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International Medical Scientific Journal     Issue-2 

10.5281/zenodo.5080550 

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Art of Medicine          Volume-1 

International Medical Scientific Journal     Issue-2 

10.5281/zenodo.5080550 

23 

Art of Medicine 

International Medical Scientific journal 

 

Founder and Publisher Pascual Izquierdo-Egea 

Published science may 2021 year. Issued Quarterly. 

Internet address: http://artofmedicineimsj.us 

E-mail: info@artofmedicineimsj.us 

11931 Barlow Pl Philadelphia, PA 19116, USA +1 (929) 266-0862 

 

 

 

 

 

 

  



Art of Medicine          Volume-1 

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CLINICAL MANIFESTATION OF IRRITABLE BOWEL SYNDROME  

Makhmudova L.I., Akhmedova N.Sh., Ergashov B.B. 

Bukhara State Medical Institute, Bukhara, Uzbekistan 

E-mail address: makhmudova.lola.89@mail.ru 

Abstract. Irritable bowel syndrome (IBS) is a biopsychosocial disease 

consisting of a set of functional disorders not explained by organic changes in the 

intestine. Patients with IBS were divided into two groups: with non-refractory (IBSn - 

35 people) and refractory (IBSr - 47 people) the course of the IBS. Of these, taking 

into account the leading clinical syndrome,  patients with IBSn-d (diarrhea) - 21 

people were identified (25.6%), IBSn-c – (constipation) 14 people (17%), IBSr-d - 28 

people (34.2% ), IBSr-c - 19 people (23.2%). More abdominal pain syndrome was 

noted in patients with a clinical form of IBS with a predominance of diarrhea. The 

ordinal assessment of the severity of IBS symptoms allows to objectify the severity of 

clinical manifestation of intestinal dysfunction in patients, identify the clinical 

features of the course of this pathology. 

Key words: irritable bowel syndrome, clinical symptoms, Bristol scale 

 Introduction. Functional bowel diseases (FBD) make up the majority of 

functional gastrointestinal (GI) pathology, characterized by a variable combination of 

chronic or recurrent symptoms related to different parts of the GI tract that cannot be 

explained by morphological or biochemical abnormalities. These disorders are 

diagnosed by excluding a number of organic gastrointestinal diseases that have 

similar manifestations, after a thorough examination of the patient. In May 2016, the 

world gastroenterological community at the American Gastroenterology Week got 

acquainted with the Rome IV criteria, the main provisions of the consensus have 

already been published [1,2,3,4]. 

Table 1. Rome criteria IV. Section C. "Functional bowel disorders" 

C1. Irritable bowel syndrome 

mailto:makhmudova.lola.89@mail.ru


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C2. Functional constipation 

C3. Functional diarrhea 

C4. Functional bloating 

C5. Nonspecific functional intestinal disorder 

C6. Opioid-induced constipation 

 

 Irritable bowel syndrome (IBS) is a biopsychosocial disease that is a complex 

of functional disorders that cannot be explained by the organic changes in the 

intestine in the patient [5,6,7,8]. 

 According to the metaanalysis published in 2012, in which, according to 

quite strict selection criteria, 80 clinical studies with a total number of patients 

260,960, the prevalence of IBS in the world is 11.2% [9]. Only 12-15% of patients 

seek medical care. In Southeast Asia, its frequency is 7%, in Europe 20%, 21% in 

South America. According to literature, the number of patients with functional 

disorders of the gastrointestinal tract, including the IBS, in a specialized 

gastroenterological hospital reaches 41-45% [10,11,12]. The Massage of the IBS 

among women remains higher than among men. Young people are more susceptible 

to the development of the disease, rather than 50 years old. Any case of the 

manifestation of the clinical picture of the IBS in patients of an older age category 

should alarm in relation to the elimination of organic pathology. 

The purpose of the study. A study of the clinical symptoms of patients with 

different forms of IBS. 

Material and research methods. The article summarizes the data of surveys 

82 patients with the IBS on the examination and treatment in the Gastroenterology 

bombing department from 2017 to 2019. The average age of patients was 33,2 ± 0.8 

years. 

