Gastroenterology Book

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Irritable Bowel Syndrome

Aka: Irritable Bowel Syndrome, Functional Chronic Diarrhea
  1. Epidemiology
    1. Lifetime Prevalence: 10-22%
    2. Slightly more common in women
    3. Prevalence for elderly same as for young
    4. Most common condition seen by Gastroenterologists
  2. Pathophysiology
    1. Organic gastrointestinal hypersensitivity
    2. Provoked by psychosocial risk factors
    3. Severe Gastroenteritis episode may be associated
  3. 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
  4. Risk Factors: Psychosocial
    1. Anxiety
    2. Major Depression
    3. Somatization Disorder
    4. Sexual abuse or physical abuse
    5. Stressful life events
    6. Substance Abuse
  5. Types
    1. Alternating Diarrhea and Constipation
    2. Nervous Diarrhea
    3. Predominant Constipation
    4. Upper abdominal bloating and discomfort
  6. Symptoms
    1. Altered bowel habits
      1. Diarrhea
      2. Constipation
      3. Scybalous stools
    2. Recurrent and Chronic Abdominal Pain
      1. Upper abdominal discomfort after eating
      2. Left Lower Quadrant Abdominal Pain
      3. Right Lower Quadrant Abdominal Pain
      4. Abdominal Pain relieved with Defecation
    3. Gaseousness
      1. Excessive Flatulence or Eructation
      2. Normal patients experience about 13 farts per day
    4. Nausea or Vomiting
  7. 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
  8. 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
  9. 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)
  10. 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
  11. 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
      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
      1. Lactose Intolerance
      2. Sorbitol
      3. Wheat (Gluten Sensitive Enteropathy)
  12. 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. StoolOva 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. Special topics
      1. Flexible Sigmoidoscopy or Colonoscopy
        1. Not absolutely indicated if remainder of evaluation suggests Irritable Bowel Syndrome
        2. Consider if red flags or age over 50 years
    5. Reference
      1. Fass (2001) Arch Intern Med 161:2081-8
  13. Diagnostic studies
    1. Flexible Sigmoidoscopy
      1. More uncomfortable in Irritable Bowel Syndrome
    2. Consider additional studies as indicated
      1. Upper GI Study
      2. Barium Enema
  14. Management: General Measure
    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. General Diet recommendations
      1. Get adequate fluid intake (>64 ounces/day)
      2. Bulk agents (gradually increase)
        1. Metamucil
        2. Citrucel
        3. High fiber-bran
      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
        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
    6. Avoid Provocative or addictive medications
      1. Stimulant Laxatives (except brief use)
        1. Correctol
        2. Dulcolax
        3. Cascara
      2. Sedatives or Tranquilizers (Benzodiazepines)
      3. Narcotics
  15. Management: Symptom specific medications
    1. Diarrhea
      1. Consider eliminating lactose, caffeine from diet
      2. Cholestyramine 4 grams qhs to 6 times daily
      3. Loperamide (Imodium) 2-4 mg qid prn
        1. Before meals
        2. As needed in stressful social situations
      4. Ondansetron (Serotonin antagonist)
        1. Reduces rapid transit
      5. 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)
      6. Peppermint
        1. Pittler (1998) Am J Gastroenterol 93:1131-5
    2. Comorbid Mood Disorders
      1. Major Depression
        1. SSRI Medications or other Antidepressants
      2. Anxiety
        1. Buspar
        2. Amitriptyline (Elavil)
    3. Pain dominant symptoms
      1. Chronic Pain
        1. Amitriptyline (Elavil) 25 mg qhs
        2. Desipramine (Norpramin) 50 mg tid
        3. Tegaserod (Zelnorm)
          1. Nyhlin (2004) Scand J Gastroenterol 39:119-26
        4. SSRI medications may be effective as adjunct
          1. Tabas (2004) Am J Gastroenterol 99:914-20
      2. Post-prandial pain: Anticholinergic
        1. Avoid chronic 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
    4. Constipation
      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
      3. Second line (use at bedtime for AM stool)
        1. Osmotic agents
          1. Lactulose 1-2 teaspoons at bedtime
          2. Polyethylene glycol solution 8 ounces at bedtime
          3. Milk of Magnesia 1-2 tablespoons at bedtime
          4. Miralax
        2. Consider Stimulant Laxatives if osmotic agents fail
          1. Senna or Cascara
          2. Bisacodyl
      4. Third line (prescription agents)
        1. Amitiza (Lubiprostone)
      5. Restricted Use agent (emergency use only due to risk)
        1. Tegaserod (Zelnorm): 5-HT4 agonist
          1. 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
        2. Peppermint
          1. Pittler (1998) Am J Gastroenterol 93:1131-5
        3. Loxiglumide (cholecystokinin-A receptor antagonist)
    5. Excessive flatus (gas)
      1. Simethicone 40 to 125 mg up to qid
      2. Beta-galactosidase (Beano)
  16. Resources
    1. International Foundation for Functional GI Disorders
      1. http://www.iffgd.org
    2. American College of Gastroenterology
      1. http://www.ACG.GI.org
    3. Mind-Body Digestive Center
      1. http://www.mindbodydigestive.com
  17. References
    1. Camilleri (2000) Gastroenterology 120:652-68
    2. Camilleri (1999) Am J Med 107(5A):27F-32S
    3. Chang (2006) Curr Treat Options Gastroenterol 9(4):314-23
    4. Drossman (1999) Am J Med 107(5A):41S-50S
    5. Hammer (1999) Am J Med 107(5A):5S-11S
    6. Heymann-Monnikes (2000) Am J Gastroenterol 95:981-4
    7. Holten (2003) Am Fam Physician 67(10):2157-62
    8. Jailwala (2000) Ann Intern Med 133:136-47
    9. Mertz (2003) N Engl J Med 349:2136-46
    10. Naliboff (1999) Curr Rev Pain 3:144-52
    11. Ringel (2001) Annu Rev Med 52:319-38
    12. Viera (2002) Am Fam Physician 66:1867-80

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
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Irritable Bowel Syndrome (C0022104)

Definition (NCI) A common syndrome manifested by symptoms of bloating, abdominal cramping, constipation, and/or diarrhea. In most patients the symptoms are not severe and they can be controlled with diet, stress, and lifestyle management. A small percentage of individuals may experience severe symptoms. The cause is unknown.
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. Some go back and forth between constipation and diarrhea. Although IBS can cause a great deal of discomfort, it does not harm the intestines.

