IBS

Question 1

what are the worrying signs of functional gut disorders (poor prognosis)?

Answer 1

patient in wheelchair due to pain
patient given up work due to pain
partner given up work to look after patient
patient wears dark glasses
patient carries water everywhere and drinks during interview

Question 2

what is IBS?

Answer 2

chronic relapsing problem
abdo pain
bloating
change in bowel habit
10-20% population (peak in 30s-40s)
females>males

Question 3

what is the pathophysiology of IBS?

Answer 3

genes + environment
disturbed GI motility; high amplitude propagating contractions - exaggerated by gastro-colic reflex, pain
visceral hypersensitivity

Question 4

what is visceral hypersensitivity?

Answer 4

seen in 2/3rds patients
peripheral sensitisation
- inflammatory mediators up regulate sensitivity of nociceptor terminals
central sensitisation
- increased sensitivity of spinal neurones

Question 5

how is peripher hypersensititvy evidenced?

Answer 5

up to 20% recall onset after infectious gastroenteritis

Question 6

how is central hypersensitivity evidenced?

Answer 6

increased pain radiation

Question 7

what is rome III criteria?

Answer 7

recurrent abdopain/discomfort for 3 days per month for 3 month + 2 or more of
- improvement/worse with defecation
- onset assoc with change stool frequency
onset assoc with change in stool form

Question 8

what other clues can indicate IBS?

Answer 8

bloating
urgency
sensation of incomplete emptying

Question 9

what illnesses is IBS associated with?

Answer 9

fibromyalgia
chronic fatigue
TMJ dysfunction
chronic pelvic pain
overlap causes more more sever IBS, psychiatric problems

Question 10

how common is psychiatric problems in IBS?

Answer 10

50%

Question 11

what is the best way to identify IBS?

Answer 11

history

• bowel habit
• bloating, nocturia
• diet (bread, fibre, meal times)
• trigger factors (infection, menstruation, drugs)
• opiate use (codeine and opiate/narcotic bowel syndrome)
• psychosocial factors (stress)
• underlying fears (cancer)

Question 12

what are the alarm features of IBS?

Answer 12

age >50
ahort duration of symptoms
woken from sleep
rectal bleeding
weight loss
anaemia
family history of colorectal cancer
recent antibiotics (potentially C diff caused)

Question 13

what are the investigations for IBS?

Answer 13

FBC
ESR/ plasma viscosity
CRP
antibody testing for coeliac disease (TTG)
lower GI testing if >50 or strong family history of colorectal cancer

Question 14

how is IBS managed?

Answer 14

diet
- regular meal times
- reduce fibre
- FODMAP/GFD
drugs
- stop opiates
- anti-diarrhoeals
- anti-spasmotics
- anti-depressants

Question 15

what is the relationship between fibre and IBS?

Answer 15

suggestion that low fibre diet improves symptoms

Question 16

what can prolonged use of opiates lead to?

Answer 16

opiate/narcotic bowel syndrome

can cause opiate induced pain

Question 17

name 2 anti-spasmodics

Answer 17

mebeverine

hyoscine

Question 18

what can aggrevate IBS?

Answer 18

fibre

lactose

Question 19

what laxative is usually used for IBS?

Answer 19

lactulose

Question 20

name an anti-diarrhoeal

Answer 20

loperamide

opiate analogue

Question 21

what are the benefits of amitriptyline?

Answer 21

reduce diarrhoea

reduce afferent signals from gut

Question 22

what psychological treatment can be offered for IBS?

Answer 22

if sever anxiety/depression
if no response to empiric anti-depressants
relaxation therapy
cognitive behavioural therapy

Question 23

what is the minimum number of relevant investigations?

Answer 23

few as possible to rule out sinister cause