Patients with IBS were divided into two groups: with non-refractory (IBSn - 35 

people) and refractory (IBSr - 47 people) the course of the IBS. Of these, taking into 

account the leading clinical syndrome,  patients with IBSn-d (diarrhea) - 21 people 



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were identified (25.6%), IBSn-c – (constipation) 14 people (17%), IBSr-d - 28 people 

(34.2% ), IBSr-c - 19 people (23.2%). The control group included 20 healthy 

volunteers (6 males and 14 females) who underwent prophylactic screening as part of 

the examination of gastrointestinal tract pathology at BRMMC (Bukhara Regional 

Multidisciplinary Medical Center). The mean age of the control group was 27,8 ± 4,1 

years. 

The diagnosis of IBS was established taking into account the Roman criteria - 

IV (2016), recommendations of the bomb. When determining the clinical version of 

the IBS used the Bristol Cala's forms [Blake M.R., Raker J.M., Whelan K., 2016]. 

Patients were examined according to standards: General blood test, biochemical 

blood test with assessment of liver and kidney function, general urine analysis, 

electrocardiogram, coprogram, test for hidden blood, ultrasound examination of 

abdominal organs (VIVID S-60,2014, Norway), esophagogastroduodenoscopy 

Fuginon. Fugi Film EPX-2500, 2014, Japan; Fugi Film-EG-530PF, 2014, Japan), 

Fibrocolonoscopy (Fugi Film-EG-530FL, 2014, Japan), Contrast X-ray. In 82 

patients with CRC, microelements were performed (mass-spectrometry of Usuli, 

Perkinelmer Inc., Shelton, CT 06484, USA) on her hair. In 42 patients with IBS, 

bacteriological examination of feces on dysbacteriosis. 

Results and discussion. The non-refractory IBS was determined taking into 

account the anamnesis data. In case of non-refractory IBS, the total length of 

symptoms over the past year to the present appeal to the doctor was an average of 

11.14 ± 0.29 weeks, a positive effect was observed from the therapy appointed in 

accordance with the clinical recommendations of the bomb. The overall duration of 

the disease at a non-refractory IBS was 4.3 ± 0.39 years. With refractory IBS, the 

total duration of symptoms over the past year to the present appeal to the doctor was 

an average of 29.81 ± 0.27 weeks, there was a low effectiveness of the therapy 

appointed in accordance with the clinical recommendations of BRMMC, with a 

confirmed diagnosis of IBS and sufficient adherence to treatment. The total duration 

of the disease in the refractory IBS was 4.7 ± 0.27 years. 



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Data on the age of debut of the IBS are presented in table. 2.  

 

Table 2. The debut of the disease is the debut of the disease in various types of 

IBS 

Index Sex IBSn-d 

(n =21) 

IBSn-c 

(n=14) 

IBSr-d 

(n = 28) 

IBSr-c 

(n=19) 

1 2 3 4 5 6 

Medium debut 

age М±m 

male 21,2 ± 0,4 26,2 ± 0,6 19,3 ± 0.3* 24,0 ± 0,2 

female 22,0 ± 0,4 28,6 ± 0,5* 24, ± 0.3 20,1 ± 0,3* 

Regardless of 

the sex 
21,9 ± 0,3 27,6 ± 0,5* 21,6 ± 0.5 21,9 ± 0,5 

Notes: IBSn-d - non-refractory IBS with diarrhea; IBSn-c - non-refractory IBS with constipation; 

IBSr-d - refractory IBS with diarrhea; IBSr-c - refractory IBS with constipation; * Differences with 

an average of the middle-aged debut in the entire sample of patients with IBS (p <0.05) 

 

The age of the debut with an non-refractory version of the IBS 24,14 ± 0.54 

years: with IBSn-d - 21.9 ± 0.3 years, with IBSn-c - 27.6 ± 0.5. Later, the very 

beginning of the disease was noted in women with IBSn-c (28.6 ± 0.5) in comparison 

with the overall sample of patients with IBS (p <0.05). 

The age of debut of the disease in patients with a refractory variant of the flow 

of the IBS was 21.6 ± 0, years, which is significantly lower (p <0.05) than with the 

irrefractive course of the disease. In men earlier, the IBSr-d (19.3 ± 0.3) was debuted, 

in women – IBSr-c (20.1 ± 0.3). 

