain Must include two or more of the following occurring at least once per week for a minimum of 1 month with insufficient criteria for a diagnosis of irritable bowel syndrome: 1. Two or fewer defecations in the toilet per week in a child of a developmental age of at least 4 years 2. At least one episode of fecal incontinence per week 3. History of retentive posturing or excessive volitional stool retention 4. History of painful or hard bowel movements 5. Presence of a large fecal mass in the rectum 6. History of large- diameter stools that can obstruct the toilet After appropriate evaluation, the symptoms cannot be fully explained by another medical condition. From Hyams JS, Di Lorenzo C, Saps M, et al. Childhood functional gastrointestinal disorders: child/adolescent. _Gastroenterology_ . 2016;150(6):1456\u20131468."
  },
  {
   "source": "Caring for the Hospitalized Child, p. 322",
   "text": "**295** ~~**CHAPTER 40**~~ ## **Inflammatory Bowel Disease** ## **Introduction** Inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn disease (CD), cause chronic intestinal inflammation characterized by clinical exacerbations and remissions. Inflammatory bowel disease affects children of all ages. Disease in the first 2 years after birth is referred to as infantile-onset IBD, while very early\u2013onset IBD occurs in patients between 2 and 6 years of age."
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 2323",
   "text": "The term _inflammatory bowel disease_ (IBD) is used to represent two distinctive disorders of idiopathic chronic intestinal inflammation: Crohn disease and ulcerative colitis. Their respective etiologies are poorly understood, and both disorders are characterized by unpredictable exacerbations and remissions. The most common time of onset of IBD is during the preadolescent/adolescent era and young adulthood. A bimodal distribution has been shown with an early onset at 10- 20 years of age and a second, smaller peak at 50- 80 years of age. Approximately 25% of patients present before 20 years of age. IBD may begin as early as the first year of life, and an increased incidence among young children has been observed since the turn of the 20th century. Children with _early- onset_ IBD are more likely to have colonic involvement. In developed countries, these disorders are the major causes of chronic intestinal inflammation in children beyond the first few years of life. A third, less- common category,"
  },
  {
   "source": "Netters Pediatrics (Florin \u0422., Ludwig St.), p. 721",
   "text": "Jessica Wen and Rose C. Graham _I_ nflammatory bowel disease (IBD) is an idiopathic, likely immune-mediated, inflammatory disease involving the gastrointestinal (GI) tract. There are two subtypes, ulcerative colitis (UC) and Crohn\u2019s disease. In the pediatric population, Crohn\u2019s disease is more common than UC, with the majority of children diagnosed in adolescence, although some are much younger. Worldwide, the incidence of IBD is higher in developed countries than developing countries. Persons living in urban areas have increased rates of IBD compared with persons living in rural areas. Currently, there is no cure for IBD, and the goal of therapy in the pediatric population is maintenance of long-term remission and normal growth and nutritional status. ## **ETIOLOGY AND PATHOGENESIS**"
  }
 ]
}