IBS is a common disorder and happens more often in women than men. No one knows the exact cause of IBS. There is no specific test for IBS. However, 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 and medicine.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases
Definition (NCI) 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 (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
English Irritable Bowel Syndrome, IRRITABLE COLON, COLITIS, MUCOUS, COLON SPASTIC, COLON, SPASTIC, IRRITABLE BOWEL SYNDROME, IRRITABLE COLON SYNDROME, Mucous Colitis, SPASTIC COLON, COLITIS MUCOUS, Irritable Colon Syndrome, Membranous Colitis, IBS, irritable bowel, irritable bowel syndrome (diagnosis), irritable bowel syndrome, mucous colitis, irritable colon, Functional bowel syndrome, Colon spastic, Colitis mucous, BOWEL IRRITABLE, BOWEL IRRITABLE SYNDROME, 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, mucus colitis, spastic colon, Colitides, Mucous, Colitis, Mucous, Colon, Irritable, Irritable Bowel Syndromes, Mucous Colitides, Syndrome, Irritable Bowel, Syndromes, Irritable Bowel, Irritable Colon, Mucous colitis, Irritable colon syndrome, Irritable bowel syndrome, Irritable colon, Spastic colon, Adaptive colitis, Membranous colitis, Colon spasm, Functional bowel disease, IBS - Irritable bowel syndrome, Irritable bowel, Nervous colitis, Spastic colitis, IC - Irritable colon, Irritable colon (disorder), [X]Psychogenic IBS, 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, Irritable bowel - IBS, Irritable colon - Irritable bowel syndrome, IBS (irritable bowel syndrome)
Dutch slijmerige colitis, colitis met slijm, prikkelbaar colon, prikkelbare darm, colon spastisch, spastisch colonsyndroom, functioneel darmsyndroom, spastisch colon, Spastisch colon/IBS, 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, Colopathie fonctionnelle, Colite mucoïde, COLON SPASMODIQUE, SYNDROME DU COLON IRRITABLE, Syndrome du colon irritable, 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, funktionelles Kolonsyndrom, COLON IRRITABILE, COLONSPASMUS, spastisches Colon/Colon irritabile, 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 funzionale intestinale, Sindrome da colon irritabile, Colite mucosa, Colite spastica, Colon irritabile, IBS, Sindrome dell'intestino irritabile
Portuguese Síndrome de cólon irritável, Síndrome intestinal funcional, Intestino irritável, Colite mucosa, Cólon espástico, Cólon irritável, COLON ESPASTICO, SINDROME DO INTESTINO IRRITAVEL, Sindrome do colon irritavel, Síndrome de intestino irritável, Colite Mucosa, Cólon Irritável, Síndrome de Intestino Irritável, Síndrome do Intestino Irritável, Síndrome de Colo Irritável, Síndrome de Cólon Irritável, Síndrome do Colo Irritável, Síndrome do Cólon Irritável, Colo Irritável
Spanish Síndrome intestinal funcional, Colon espástico, Intestino irritable, Colon irritable, Síndrome de colon irritable, Colitis mucosa, Irritable bowel - IBS, Irritable bowel syndrome, Spastic colon, [X]Psychogenic IBS, Irritable colon - Irritable bowel syndrome, COLON ESPASTICO, Sindrome de colon irritable, colitis espástica, colitis mucosa, colitis nerviosa, colon adaptable, colon espástico, colon irritable (trastorno), colon irritable, enfermedad funcional del intestino, espasmo colónico, síndrome de intestino irritable, Síndrome del intestino irritable, colitis membranosa, Colitis Mucosa, Colon Irritable, Síndrome del Colon Irritable, Síndrome del Intestino Irritable, Sindrome del Colon Irritable, Sindrome del Intestino Irritable
Japanese 痙性結腸, 機能性腸管症候群, 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, ｷﾉｳｾｲﾁｮｳｶﾝｼｮｳｺｳｸﾞﾝ, 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
Swedish Irritabel tarm, COLON IRRITABILE
Czech syndrom dráždivého tračníku, colon irritabile, kolitida mukózní, tračník dráždivý, Funkční střevní syndrom, Syndrom dráždivého tračníku, Mukózní kolitida, Spastický tračník
Finnish Ärtyvän suolen oireyhtymä, ARTYNYT PAKSUSUOLI
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
Norwegian IRRITABEL COLON
Danish Irritabel kolon
Hungarian irritab. colon tunetegyuttes, IBS, Irritabilis bél, Colon spasticum, Spastikus vastagbél, Irritabilis colon, Irritabilis vastagbél syndroma, Irritabilis bél syndroma, Colitis, nyákos, Nyákos colitis, Funkcionális bél syndroma
Korean 자극성 장증후군
Croatian SINDROM IRITABILNOG CRIJEVA
Basque HESTE LODI SUMINKOR SINDROMEA
Hebrew tosmonet hamei haragiz IRRITABLE
Polish Zespół drażliwego jelita, Zespół nadwrażliwego jelita, Zespół jelita nadwrażliwego
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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