To determine the clinical severity of the IBS flow, we accepted a ballroom 

system of assessment of symptoms: the lack of a sign was evaluated as 0 points, from 

weak severity to moderate manifestations - 1 point, expressed manifestations - 2 

points. Summing the number of points for each patient is carried out in eight signs 

(the presence of abdominal pain, diarrhea, constipation, flatulence, feelings of 

incomplete intestinal emptying, false urges, secretion of mucus, long-term outline 



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during defecation). Patients who scored 11-16 points were attributed to a group with 

severe / pronounced manifestations that scored 6-10 points - in a group with moderate 

/ mid-severity, and received 1-5 points - to a group with light manifestations (table 3). 

 

 

Table 3. Palk scale to determine the severity of the flow of the IBS 

Basic symptom 0 балла 1 балла 2 балла 

Abdominal pain "Not very serious", 

rarely 

"Not very serious", 

rarely 

very strong, "terrible" 

Diarrhea less than 3 times a 

day 

less than 3 times a day over 5 times a day 

Constipation 1 time less than 2 

days 

1 time less than 2 days 1 time in 5-7 days 

Metiorism + ++ +++ 

Feelings of 

incomplete 

emptying of the 

intestine 

+ ++ +++ 

False urges seldom seldom always 

Selection of 

mucus 

seldom seldom always 

Long strain 

during 

defecation 

seldom seldom always 

 

The distribution of patients depending on the severity of the clinical 

manifestations of the IBS, obtained as a result of the use of a ball assessment of the 

severity of symptoms as follows (table 4). 

 

Table 4. Clinical severity of flow and signs of illness during the period of 

exacerbation in various clinical versions of the IBS  



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Clinical symptoms 

 

Вариант течения СРК 

IBSn-d 

(n =21) 

Abs.num. (%) 

IBSn-c 

(n=14) 

Abs.num. (%) 

IBSr-d 

(n = 28) 

Abs.num. (%) 

IBSr-c 

(n=19) 

Abs.num. (%) 

Abdominal pain 21 (100) 14 (100) 28 (100) 19 (100) 

Diarrhea 21 (100) 0 (0) 28 (100) 0 (0) 

Constipation 0 (0) 14 (100) 0 (0) 19 (100) 

Flatulence 15 (71,4) 9 (64,2) 11 (39,3) 15 (78,9) 

Feelings of 

incomplete 

emptying of the 

intestine 

8 (38,2) 11 (78,5) 13 (46,4) 16 (84,2) 

False urges 8 (38,2) 2 (14,2) 12 (42,8) 9 (47,4) 

Selection of mucus 9 (42,8) 3 (21,4) 17 (60,7) 10 (52,6) 

Long strain during 

defecation 

9 (42,8) 7 (50) 9 (32,1) 13 (68,4) 

Frequency chaul 

1-4 times a day 12 

(57,1%±11,1)* 
0 (0) 

6 (21,4%±7,9)* 

# 
0 (0) 

5 or more than a day 
9 (42,9%±11,1)* 0 (0) 

22 (78,6%±7,9)* 

# 
0 (0) 

1 time in 3-4 days 0 (0) 8 (57,1%±13,7) 0 (0) 6 (31,6%±11,0) 

1 time in 5-7 days 
0 (0) 6 (42,9%±13,7) 0 (0) 

13 

(68,4%±11,0) # 

Clinical severity of the flow of the IBS 

Easy 10 (47,6) 9 (64,3) 6 (21,4) 4 (21,1) 

Average 8 (38,2) 5 (35,7) 9 (32,2) 6 (31,6) 

Heavy 3 (14,2) 0 (0) 13 (46,4 9 (47,3) 

Notes: IBSn-d - non-refractory IBS with diarrhea; IBSn-c - non-refractory IBS with constipation; 

IBSr-d - refractory IBS with diarrhea; IBSr-c - refractory IBS with constipation; * Differences with 

indicators of a group of non-refractory patients (p <0.05); *# Differences with indicators of a group 

of refractory patients (p <0.05) 

 



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 The "intestinal" symptomatics in the refractory current of the IBS was more 

pronounced than with a non-refractory: at the IBSr-d, the chair was rapid up to 5 or 

more than a day (p = 0.0011), in the morning hours, with an admixture of mucus, 

tensies were more often marked (p = 0.0341) and a sense of incomplete emptying of 

the intestine after defecation (p = 0.0314). 

