Irritable Bowel Syndrome

Question 1

What symptoms suggest a diagnosis of IBS?

Answer 1

> 12 consecutive weeks (in past 12mo) of abdo discomfort/pain w/ 2/3 of:

• relieved w/ defecation
• associated w/ change in frequency of stool
• associated w/ change in form of stool

Question 2

What additional sx may be present?

Answer 2

At least 2 of:

• bloating
• passage of mucus
• stool passage sx (tenesmus, feelings of incomplete evacuation)
• gynae sx (dysmenorrhoea/dyspareunia)
• urinary sx (frequency, urgency, nocturia)
• back pain

Question 3

How common is IBS?

Answer 3

10-20% prevalence
F:M >2:1
Onset <40yrs

Question 4

What are the current theories regarding the pathophysiology of IBS?

Answer 4

Mixed group of abdo sx w/ no organic cause
Possible difference in ‘brain-gut’ axis, leading to increased visceral perception & decreased visceral pain threshold

Question 5

What investigations are appropriate in suspected IBS?

Answer 5

CPR/ESR
Faecal calprotectin (exclude IBD)
TTG/anti-endomysial antibodies (exclude coeliac)
FBC (anaemia)

Question 6

What are the ‘red flag’ sx in suspected IBS?

Answer 6

Unintentional wt loss
Rectal bleeding
FH bowel/ovarian cancer
Change in bowel habit in >60yrs
Incontinence
Having to open bowels frequently at night

Question 7

What are the management options in IBS?

Answer 7

Lifestyle measures
Dietary advice (from dietician)
Antispasmodics
Laxatives
Medical management

Question 8

What lifestyle measures should be taken to manage IBS?

Answer 8

Relaxation
Exercise/diet
Regular mealtimes
Lots of water
Limit tea/coffee
High insoluble fibre food intake

Question 9

What are the medical options for managing IBS?

Answer 9

1st line = Loperamide
2nd line = Low dose TCAs once daily (at night)
3rd Line = SSRIs

Question 10

What is refractory IBS?

Answer 10

Sx persisting after >12mo of antidepressant medications

Refer for CBT