Irritable Bowel Syndrome Flashcards
Who is most susceptible to IBS?
females
people aged 30-40
What causes IBS?
Genes
Visceral hypersensitivity: disturbed GI motility, exaggerated gastro-colic reflex, pain, high amplitude propagating contraction
What are the two components of Visceral hypersensitivity?
peripheral sensitisation - inflammatory mediators up regulate sensitivity of nociceptor terminals
central sensitisation - increased sensitivity of spinal neurons
What causes central sensitisation?
increased pain radiation to somatic structures e.g. fibromyalgia
What causes peripheral sensitisation?
onset after infectious gastroenteritis
What constitutes the Rome 3 criteria for IBS?
recurrent abdo pain/discomfort for 3 days per month for 3 months:
and 2 or more of:
improvement with defecation, onset associated with increased stool freq, onset associated with change in stool form
What are the important parts of history for IBS?
trigger factors opiate use (cannabis has a link) bloating, nocturia bowel habit psychosocial factors underlying fears
What are the alarm features for a patient with suspected IBS?
age over 50 short duration of symptoms woken from sleep by bowel habits weight loss rectal bleeding anaemia FH of coloerectal cancer
What are the diagnostic investigations for IBS?
CRP, FBC, ESR, Antibody testing for coeliac disease (TTG), Lower GI tests if under 50 or strong family history
What is the treatment for IBS?
Diet – regular meal times, reduce fibre, FODMAP – basic food, gluten free
Drugs – stop analgesia, anti-diarrhoeals (loperamide, inhibits peristalsis and gut secretions), anti-spasmodics, anti-depressants (tricyclics e.g. amitriptyline – reduces afferent signals from the gut)