Most patients with IBSr-c presented complaints to constipation up to 5-7 days 

(p = 0.0000), admixture of mucus in feces (p = 0.0087). Tenses (p = 0.0007) and a 

sense of incomplete emptying of the intestine (p = 0.0263) were noted more often 

than with the non-refractory course of the IBSn-c. 

IBS with constipation prevailed the types of chaul 1st (IBSr-c) and 2nd (IBSn-

z) on a Bristol scale. For the IBS with diarrhea, the types of chaul 5th (IBSn-d), 6th 

(IBSr-d) were characterized. The type of chaul 7th was noted in 8 (28.6%) patients 

with IBSr-d. The normal forms of chaul (3rd and 4th in a Bristol scale) with a change 

in the multiplicity of defecation and a sense of incomplete emptying of the intestine 

in 10 (24.4%) patients with a non-refractory version of the IBS and 8 (7.5%) of 

patients with refractory  variant of the disease (table 5). 

 

Table 5. Forms of a chaul in a Bristol scale 

Типы стула Option of the flow of IBS 

IBSn-d 

(n =21) 

Abs.num. (%) 

IBSn-c 

(n=14) 

Abs.num. (%) 

IBSr-d 

(n = 28) 

Abs.num. (%) 

IBSr-c 

(n=19) 

Abs.num. (%) 

1 0 (0) 2 (14,2) 0 (0) 13 (68,4) *# 

2 0 (0) 8 (57,1) 0 (0) 4 (21,1) *# 

3 2 (9,5) 2 (14,2) 0 (0) 2 (10,5) 

4 3 (14,2) 2 (14,2) 3 (10,7) # 0 (0) 

5 6 (28,5) 0 (0) 6 (21,4) *# 0 (0) 

6 10 (47,6) 0 (0) 11 (39,3) # 0 (0) 

7 0 (0) 0 (0) 8 (28,6) *# 0 (0) 

Notes: IBSn-d - non-refractory IBS with diarrhea; IBSn-c - non-refractory IBS with constipation; 

IBSr-d - refractory IBS with diarrhea; IBSr-c - refractory IBS with constipation; * Differences with 



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indicators of a group of non-refractory patients (p <0.05); *# Differences with indicators of a group 

of refractory patients (p <0.05) 

 

When estimating the intensity of abdominal pain on a visual analog scale 

(VAS), a moderate (p = 0.0082) and an intense (p = 0.0001) abdominal pain 

syndrome (table 6) was more often recorded during the refractory flow. 

 

Table 6. The intensity of abdominal pain (VAS) 

Pain intensity IBSn-d 

(n =21) 

Abs.num. (%) 

IBSn-c 

(n=14) 

Abs.num. (%) 

IBSr-d 

(n = 28) 

Abs.num. (%) 

IBSr-c 

(n=19) 

Abs.num. (%) 

Weak 12 (57,1%±11,1) 8 (67,1%±13,0) 3 (10,7%±5,9)* 2 (10,5%±7,2)* 

Average 9 (42,9%±11,1) 6 (42,8%±13,7) 14(50%±9,6)* 9 (47,5%±11,8)* # 

Strong 0 (0) 0 (0) 11(19,3%±7,6)* # 8 (42,2%±11,7)* 

Notes: IBSn-d - non-refractory IBS with diarrhea; IBSn-c - non-refractory IBS with constipation; 

IBSr-d - refractory IBS with diarrhea; IBSr-c - refractory IBS with constipation; * Differences with 

indicators of a group of non-refractory patients (p <0.05); *# Differences with indicators of a group 

of refractory patients (p <0.05) 

 

The index of abdominal pain according to your refractory IBS was estimated as 

moderate pain syndrome and was significantly higher than with an non-refractive IBS 

(3.6 ± 0.2 points, p = 0.0000). The intensity of abdominal pain at the IBSr-d (5.7 ± 

0.3) was lower than when IBSr-c (6.0 ± 0.4, p = 0.0000). 

 

Conclusion 

1. More abdominal pain syndrome was noted in patients with a clinical form of IBS 

with a predominance of diarrhea. 

2. The ordinal assessment of the severity of IBS symptoms allows to objectify the 

severity of clinical manifestation of intestinal dysfunction in patients, identify the 

clinical features of the course of this pathology. 

  



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