IBS Flashcards
IBS definitions
Pragmatic definition
- 6 months
- abdo pain
- change in bowel habit
- absence of red flags
Otherwise Rome IV criteria
Initial Ix for all patients
Bloods: fbc, crp, coeliac serology
if <45 and diarrhoea then faecal calprotectin
Colonoscopy
No role unless
- red flags
- possibility of microscopic colitis: ssris, nsaids, ppis, female, >50, autoimmune disease, nocturnal/severe watery diarrhoea, weight loss
Sehcat scan
IBS with diarrhoea and
- nocturnal diarrhoea
- cholecystectomy
Faecal incontinence
- PR! Think cauda equine
- consider anorectal physiology tests
SIBO
Test: hydrogen breath test
Risk factors
- gastric / small bowel surgery
- crohns with fistula formation
- scleroderma
- radiation
- coeliac
- diabetes / other motility disorders
- diverticulosis
Faecal elastase
Only test in
- etoh excess
- diabetes
Lifestyle recomendations
Exercise regularly (especially IBS-C)
Diet
1) reduce etoh, caffeine, spicy foods, high fat foods, eat slowly to digest,
- consider low lactose if ibs-d, prev gastroenteritis, symptoms triggered
- high fluid intake (ibs-c)
- ibs-d: reduce fibre, limit caffeine, stay hydrated, reduce sugar free mints (mannitol, sorbitol, xylitol)
- wind: limit beans, pulses, sprouts, sugar free mints. Trial fibre (oats, linseeds)
2) Fodmap
Do not advise igg dietary elimination or gluten free diet
Constipation
1) ispaghula (soluble fiber). 3-4g/day initially and build up
2) linaclotide / lubiprostone
Diarrhoea
Loperamide
2) rifaximin
Abdo pain
Buscopan
Mebeverine
Peppermint oil (not really evidence based on recent randomized control trial)
2) TCAs / SSRIs - especially if global symptoms
Paychological therapies
For global symptoms after 12 months of attempted drug treatment
IBS specific CBT
Gut directed hypnotherapy
Probiotics
No evidence for particular strain, but can help abdo pain - give 12 week trial and stop if worse
