What are the symptoms of IBS?
abdominal pain, bloating, gas, cramping, change in stool form and frequency
what are the diagnostic behavioural features of IBS?
- symptoms for >6 months
- frequent consultations for non GI symptoms
- previously medically unexplained symptoms
- stress aggravates symptoms
What is the manning criteria for IBS?
- pain relieved by defecations
- more frequent stools at pain onset
- visibe abdominal distension
- passage of mucus per rectum
- sense of incomplete evacuation
What are the 7 parts of the Bristol stool chart?
1 - separate hard lumps
2 - sausage shape with lumps
3 - sausage with cracks
4 - smooth sausage
5 - soft blobs with clear cut edges
6 - fluffy pieces with ragged edges and mushy stools
7 - entirely liquid
DD for IBS?
colonic cancer, IBD, bile acid malabsorption, coeliac, gastroenteritis, diverticultis, gynological problems, anxiety
What causes IBS?
stress, post GI infection, genetic, autoimmune nervous dysfunction, visceral hypersensitivity, altered gut microbiota
What is the epidemiology of IBS?
more common in females
in 3.6-15% of western population
What is the Carnetts test for IBS?
ask the patient to fold arms across the chest and raise head off pillow with resistance from doctor
Investigations for IBS?
Carnetts test, examine perianal region and rectum, ask location of pain, endoscopic examination, hospital anxiety and depression scale, hydrogen breath test, cap refil, faecal calprotein coeliac screen
What is the treatment of IBS?
FODMAP diet, antispasmodics, laxatives, anti motility medicines (loperamine), low dose tricyclic antidepressants, exercise, education and reassurances, regular mealls, gluids, avoid caffiene and alcohol, increase soluble fibre, CBT